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Comment by jeroenhd | Hacker News Reader

Thi will never cure the underlying cause of suicides, of course, but adding even slight obstacles has proven to have an effect on suicide rates. Many suicides aren't thoughtfully planned out, but are just a combination of motive and easy opportunity. Even adding something as seemingly silly as a moderately difficult to climb fence to a bridge can reduce suicide rates.

This is a fine measure, assuming that it's followed by investment into mental health. I do believe it'll save lives, even if it's just a few, but the necessity proves that there's still a lot that needs to be done.

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Right, but it is really important that you follow up with psychological help.

Sometimes I wonder if suicide prevention measures like this just remove the last bit of agency that people have, and while they will live on, they will just suffer silently. Maybe suicides are not thoughtfully planned out, but they are often preceeded by a very long phase of suicidal thoughts and rumination, and sometimes fixation on specific methods (e.g. a certain bridge, or in this case a fan). Similarly, by not reporting on suicides you prevent some, but you basically take away their last voice. I don't know, I think it is a very hard dilemma.

That is all assuming that all will remain suffering. How likely is that? It seems much more likely that some may look on this dark period in their life and be grateful they didn't go through with a suicide.

Surely that would depend greatly on the cause of the suicidal thoughts.

I've been severely depressed and borderline suicidal twice. The second time was worse than the first. Baking a single potato was the first sign I was pulling out of it. I could barely walk. It was bad. I prayed a lot, and I'm usually the pithy type with prayer.

The only reason I consider it borderline suicidal is that I had an internal rule to call 911 the first moment I started making plans and I think that kept my mind away from doing that because I didn't want to get checked into a mental hospital.

I cannot express to you just how happy I am to have held on. I am truly joyous again. It seemed impossible during the dark times.

I can't speak for everyone, I believe in free will to some extent, but I also believe that life is precious and sacred. Sometimes all someone needs to do is to just keep holding on and pushing through and that really easy to jump off of bridge that they have to walk by every day is not helping one bit.

Anyway, if anyone is reading this and is struggling like I have, please feel free to email me if you want advice or even if you just want someone to vent to.

Being a student can be especially depressing, odds are that people will get better once they have that phase behind them.

I wonder if this is a bigger problem now than it was when I as a student forty five years ago. In those days a degree was not such a necessity as it is now but was even more worth having. Where and when (Exeter Uni. '74-'77) I studied the drop out rate in the first year was fairly high as people discovered that they were not suited to academic study, felt they had chosen the wrong subject, or were simply not capable. A noticeable minority didn't return after the Christmas holiday having done just one term.

The result was that the student body was composed to a greater degree of people who really wanted to be there doing what they were doing and to a slightly greater degree capable of doing it. I suspect that this would mean a slightly lesser incidence of depression.

I can easily imagine that a lot of students now also feel that they are unsuited to study but also feel that they must continue with the degree because the piece of paper they receive at the end is so important now because so many jobs demand it. So instead of dropping out and, perhaps, taking a vocational course instead they continue studying a subject that is beyond them or perhaps merely uninteresting.

Of course this is just speculation that seems plausible to me. Are there any good and approachable statistical analyses on the subject?

Some suicides are after long rumination, others are momentary impulse. Sometimes triggered by psychosis, bout of paranoia, manic phase, PTSD or something other of the sort acting out. There are people who have multiple suicidal attempts, but from what I recall from stats many try once and that is it.

Following may be biased sample, but when I read mental health forums a while ago there were people who wanted to try suicide in the past and were glad it did not worked out.

I remember a story about an army that had a lot of suicides when soldiers would go home and take their gun with them. Not allowing them to take their gun home apparently really cut down on the suicides. Having a bit more time to think about it can save lives.

But of course they should still address the underlying reasons that make people consider suicide.

It used to be the case in the US that women attempted suicide at a higher rate than men, but men succeed at a higher rate. The difference was said to be the method, and of course guns were a favored method with men.

