| 4. In which ways is the initiative creative and innovative?
■ Organization and System
Nowon-gu created systems and organization in order to implement the project more effectively.
As the first such project in the nation, in October 2010, the Respect Life Team in a community health center and the Suicide Prevention Team within the Nowon Mental Health Center were organized.
These two structures are the core of the Nowon suicide prevention efforts and they ensure the smooth operations of various programs under the project.
In addition, in December 2010, the Ordinance on Respect Life Culture and Suicide Prevention was created as the first district office in the nation. The ordinance gives responsibility and rights to the mayor of the district and residents, the installation of the Respect Life Committee, the establishment of a suicide prevention system, and preventive education to ensure the systematic and sustained implementation of the project.
■ Private-Public Cooperation Governance
In October 2010, Nowon-gu signed an MOU with police stations, fire stations, and emergency medical centers within the district to establish a public private cooperation system. The MOU aims at sharing information about people who committed or attempted suicide, their families and monitoring activities.
By 2013, about 20 MOUs were signed with the Association of Doctors in Nowon-gu, the Association of Pharmacists, and universities to establish a crisis management system to prevent suicide.
■ Intensive Preventive Measure
As an intensive preventive measure, in order to share information on people who committed or attempted suicide and monitoring, and to coordinate responses to an emergency situation, an MOU was signed with three emergency medical centers, Nowon police station, and Nowon fire stations.
In addition, in 2012, a cooperative system with mental health treatment centers was built to reduce treatment costs and reduce the rate of suicide repeat.
■ Optional Preventive Measure
The optional prevention measure targeted socially disadvantaged groups vulnerable to suicide, such as the elderly, basic livelihood support program beneficiaries, the unemployed and day laborers.
In order to collect the targets, mental health evaluations – a depression test – have been conducted since 2011, and as of 2013, a total 102,147 people were tested.
From the test, 16,216 people were diagnosed as being at a high risk of committing suicide. To help them, gatekeeper volunteers and the mental health center have provided counselling, treatment, and welfare service resources.
■ General Preventive Measure
In order to increase awareness about respecting life and strengthening suicide prevention for the whole population of Nowon-gu, publicity towards religious organizations began in 2011.
In June 2012, a joint workshop with the Association of Doctors in Nowon-gu was conducted to increase doctors’ awareness of suicide prevention. In September 2013, on the occasion of the Suicide Prevention Month, the ‘Nowon Community Mental Health Walking’ event was held to raise awareness of the need to respect life among the youth and to promote dialogues and communication among family members.
In September 2013, residents and the district office staff conducted Ribbon-wearing for the Respect Life campaign, and held various promotional activities, including theatrical performances. In addition, education for religious leaders, teachers, welfare program personnel, students, civil employees, and residents of Nowon-gu has been established.
| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
■ Nowon-gu suicide prevention team
On Oct 1, 2010, a respect life team was created to cultivate a respect life culture and supervise the suicide prevention project of Nowon-gu with one team leader and two team members from the public health department of the community health center.
The team reviews the achievements of the previous year and sets a new business plan for the following year. Based on the basic plan, the team is responsible for stronger public and private cooperation, the early detection of people at risk through mental health assessments, education and reviews, the operation of gatekeeper volunteers, suicide prevention education and promotions for residents.
■ Nowon mental health center supplied mental health professionals
The Suicide Prevention Team under the Nowon Mental Health Center has a team leader and five working-level members. They are mental health specialists, such as mental health workers and mental health nurses.
The team takes care of the ‘high suicide risk group’ such as those who attempted suicide and
family members of those who committed suicide, and the ‘suicide risk group’ diagnosed as
having a high level of depression. The team offers mental health counselling, tailored case
management, a self-healing program for the family of people who committed suicide.
■ MOU collaborators
Nowon police stations, fire stations, and three emergency medical centers supply information on those who committed suicide and attempted suicide in accordance with MOU with Nowon-gu to jointly cope with crisis.
Based on this information, the family members of those who committed suicide and attempted suicide are guided on the suicide prevention efforts of Nowon-gu and are advised to agree to receive counselling from the Nowon Mental Health Center. In addition, the Bukbu Employment Center, the Nowon branch of Korea Senior Citizens Association, and the Bukbu Women Development Center are conducting mental health evaluations for the elderly, jobless, day laborers and women who visit them.
| 6. How was the strategy implemented and what resources were mobilized?
■ Bold investment to save lives despite unfavorable financial conditions
As of 2013, the fiscal self-reliance ratio of Nowon-gu is 22.3%, the lowest among the 25 districts of Seoul. The cause of the poor fiscal condition is a huge expenditure on health and welfare due to the highest number of socially disadvantaged groups, such as the basic livelihood support program recipients, the handicapped, and the elderly residents in Nowon-gu.
Mayor Kim, despite such adversity, invested courageously in this suicide prevention project by saving in other sectors, in order to rescue people before it was too late.
In 2011, as the project intensified, 403 million won was spent, with a total 1.38 billion won spent over a three year period. This represents a 24.8% increase over 2011, with 15 million won allocated to private sector cooperation, 83 million won for public-relations efforts and education, and 1.29 billion won for the management of resources to care for the high-risk suicide group and case management.
■ Suicide Prevention Project needs ‘humanism’
Besides a fiscal injection, the other important factor in suicide prevention efforts is human resources. Human resources are needed to identify people with suicidal tendencies and to prevent those with suicide intentions from making a fatal decision.
