Bridging to Life

New suicide prevention efforts to curb an epidemic

Published on October 17, 2013by Chris Tait

“There is but one truly philosophical problem, and that is suicide.”

French philosopher, Albert Camus, was just one of many to have contemplated the problem of suicide—an issue that has transcended nations and cultures, ages and gender, race and religion, in what has been recognized as a truly universal phenomenon.

In 2010, I was in the midst of finishing my junior year at Cornell University, during a time where my college had garnered the reputation of  “a suicide school”.

In March of that year, the campus was reeling from a string of deaths, occurring in rapid succession, from students jumping off bridges that span the many gorges unique to Ithaca, New York. While not knowing any of the victims personally, I found myself deeply affected by the sudden tragedies that sent shockwaves throughout the entire Cornell community.

“When suicides take place behind closed doors there is limited visibility,” says Dr. Tim Marchell, director of mental health initiatives at Cornell University. “But when they occur in such a public manner as jumping off a bridge, the impact on a community is much greater.”

Bridging to life in South Korea

South Korea has consistently topped the 34 Organization for Economic Cooperation and Development (OECD) countries with the highest suicide rate for the past 9 years. On average, the U.S. sees 10.5 suicides per 100,000 people. South Korea’s rate, however is almost triple in magnitude, with 28.4 suicides per 100,000—a rate that has doubled over the past decade.

Between 2003 and 2011, the capital city of Seoul, saw 1,090 people die by suicide by jumping off the many bridges that span across the Han River. The Mapo Bridge, often referred to as the “Bridge of Death”, was the site of the majority of suicides, in a country where it is the leading cause of death for people under 40.

In South Korea, cultural beliefs have held that suicide is an individual problem, and the government has thus faced challenges in implementing interventions and educational programs aimed at reducing the staggering rates.

In recognition of the problem, however, the city of Seoul partnered with Samsung Life Insurance to transform the bridge where many South Koreans frequently commit suicide. What was previously known as the “Bridge of Death” has taken on a new identity as the “Bridge of Life”.

The approach taken by the city government and the country’s largest insurance company is manifested through an interactive experience displaying messages of hope as people walk by, intended to elevate the opportunity for social connectedness.

Sensors that react to a person’s movement have been installed on the railings of the bridge, responding with messages of hope and optimism. A popular YouTube video describes the intervention that took place.

“With each step, a different greeting or message of inspiration is revealed to the person contemplating suicide. We wanted to keep them company and have them walk all the way across the bridge,” the video explains.

Messages illuminated by the handrail include sentiments such as, “Why don’t you talk to us?”, “We’re always here for you”, and “The best is yet to come”, and were developed by a team of psychologists and suicide prevention experts with the goal of having a strong impact in changing human behaviors.

Thanks to this novel approach to suicide prevention, according to the video, the Seoul city government has experienced a 77 percent reduction in the suicide rate on the Mapo Bridge since the newly redesigned bridge opened in September 2012.

While no formal reviews have surfaced in response to the “Bridge of Life”, the reports from South Korea suggest that things may be moving in a positive direction.

“Helping suicidal individuals feel socially connected is important, and the initial reports from this intervention are encouraging. But it will be important to conduct a thorough evaluation to assess its effectiveness over time,” says Dr. Marchell.

Bridge Suicides

Suicide, especially by bridge jumping, is often motivated by a high degree of impulsivity. Many contemplating suicide choose this option because it offers ease, speed, and near certainty of death.

While a large proportion of those who attempt suicide tend to suffer from a mental illness, those who commit suicide by jumping off of bridges often display few of the classic warning signs associated with suicidal behavior.

The Golden Gate Bridge in San Francisco is the site of the greatest absolute number of suicides in the world. In 2010, the Golden Gate Bridge directors gave the approval for a stainless steel net to be built, with the stipulation that the funds must be available to construct it.

As efforts in recent years advocating for a suicide barrier to be constructed have continued to be contested, trends in suicide mortality on the Golden Gate Bridge have stagnated with 33 deaths in 2012, compared to 37 in 2011, 32 in 2010, 31 in 2009, and 34 in 2008. Moreover, historical trends suggest that not much has changed in the suicide rate on the Golden Gate Bridge since 1965.

