Workshop on Railway Suicide Prevention and Reduction of Impact

 Vancouver, October 11th, 2013, a satellite activity of the International Railway Safety Conference

 

Objectives of the workshop

  • Learn about the incidence and characteristics of railway suicides and other fatalities in Canada and around the world
  • Examine best practice models for railway suicide prevention and how they may be implemented
  • Understand the impact of fatalities and critical incidents on railway workers
  • Develop best practice models for prevention and intervention for workers involved in fatalities and other critical incidents
  • Share knowledge and experiences on railway suicide prevention and help for workers
  • Discuss consensus recommendations for standards and practices

 

Structure of the workshop

Formal presentations preceeded group discussions based on specific questions aimed at providing recommendations on suicide prevention and support practices.

Overall, there were 43 participants in this all day workshop, including representatives from the major Canadian railways, Transport Canada, the Railway Union, as well transportation police, Transport Canada and other regulators, and representatives from several railways and researchers in other countries.

Preventing railway suicides

The first session of the workshop addressed issues related to the prevention of railway suicides. It was introduced by a presentation by Brian Mishara, summarizing the content of the relevant sections of the website.

Technical solutions to help reduce railway suicides

Fencing remains the most effective form of protection; however, it may not always be the most cost-effective. Multiple layers of fencing techniques were identified as potential solution, using the concept of “fencing depth” within the 3 to 5 meters of corridor along the tracks, including vegetation, walls, wires, etc. Fences should be high and made of resistant materials, impossible to cut.

Identification of the presence of a potential suicide attempter along the tracks was also identified as a potentially effective solution. Movement or heat detectors could trigger lights, with two way speakers to alarm and engage the trespassers. These detection devices can be implemented on tracks and on platforms.

Cameras seem to be a useful means to verify the situation and identify suicidal people when there is a trespassing alarm.

For suicides in stations, an emergency stop system could be activated from the station by the station manager after a suicidal person has been noticed on a platform. Another interesting strategy in stations would be to test the effectiveness of blue lighting at the end of platforms.

-          In Canada, most suicides do not take place in stations, except in Subways and some commuter trains that are only accessible by platforms (such as the Vancouver SkyTrain).

Train modifications have been discussed for safety improvement, along the same lines as road vehicle improvements: Airbags that push people to the outside of the track and soft bumpers on slower trains may be useful, as well as body kits along the wheels to prevent someone from rolling under the train from the side, lower cow-catchers to reduce the risk of rolling under the front of the train after impact.

Psychosocial solutions to help reduce railway suicides

Posters were suggested as probably the most feasible strategy along the tracks and in stations. Posters could advertise the presence of emergency phones in stations. Posters could also be placed at crossings and along sensitive areas. Emergency phones installed in sensitive areas and crossings would be better, although increased financial costs may lower their cost effectiveness.

Another strategy is to develop better collaboration between local police departments and train crews to report all trespassing activities so that the police may act upon these reports to intercept people wandering on tracks. Trespassers could then be screened for suicidal ideation.

Railway staff could be trained to identify at risk people in stations and on platforms. Training should also be associated with video monitoring, in order to avoid unnecessary alerts.

However, the above strategies are limited to deterring people once they reached the tracks.

Railway suicide prevention should be addressed in the community as part of suicide prevention strategies. Campaigns should help increase community awareness and involve all local partners within concerted strategies. Railway suicide attempters could be identified before they get to the tracks by increased education of mental health workers about suicide risk assessment and the danger associated with railway tracks. There should be more intense and efficient safety plans for suicidal people in the community and a greater involvement of helplines in railway suicide prevention strategies, under government leadership.

Social media could be a useful medium to increase awareness of the issues associated with railway suicides in communities.

Overall, it was agreed that to reduce railway suicide, we need to reduce the overall number of suicides in Canada. Therefore, railway companies and stakeholders could and should be involved in existing suicide prevention strategies across the country.

At the present time in Canada, the Media are not reporting railway suicides in a way that could increase the risk of contagion. It is important to maintain these good practices through continuous education and surveillance by railway stakeholders.

