The Role and Future Tasks of the National Assembly Suicide Prevention Forum - Focusing on the Legislative Content of Suicide Prevention Laws -
Article information
Abstract
Objective
In South Korea, there were 12,906 suicides in 2022. This number is 4.7 times higher than the number of traffic accident deaths—i.e., 2,753—in the same year. Suicide is so serious that it is the fifth leading cause of death in South Korea. We would like to discuss how the National Assembly Suicide Prevention Forum was established, what role it has played in preventing suicide, and what role it should play in the future.
Methods
We will look into the representatives and lawmakers who made up the National Assembly Suicide Prevention and summarize the topics of seminars conducted in each period.
Results
Through the establishment of the National Assembly Suicide Prevention Forum in 2018, which is referred to hereafter as the “Forum,” various efforts have been made to garner the attention of government ministries, which has led to an increase of 6.7 times in the budget for suicide prevention compared to 2017. With the launch of the forum, private organizations that had previously been working independently in their own fields were able to come together and speak with a unified voice. The formation of the Forum has brought the issue of suicide, which had previously been buried in the dark corners of our society, to the forefront as a social problem, and it has provided an impetus for seeking solutions.
Conclusion
In the 22nd National Assembly of South Korea, the National Assembly Suicide Prevention Forum is expected to play a more prominent role, which is expected to lead to substantial achievements in suicide prevention.
INTRODUCTION
In 2022, there were 12,906 suicides in Korea [1]. This number is 4.7 times higher than the number of traffic accident deaths in 2022, which was 2,753. From 2020 to 2022, the number of deaths by suicide totaled 39,453, thereby exceeding the approximately 35,000 deaths caused by coronavirus disease-2019 (COVID-19) during the same period. A relevant factor is that the prevalence of depression, which is highly associated with suicide, has increased during the COVID-19 period [2].
Suicide is the fifth leading cause of death in South Korea. By age group, it is the leading cause of death among individuals in their teens, twenties, and thirties, while it is the second leading cause of death among those in their forties and fifties. The suicide rate per 100,000 people is 27 for those in their sixties, 37.8 for those in their seventies, and a staggering 60.6 for those aged eighty and above [1].
Moreover, the relatives of suicide victims belong to a high-risk group for suicide themselves, with approximately 90,000 individuals being added to this group annually. The socioeconomic loss due to suicide amounts to a staggering 5.4 trillion Korean won annually [3], thus highlighting the significance of suicide as a social issue in South Korea.
The direct causes of suicide include mental disorders such as depression, economic problems, and illnesses. However, suicide occurs when individual internal risk factors coincide with societal factors such as rapid changes in social structure and values as a result of weakened social cohesion, the emergence of economic problems, and social isolation, all within a context where the nation’s welfare, human rights, and healthcare systems fail to function properly.
The increase in the suicide rate in South Korea can be attributed to various factors. Suicide should be approached as a problem that requires efforts to address social prejudice and social issues that can be solved. However, this is not how it is typically approached in reality. Particularly noteworthy here is Korea’s low level of government attention and investment compared to countries with lower suicide rates, which is a problem that needs to be reconsidered.
In reality, policies regarding suicide in South Korea are overseen by the Ministry of Health and Welfare, but they are fragmented across different ministries; further, within each ministry, the prioritization of suicide prevention is lacking, leading to ongoing concerns about the effectiveness of policies. Moreover, the involvement of civil society organizations, the medical profession, religious groups, and other private sector networks and support in suicide prevention is virtually non-existent.
However, through the establishment of the National Assembly Suicide Prevention Forum in 2018, which is referred to hereafter as the “Forum,” various efforts have been made to garner the attention of government ministries, which has led to an increase of 6.7 times in the budget for suicide prevention compared to 2017. With the launch of the forum, private organizations that had previously been working independently in their own fields were able to come together and speak with a unified voice. The formation of the Forum has brought the issue of suicide, which had previously been buried in the dark corners of our society, to the forefront as a social problem, and it has provided an impetus for seeking solutions.
