Japan's struggle with suicide has been well documented even as deaths due to suicide had been declining for 11 straight years until Covid-19 hit.
From the "suicide forest" of Aokigahara - one of the world's most-used suicide sites - to Takahiro Shiraishi, the rapist and serial killer who used Twitter to lure suicidal women to his home, the spectre of suicide looms large over Japan and its perception abroad.
Behind every suicide and suicide attempt is an individual tragedy exacerbated by isolation and lack of a social support network.
Suicide has been consistently ranked among the top 10 causes of death in Japan for the past decade.
Amid the pandemic last year, suicide fatalities in Japan rose by 3.7 per cent to 20,919, with a worrisome spike among women and youth. Comparatively, Japan had 3,492 deaths from Covid-19 last year.
The rise in suicides comes despite Japan recording fewer deaths overall last year than in 2019, with the figure decreasing by 0.7 per cent, the first such fall in 11 years, Health Ministry data showed on Monday.
The number of suicide deaths last year is well under the all-time high of 34,427 in 2003. But last year marks the first year-on-year rise since the 2009 financial crisis.
This prompted Prime Minister Yoshihide Suga to create a new Cabinet post to address mental health issues.
Mr Tetsushi Sakamoto, 70, who is concurrently regional revitalisation minister and minister-in-charge of reversing Japan's falling birthrate, takes on the position of "Minister of Loneliness".
He heads a new office on suicide countermeasures, with about 30 officials. It began work last Friday.
Mr Suga instructed Mr Sakamoto: "Women are suffering from isolation more (than men), and the number of suicides is on a rising trend. I hope you will identify problems and promote policy measures comprehensively."
Helplines in S'pore
Samaritans of Singapore: 1800-221-4444
Singapore Association for Mental Health: 1800-283-7019
Institute of Mental Health's Mobile Crisis Service: 6389-2222
Silver Ribbon: 6386-1928
Tinkle Friend: 1800-274-4788
Aware Women's Helpline: 1800-777-5555
PAVE Integrated Services for Individual and Family Protection Specialist Centre: 6555-0390
National Care hotline: 1800-202-6868
Care Corner Counselling Centre (Mandarin): 1800-353-5800
Japan follows in the footsteps of Britain which, in 2018, appointed a minister-in-charge of loneliness.
Mr Sakamoto wrote on his personal webpage: "It seems that Britain's isolation problem lies with its elderly. But in Japan, the problem is lurking across age groups - including children, young people, women and older people - a problem that has manifested with the prolonged Covid-19 crisis."
Japan has grappled with isolation issues described by words such as hikikomori (acute reclusiveness, typically of people who are unemployed and shun social interaction) and kodokushi (dying alone, a growing problem with a rise in single households).
This has been compounded by Covid-19. Waseda University socio-logist Michiko Ueda, who studies suicide, said women and youth are at higher risk of feeling psychologically cornered. She noted that women are more likely to be contract workers whose jobs are at greater risk of being cut and are more likely to work in service industries hard hit by the pandemic.
Youth may feel isolated from being unable to attend school in person, she said, citing a study by the National Centre for Child Health and Development that showed 72 per cent of students reporting stress and 28 per cent depression from school closures.
Japan was rocked by a series of celebrity suicides last year, including those of reality TV star Hana Kimura, 22, actor Haruma Miura, 30, and actress Yuko Takeuchi, 40.
Prof Ueda is concerned that these deaths could have inspired copycat suicides. Female suicides soared 90 per cent in October from the same month in 2019 after the abrupt death of Takeuchi, an award-winning actress, on Sept 27.
There were 1,646 suicides last month, when Japan enacted a state of emergency as it battles a third wave of Covid-19 cases. This may be a fall from 1,694 in December, but Prof Ueda said the situation remains severe and called for proactive approaches that target vulnerable groups, beyond conventional strategies such as helplines.