The findings of a pilot study on restricting
of sales of charcoal in Hong Kong were
everything Professor Paul Yip could hope
for: they pointed to a way to reduce
suicides, they were evidence-based, they
received international recognition. The
only problem is, the results have yet to be
put into action to help Hong Kong people
territory-wide.
Professor Yip and his team conducted a one-year study comparing suicides in Tuen Mun, where charcoal packs were removed from the open shelves of major retail outlets, to those in Yuen Long, where charcoal was sold openly as usual. Charcoal burningrelated suicides fell sharply in Tuen Mun, by 31.8 per cent, but similar results were not seen in Yuen Long. Apparently, the lack of easy access to charcoal frustrated potential suicides or made them think twice, and they didn't follow through. The results compared to an overall drop in Hong Kong's suicide rate of 5.7 per cent during the same period.
Encouraging as the results were, though, they have not yet had much impact on charcoal access in Hong Kong. Wellcome Supermarket dropped the system of restricted access after the study period and Park'N'Shop has yet to extend it to its other stores.
Professor Yip, who is Director of the Hong Kong Jockey Club Centre for Suicide Research and Prevention, has been negotiating with these two major supermarket chains and others for well over a year to lock up all of their charcoal.
"We are grateful for their participation in the study, however, we are frustrated that they don't want to continue. It is not that difficult for them and we are helping vulnerable members of the community," he says.
"People say, why control charcoal? They can still jump off buildings. Yes, they can do that, but the point is that those who attempt suicide are usually not good at problem solving. Their cognitive thinking is different from us. So if you take away a means of suicide that is very appealing to them, they will have problems finding another means.
"The whole rationale is to make it more difficult and buy time. Once we have bought time, we have an opportunity. Their family members and friends can intervene before they do anything, and they can also seek help."
Burning charcoal, which can lead to carbon monoxide poisoning, is appealing to potential suicides because it is considered easy and clean and it can be done at home. Eighty per cent of charcoal suicides are committed at home, which adds to the imperative to control sales.
"Charcoal burning started with one person in Hong Kong in 1998 and by 2003, 320 people committed suicide this way. All other causes had very little change, only charcoal burning went up. By 2009 the number had come down to about 120. I would say 60-70 per cent of the rise and fall in Hong Kong's suicide rate has been exacerbated by charcoal burning. The situation is even worse in Taiwan," he says.
There is a precedent that product restriction can reduce suicides. Suicides in the UK fell after sales of paracetamol were limited to packets of at most 24 tablets in the late 1990s, making it difficult to overdose on the product without making multiple purchases.
"Evidence-based research has shown that restriction of means is one of the most effective measures to reduce suicides," Professor Yip says.
"We can't prevent all suicides but at least we can make a difference. We can help to reduce the number."
The results of Professor Yip's study have been published in the British Journal of Psychiatry and reported in the British Medical Journal and the publication of the International Association for Suicide Prevention.
Professor Yip and his team conducted a one-year study comparing suicides in Tuen Mun, where charcoal packs were removed from the open shelves of major retail outlets, to those in Yuen Long, where charcoal was sold openly as usual. Charcoal burningrelated suicides fell sharply in Tuen Mun, by 31.8 per cent, but similar results were not seen in Yuen Long. Apparently, the lack of easy access to charcoal frustrated potential suicides or made them think twice, and they didn't follow through. The results compared to an overall drop in Hong Kong's suicide rate of 5.7 per cent during the same period.
Encouraging as the results were, though, they have not yet had much impact on charcoal access in Hong Kong. Wellcome Supermarket dropped the system of restricted access after the study period and Park'N'Shop has yet to extend it to its other stores.
Professor Yip, who is Director of the Hong Kong Jockey Club Centre for Suicide Research and Prevention, has been negotiating with these two major supermarket chains and others for well over a year to lock up all of their charcoal.
"We are grateful for their participation in the study, however, we are frustrated that they don't want to continue. It is not that difficult for them and we are helping vulnerable members of the community," he says.
"People say, why control charcoal? They can still jump off buildings. Yes, they can do that, but the point is that those who attempt suicide are usually not good at problem solving. Their cognitive thinking is different from us. So if you take away a means of suicide that is very appealing to them, they will have problems finding another means.
"The whole rationale is to make it more difficult and buy time. Once we have bought time, we have an opportunity. Their family members and friends can intervene before they do anything, and they can also seek help."
Burning charcoal, which can lead to carbon monoxide poisoning, is appealing to potential suicides because it is considered easy and clean and it can be done at home. Eighty per cent of charcoal suicides are committed at home, which adds to the imperative to control sales.
"Charcoal burning started with one person in Hong Kong in 1998 and by 2003, 320 people committed suicide this way. All other causes had very little change, only charcoal burning went up. By 2009 the number had come down to about 120. I would say 60-70 per cent of the rise and fall in Hong Kong's suicide rate has been exacerbated by charcoal burning. The situation is even worse in Taiwan," he says.
There is a precedent that product restriction can reduce suicides. Suicides in the UK fell after sales of paracetamol were limited to packets of at most 24 tablets in the late 1990s, making it difficult to overdose on the product without making multiple purchases.
"Evidence-based research has shown that restriction of means is one of the most effective measures to reduce suicides," Professor Yip says.
"We can't prevent all suicides but at least we can make a difference. We can help to reduce the number."
The results of Professor Yip's study have been published in the British Journal of Psychiatry and reported in the British Medical Journal and the publication of the International Association for Suicide Prevention.