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Suicide doc fights rising rates, bias
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A couple of chairs, two desks and a privacy partition between - that's all Dr Hui Xiaoping has in his crisis intervention and suicide prevention center. It doesn't take a fancy office to save someone's life.

The doctor's day is crammed with phone calls to his patients to check their mental state, face-to-face talks, taking notes, keeping records and updating his database of people who attempt suicide. His job is to keep them from trying again, and maybe succeeding.

When a patient just hangs up the phone on hearing his voice, or when someone says "You have the wrong number," he knows there's a problem. Because of the stigma attached to suicide for both the person and his or her family, many people deliberately give wrong numbers and false addresses.

And when he does get through, some patients have shouted, "Why didn't you let me die?" Relatives have screamed, "Leave us alone."

Hui is head of the Psychological Crisis Intervention Center at Gongli Hospital in Pudong, a comprehensive, state-run hospital. He is also director of the Emergency Department and the Intensive Care Unit.

The doctor, who is not a psychiatrist, believes he is the city's first medical professional in a comprehensive hospital dedicated to helping those who have tried to take their lives at least once. His may be the only project systematically studying such cases, he says.

He is a powerful advocate for immediate crisis intervention because the rate of second suicide attempts is higher without it.

He encounters his cases after they are rushed to the emergency room. He follows up, or tries whenever possible.

"These people get physically healed in the hospital but not mentally. If we doctors don't make follow-ups, keep records and give them proper psychological counseling and medication, they might hurt themselves again and again. And there'll be always one day when their attempts succeed," Hui says.

Follow-up is extremely difficult, he says. "Chinese people are tied up by too many traditions and old ideas. They regard suicide as something humiliating that should be kept secret forever."

Hui persists. He has a small team of volunteer psychology professors and students to help. He doesn't have a hotline.

The 64-year-old doctor has more than 25 years' experience in emergencies and near death-traffic accidents, fires, explosions, gas poisoning and many traumas. Suicides, of course.

"I am always puzzled why in recent years more and more people try to kill themselves as their ultimate resort when they're in trouble," Hui says. But he knows that suicide is part of the fallout of hurtling progress when people cannot adjust. "The suicide rate is soaring and it has already become an important social problem."

China estimates that 280,000 people commit suicide each year and another two million try--that is believed to be a gross underestimation. Numerous cases are not reported as suicide or attempts. Shanghai does not collect suicide statistics. Awareness of mental health issues, such as depression, is still very limited.

Each month, Dr Hui treats three to four new patients who have attempted suicide more than once. In 2004, when he began his project, and 2005, it was as much as two to three cases each week. He believes his interventions have brought down the number at least at his hospital.

Since 2004 he has treated and studied 153 cases.

About 10 years ago, he saw very few. "The city is developing at an accelerated speed and undergoing huge changes. All kinds of people are caught up in this and so the pressure is getting greater and greater. Those who haven't gotten prepared mentally and physically resort to suicide," Hui says.

The situation is serious in rapidly expanding Pudong, where thousands of migrant workers have poured in for construction and other work. "Without special skills and proper education, they can easily get frustrated and lost in the big city," says Hui.

In 2004, Hui and Shan Huaihai, a psychiatrist at Shanghai Xuhui District Mental Health Center, launched a study on the characteristics of people who attempt suicide. In 2005, the project was supported by the Natural Science Foundation of Shanghai.

All of Hui's 153 cases over three years were once patients in the emergency ward or ICU. Some tried to drown themselves, some jumped off buildings or Metro platforms, some poisoned themselves with carbon monoxide, some hanged themselves, some cut their wrists. But most tried drugs, such as sedatives, some tried pesticides.

Last month, Hui presented his findings at the 5th Sino-US Symposium on Medicine in the 21st Century.

Of the 153 cases, 126 are women, accounting for more than 82 percent. Hui says this is because women are under more pressure than men: work pressure, family pressure, marriage pressure.

The age range is 14 to 82 years old, but most of those who attempt suicide are between 20 and 30 years old.

Hui found no relationship between suicidal behavior and education level: Both illiterates and those holding advanced degrees try to kill themselves.

He found no evidence linking income to suicides though low-income people are often more desperate.

"So far I haven't found any comprehensive hospital in China that follows up this group. They get physically healed and go home but after a few months they may well be back with their second suicide attempt," the doctor says.

Hui collects detailed information about the patients with their consent and enters it into a database by age, gender, background, family, health history, motives, methods, time of day, and so on.

Then comes the hard part. Follow up. Hui makes home visits after patients leave the hospital - if they give their true address--and makes regular psychological assessments. Most compliant patients prefer telephone follow-up, he says. Others give wrong numbers.

One case is 27-year-old Mr Piao who works in the catering industry. He overdosed on sleeping pills in July after his girlfriend dumped him. During his one-week hospitalization and in the following three months, Hui kept in touch, monitoring his condition.

Now Piao seems to have resumed a normal, healthy life and has a new girlfriend. He doesn't want to talk about the past.

"No, I don't want to talk about it anymore. Let bygones be bygones. Sorry," Piao said, hanging up the phone when Shanghai Daily tried to interview him. His new girlfriend called Shanghai Daily and said, "Stop bothering him."

Piao is one of the cooperative patients.

"We understand that suicidal behavior injures reputations and we're professional doctors who won't reveal the information to a third party. We understand them, but it seems they don't understand us," the doctor says with a sigh.

"I'm trying," he says. "At least someone is doing something, which is better than nothing."

(Shanghai Daily November 19, 2007)

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