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Behaviours preceding suicides at railway and underground locations: a multimethodological qualitative approach

To access full article: https://bmjopen.bmj.com/content/bmjopen/8/4/e021076.full.pdf

ABSTRACT

Objectives

Suicides by train have devastating consequences for families, the rail industry, staff dealing with the aftermath of such incidents and potential witnesses. To reduce suicides and suicide attempts by rail, it is important to learn how safe interventions can be made. However, very little is known about how to identify someone who may be about to make a suicide attempt at a railway location (including underground/subways). The current research employed a novel way of understanding what behaviours might immediately precede a suicide or suicide attempt at these locations.

Design and methods

A qualitative thematic approach was used for three parallel studies. Data were gathered from several sources, including interviews with individuals who survived a rail suicide attempt (n=9), CCTV footage of individuals who died by rail suicide (n=16) and qualitative survey data providing views from rail staff (n=79).

Results

Our research suggests that there are several behaviours that people may carry out before a suicide or suicide attempt at a rail location, including station hopping and platform switching, limiting contact with others, positioning themselves at the end of the track where the train/tube approaches, allowing trains to pass by and carrying out repetitive behaviours.

Conclusions

There are several behaviours that may be identifiable in the moments leading up to a suicide or suicide attempt on the railways which may present opportunities for intervention. These findings have implications for several stakeholders, including rail providers, transport police and other organisations focused on suicide prevention.

Reference: Mackenzie J, Borrill J, Hawkins E, et al. (2018). Behaviours preceding suicides at railway and underground locations: a multimethodological qualitative approach. BMJ Open, 8: e021076. doi: 10.1136/bmjopen-2017-021076

Suicide patterns on the London Underground railway system, 2000-2010

To access full article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623887/

ABSTRACT: 

Aims and Method Suicidal acts on underground railway networks are an area of public health concern. Our aim was to review recent epidemiological patterns of suicidal acts on the London Underground to inform future preventive interventions. Data from 2000 to 2010 were obtained from the British Transport Police via a Freedom of Information request.

Results The mean annual rate of suicidal acts from 2000 to 2010 was 5.8 per 100 million passenger journey stages. Of those who died by suicide, 77.3% were of White Northern European ethnicity. A fifth had a history of mental illness.

Clinical implications The widening gap between the number of recorded suicide attempts and completed suicides is encouraging. Further research is required regarding the role of drug and alcohol use, psychiatric history and area of residence. Installation of platform screen doors should be considered in future railway network expansion.

Reference: Martin, S., & Rawala, M. (2017). Suicide patterns on the London Underground railway system, 2000-2010. BJPsych bulletin41(5), 275-280.

Lessons learned from the collaborative European project RESTRAIL: REduction of suicides and trespasses on RAILway property

To read full article: https://link.springer.com/article/10.1007/s12544-016-0203-y

Abstract:
Background
RESTRAIL was a three year EU FP7 research project which aimed to help reduce the occurrence of suicides and trespasses on railway property and the costly service disruption caused by these events. The project was coordinated by the International Union of Railways (UIC) and provided the rail industry and researchers worldwide with an analysis of the most cost-effective prevention and mitigation measures. The goal of this paper is to inform the railway and scientific community about the successful completion of the project and to present an overview of the main results and key innovations.

Method
The project covered five relevant issues which significantly contributed to improve the prevention of railway suicide and trespass, and to mitigate their consequences: (1) collection and analysis of data related to railway suicides and trespassing accidents and information about preventative strategies; (2) assessment of preventive measures to reduce railway suicide and trespass; (3) assessment of measures to mitigate the consequences; (4) pilot tests to evaluate some promising measures on the field; and (5) practical recommendations and guidelines.

Results
The main project outcomes included: an integrated data analysis on railway suicide and trespass, a list of 25 recommended measures, 11 field tests which provided new pieces of evidence for the effectiveness of different measures, and a free online toolbox for decision-makers.

