Japan is well known for having one of the highest suicide rates in the developed world. It is less often noted that numbers have been falling dramatically in recent years, with a 38% plunge from their peak in 2003 to 21,321 cases last year.
Economic recovery from the post-bubble crisis does not alone explain the phenomenon. The government deserves credit for consistent steps to reduce suicide, especially as this is the week of World Suicide Prevention Day, established 15 years ago by the World Health Organization.
An even more powerful lever in cutting suicides may be a change in public perception. The Japanese concept of suicide has evolved from a somewhat romanticized act of taking ultimate control of your life after a failure or a loss of honor -- glamorized in samurai movies -- to a modern recognition of suicide as connected to social pressure and mental illness.
But much more still needs to be done, not least by employers. With workplace problems prominent among the causes of suicide, companies have a duty to act.
Japan's suicide tally remains far too high. The recent declines only put the country back to early 1990s levels, before Japan's prolonged economic stagnation hit hard. According to data by the Organization for Economic Cooperation and Development, Japan's suicide rate of 16.6 for every 100,000 persons ranks third among the Group of 20 states, behind only South Korea on 25.8 and Russia on 19.3. To put into perspective, Japan lost six times more people to suicide than to traffic accidents in 2017. Some 70% of the victims were men.
Of course, every suicide is unique. But, in roughly 10% of cases work is identified as a cause. Statistically, most of these people will have had depression, as, according to WHO, over 90% of those who attempt suicide suffer depression.
Tackling depression -- and so attacking a root cause of suicide -- comes down to three key things -- prevention, early detection and treatment. And in all three, employers can play a role.
Prevention comes first. Overwork is such a big problem in Japan that karoshi, death from overwork, has become an internationally recognized word. The Ministry of Health, Labor and Welfare publishes details of karoshi cases approved for payouts under the workers' compensation insurance scheme. While karoshi cases by brain or heart failure fluctuate at around 100 annually, suicides caused by work-related mental problems are gradually rising and totaled 84 in fiscal 2016 (the ministry's figure includes attempted suicides).
While the absolute number of karoshi suicides may be small, this particularly Japanese malaise highlights a widespread problem of people working notoriously long hours.
Perhaps the most painful recent case is that of Matsuri Takahashi, a 24- year-old employee at Dentsu, the media agency, who took her life in 2015 out of depression caused by overwork. This young death reignited the controversy over excessive work hours, which finally led to a package of work reforms, including a 100-hours-a-month cap on overtime. Takahashi for the month before her taking life reportedly recorded 105 hours' overtime.
While cutting working hours is an obvious step, employers can do more to fight employee depression. They can improve the work environment, for a start. Bullying and harassment by superiors rank highest among the causes of mental distress at work. Such behavior accounted for 40% of mental distress cases approved under workers' compensation insurance schemes in fiscal 2017, or about 200 cases out of total 500.
A lack of diversity -- the flip side of excessive uniformity -- is partly responsible: Japanese returning from working overseas often feel depressed after struggling to readjust. Diversity initiatives -- necessary for many reasons -- help keep depression at bay.
Early detection of depression also matters. The stigma associated in Japan with admitting to mental illness is fading thanks to public health campaigning. But it persists. A London School of Economics survey in 2016 reveals that Japanese, followed by Americans among eight countries studied, are least likely to tell their employers about depression. Particularly vulnerable are Japanese men not used to admitting to "weakness." Over 30% of Japanese suicide victims are males between 30 and 60, double their 16% share of the population. A pattern emerges where middle-aged men self-medicate with alcohol, which is easy to do in the Japanese after-work social scene, triggering alcoholism and masking the underlying depression.
Paradoxically, Japan has a relatively low percentage of patients diagnosed with depressive disorders -- 4.2%, lower than the U.S. at 5.9% or Germany at 5.2%, according to WHO. The high suicide rate suggests that many Japanese suffer in silence. Better early diagnosis would increase the number of those seeking treatment and save lives.
To promote early detection, the government has made regular stress tests mandatory since December 2015 at workplaces with more than 50 employees. While this is a step in right direction, generic tests may be too imprecise to capture individual problems. Again, companies can do more. Employees will feel more comfortable about seeking help if clear policies are in place guiding workers to consultations and protecting privacy.
Finally, there is treatment. Even with effective detection, the hurdles to proper treatment are many. The traditional Japanese virtue is to stand up to adversity. Unlike in U.S., therefore, accepting counseling as treatment is not common practice. Medical experts say that care is instead skewed toward over-medication with anti-depressants. Furthermore, once admitted into hospital for mental illness, patients are often kept in longer than elsewhere, exacerbating worries about missing work. The health services need urgently to address these concerns.
Companies can also help by better supporting workers diagnosed with depression. A good example is the assistance given by progressive employers for other illnesses. For instance, Itochu, a trading house, has recently announced a program to support cancer-surviving employees. A similar approach to mental illnesses could yield big gains for employers, especially at a time of labor shortages.
The government is doing much to tackle suicide, including in the workplace. But it cannot carry the burden alone. A recent government-led initiative to persuade workers to go home early on the last Friday of each month was largely ignored. Employers must take on such challenges.
Depression at work is not only a medical but also an economic problem. The LSE report estimates that depression costs Japan $14 billion in lost productivity annually through employees either reporting sick or turning up for work and not being productive.
But, far more important is the moral obligation to help the sufferers. WHO estimates that one in four people experiences mental illness, including one in five at work. It can happen to any of us. Fighting depression at work needs to be higher on the management agenda.
The author would like to thank Ms. Vickie Skorji, lifeline director from TELL Japan, for valuable insights. Details of this English-language hotline for people with depression are available at https://telljp.com/.
Nobuko Kobayashi is a partner with A.T. Kearney, a global management consulting firm. Based in Tokyo, she specializes in the consumer sector with a special focus on multinational corporations operating in Japan.