Suicide is the number one killer of people aged 15-34 in China, particularly young women in rural areas. The government has started to deal with the problem, but experts say the resources allotted fall far short of what is needed.
The trained nurses staffing China's first suicide hotline, in Beijing, take calls from about 70 distressed people a day, a tiny drop in the ocean of China's vast population.
The service is the only 24-hour national suicide hotline for 1.3 billion people and is one of the government's first, small steps in addressing an enormous problem.
China's suicide rates are not exceptionally high compared with many other countries, but several factors make suicide a big public health problem.
First, the sheer size of China's population means the numbers are startling: More than 250,000 people commit suicide each year and two million more make the attempt.
In addition, researchers say China is one of the few countries where more women kill themselves than men. Young, rural women are particularly at risk, and some observers say that may be because of their limited education, work and marriage options.
But Canadian psychiatrist Michael Phillips, the director of the Beijing Suicide Research and Prevention Center, disagrees. He says that while more women than men attempt suicide in many other countries, in China they succeed more often. "Because of the method they use, which is usually pesticides, and because of limited resuscitation abilities in rural areas, a lot more are dying," he says.
Outside the big cities, the problem begins with a lack of awareness about mental illnesses and its consequences.
One man, who lives in rural Hebei province, lost his wife to suicide five years ago. He explains that he did not know a lot about mental illness until his wife's death. When she committed suicide, he says she was severely depressed, which he did not understand until he went to a gathering for families who had been affected by suicide.
China has a severe shortage of mental health workers. The World Health Organization says mental illnesses account for 20 percent of China's health burden, but mental health services get only two percent of the national health budget.
While mental illness is a serious issue in China, Dr. Phillips cautions that it is not the cause of all suicides. "Everybody in the West assumes that if somebody attempts or commits suicide, they have a mental illness - it's almost a required condition. In China, the attitude is very different - if you talk to people in rural and urban areas, it's always conflicts and failure at school, negative social events," he says.
Sonya Pritzker is a researcher who studies the use of Chinese medicine to treat depression. She says depression is a normal reaction to pressures from rapid change in a developing country. "A kid today who didn't get into school and that was his dream. It's also quite a normal reaction when you've been fired from a factory that you've been working at for 20 years and have a family to support," she says.
A new documentary aired on national TV is often the first time that troubled people realize help can be found on the telephone.
The documentary advertises the number of the national suicide hotline. The staff says when the documentary airs, a flood of calls lights up the switchboard. Callers are directed to one of five suicide centers.
With scant resources, the centers offer counseling and support, but their administrators say there is much more to be done.
Still, the decision to start a national program to deal with suicide is a big step for a country that did not even publish suicide statistics until 1990.