It is still the case that women attempted suicides is higher and the results a lot lower, but as far as I remember in most cases for women it was just a way to cry for help, not to actually do it, while men were on the other side. I cannot find a link right now, I think it was a video of a psychology class.

I think for most it's a cry for help, but some people die before they get the help because their method is too effective.

Of course there are also people who have carefully considered their options and decided they really want to die, but I suspect that's a very different group.

Men usually do it with the intention of success, that explains the huge disparity (4 to 1) in results.

Intention of success is hard to know... What we do know is women use less lethal methods like pills, rather guys who use more lethal methods like firearms.

To get a better picture, it might help to compare men with easy access to firearms to men without such access.

You can do that by comparing the rates in various states against the rate of firearm ownership. There does seem to be a positive correlation between firearm ownership and suicide in the United States, although other correlations are equally present and might be causative as well. Rural areas tend to to have high suicide rates[0], and tend to both be more poor and have more firearms than urban areas per capita.

Globally it's more complicated, as there are plenty of countries with fewer firearms than the US and more suicides, as well as countries with fewer firearms and fewer suicides. Material conditions (poverty, etc.), prevailing attitudes around substance use, hard to describe social well being factors, and stigma/quality of mental health care seem to be factors.

For my part, I think that easy access to a means of suicide, such as firearms, is one part of the equation, but not the dominant part. The dominant part is the prevailing experience in the population as a whole, as a population that feels like it's lost hope is more likely to attempt suicide on average than one that has not. But it does seem like wide spread misery and access to an easy and quick means of suicide is a very bad combination.

0 - https://www.cdc.gov/media/releases/2017/p1005-rural-suicide-...

Doing the comparison between South Korea and USA, restricting firearm access look to be increasing suicide rate. Of course this is not true, just an extreme outlier, the point is that cultural differences have a much stronger impact than access to a particular method.

The Turkish Army fitted sheet metal trigger guard boxes designed to make it harder for a depressed conscript to pull the trigger on their G3 rifle when the muzzle is in their mouth or under their chin.

https://silahreport.com/2020/04/27/suicide-prevention-trigge...

No word on its effectiveness in practice.

It’s a good point. There are places / mechanisms that become iconic and if you remove that or make it harder, people don’t necessarily move to something else.

Palo Alto had a spate of suicides at a particular crossing, so they added guards and fences, and the suicides did not significantly move to other stops.

Yes, but has the number decreased because of some fancy fences at the Last Exit Caltrain or because of a whole program of measures?

https://evolvetreatment.com/blog/palo-alto-teen-mental-healt...

Suicide isn't logical or rational. It's almost always the result of a temporary state of mind, therefor it matters how accessible the means of ending one's life is.

Easy and instant access to firearms for example leads to way more successful (and even just attempted) suicides because it takes less time to take out a gun and shoot than virtually anything else.

> Suicide isn't logical or rational

Sometimes it is.

Not for most of the type of suicide we talk about here, I agree with you. But there are differences.

Regarding firearms, what about suicide rates in Japan? Would they be higher with easier access to firearms?

https://en.wikipedia.org/wiki/Suicide_in_Japan

What do you think I meant by "almost always"?

And yes, I believe there would be even more successful suicides in Japan if the Japanese had easier access to firearms.

> What do you think I meant by "almost always"?

Actually I did not consider what you meant with "almost always", because it is quite fuzzy and the value of that variable will may change over the discussion.

> Would they be higher with easier access to firearms?

Quite possibly. Is there a reason to think they would not?

And yes, culture where suicide can be honorable or beautiful ending will likely have more suicides. Western tradition was treating suicide as a sin and stigma.

> Is there a reason to think they would not?

Yes, It could be dishonorable to use a firearm. A little bit of pain may make you look more manly, such stuff. The socio-cultural embedding of an an act that makes it logical and rational.

> Suicide isn't logical or rational.