Discussion
These achievements are discussed in relation to the ongoing need of practical and exploitable results from EU-funded research projects, since the scientific and applied outcomes of RESTRAIL are an example of good practice for the benefit of the entire railway community and society.

Keywords
Safety Security Rail suicide Trespass Incident prevention Consequence mitigation

Reference: Havârneanu, G.M., Bonneau, MH. & Colliard, J. (2016) Lessons learned from the collaborative European project RESTRAIL: REduction of suicides and trespasses on RAILway property. Eur. Transp. Res. Rev. 8: 16. https://link.springer.com/article/10.1007/s12544-016-0203-y

The effectiveness of platform screen doors for the prevention of subway suicides in South Korea

Full article: https://www.sciencedirect.com/science/article/pii/S0165032715310971?via%3Dihub

 

Abstract

BACKGROUND:
Subway suicide can significantly impact the general public. Platform Screen Doors (PSDs) are considered to be an effective strategy to prevent suicides at subway stations, but the evidence on their effectiveness is limited.

METHODS:
We assessed the effectiveness of installing half- and full-height platform screen doors in reducing subway suicides using Poisson regression analysis. Ten-year monthly panel data for 121 subway stations between 2003 and 2012 in the Seoul metropolitan area were used for the analysis.

RESULTS:
We found that installing PSDs decreases fatal suicide cases by 89% (95% CI: 57-97%). We also found that the installation of full-height PSDs resulted in the elimination of subway suicides by completely blocking access to the track area; however, half-height PSDs, which do not extend to the ceiling of the platform, were not as effective as full-height ones.

LIMITATION:
Our findings were based on the data from a single subway operator for a limited period of time. Accordingly, we did not consider the possibility that some passengers choose to die at a station run by other operators. Our study did not examine the potential substitution effects of other suicide methods.

CONCLUSION:
Installing physical barriers at subway stations can be an effective strategy to reduce the number of subway suicides; however, half-height PSDs are not as effective as full-height ones, even when they are as high as the height of an adult. Thus, these barriers should be made high enough so that nobody can climb over them.

KEYWORDS:

Metro suicide; Platform screen door; South Korea; Subway; Suicide; Suicide prevention

Reference: Chung, YW, Kang, SJ, Matsubayashi, T, Sawada, Y, Ueda, M. (2016). "The effectiveness of platform screen doors for the prevention of subway suicides in South Korea". J Affect Disord. 194:80-3. doi: 10.1016/j.jad.2016.01.026

New article: Suicide on the Railways in Belgium: A Typology of Locations and Potential for Prevention

Abstract:

Suicide on railway networks comprises a serious public health problem. However, the geographical distribution and the environmental risk factors remain unclear. This study analyzed the geographic distribution of railway suicides in Belgium from 2008–2013 at the level of a railway section (average length of 3.5 km). Principal component analysis (PCA) identified three groups of correlations that helped explain the variance of railway suicide. The three groups are related to characteristics of urban spaces, psychiatric facilities, and railway traffic density. Based on the PCA results, the study found four types of railway sections. The density of railway suicide was average and low in the urban and rural/industrial sections, respectively. However, it was high in the suburban sections and the sections close to psychiatric facilities. As the geographical proximity of a psychiatric facility comprises a specific risk factor for suicide on railways, preventative measures should target these sections and establish collaborations with psychiatric facilities. The typology of locations found in this study constitutes crucial information for national and local suicide prevention on the Belgian railway network.

Reference: Strale, M., Krysinska, K., Van Overmeiren, G. &l Andriessen, K. (2018). Suicide on the Railways in Belgium: A Typology of Locations and Potential for Prevention. Int. J. Environ. Res. Public Health, 15(10), 2074.

To see full article: https://doi.org/10.3390/ijerph15102074

New report: Characteristics of trespassing incidents in the US

To read the full report: https://www.fra.dot.gov/eLib/details/L19581

Stephanie G. Chase, Danielle Hiltunen, Scott H. Gabree (2018). Characteristics of trespassing incidents in the United States (2012-2014). Report number DOT/FRA/ORD-18/24, Federal Railroad Administration, US Department of Transportation, Washington, DC, July 2018.