Issues and improvement methods regarding laws and regulations for suicide prevention have been discussed in the National Assembly alongside criticisms and encouragements directed toward the government’s role. Various efforts have been made to discover and reward contributors dedicated to suicide prevention, and exchanges with other members of the international community, which had started reducing suicide rates before Korea did, were also facilitated.
The previously stagnant budget for suicide prevention has been consistently increased, and there have been notable achievements such as social problematization through active amendments to related laws, particularly the Suicide Prevention Act. As the 22nd National Assembly begins, by reflecting on the accomplishments of the Suicide Prevention Forum’s establishment and activities, I aim to contribute to helping us break away from the stigma of being known as the “Republic of Suicide” by examining the outcomes of the amended Suicide Prevention Act and to the efforts aiming for a reduction in the suicide rate.
THE BACKGROUND AND COMPOSITION OF THE NATIONAL ASSEMBLY SUICIDE PREVENTION FORUM
According to Constitution of the Republic of Korea, the nation must protect the lives and property of the people, and Article 34, Paragraph 6 states that the nation must strive to prevent disasters and protect people from the dangers [4].
The significant reduction that has been achieved in traffic accident fatalities, which peaked at 13,492 in 1991 [5] and had fallen to 2,735 by 2022, can largely be attributed to the state’s adherence to the roles and responsibilities specified in the Constitution above, specifically by prioritizing efforts to protect citizens from traffic accidents.
While there may be various reasons for this reduction, such as the expansion of safety facilities, strengthened enforcement, and the implementation of traffic safety education, what made these efforts possible was the overall enhancement of traffic safety standards through the revision and enactment of relevant laws such as the Traffic Safety Act, Road Traffic Act, and Pedestrian Safety Act, which was supported by increased budget allocations.
In South Korea, the drafting and revision of bills and the allocation of budgets are solely within the authority of the National Assembly. Article 40 of the Constitution stipulates that “legislative power belongs to the National Assembly,” while Article 54 states that “the National Assembly deliberates and confirms the national budget.” [4] In other words, based on its legislative and budgetary powers, there have been various efforts made to protect precious lives from being lost in traffic accidents.
This was made possible by the establishment of the “National Assembly Traffic Safety Forum,” which was first formed in the 17th National Assembly in 2004 and continues to operate to this day.
The National Assembly Traffic Safety Forum, which is an unregistered research group composed of Members of the National Assembly, has for years been actively engaged in various activities aimed at enhancing traffic safety legislation. These activities include prohibiting the viewing of video devices while driving, securing pedestrian rights on side roads, strengthening provisions related to school buses for children, introducing devices to prevent drunk driving, and advocating for the investment of all traffic violation fines into traffic safety measures, securing budgets, and establishing networks among civil society, government, and the National Assembly, as well as recognizing and rewarding contributors (Table 1) [6-26].
Reflecting on the history of suicide prevention in South Korea, three pivotal stages can be seen to emerge: the first milestone is the establishment of the Korea Association for Suicide Prevention, a non-profit private organization that was formed with the goal of embodying a spirit of valuing life in society and conducting various organized activities such as education, promotion, crisis intervention, research, program development, and policy proposals for suicide prevention. In December 2003, experts from the medical, media, legal, and local community sectors convened for a inaugural general meeting. Subsequently, in April 2004, the organization received approval from the Ministry of Health and Welfare to be designated as a corporation. Since then, it has performed its role as a private organization for suicide prevention while focusing on education, research, and policy direction [27-30].
The second milestone is the “Suicide Prevention and Respect for Life Culture Promotion Act (Act No. 18900)”, which was enacted on March 30, 2011 and enforced from March 31, 2013 [31]. The Suicide Prevention Act was established to protect the precious lives of all people and promote a culture of respect for life by stipulating necessary matters regarding the national duty and prevention policies concerning suicide. The enactment of the Suicide Prevention Act was significant in that it acknowledged the serious harm that is caused by the prevalence of suicide in our society and emphasizes the need for national and public efforts to prevent it.
