How can a nation fight a suicide crisis?

On this question, South Korea, known for having one of the world’s highest suicide rates, may become a compelling case study. Here, as of the end of 2021, one person dies by suicide every 40 minutes.

While addressing the root causes of the crisis remains daunting, demanding a comprehensive approach to mental health and a stronger social safety net, critical work is being carried out on the frontlines of suicide prevention.

These initiatives, some of them untested, typically employ a combination of technology, physical deterrent structures, and human intervention, such as AI monitoring bridges around the clock to alert authorities about potential jumpers, along with the installment of crisis hotlines and anti-jumping guardrails.

Government data shows that more than 13,000 people took their own lives in South Korea in 2021.

Tense river: Efforts to detect potential jumpers on bridges

Along the Han River that runs through the center of Seoul, most of the 31 bridges that cross it are equipped with higher railings, surveillance cameras, and emergency telephones connected to crisis hotlines.

These physical barriers and immediate access to support aim to deter impulsive suicide attempts and provide immediate help to those in crisis.

At Mapo Bridge, one such suicide blackspot, a fence taller than human height separates the sidewalk from the river and has been specially designed to deter such attempts. The Seoul government in 2016 added a roller-type extension to the existing 1.5-meter fence, increasing its height to 2.5 meters. Rollers at the top of the barrier are designed to prevent individuals from grabbing the fence to climb or stand on it.

The city also deployed AI to detect risk indicators in 2022 with an investment of 1.24 billion won ($897,510). Currently, there are 812 surveillance cameras installed on the 14 bridges with the highest foot traffic. All footage from these cameras is sent to an integrated control center, where every individual is identified with their specific appearance in color.

If anyone remains on a bridge for more than 300 seconds or attempts to climb over the railing, the AI sends an alert to the control center.

For those lingering, the control center again assesses whether they appear distressed, are holding alcoholic drinks or are making a move to climb the railing.

If it is deemed a risk, the center contacts the rescue team, which “typically arrives within five minutes to any bridge,” according to Kim Joon-young, head of the control center.

Before adopting the AI surveillance system, human operators monitored the surveillance footage 24/7 and alerted a rescue team when a suicide attempt was in progress.

With the AI, alerts are sent for any detected signs of distress, typically before one attempts to jump. Furthermore, the physical difficulty of climbing the fence provides rescue teams with crucial time to intervene, resulting in a nearly 100 percent rescue rate.

The AI system seems to have increased detection. Before its full implementation in 2021, 550 alerts were sent to the water rescue team. This number increased to 1,000 in 2022 and 1,036 in 2023.

At the same time, the national suicide rate fell slightly, from 26.0 per 100,000 in 2021 to 25.2 per 100,000 a year later.

In 2022, all suicide attempts at Mapo Bridge were successfully prevented or rescued.

Crisis hotlines

There are also 75 emergency telephones on Han River bridges connected to "The Lifeline,” a crisis hotline with counselors on standby to talk to those in distress.

Funded by 18 life insurance companies in the country and operated by the Life Insurance Philanthropy Foundation, the hotline operators collaborate closely with emergency responders from police and fire departments. Upon detecting signs that a caller may be contemplating suicide, counselors signal an assistant while continuing the conversation. The assistant then contacts the 119 emergency service, with the counselor staying on the line until the police arrive.

Na Ji-hun, a professor at Daegu Catholic University who has volunteered as a counselor at the Lifeline call center for 10 years, said the largest age groups using the hotline are those in their 10s and 20s. The major concerns of these callers include relationships with friends, colleagues and partners, followed by family conflicts, careers and studies.

“As for teenagers who called, many of them have anxiety about not satisfying their parents’ expectations. When their career goals were not achieved, they come to bridges not because of their personal disappointment but out of fear their parents might be disappointed,” said Na, who has volunteered for more than 5,400 hours for the Lifeline. “Those in their 20s often experience great anxiety about failure. When they encounter failure, they tend to believe their entire life is a failure. This mindset may be tied to the societal pressure that does not tolerate failure.”

Kim said that the counselors do not give directions or advice to callers contemplating suicide.

“Because they lack experiences of being understood or respected, what is most important to them is good listening and empathy,” he said. “When counselors approach the callers as if they understand everything and express cliched empathy, it often leads to more disappointment. However, when callers feel they are fully understood, most of them end the call saying they will choose to live.”