Preventing suicide

Anne Sexton, an American poet known for writing about her own suicidal thoughts—and who ultimately committed suicide—writes, “Suicides have a special language, like carpenters they want to know which tools, they never ask, why build.

Given that people are always going to be driven to suicide, what, if anything, can we do to prevent these losses?

Experts advise that a comprehensive approach to suicide prevention is essential, with particular attention to mental health. Further strategies should include identifying those at risk, increasing help-seeking behavior, and restricting access to potentially lethal means.

The latter construct has been a widely studied approach to suicide prevention, and one that became an important factor in Cornell’s response to the events of 2010.

The theory behind restriction comes from the idea that because suicide can be such an impulsive act, people are likely to turn to whatever means are immediately available—those that are easy and quick.

In essence, focusing on the how a person attempts suicide, and taking away the means to act on an impulse may play a critical role in whether that person lives or dies.

“Suicidal action depends a combination of suicidal thoughts and access to lethal means,” explains Dr. Marchell. “Means restriction buys time for the suicidal impulses to pass and can increase the chance for human intervention when someone is in distress.”

The role of the media

Experiencing the cluster of suicides on campus during my junior year, I was surprised to see that the stories covering the deaths were not making the front page of the Cornell Daily Sun, the school’s newspaper, which students read every morning.

It wasn’t until after talking with Dr. Madelyn Gould, professor of clinical epidemiology in psychiatry at Columbia University, that I began to understand the role of the media in helping or hindering suicide prevention efforts.

Dr. Gould, whose work has informed state-level and national suicide prevention strategies, is well known for her investigation into the role of the media in the initiation of suicide clusters. She was an influential consultant to Cornell in their response to the wave of suicides in 2010, particularly with respect to the implementation of media reporting guidelines that called for responsible coverage.

While the media has the potential to give pro-social health information, there is also the potential to increase the likelihood that more suicides will occur.

“The media has the ability to glamorize suicide,” says Dr. Gould, “such that vulnerable individuals may be attracted to suicide hotspots portrayed in the media. Suicides that are made more visible due to media attention are more likely to spur a cluster of suicides.”

Just as the Mapo Bridge was being praised for its novel approach to suicide prevention, South Korean media members became the center of a controversy in August after failure to intervene in a suicide attempt that ultimately turned fatal.

After a South Korean human rights activist had warned via Twitter that he would be jumping from the bridge later that day, media members arrived on scene only to film the man jump to his death, ultimately leading to their arrests as accomplices to the suicide.

A comprehensive approach

Though the intervention on the “Bridge of Life” may be laudable due to its innovative approach, its effectiveness as a suicide prevention strategy needs to be considered with caution.

Assuming there has been a significant reduction in the suicide rate on the Mapo Bridge, to what extent might this reduction be sustained and how much of its purported impact might be due to the sheer novelty of the intervention?

It may also be important to consider whether the data suggest actual reductions across the city more broadly, taking into account that there is the potential for displacement to other bridges and locations throughout Seoul.

No one strategy can be wholly effective on its own. Perhaps the theories that went into designing the “Bridge of Life” can be combined with proven effective strategies for suicide prevention.

Restricting access to lethal means when people are at their lowest moment, increasing feelings of social connectedness, and even the influence of the media all have the ability to work together in forming a comprehensive approach to mitigate suicide.

The National Action Alliance for Suicide Prevention has the goal of eliminating the tragic experience of suicide altogether, with the target of zero suicides. While ambitious, their mission is an important one, and their work at the state and local levels has had a strikingly positive impact over the years in reducing suicide rates across the most vulnerable age groups.

Building with the tools of public health

Inevitably, ending one’s own life will remain an option for those suffering from mental illness, or for whom an existential crisis proves too burdensome.

But for that which Albert Camus identified as the one true philosophical problem, public health measures can change the population-level impact. Novel interventions like those that turned the “Bridge of Death” into the “Bridge of Life” can shift what Anne Sexton describes as the language of suicide, such that the question of which tools becomes a question of why build.

Photograph of Jenny Holzer’s PROJECTIONS at MASS MoCA by bgblogging via flickr. Edited by Dana March