This is bullshit. It may or may not be depending on individual conditions. If someone knows that they will suffer significatly for the rest of their lives, then it's entirely logical ans rational for them to end their life. It would be irrational to continue living if the cons were guaranteed (or even had a high likelyhood) to outweigh the pros.

You ignored the "almost always" part.

And for me "suffering" is not that logical or rational at all, for that matter. The expectation of such suffering can be reasonable. The willingness to end this suffering can be reasonable. This, however, is a small minority of suicides, suicide attempts and even more so, suicidal ideation.

No, I didn't. You wrote "Suicide isn't logical or rational." not that suicide almost always isn't logical or rational; and then you gave an explanation that you claimed (without evidence or argument) is "almost always" the case.

> This, however, is a small minority of suicides, suicide attempts and even more so, suicidal ideation.

What data do you base this on and why do you believe that data to be representative?

It’s impossible to understand the future with 100% certainty, ergo illogical.

This isn't even true in anything but a irrelevantly literal way, first of all. There are incurable diseases which can cause massive suffering. It would be irrational to live with one when consensus is that a cure won't be remotely on the horizon for one's lifetime. Sure, something could come up unexpectedly but you could also win the lotto too and it's irrational to play that. Second of all, your argument invalidates all decision making and planning, so is really a reductio ad absurdum for itself.

> It's almost always the result of a temporary state of mind,

Your every decision is a result of a temporary state of mind.

Unless you think hope is always logical or rational, then there are some situations in which suicide can be logical or rational. Or maybe simply humane, if you want. While reducing impulse suicides (and all suicides) is a noble goal, saying suicide isn't logical or rational to me is downplaying and disconnecting from the suffering of those that need the support (and not the judgement) the most.

Probably the fencing. We have enough pseudo-experiments now that we can say the fencing makes a difference. There's a carpark in the UK that had trouble adding fencing, so they closed the top level.

> Probably the fencing.

That may well be.

I do not deny that it is a solution for spontaneous suicides in a younger (male?) demographics. Do suicide methods of women or middle aged/elderly people differ? What types of suicides do access restricting measures prevent? Do people change methods? And so on.

Suicide is a graven field for social scientists.

Before I read your comment, I came here thinking they are patching the symptoms rather than diagnosing and fixing the actual root cause. Just understood, it's more important to reduce the easy of committing suicide before solving the actual problem. Thanks for the wonderful comment.

Most accidents happen in the own households. I won't be more specific to give any suggestions but this approach makes the likely root cause - hardship in the pandemic - even worse.

> This is a fine measure, assuming that it's followed by investment into mental health.

More recreational opportunities and less pressure during studies are probably more helpful. From a documentary I've seen recently stress at India's universities must be extreme in some cases.

This may be true, however after living in the tropics for many years I can attest that if you're unable to afford Air conditioning, someone taking your fan away would be enough to send even the happiest person over the edge.

Which is why they are replacing the ceiling fans with wall mounted fans (it's explained in the article)

> This is a fine measure, assuming that it's followed by investment into mental health.

I don't know if it's a problem with the institution or a problem with the reporting but you could avoid a lot of "But they're not fixing the root cause, just the symptoms." outrage just by confirming this assumption. More engagement I guess...

Everyone knows that fixing the root cause is the way to go, it's weird to see that some people seem to think patching symptoms and fixing the underlying issue are two opposite things and you somehow only can do one or the other and not both.

There's also the question whether any given institution is even capable of addressing the underlying causes, or whether it's in its best interest to do so. Sometimes the causes are big and deeply rooted, and a college is not capable of pushing back the metaphorical tide.

Focusing in on students specifically, I suspect (but do not know) that the extremely high pressure nature of going to a University in India is a factor. If that assumption is true, it's not clear whether the University is capable or willing to change that.

What I am wondering: Will these obstacles reduce overall suicide rates or just local ones? Hard to measure I guess.

