‘Hello, I need someone to talk to. Who wants to talk to me?” asked Sai. “I have a secret that I can’t tell, not even to my family members.”
Sai just found out that her boyfriend already had a wife, and that she was just a mia noi, or mistress.
“Do you think I’m a bad person?” she asked.
“You are not alone any more, Sai. I am here to listen to you,” said Ploy, who answered Sai’s phone call to the Samaritans of Thailand suicide prevention hotline.
At their first two-day recruitment session of the year, the Samaritans, an NGO that provides emotional support to anyone in distress, drew 60 participants.
Last year, there were around 9,000 cries for help to the hotline — the highest since the 1997 “Tom Yum Kung” financial crisis, which recorded around 10,000 calls. But while demand is growing and the organisation needs more volunteers than ever, the process of becoming one is not easy.
Sai and Ploy were participating in a mock call — Sai is in fact an instructor for Samaritans, while Ploy is one of the hopeful applicants. During the mock call, each member of the audience would take turns saying one sentence at a time. Sai would reach out her hand to anyone in the audience who made her feel better.
The conversation continued as Sai and Ploy walked hand in hand.
A few minutes later, Sai left the room abruptly. She had decided to end her life.
Ploy was left stunned.
“I felt like standing on the edge of a cliff, and I was planning to take her across this bridge to the other side,” said Ploy, a psychology student from Kasetsart University. “But she ended up walking the other way.”
Suicide prevention programme director Prapat Ukranan.
A CRY FOR HELP
While on-the-spot suicide attempts represent less than 10 out of the roughly 7,000 phone calls the Samaritans receive on average each year, some 60-70% of the callers express suicidal feelings.
Although last year’s increase in phone calls was partly due to the organisation having more volunteers, the Samaritans group wants to increase the number of helplines it operates from four (including an English line) to 10 to accommodate the growing demand.
“Many callers have complained about the phone lines being busy,” said Samaritans of Thailand director Trakarn Chensy, 54, who has been involved in the association since 1997. “And when one caller hangs up, we immediately receive another call.”
About 500 volunteers have been recruited throughout the organisation’s 36-year history in Thailand. There are currently 60 active volunteers, up from the average of 40.
The Samaritans provide Thai-language services from noon to 10pm every day, with three to four volunteers working in four-hour shifts.
An English-language helpline was set up in 2007, but it still operates as a call-back service, with only 100 calls received per year under the supervision of three volunteers. Mr Trakarn estimates it would take around 130-140 active volunteers to turn the helpline into a 24-hour service like in the UK, where the organisation was founded in 1953.
Due to the high demand, the Samaritans is also in talks with a mobile operator for potential cooperation to implement a call-back service, which would require an increase in funding and volunteers.
UNCONDITIONAL ACCEPTANCE
On a Saturday morning at the Xavier Hall in Bangkok, the participants were presented with their first case study at 11am. A woman had a fight with her husband Somchai last night after he arrived home late, raising suspicion that he is involved with another woman.
“I think you need to calm down,” said one female participant, who acted as a volunteer. It was a cliched response to someone unable to stop sobbing, and only made matters worse.
“Are you saying I’m hot-tempered?” the woman on the phone asked.
Finding a solution to a problem is one of the most common things asked of hotline operators, but all volunteers are prohibited from providing suggestions, instead they try to be empathetic and non-judgemental.
Listening to a friend giving out advice can be annoying, Mr Trakarn said, and providing suggestions will also increase the dependence of callers on the volunteers.
Samaritans director Trakarn Chensy.
“If a 13-year-old girl tells us that she plans to run off with her boyfriend, we can’t tell her to go back home, because right and wrong do not depend on our standards,” he said.
Instead, volunteers are trained to ask the caller to consider the consequences of each possibility. By listening and asking questions, they help people explore their feelings and work out their own way forward.
The majority of the participants at the workshop believed asking about suicide would somehow encourage the act. But volunteers are expected to ask whether or not the caller has suicidal thoughts, and whether they had actually drawn up a suicide plan.
In the middle of a “crisis”, where the caller is in the middle of a suicidal act, the volunteer will ask him or her to stop whatever it is they are doing.
Although all phone calls are confidential, in a crisis case, volunteers may ask for the caller’s number and address, as well as permission to call back. The director will be alerted about the issue and may also send a volunteer to the caller’s house for a follow-up.
Some 75% of callers are female, and half of the callers are 30-45 years old.
This corresponds with data from the Department of Mental Health (DMH) National Programme for Suicide Prevention, which shows that more women attempt suicide than men, at a ratio of 1.5 women to each man. However, men are more likely to die from committing suicide at a rate of 3.5 to each woman.
The majority of phone calls to the Samaritans, however, indicate suicidal thoughts without any specific plan of action, said Mr Trakarn, whose mobile phone is turned on 24 hours a day in case of an emergency.
No judgement: Psychologist Maj Panomporn Phoomchan advocates using the Samaritans’ technique of listening with unconditional acceptance.
STRUGGLING FOR RESOURCES
Unlike its UK counterpart, which receives funding from the British government, the Samaritans of Thailand depends solely on donations.
But even when compared with its regional peers, the Samaritans of Thailand is less equipped in terms of manpower.
The Samaritans of Singapore and the Befrienders in Malaysia, which was modelled on the Samaritans, both have 24-hour hotlines and larger armies of volunteers. The former is supported by its national government, and works closely with the Singapore police force to help those who are suicidal.
Mr Trakarn estimates it currently costs 500,000 baht annually to run his operations, including electricity bills, phone calls and rent.
Last year, Rotary International provided a grant of one million baht for goal-specific purposes like recruitment and community outreach programmes. Because of that assistance, Samaritans of Thailand has been able to recruit more extensively and increase the number of active volunteers significantly since last year.