KEYWORDS: Suicide, trespass, railroad, countermeasure, fatalities, grade crossing
ABSTRACT: : Trespassing is the leading cause of rail-related fatalities in the United States. A large proportion of these trespasser fatalities are from intentional acts (i.e., suicides). The John A. Volpe National Transportation Systems Center (Volpe Center) has been tasked by the Federal Railroad Administration (FRA) to examine trespasser and suicide incident data on railroad rights-of-way to provide a better understanding of the contributory factors involved in these incidents and provide recommendations of potential mitigation strategies. This document provides a baseline measure of FRA trespassing and suicide incident data from 2012 through 2014. Findings illustrate a number of environmental and individual factors that are associated with each incident, such as location (region, state, and right-of-way vs. grade crossing), time (season, month, day of the week, time of day), and characteristics of the individual (age, gender, physical act that immediately preceded the incident). Each of these factors is analyzed in the hope that they may give predictive value in the future and a better understanding of the best ways to mitigate trespasser incidents on rail. 

Reporting of suicide and trespass incidents by online media in the US

To read full report: https://rosap.ntl.bts.gov/view/dot/12424

Scott H. Gabree, Ph.D. and Bianka Mejia. (2017). The Reporting of Suicide and Trespass Incidents by Online Media in the United States. Final Report. U.S. Department of Transportation, Federal Railroad Administration. Available online: https://rosap.ntl.bts.gov/view/dot/12424

Abstract: The reporting of a suicide death in the media has the potential to increase imitative suicide attempts for vulnerable individuals who read the article, a phenomenon known as suicide contagion or the “Werther effect.” Organizations around the world have developed recommendations forhow to responsibly report on suicide incidents in a wayless likely to result in contagion. For this research, 1,173 articles on FRA-reported suicide and trespass incidents were collected and analyzed for content.While media outlets often followed many of the suicide reporting recommendations, none were consistently followed in every article analyzedand a few key recommendations were often never applied. For example, the term “suicide” wasoften included in the title of articles, details about the location where the suicide took place andthe actions preceding impact were often provided, while help-seeking information was only rarely included. In general, railway suicide incidents tended tobe reported in a similar way to trespass incidents, rather than as a suicide by another means. The development of railway-specificrecommendations couldhelp to encourage responsiblereporting practices regardingrailway trespass and suicide incidents.

Evaluation of a novel approach to preventing railway suicides: the community stations project

To read the full article, click here.

Purpose: The purpose of this paper is to describe an evaluation of the Community Stations Project. The Community Stations Project was designed to address railway suicides in two ways: by improving the station environment in a manner that might improve community members’ feelings of wellbeing; and raising community members’ awareness of poor mental health and likelihood of reaching out to at-risk individuals. It involved four types of interventions (arts and culture, music, food and coffee, and “special events”) delivered at four stations in Victoria. Design/methodology/approach: A short anonymous survey was administered to community members on iPads at the four participating railway stations during the implementation of the interventions (between October and December 2016). The survey included questions about respondents’ demographics, their awareness of the intervention(s), their views of the station, their attitudes towards people with poor mental health and their emotional wellbeing. Findings: A total of 1,309 people took part in the survey. Of these, 48 per cent of community members surveyed reporting noticing an intervention at their station. Noticing the events was associated with positive views of the station, improved understanding of poor mental health, and a greater likelihood of reaching out to someone who might be at risk of poor mental health. Awareness of intervention events was not associated with respondents’ own emotional wellbeing. Practical implications: Continuing to focus efforts on mental health awareness activities may further strengthen the impact of the Community Stations Project interventions and ultimately prevent suicides at railway stations. Originality/value: This paper evaluates a novel approach to improving wellbeing and understanding of poor mental health in the train station environment.

Reference: Ross, A., Reavley, N., Too, L. S., Pirkis, J. (2018) Evaluation of a novel approach to preventing railway suicides: the community stations project. Journal of Public Mental Health, 17(2), 51-60.