The claim is that they do reduce overall suicide rates. They are not offseted by more suicides at other places or later on.

Generally, as far as I can tell from reading about suicides and mental health, this is largely settled research. I dont understand why there is so much opposition to it on HN as if it was something new or controversial.

> I dont understand why there is so much opposition to it on HN as if it was something new or controversial.

The HN crowd likes to question everything because this is one of the ways we learn. Being unfamiliar with well settled research on the subject is a contributing factor. Few would question the Earth is round por that birds aren't robots because we all know that, but when it comes to niche knowledge, the questioning is more frequent.

HN crowd instantly jumps to some claims with zero doubt. And instantly doubt others.

I don't even think it is about self interest or other such motivation.

This looks as bikeshedding. If you want to eliminate suicides, finding and fixing the motivation to commit the act is the way to go. Having a fan on a ceiling is not an opportunity, just one of the many available means to an end and not a compelling one, so it is really a way to pretending to care while not doing the right thing.

Well, it turns out your intuitions on this one are wrong. Means restriction is one of the most empirically supported suicide-prevention strategies.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6191653/

The study do highlight some conditions. Means restriction is mostly effective when the suicide method is common and highly lethal, its more effective in reducing suicide for women then for men, and when the specific means restriction need to be culturally supported. The specific method also need to be popularly known among the population.

Import note that the study does actually not compare alternative suicide-prevention strategies. It is a meta study of mean restriction and not a meta study of suicide-prevention strategies. It does not compare the effectiveness of healthcare, reducing risk factors, hotlines and others suicide-prevention strategies.

I think the point is, does removing fans make someone less depressed in the long run, or increase their quality of life?

If someone still wants to kill themselves, but cannot because all means have been eliminated, have you solved any problems?

I'm honestly not sure that I'd argue it doesn't increase quality of life, but using suicide prevention as an outcome seems superficial to me.

Well you've solved the immediate problem of having zero further opportunity to solve the underlying problem (because they're dead).

One point made in the linked article is that identifying risk in individuals isn't something we've found a good way to do. If we know who needs help, helping them is better than removing a fan. But we usually don't know who needs help, despite a variety of sensible-seeming approaches to figuring it out.

There's still an argument that aside from the individual level, we should address things at the societal level: what socioeconomic forces contribute to people being in tough situations where suicide seems like the only way out, and how can we change those socioeconomic forces?

That's a great question and a great place to focus our energy. And, while we're working on changing the world in bigger ways, we can make it a safer place.

Means restriction is an effective way of preventing a lot of things. To the point we have phrases like "If all you have is a hammer, everything looks like a nail".

Food for thought.

I'm not really sure what you're trying to say. You seem to be hinting at something, rather than being direct, but it's not clear what you're hinting at.

It's trivial to take the direct approach of "Let's just treat the symptom."

Symptoms are caused by underlying disease. If you have people killing themselves in excessive numbers, one should not look at the means they employed as the problem. Doing so, is having a hammer, therefore the nail (removal of the offending thing, in this case the instrument of suicide.)

Treat. The. Disease. Why are they suicidal?

Overly high standards/expectation? High stress? Corrupt systems? Social stigma? Failure to teach/communicate/cross cultural divides? Miscalibrated assessment methodologies? Lack of opportunity or alternatives in the face of failure? Physical stressors? Bad nutrition, poor food, unsafe environment?

To stop at "just get rid of offensive thing" in this particular case is to indulge in willful ignorance of the root cause of suicidal ideation; the final conclusive cessation of suffering. What is causing them to suffer?

Relieve that. Engage in 2nd and higher order thinking.

> To stop at

Who said anything about stopping? Building a better, healthier society is a massive undertaking, and people are engaged in doing that.

In the meantime, we're also making the world a bit safer.

I am not convinced it is as effective as pretended, otherwise the Mapo Bridge in Seoul would be razed and the Aokigahara Forest in Japan would be fenced with barbed wire.

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