New threat rising

Carbon monoxide poisoning has risen as a suicide prevention challenge, particularly among men and middle-aged people.

In response, the government began requiring suicide prevention messages on the packages of charcoal briquettes, which are readily available at supermarkets. Additionally, it encouraged the media to avoid depicting their use as a means of suicide.

Regional governments have also urged supermarkets to inquire about customers' reasons for purchasing briquettes.

In June, a store owner, suspecting plans of self-harm, called the police when a customer bought charcoal briquettes and green duct tape. The police located the customer’s residence and were able to rescue the person, who had indeed attempted to induce carbon monoxide poisoning.

The central government's attempts to restrict access to briquettes or discontinue their production have faced resistance from both producers and consumers. Briquettes are used in barbecue restaurants and low-income households that rely on coal for heating.

Now, the focus is on developing alternative charcoal briquettes that do not pose a lethal risk to humans.

Risks in farming areas

Restricting access to poisons is another key strategy to prevent suicides in rural areas.

In November 2011, the government took a decisive measure, banning the production, sale and storage of a key herbicide and the number of suicides from poisoning dropped significantly.

In 2012, there were 2,103 deaths from poisoning, which halved to 959 in 2015. By 2021, the number further declined to 741.

To prevent potential misuse of other poisonous chemicals, rural governments have taken proactive measures to monitor public access to toxic substances.

In Miryang, South Gyeongsang Province, stickers with the message “Are you feeling emotionally burdened?” and the suicide prevention hotline number 1393 have been distributed to weed killer producers to place on the lids of their products since last year.

Other provinces, including South and North Jeolla Provinces, installed public storage containers with locking devices where farmers store their weed killers, ensuring that they do not keep them at home.

Other items under special management

In 2020, the government enacted the “Notice Regarding Items for Suicide” to designate substances frequently used for suicide.

Initially, charcoal briquettes and toxic substances causing poisoning effects such as herbicides, insecticides and fungicides were designated as hazardous items for suicide prevention. Considering the increasing trend of drug overdose-related suicides, substances causing poisoning effects due to antiepileptic drugs, sedatives, sleeping pills and antiparkinsonian drugs were additionally designated in January 2023. In December, other substances, such as chemical preservatives, were included.

When distributing substances designated under the Notice Regarding Items for Suicide are sold online with the intent to cause suicide, individuals will be subject to punishment of up to two years in prison and a fine of 20 million won ($14,000).

Interventions, not a fundamental cure

Chung Taek-soo, head of the Korea Suicide Prevention Center, stated that suicide means restriction can play a crucial role in halting a person’s impulse to commit suicide and delaying the action. Yet, they are not fundamental solutions to the problem the country is facing.

"When a person contemplates jumping from a bridge but finds it difficult and notices the Lifeline, they might choose to call for help instead of jumping," he said.

Or, the suicidal individual may seek other alternatives.

For example, after screen doors were installed in all Seoul metropolitan subways, falling accidents in the subways dramatically decreased. Nevertheless, the total number of suicides continued to rise as the at-risk individuals chose other methods of self-harm.

In the end, the root causes of suicide must be addressed.

"For problems that individuals perceive as insurmountable, such as economic difficulties, sudden legal issues or mental health struggles, if the government could lower the barriers related to these issues just a bit, people might find life more livable."

Experts also emphasize the need for stronger mental health interventions to predict high-risk individuals for suicide. In 2021, the primary causes of suicide in South Korea were identified as mental health issues (39 percent), economic problems (24 percent), and physical illnesses (17 percent), according to the Korean National Police Agency.

"It is urgent to place local clinics, such as those in internal medicine, family medicine, obstetrics and gynecology, pediatrics, and surgery, at the center of suicide prevention policies," said Hong Seung-bong, president of the Korean Association for Suicide Prevention and neurology professor at Samsung Medical Center.

"Like Japan and the United States, all doctors in Korea should participate in depression treatment and suicide prevention. Without this, Korea's suicide rate, which is the highest among OECD countries, will not decrease quickly."

If you're thinking about self-harm or suicide, contact the Ministry of Health and Welfare's helpline at 109, available 24 hours a day, 7 days a week. Please request a translator for English-language services.