The last time they received financial assistance from the government was in 2011, when the DMH provided a 100,000-baht grant.
“They [the DMH] saw it as something abstract rather than concrete,” Mr Trakarn said, referring to the inability to determine the success rate of the Samaritans’ services.
“But our success is reflected in the large amount of callers who had called back to thank the organisation for helping them survive.”
Some critics, like the American clinical psychologist Kay Redfield Jamison, have also questioned the demonstrable effect that crisis hotlines have had on suicide rates.
This is because they tend not to be used by the most severely depressed or suicidal individuals, according to Ms Jamison in her book Night Falls Fast: Understanding Suicide.
“Additionally, many suicides are impulsive, which generally precludes contacting anyone,” she wrote.
Call of duty: Samaritans of Thailand director Trakarn Chensy guides volunteer candidates through a mock counselling session to test their mettle.
WHERE THAILAND STANDS
Thailand’s suicide rate has remained fairly stable during the past decade, with an average of six deaths per 100,000 people, which DMH deputy director-general Panpimol Wipulakorn considers “low”.
The DMH began collecting suicide statistics in 1997, the year of the “Tom Yum Kung” financial crisis. The suicide rate reached a record high in 1999 of 8.59 deaths per 100,000, before reaching a low of 5.77 in 2006.
According to the latest available information Spectrum obtained from the National Programme for Suicide Prevention, 3,150 people committed suicide during the first 10 months of last year, although some experts believe actual suicides to be twice that due to under-reporting.
Prapat Ukranan, director of the DMH’s National Programme for Suicide Prevention, which was set up in 1999, said although the overall suicide rate has fallen below the target of 6.5 deaths per 100,000 people, suicides in Khon Kaen, Maha Sarakham, Roi Et and Kalasin have still been increasing on an annual basis.
Provinces with the highest suicide rates are in the lower northern regions, while the South has the least number of suicides.
“We are seeing suicide rates starting to increase in some northeastern provinces such as Loei, for instance, which is unusual because we often consider it is a ‘slow-paced’ city without the bright lights and noises,” said Dr Prapat, who is also director of Khon Kaen Rajanagarindra Psychiatric Hospital.
“I don’t think we can ignore the issue, especially when children nowadays grow up to be weak emotionally.”
Suicide rates are highest among farmers and manual labourers, while hanging, the ingestion of pesticide and firearms are the top three methods of suicide.
The World Health Organisation made suicide prevention part of its mental health action plan in 2013, with the goal of reducing the rate of suicide in all countries by 10% by 2020.
An estimated 804,000 suicide deaths occurred worldwide in 2012, representing a global suicide rate of 11.4 per 100,000 population.
In Thailand, the Mental Health Act was recently amended to allow suicide survivors to be covered under the 30-baht universal healthcare scheme, the social security scheme and the civil servant medical benefit scheme.
POLICY OF PREVENTION
The WHO has outlined three basic steps for the prevention of suicide, including restricting access to means of self-harm, developing policies to reduce harmful use of alcohol, and encouraging the media to follow responsible suicide reporting practices.
Dr Panpimol of the DMH said the department is placing increased focus on preventing alcohol abuse, as it is considered a major risk factor for suicide.
“We are increasingly monitoring this group, because depressives, under the influence of alcohol, are more likely to attempt or commit suicide,” she said.
The DMH’s suicide prevention programmes include increasing the quality of assessment of depression in chronic patients, community programmes aimed to reduce the stigma associated with mental health and the training of public health volunteers for recognition of at-risk behaviour.
The department also has its own hotline for mental health issues.
Maj Panomporn Phoomchan, deputy director Kasetsart University’s Department of Psychology and vice-president of the Thai Clinical Psychologist Association, advises using the Samaritans’ techniques of listening and unconditional acceptance in everyday life, even with close friends, without judging that committing suicide is wrong.
She also suggests consulting a clinical psychologist and/or psychiatrist to relieve distress or treat chemical imbalances.
THE FINAL STEP
By Sunday afternoon, 20 of the applicants participating in the Samaritans’ workshop had decided to drop out, leaving just 40 candidates. Of those remaining 40, only half decided they wanted to apply to become volunteers.
Each was given a pencil and paper, and asked to draw freely, writing a description of their picture on the back.
They were then split into four groups, with three mentors assigned to each, and called one by one into a room to be interviewed.
The mentors assessed the drawing, the candidate’s attitude towards helping people, their availability and ability to withstand pressure.
They asked discerning questions: Would the candidate be able to handle his or her emotions if the caller faced the exact same problems as the candidate? And how would they deal with their emotions afterwards?
It takes another three weeks of general training and another four to six months of one-on-one instruction from mentors before a volunteer is allowed to handle genuine calls.
“It’s a tough process because we deal directly with the lives of human beings,” said Mr Trakarn, adding that some volunteers were put through 12 months of training.
A day later, the results were announced by phone, and 13 of the candidates passed the first round, including Rakchart (not his real name).
Volunteers are prohibited from disclosing their identity to callers, and are not allowed to let other people apart from their immediate family members know that they are Samaritans volunteers.
A 54–year-old part-time university lecturer in Phuket, Rakchart flew all the way from the southern province just to attend the training programme.
He learned about the Samaritans from a local television programme on World Suicide Prevention day last September.
“Phuket has many local newspapers, and every week the front pages would contain at least one local or foreign suicide victim,” Mr Rakchart said. “One day, I hope to establish a suicide crisis hotline in my province.” n
Anyone who feels depressed, lonely or suicidal can call the following service numbers: The Samaritans of Thailand 02-713-6793 (Thai), 02-713-6791 (English) or 02-713-6790 (for those interested in volunteering). The Department of Mental Health can be reached on 1323 (Thai).