China struggles to cope with suicide epidemic

It's a grey, depressing morning and Wang Cui Ling knows she is facing another busy day. Taking her seat at a tiny cubicle in the bowels of Beijing's Suicide Research and Prevention Centre, the 37-year-old former psychiatric nurse will for the next eight hours be on the front line of a harrowing national epidemic.

Chinese people are taking their own lives in record numbers. More than a quarter of a million people a year are killing themselves - 685 a day. And 3.5 million make unsuccessful attempts. Suicide is now the primary cause of death among Chinese aged 20 to 35.

Ms Wang and her 17 colleagues at China's only suicide hotline get 10 calls for every one they can answer.

"The phones are always ringing," says Marlys Bueber, a nurse from South Dakota who trains hotline operators such as Ms Wang.

The service gets 22,000 calls a month. About 20 per cent are from people in Beijing but the rest come from across China and as far afield as Tibet and Hainan Island in the south. Disproportionate rates of suicide and depression among young people appear to be a direct result of increasing stress in China's rapidly changing society.

"Society is full of pressure and competition, so young people, lacking experience in dealing with difficulties, tend to get depressed," said Liu Hong, a Beijing psychiatrist.

The world's most populous country has lurched from rigid, isolated Communism to rapacious capitalism in one generation and many, especially in rural areas, are left behind by the pace of change.

"During the old times, people had different thoughts about suicide," Zhang Mingyuan, the president of the Chinese Society of Psychiatry, said. "In the Communist Party, suicide was considered an act of betrayal of the party."

Mental illness and suicide remain taboo subjects. There are just 4,000 fully qualified psychiatrists in the country for a population of 1.3 billion, and they earn a paltry average monthly salary of 2,500 renminbi (£170). Working with the mentally ill carries such a stigma that few medical graduates consider it as an option.

Despite China's soaring suicide rate, the Beijing research and prevention centre is the only one of its kind and opened only two and half years ago.

Its executive director is Michael Phillips, a 55-year-old from Montreal. "My major goal is to use the hotline to get the issue of suicide into the public mind," he said. "To me, the fact that 60 per cent of the people who call in have never sought psychological help before is already a major success. Now, we would like to develop 10 centres with hotlines around the country. But we need about $1m (£550,000) to do that. That isn't a lot of money in China any more, but it is for psychological services."

It is obvious from looking around the centre that funds are in short supply. Located in the Hui Long Guan psychiatric hospital, a Sixties facility on the northern outskirts of Beijing, the place has not been painted for years.

"Sixty per cent of the people in rural areas we've studied have never heard of the word 'depression'," Dr Phillips said. "It's not seen as an illness and so a person who develops a serious depression and starts feeling suicidal doesn't think it's a mental illness that can be treated."

In contrast with Western countries, Chinese women are more suicidal than men. Death rates are particularly high among young women in rural areas, where researchers say, people are increasingly aware of the opportunities they are denied and kill themselves to escape the suffocating embrace of isolated communities. Most use pesticides, and for many, it is a snap decision.

The prevention centre can reduce these numbers, according to Dr Phillips. "You have to have an environment where people have other options and are aware of them and where suicide is a less acceptable way of dealing with acute stress."

But for Ms Wang and her colleagues, mostly psychiatric nurses in their early thirties, it is an exhausting struggle. They work on a rota of one week on, one week off, and are monitored to ensure they do not take their work home with them.

"We debrief them at the end of the week-long shift, and the goal isn't just to talk about what was hard, but to lighten them up and get them to feel good about themselves again," Ms Bueber said.

Ms Wang, who has been with the hotline since it opened, admits she is haunted by her work. "At the beginning, I'd come home and worry about the callers and whether I'd been able to help them. But now, even though I still worry about them, I know I can't do any more for them."

Photographs of her husband and 11-year-old daughter adorn her computer as reminders of home.

"There are some problems we can't solve, like if the caller is short of money or has a severe physical illness. But we can focus on the way they're feeling and support them."

When staff get a high-risk caller, it is up to them to convince the caller to step back from the brink, because they get precious little support from the authorities. They cannot send an ambulance, Ms Bueber said, as that must be paid for by the person who called it. Co-operation with the emergency services is non-existent.

For now, though, Ms Wang and her colleagues will continue to field calls from people who have no one else to turn to. "I've never thought of giving up my job, even when it is hard and upsetting. I always feel happy if I think I have helped someone," she said.