The third milestone is the establishment of the National Assembly Suicide Prevention Forum. On February 27, 2018, 34 members of the National Assembly spearheaded the formation of the forum. The National Assembly Suicide Prevention Forum, which is composed of voluntary unregistered research groups of legislators who are driven by interest in and passion for suicide prevention among residents and the entire nation, aims to promote legislative initiatives for suicide prevention-related laws and institutional improvements, secure budgets, facilitate information sharing among relevant organizations, maintain organic networks and cooperative relationships, and provide various policy support for suicide prevention research and initiatives. By the end of the 20th National Assembly, the membership had increased to 39 members (Table 2) [32,33].
The launch of the National Assembly Suicide Prevention Forum signifies the complete formation of a suicide prevention network through mutual complementation and support, including efforts from civil society (the establishment of the Korea Association for Suicide Prevention) and the government (the enactment of the Suicide Prevention Act), along with the participation of the National Assembly in activities aimed at preventing suicide. This marks the emergence of a focal point for suicide prevention activities and initiatives, which were previously scattered, thus indicating the birth of a central hub for suicide prevention efforts.
ACHIEVEMENT OF HOSTING POLICY SEMINARS BY THE NATIONAL ASSEMBLY SUICIDE PREVENTION FORUM
The most important objectives of the parliamentary research group’s operation are the “enactment and revision of laws” and “securing budgets.” To support these goals, this group explores relevant social factors, gathers opinions from various sectors, and holds policy seminars to devise effective alternatives. The National Assembly Suicide Prevention Forum has held 23 policy seminars from its inception in 2018 through 2023 (Table 3) [34-57]. Since raising concerns about suicide statistics on July 23, 2018, there have been ongoing efforts to clarify the causes of suicide, raise issues related to organization and budget, and find specific solutions for workers, adolescents, and others. The seminar topics were distributed as follows: target 22%, policy 17%, cause 13%, budget 9%, organization 9%, and other 30% (Figure 1).
In particular, the forum has been benchmarking international efforts related to suicide prevention annually and organizing international seminars to grasp the latest trends.
The issues and bills uncovered through this process have led to legislative proposals, government requests, and inquiries that have achieving social outcomes for suicide prevention.
KEY PARTICIPATION OF THE KOREAN NEUROPSYCHIATRIC ASSOCIATION
The establishment of the National Assembly Suicide Prevention Forum spearheaded efforts for institutional improvement due to the active participation and advocacy of the Korean Neuropsychiatric Association (referred to hereafter as ‘KNPA’), which has been dedicated to suicide prevention since the 1990s.
Since the inaugural policy seminar of the forum titled “How Serious is Suicide? Are the Statistics Accurate?”, the KNPA has made proactive contributions toward suicide prevention by accounting for leadership roles in 11 out of 23 seminars as Chairs and 13 out of 23 seminars as presenters (Table 4).
As a ripple effect of the first seminar, which raised the issue of the immediacy of statistics, the Ministry of Health and Welfare began releasing provisional monthly statistics for suicide victims from 2020 onwards. Moreover, prompted by the issues raised by Jong-Woo Paik (Kyunghee University) during the second seminar regarding the shortcomings and recommendations for suicide prevention budgets, the budget increased significantly from 137 billion won in 2018 to 234 billion won in 2019, and it further increased to 489 billion won by 2023.
Participants from the KNPA also advocated for evidence-based suicide prevention policies targeting specific groups such as workers and adolescents, specifically by urging for their legislation. They also called for the need for support for local governments and communities, as well as the establishment of improvement measures in legislation and systems.