Available online at: https://www.emeraldinsight.com/doi/abs/10.1108/JPMH-06-2017-0022

Small Talk Saves Lives : a novel partnership to reduce suicide on the railway

The UK rail industry is working in partnership with Samaritans and the British Transport Police on the Small Talk Saves Lives bystander campaign, launched in November 2017. The first campaign of its type on the railway, it encourages the general public to support those who may be in emotional crisis around them on the railway network.

The campaign aims to give commuters the confidence to trust their own instincts and intervene if they see someone vulnerable who may be at risk of suicide on or around the rail network, and to talk to them to interrupt their suicidal thoughts. It proposes four "lifesaving questions" that passengers can ask someone who displays warning signs of suicide. 

To learn more about this initiative, visit https://www.networkrail.co.uk/communities/safety-in-the-community/safety-campaigns/suicide-prevention/

New article: Developing a framework of behaviours before suicides at railway locations

To read the full article: https://www.tandfonline.com/doi/abs/10.1080/00140139.2017.1401124

Abstract: Better knowledge of behaviours of people at railway property could help with identifying those at risk of suicide. Literature has been reviewed from a range of disciplines on what is known about studying behaviour in this type of public location. Secondary analysis has been carried out on descriptions of behaviour from structured exercises with experts and other pre-existing sources. A framework has been produced with five main classes (display of emotion, appearance, posture/movements, activities and interactions) and associated sub-classes. Commentary has been provided on factors that influence identification of suspicious behaviours, how to distinguish these from normal behaviours and the circumstances that inhibit timely reactions to the behaviour amidst the complexity of the operational railway. Opportunities to develop and use the framework are discussed, including using this to prompt collection of additional behavioural data from wider resources, enhancing staff training and developing requirements for effective use of surveillance technologies.

Practitioner Summary: Many railway suicides could be prevented with better understanding of behaviours before events. Pre-existing data sources have been analysed, producing a framework highlighting five aspects of behaviour. This can prompt the collection of better evidence on pre-suicidal behaviours, with future applications in developing surveillance technologies, training staff and public awareness.

Keywords: Suicidal behaviour, railway, reporting, observation, surveillance technologies

Reference: Ryan, B. (2018). Developing a framework of behaviours before suicides at railway locations. Ergonomics, 61(5), 605-626. DOI: 10.1080/00140139.2017.1401124

Suicides on the Austrian railway network: hotspot analysis and effect of proximity to psychiatric institutions

To read the full article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5383816/

Abstract: Railway suicide is a significant public health problem. In addition to the loss of lives, these suicides occur in public space, causing traumatization among train drivers and passengers, and significant public transport delays. Prevention efforts depend upon accurate knowledge of clustering phenomena across the railway network, and spatial risk factors. Factors such as proximity to psychiatric institutions have been discussed to impact on railway suicides, but analytic evaluations are scarce and limited. We identify 15 hotspots on the Austrian railway system while taking case location uncertainties into account. These hotspots represent 0.9% of the total track length (5916 km/3676 miles) that account for up to 17% of all railway suicides (N=1130). We model suicide locations on the network using a smoothed inhomogeneous Poisson process and validate it using randomization tests. We find that the density of psychiatric beds is a significant predictor of railway suicide. Further predictors are population density, multitrack structure and—less consistently—spatial socio-economic factors including total suicide rates. We evaluate the model for the identified hotspots and show that the actual influence of these variables differs across individual hotspots. This analysis provides important information for suicide prevention research and practice. We recommend structural separation of railway tracks from nearby psychiatric institutions to prevent railway suicide.

Keywords: railway, suicide, prevention, cluster, hotspot, spatial point pattern, Austria

Reference: Strauss, M. J., Klimek, P., Sonneck, G., & Niederkrotenthaler, T. (2017). Suicides on the Austrian railway network: hotspot analysis and effect of proximity to psychiatric institutions. R Soc Open Sci, 4(3), 160711.