In 20 Years, Akita Prefecture Reduces Suicides by a Third! Empowering 1% of Population with Specialized Knowledge

Japan is said to have one of the highest suicide rates among developed countries.

How did Akita Prefecture, which once had the worst suicide rate in Japan for 19 consecutive years, reduce its suicide rate and escape from the worst situation? The following is a report on Akita Prefecture’s suicide prevention measures, now called the “ Akita Model,” based on the book “The Elderly Who Have No Relatives” (Kota Ishii, Ushio Publishing Co., Ltd.), which describes the loneliness of the elderly today.

In the 2000s, the number of suicides increased nationwide in Japan amid the recession caused by the bursting of the bubble economy. Akita Prefecture was no exception, and officials and lawmakers were wondering if they could somehow reduce the suicide rate.

However, government officials were not suicide experts and were completely lacking in manpower. At this time, the prefecture chose Hisao Sato, the founder of the non-profit organization “Spider’s Thread,” as its partner in suicide prevention, based on research conducted by Naofumi Yoshioka of Akita University, whom we saw in the <Part 1> section. The university offered its expertise, and with the prefecture’s backing, the private sector was to make use of it.

The Basic Law on Suicide Prevention enacted in 2006 provided a tailwind for the prefecture’s efforts. With the number of suicides in Japan surpassing 30,000, the national government decided to create a new law to comprehensively support awareness-raising activities, the development of a medical system, support for the private sector, and mental health care for bereaved families.

Three trends targeted by Akita Prefecture

 

Noriki Terada, the governor of Akita Prefecture at the time, took this law and stepped on the accelerator for suicide prevention in the prefecture in one fell swoop. At the urging of the Akita prefectural government, a seminar was held for top officials from each municipality, bringing together representatives of private organizations from the chiefs of municipalities and urging them to work together as one.

Thus was born the “Akita Model. The three arrows of the private sector, the university, and the local government were united and set in motion.

Specifically, Akita University analyzes the current status of each municipality through a regional diagnosis. Based on the data, the local government will launch preventive measures, such as “round-the-clock consultations,” “lectures,” “exchange events,” and “creating a sense of purpose in life. Finally, private organizations will implement specific activities with support from the government.

The following steps will be taken to achieve the following goals

1. Raise awareness of suicide prevention
2. Activation of residents’ activities

3, Phenomenon of suicides

At the same time, the prefecture and the university will raise awareness of suicide prevention throughout the medical industry. Until then, psychiatry had been the basic response to suicide. The idea of stove-piping was removed, and the entire medical community was made aware of the need for prevention and to work together in a cooperative system.

This series of moves took the form of the “Akita Prefectural Citizens’ Movement” based on the organization built by Mr. Sato. Under the banner of suicide prevention, this movement brings together 107 NPOs and other organizations, 25 municipalities, and several companies in the prefecture.

Soon after, the results of the Akita Model began to show. While the number of suicides in the prefecture peaked in 2003 at 519, it steadily decreased from 2007 onwards, reaching 177 in 2021. Over 20 years, this represented a reduction of one-third, and the suicide rate, which was once the worst in the country, dropped to 10th place.

An official from the Health and Welfare Department’s Health and Disease Control Division in the prefecture stated:

“The strength of the Akita Model lies not only in the prefecture’s support for private organizations but also in actively conducting training courses for individuals involved in suicide prevention measures. We aim to cultivate supporters who, while not specialists themselves, possess knowledge and can connect with specialists.”

In the Akita Model, experts in suicide prevention are referred to as “Mental Health Supporters,” while supporters are called “Gatekeepers.”

The training courses for Mental Health Supporters aim to provide individuals already engaged in suicide prevention activities with advanced specialized knowledge. Medical doctors and clinical psychologists are invited as instructors to teach about the process leading to suicide, methods of active listening to those seeking help, and promoting mental well-being.

In the Gatekeeper training courses, participants learn how to identify individuals contemplating suicide and how to connect them with Mental Health Supporters or medical professionals. Essentially, they serve as bridges to specialists.

Involving the younger generation

The aforementioned official stated:

“At the end of the fiscal year 2021, the number of participants in the Gatekeeper training course reached 7,921, and we are soon approaching nearly 10,000 Gatekeeper participants. Considering Akita Prefecture’s population of approximately 930,000, about 1% of the population possesses specialized knowledge in suicide prevention and is engaged in some form of activity. The prefecture’s suicide prevention efforts are fundamentally based on their presence.”

The prefecture aims to equip young students with specialized knowledge in the future, hoping they will take on roles as Mental Health Supporters or Gatekeepers. Suicide is the leading cause of death among individuals aged 10 to 30. With this in mind, involving younger generations could further reduce the suicide rate.

Furthermore, Akita University established the “Comprehensive Research Center for Suicide Prevention” in 2021. The center’s purpose is to conduct research and evaluation related to suicide prevention, as well as to advance awareness activities.

 

Currently, the center is focusing on the following four areas:

• Support for the elderly through SNS
• Mental health survey for workers
• Education for junior high and high school students on how to raise SOS
• Research and projects such as mental health supporter follow-up training sessions

Of particular interest is the first section, “Support for the Elderly Utilizing SNS. Here, tablet terminals are lent to elderly people with high suicide rates, and Akita University students are paid part-time to interact with them through SNS.

Suicide among the elderly is often caused by social isolation and increased health concerns. The idea is to help prevent suicide by having students connect with the elderly as if they were part-timers, and provide them with a reason to live and a place to look after themselves.

The deputy director of the center said the following in an interview for my book.

“Even if the prefecture or private organizations try to tackle suicide prevention on their own, the hurdles are high. It’s a job that deals with people’s lives, so there’s always the looming anxiety about what to do if we fail or if we’re doing something wrong. But when universities join in, it brings a sense of reassurance with experts backing us up. We gain confidence knowing that we’re learning specialized knowledge and putting it into practice, making various tasks easier to handle. The significance of having ‘learning’ in the tripartite collaboration of government, academia, and industry lies precisely there.”

For more details of the Akita Model, please read “Mukonenrei” (The Unrelated Old Man).

At any rate, the Akita Model is an effort to foster opportunities and the ability for people to connect with each other throughout society. Similar efforts can be made in one city or one region, not in the whole prefecture. And it would not be a dream to significantly reduce the number of suicides by doing so.