Suicide surveillance / aftercare system: Experience from Taiwan

People with previous suicide attempt have been identified as at highest risk of re-attempt and subsequent death from suicide. Yet timely postvention services are seldom delivered mainly because attempters are difficult to track. In order to tackle this issue, Taiwan, in December 2005, established a National suicide surveillance/aftercare system. This paper examines and evaluates the newly integrated and refined case reporting and care delivery mechanism. During 2008, there were 24,180 attempt (23,482 attempters) reported, translating to an attempt/complete ratio of 6.1. Two thirds of the cases were attempted by female. 53.6% of the attempters aged between 25 and 44, followed by 45-64 (21.2%), and 15-24 (16.9%). Top three methods used by attempters were self-poisoning (58.3%), cutting (22.1%), and other specified gases and vapors (6.7%); while for complete suicide, hanging (33.5%), other specified gases and vapors (30.9%) and self-poisoning (15.9%). Relationship problems was the leading reason for attempting suicide (48.6%), followed by mental illness (37.6%). About 88% of the reported cases were outreached either through telephone call or home visit. Re-attempt rate within 6 months after reporting was 10.9%. Information collected through the system provided valuable data, reflecting Issues related to the reluctance of potential reporting agency to report as well as to the willingness of the reported cases to accept aftercare services, which have been constantly under debate. Beside ethical/privacy concerns, efficiency of this web-enabled system, continuity of care between crisis intervention and aftercare services, and the training of outreach personnel are among the tough challenges facing the system.