Wang Hong (not her real name) complained about a headache. Lying among bandages and tubes, she moaned weakly, rubbing her forehead with her one free hand and trying to pull the tubes away from her nose.

The nurse brought her a pill and Doctor Lin Zhaofen said the pain was normal since she had serious cerebral injuries. The doctors were most concerned about whether they could save her seriously broken left arm and right leg, which were already seriously infected. "If the infection can be brought under control in one or two months, we will be able to save all her limbs," Lin said.

Wang Hong, 23 years old, was the seventh person to attempt suicide by jumping in front of an underground train in Shanghai this year.

Leaping numbers

According to Shanghai Star, there were typically about eight suicide attempts on the Shanghai underground annually, the staff at the Metro estimated, but in the first six months of this year there had already been eight cases. The eighth case took place only one day after Wang tried to end her life beneath an underground train. Fortunately, that man - in his 40s - only received slight injuries, leaving the hospital after paying a fine for "infringing Metro administrative regulations".

Wang is a migrant worker serving in a hotel in Pudong. A love affair with a married man triggered her suicide attempt. By the time she was sent to Changzheng Hospital, her left arm and right leg were seriously broken with large open injuries and she had lost most of her blood.

But she was lucky. Her life is safe now, despite the acute pain she suffers every day. Only one quarter of those who attempt to kill themselves in the Shanghai Metro survive.

Suicide attempts often leave a lifelong aftermath, Lin said. There can be a loss of brain function, which leave the victim lying unconscious or spinal injuries that lead to paralysis, warned Lin.

Local psychiatrists and medical experts held a conference last week, calling for positive steps to be taken against the rash of suicides in the city. Psychiatrists suggested that work should begin in collaboration with the Metro system.

"There is a chain reaction. People follow suit as they read news stories about metro suicides," said Shan Huaihai from the Mental Health Center of the Xuhui District. "Also there is a mental attachment to 'dying in front of public'. That is why they tended to take the jump in crowded stations such as People's Square," he said.

The intervention campaign may start with the training of Metro staff, helping them to pay better attention to potentially dangerous situations during their regular patrols.

"We are an enterprise. It is impossible for us to solve this social problem of suicide and stop such things," said Yin Wei, a staff member of the Shanghai Metro Company.

Another method the company will take is to install screen doors on the Metro station platforms. "Metro Line 1 left space for screen doors at the very beginning of the design process," he said, "but there has been no timetable for the installation yet." No such doors will be installed on Metro Line 2 or the Pearl Line since they were not compatible with the original design.

Bad suggestions

"Please don't highlight such suicide cases any more," he said. "It gives people very bad suggestions."

The Metro company has no other plan to prevent people jumping off its platforms. "We have heard about methods in other countries, such as playing classical music," Yin said, "but none of these methods have been proved effective. Besides, we already have warning messages in huge light boxes alongside commercial advertisements."

Wang has regained consciousness but can only express her emotions vaguely. "She said she would co-operate with the doctors," said Lin. "Her mental situation has improved considerably already."

The company employing Wang sent 40,000 yuan (US$4,819) to the hospital to help pay for her treatment, but the money was used up in the first few days. As a migrant worker, Wang doesn't have the medical insurance required of every registered Shanghai citizen. And nobody responsible for her injury can cover the cost.

"It poses a question for hospitals as well," Lin said. "Who should pay the bills? Even if her employer is ready to pay for the emergency treatment, she could be hospitalized for months. Can they afford that?"

Wang's parents, farmers in Central China's Hunan Province, arrived in Shanghai this week. Standing helplessly outside her hospital ward, her father could think of no solution.

But no psychiatrists have approached Wang so far. An evaluation system for people who have attempted suicide is one important step to take, but no such system has yet been established in China. Many people with suicidal tendencies make a second or even a third attempt, so the focus of suicide prevention should be placed on them. "We wish to start psychiatric intervention for people with suicidal experience," Shan said. But the city doesn't have a sufficient number of psychiatrists. About 90 percent of psychiatrists work in mental hospitals, dealing mainly with hospitalized patients, according to Shan's research. No adequate financial support-system for such work is available.

Shan and his colleagues have begun their own suicide intervention by providing free consultation. They also want to work with local communities to prevent impulsive suicides.

In China, systematic research on suicide has only been undertaken for a decade, or even less, which means statistics are of limited value and many questions remain unanswered.

Between 30 and 60 percent of suicides in China are related to mental diseases, with Shan believing the true figure to be at the extreme upper end of this range. No detailed research has been undertaken into the causes leading to the remaining 40 percent of cases. Chinese people tend not to consult psychiatrists until their problems have become very serious.

Healing minds

"Mental health is as important as physical health and mental diseases can be as serious as SARS or AIDS, but so far only insufficient emphasis has been placed on it."

The suicide rate has been increasing in China, with the main reasons including mental diseases, drug and alcohol dependence, population migration, family and marital problems, and life pressure.

Presently, no national reporting system for suicide cases exists in the country. Statistics are collected from public hospitals, with no one making special reports on suicide attempts. Even though over two million people are sent to public hospitals every year after making suicide attempts, less than one percent of them receive professional help from psychiatrists.

The China Disease Control and Prevention Center has introduced a plan to start a national campaign against suicide, in order to reduce the suicidal rate by 20 percent - that is, saving 50,000-60,000 lives every year. But this place has yet to come into practice.

(Shanghai Star July 12, 2004)