Civil employees in charge of social welfare, 458 heads of village (welfare assistants) and 772 gatekeeper volunteers were trained at Nowon-gu district office, and currently participate in activities to detect the high-risk suicide group and to care for them.
Christians, Buddhists, and Catholics actively joined the gatekeeper volunteer activities to care for those at risk.
Furthermore, the Nowon police station, the Nowon fire station, and Sangye Paik Hospital are parties of the MOU working to build community suicide prevention & a crisis management system by actively participating in suicide prevention activities..
| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
■ Reduction of the suicide rate in Nowon-gu
The most important result is the reduction of the suicide rate in Nowon-gu. According to the data provided by the Office of Statistics Korea, the number of suicides in 2009 was 180 with a suicide rate of 29.3. This continued to fall gradually to 150 suicides and a suicide rate of 24.1.
The outcome of Nowon-gu toward suicide prevention efforts has been recognized by awards from the Minister of Health and Welfare, Excellent Community Welfare Award by Hangyeore Social Policy Research Institute, and the top prize from Korea Manifesto Center.
■ Expanding awareness of suicide prevention in the community
In Korea, having a mental problem is considered as a serious personal defect. So even patients with mental problems are not eager to see psychiatrists. Experts see this as one of the leading causes for the rising suicide rate.
From 2008 to 2010, just before the suicide prevention project was implemented in Nowon-gu, the number of suicide counselling at the Nowon Mental Health Center was a mere 118, but after the project, the number skyrocketed to 11,408 by September 2013, a 96-fold increase.
And project collaborators, such as the police station, the fire station, and emergency medical centers, actively cooperated to convey information regarding 1,430 suicides and attempted suicides.
These results are evidence which suggest there is public awareness of the need to respect life and have suicide prevention among the residents of Nowon-gu and related institutions are on the rise.
■ Significant contributions to local community formation
About 20 institutions, such as the police stations and emergency hospitals are cooperating to push for suicide prevention.
In addition, Life Love Sharing Centers were established in 19 dong (village) offices, and gatekeeper care volunteers and heads of the centers place phone calls and visit high-risk to commit suicide groups in the community to help them with talking and strolling, and to provide various welfare and medical support according to their needs.
Public and private cooperation and gatekeeper volunteer activities towards suicide prevention project have greatly contributed to the formation of a happy community through sustained activities toward a goal.
| 8. What were the most successful outputs and why was the initiative effective?
■ Academic research to evaluate the long term effect of the suicide prevention project in Nowon-gu
The relationship between the steadily declining suicide rate and the suicide prevention project needed to be analyzed. And it was necessary to generalize the project results to establish a scientific business model.
Nowon-gu requested the Academia-Industry Center of Hallym University to perform academic research, and to prepare a study on the long-term effects of the Nowon-gu suicide prevention project and expansion strategies. Research was done from June 2012 to January 2013, and in February, 2013, the academic research results were presented and discussed.
The academic research was presented to 327 participants, including suicide prevention specialists, mental health center personnel, suicide specialists, and residents. According to the research, rates of suicide and attempted suicides were reduced but they were only short-term results. So it should not be interpreted as a lasting effect. Still, the reduced rates were positive and significant.
In addition, it was concluded that, for the sustainable performance of the project, it was important to ensure that the project is implemented properly and to identify problems in individual programs and find solutions. Moreover, opinions were collected on the future directions of core projects, such as the local community network, the respect life culture project, mental health evaluations, and gatekeeper volunteer activity.
Experts were unanimous in saying that sustainability was essential for the success of the project.
So Nowon-gu holds an event to evaluate the achievements of annual gatekeeper volunteer activities at the end of every year. Volunteers are asked to present excellent cases to share and review among all members. That has enhanced the sustainability of the service.
Besides, based on the suicide statistics released by Statistics Korea every October and suicide information from the Nowon Police Station, annual results are reviewed and solutions are found and planning for the following year is made.
| 9. What were the main obstacles encountered and how were they overcome?
■ Early detection of the high-risk to commit suicide group using chiefs of tong (welfare assistants)
Nowon-gu has the biggest number of high-risk to commit suicide group, such as the elderly who live alone and the handicapped in Seoul, and thus in the early phase of the project, the availability of suicide prevention specialists was urgent.
In 2010, the high-risk to commit suicide group was estimated at 150,000, but it was not easy to obtain the personnel and budget to conduct mental health tests for the group, given the fiscal status of the Nowon-gu district.
As an alternative, chiefs of tong who were already acting as welfare assistants were asked to conduct the mental health tests, without use of a budget.
Chiefs of tong are usually very familiar with the things and people of their villages since they have lived there for a long time, and thus they are the best human resources to conduct mental health tests.
They were trained about the mental health test and gatekeeping and since 2011, they have acted as volunteers for early detection of the high-risk to commit suicide group.
■ Suicide prevention volunteers, Gatekeepers
In addition to manpower for mental health tests, Gatekeepers are another essential part of suicide prevention efforts. The major role of gatekeepers is to visit the high-risk to commit suicide group, and provide emotional support like talking and strolling with them, and to utilize welfare resources.
However, given the unfavorable fiscal condition of Nowon-gu district, the paid system of Gatekeepers was not possible.
Nowon-gu decided to run the Gatekeeper system as a volunteer group, and made several presentations to religious groups among Christians, Buddhists, and Catholics because they are more willing to help others. After the presentation, applications were received. Currently 727 Gatekeepers are now working.