Further, along with domestic experts, international experts such as Martin Vandendyck, WHO Pacific Mental Health and Substance Abuse Coordinator (2023); Christine Morgan, Chair of the National Mental Health Commission in Australia (2020); Merete Nordentoft, Director of the National Centre for Suicide Research and Prevention of Mental Ill-Health in Denmark (2020); Dan Reidenberg, Executive Director of the Suicide Awareness Voices of Education in the United States (2020); Bruce Shahbaz, member of the Public Policy Committee of the Suicide Prevention Foundation in the United States (2019); and Jan Mainz, professor of Health Services Research at Aalborg University Hospital in Denmark (2018), have participated in international seminars. They have shared advanced insights gleaned from suicide prevention cases from developed countries and made efforts to enhance cooperation in suicide prevention and mental health between Korea and other countries. This has served as the basis for the revision of suicide prevention methods, which will be described in detail later.
REVISION AND LEGISLATIVE ACHIEVEMENTS OF SUICIDE PREVENTION LAWS IN THE FIRST TERM
In the National Assembly Suicide Prevention Forum, which was launched on February 27, 2018, 17 suicide prevention bill revisions were proposed in total, and among them, four bills were passed (Table 5) [58].
Choun-sook Jung, Dong-min Ki, and others submitted a revised bill stating that the President and Prime Minister should serve as control towers; as an alternative, the Suicide Prevention Policy Committee, with the Prime Minister as its chairman, was established. This underscores the importance of suicide prevention not being the responsibility of a single ministry but requiring the involvement of multiple ministries, and it emphasizes the importance of the government’s role in actively executing this.
It was also stipulated that the Suicide Prevention Basic Plan, which is compiled by the government every 5 years, should include guidelines for media reporting on suicide and measures to ensure compliance. Measures have also been introduced to facilitate the exchange of information between the police, fire department, and suicide prevention centers, to make it possible to request location information from information communication service providers for the rescue of suicide-risk individuals, and to facilitate the exchange of information between relevant agencies to ultimately obtain a more accurate understanding of suicide trends.
These advancements have made it possible to use information for initial response, crisis intervention, and preventive measures for suicide attempts, thus enabling the scientific prevention of suicide in advance through immediate response and data utilization.
Provisions prohibiting the distribution of suicide-inducing information have also been newly established, which has made it more difficult to access suicide-related information. Measures have been put in place to address potential suicide risk groups among bereaved families, including the introduction of services related to supporting bereaved families in suicide prevention centers.
STATUS OF REVISION AND LEGISLATIVE ACHIEVEMENTS OF SUICIDE PREVENTION LAWS IN THE SECOND TERM
The 2nd National Assembly Suicide Prevention Forum was launched on September 9, 2020, at the peak of the COVID-19 pandemic. Initially, 20 members of the National Assembly participated in the launch, but as of December 31, 2023, 59 members of the National Assembly had participated, actively engaging in suicide prevention activities.
In the second session of the forum, 14 suicide prevention bills were proposed, and three of these were passed (Table 6) [58].
First, amendments to the law allow suicide prevention centers and related agencies to obtain personal information of suicide attempters without their consent. This is significant, as it causes a change from the passive role of relying on consent from suicide attempters for post-management in suicide prevention centers and support agencies within the local community, to a proactive and preemptive role that involves taking measures targeted to high-risk groups without always receiving such consent.
Further, the legal foundation, which was previously lacking even after the establishment of the Korea Foundation for Suicide Prevention (January 6, 2021), has been formalized within the Suicide Prevention Act.
Of particular note here is the mandatory provision of suicide prevention education. Younsuk Choi and 10 others have mandated suicide prevention education not only for central government agencies and local governments under the Government Organization Act, senior welfare facilities under the Senior Welfare Act, social welfare corporations under the Social Welfare Business Act, and businesses with 30 or more employees, but also for schools under the Elementary and Secondary Education Act; reporting on this matter has been mandated as well. This law will come into effect on July 12, 2024. With this, suicide prevention education, which was previously taboo and rarely mentioned, is expected to come to be available to the majority of the population thanks to the efforts of the National Assembly, thereby contributing significantly to the promotion of a culture of respect for life.
