Macabre trend that began in HK in 1998

In November 1998, a middle-aged woman in Hong Kong began a deadly trend when she sealed the door and windows of her bedroom, lit a small pile of barbecue charcoal and lay down to die.

Within two months of that lonely act - vividly covered in newspapers - charcoal burning had become the city's third-most common method of suicide.

Twelve years and thousands of deaths later, it is a truly global phenomenon. It is the leading method of suicide in Taiwan, and in 2007 the lead singer of American rock band Boston killed himself at home in New Hampshire by burning charcoal.

Since that first death, the University of Hong Kong's Centre for Suicide Research and Prevention has been monitoring the trend - and early on it identified an important factor: people who commit suicide by charcoal burning are different.

'Usually, the people who commit suicide are unemployed or elderly or have mental illnesses. These are the groups traditionally at higher risk,' the centre's director, Dr Paul Yip Siu-fai, explained.

'But with charcoal burning, people are middle-aged, they are less likely to be suffering from any mental illnesses, they are employed, and they have financial problems to a greater extent than those who die from other forms of suicide. These are people who don't find the idea of jumping or hanging appealing as a method of suicide.

'But charcoal burning is portrayed wrongly as a painless way to commit suicide - and so some people think they've identified a way to solve their problems.'

Identifying the people attracted to charcoal burning as a different type of victim led researchers to explore the theory that if access to charcoal were limited, they would not necessarily go on to commit suicide via other ways.

Their inspiration was action taken in Britain to restrict sales of paracetamol, banning its sale in large numbers in bottles and limiting it to plastic strip packets to counter a trend for what was seen in the country as an easy method of suicide - swallowing large quantities of pills.

'Three years after those measures were taken, the suicide rate in the UK is at a historic low, and one of the main reasons is the measures taken to restrict sales of paracetamol,' Yip said. 'Some people believe if people can't kill themselves by burning charcoal, they will jump off a bridge or find another way to end their lives. That isn't necessarily true. For suicidal people, only some methods are appealing. When they are removed, we have the opportunity to make a difference.'

Research conducted in Tuen Mun appears to confirm that theory - that if the route to an easy way out is restricted, a window of opportunity is opened that can save lives.

Dr Lanny Bergman, president of the American- and French-based International Association for Suicide Prevention, said the research 'demonstrated the effectiveness of efforts to make lethal methods less available and less accessible'.

He said: 'By thwarting access to such a method of suicide, time and change of mind or circumstances allow for lives to be saved and redirected.'

Professor Keith Hawton, an expert on suicide prevention based at Oxford University in Britain, said: 'One important approach [to suicide prevention] is reducing access to dangerous methods. The approach used by Paul Yip and colleagues to tackle the epidemic of suicide in Hong Kong involving charcoal burning represents an excellent example of such an initiative [which] appeared to be effective in saving lives.'

The greatest irony could be if other cities and territories act upon the research before Hong Kong, where the two main supermarket chains that helped with the project say they cannot restrict barbecue charcoal sales because of logistical challenges and inconvenience.

'At the moment, some people are committing suicide for the very reason that it is an easy way out and too convenient,' Yip said.

'In life, I believe, we sometimes have to live with a degree of inconvenience to make things better.'

Fatal attraction

Suicide by charcoal burning is now a truly global phenomenon

On Taiwan's list of most-used methods it is number: 1