CONCLUSION
Since the establishment of the National Assembly Suicide Prevention Forum, 31 amendments to suicide prevention laws have been proposed by participating members of the forum, resulting in seven revisions. The amendment and enforcement of these laws incur a budget, and the benefits return to our citizens under the name of striving to be a society safe from suicide. Efforts to protect the lives of our citizens in the National Assembly, representing the people, may be considered natural, but the establishment and activities of the forum, although they may be belated, are fortunate contributions to our society.
However, it may be regrettable that, for most of the duration of the second-term forum, substantial suicide prevention activities have rarely been pursued due to the government’s focus on responding to COVID-19, implementing social distancing measures, and isolation. This is in contrast to the growing societal interest and momentum surrounding suicide prevention.
In the upcoming 22nd National Assembly, the 3rd Suicide Prevention Forum will be reinstated. I would like to offer several suggestions regarding the future direction of the forum’s activities.
First, it is necessary to identify and review issues related not only to the Suicide Prevention Act but also to other legislations.
Moreover, legislation alone cannot prevent suicide. In particular, relying solely on the Suicide Prevention Act will not effectively reduce suicide rates in our country. The intended purpose of legislation should be to establish a social safety net to prevent the chain of events leading to suicide and to mitigate the negative cycle of suicides.
Therefore, in the next forum, it will be necessary to once again examine many laws related to suicide in our society as well as discover and revise legislation that can be effective in suicide prevention, ultimately establishing a more concrete societal system for suicide prevention. The second suggestion is to secure the budget and establish a stable suicide prevention fund. Before the forum was launched, the suicide prevention budget of the Ministry of Health and Welfare was 7.3 billion won in 2017, but it increased to 13.6 billion won the following year. Since then, it has continued to increase each year, specifically reaching 23.4 billion won in 2019, 29.1 billion won in 2020, 39.5 billion won in 2021, 45.1 billion won in 2022, and 48.9 billion won in 2023. Compared to 2017, the budget in 2023 increased by 6.7 times. While there have been various efforts made by the government, the forum has also played a significant role in deliberating upon and confirming the national budget. However, compared to Japan’s 830 billion won, which has overcome similar challenges, our budget is very low [59].
In the next forum, it will be necessary to establish and operate a “Suicide Prevention Fund” to ensure a more stable allocation of resources for suicide prevention.
The National Assembly Suicide Prevention Forum has played a crucial role in transforming the societal tragedy of “suicide,” which our society has previously tended to conceal, into a recognized problem that must be addressed. By offering a platform for discussion, it has unified suicide prevention efforts and campaigns, which previously lacked a focal point and often achieved limited success because of the scattered nature of relevant activities. The significance lies in the possibility of transnational suicide prevention activities involving participation from the private sector, public sector, and the parliament together, as such convergence has substantial benefits.
In the current reality of the “Republic of Suicide,” we must do whatever we can, even as we search for what to do for suicide prevention. In the 22nd Korean National Assembly, the role of the National Assembly Suicide Prevention Forum is expected to become increasingly prominent, ultimately leading to substantial achievements in suicide prevention.
Notes
Availability of Data and Material
Data sharing not applicable to this article as no datasets were generated or analyzed during the study.
Conflicts of Interest
Jong-Woo Paik, a contributing editor of the Psychiatry Investigation, was not involved in the editorial evaluation or decision to publish this article. All remaining authors have declared no conflicts of interest.
Author Contributions
Conceptualization: Jong-Woo Paik, Youn-Ho Lee. Data curation: Youn- Ho Lee. Formal analysis: Youn-Ho Lee. Investigation: Youn-Ho Lee. Methodology: Jong-Woo Paik. Project administration: Jong-Woo Paik, Youn-Ho Lee. Writing—original draft: Youn-Ho Lee, Hwa-Young Lee. Writing—review & editing: Jong-Woo Paik, Hwa-Young Lee.
Funding Statement
This research was supported by a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC19C0307), and the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HI22C147400).
Acknowledgements
We would like to express our deep gratitude to the members of the National Assembly, their aides, and secretaries who contributed to the National Assembly Suicide Prevention Forum, as well as to the various NGOs, including the Citizen’s Coalition for Safety, who took charge of its operation.