Education should play a bigger role in railway suicide prevention strategies. There should be more education in the railway community and more awareness campaigns in the community about suicide. We should work on reducing the stigma associated with suicide in the community.

Many railway stakeholders are not aware of existing resources in suicide prevention that they can use. It is therefore important to make these resources available and to encourage contacts between the railways and the suicide prevention networks.

Challenges to railway suicide prevention

Psychosocial strategies may be difficult to promote with the industry, since their benefits may not be easily quantified in terms that are familiar to railway stakeholders. Better collaboration is also required between industry and community partners.

Overall, the major challenges for railway suicide prevention are:

  • Costs:  Strategies, whether they are technical or psychosocial, cost a lot of money. The industry may not be prepared to invest before it has solid proof that it will save money by doing so.
  • Cost effectiveness analysis should be conducted to assess the benefits of suicide prevention strategies versus current practices.
  • Raising concerns for health issues throughout the railway network, especially regarding community health is a challenge.
  • The cost of wrong identification of suicidal people has to be considered in the development of strategies. False positives (an emergency intervention triggered by the identification of people thought to be suicidal and who were not) may be costly and discourage the implementation of a suicide prevention protocol.
  • The issue of railway suicide prevention is competing for the attention of stakeholders against a variety of other matters. Therefore, a strategy should be developed to influence decision makers.
  • A champion to raise emotional responses in the network and community needs to be identified.
  • A leader in the management of the issue who will carry out the project is needed. The coordination of the railway suicide prevention issue should be undertaken by a public organisation.
  • Railway suicides are scattered throughout long distances of tracks in Canada.  Therefore, monitoring would have to occur across long distances and may be too costly.
  • Continuity:  One of the biggest challenges may be the continuity of efforts and resources in suicide prevention by the railway network. These problems cannot be solved by a one shot intervention and sustained efforts have to be made. Therefore, the priority has to remain high over time.

Mobilisation to work on the prevention of railway suicides

Railway suicide prevention should be a political agenda. Government support is necessary to lead the efforts of stakeholders because suicide prevention is a national and not a railway -centered issue. The leadership should be shared equally between the federal government, the Transportation Safety Board (TSB) and Transport Canada (TC). Railway companies should be involved but not be leaders in solving the issue.

An interest group should build a business case to be presented to politicians. Since interventions costs money, building a business case should prove that it is cost-effective. A business case should include a cost-benefit analysis (balancing the cost of interventions with the cost of suicides on the railway and the cost of loss of life).  As an example, we can use the statistical life value as an indicator. In Canada, the cost of a death by suicide varies according to the studies, but ranges from $3,500,000 to $6,000,000.

Evaluation of practices is a key issue in developing cost-effective suicide prevention strategies.

Railway suicide prevention should involve the following partners:

  • Manufacturers and their R&D departments, who should work with researchers to develop new cab and train designs
  • Regulators and the Railways Association of Canada (RAC)
  • The federal government with Transport Canada, the mental health commission, TSB, Health Canada
  • Railways
  • Local communities where railway suicides are more common
  • Insurance company who spend large amounts of money on claims after suicides occur
  • Social services
  • Safety organisations
  • Operation Life Saver: Is suicide prevention part of their mandate?
  • Police organisations in local communities
  • Helplines

Some concrete steps have to be taken to move the agenda of railway suicide prevention forward:

  • Start the dialogue with industry partners
  • Open discussions in international forums (railway, safety, etc)
  • Bringing attention to the issue of railway suicide in management teams
  • Involve communities, industry and regulators together
  • Identify risks in the community
  • Use Bill C300 (Federal law for suicide prevention)
  • Establish a shared leadership among government agencies
  • Monitor and continually map suicides and suicide attempts on the rail network to identify potential hotspots in order to plan and implement local interventions, if needed.

 

Reducing the negative consequences of critical incidents

The second session of the workshop addressed issues related to strategies to reduce the impacts of critical incidents on the railway network

Important strategies to implement

The following question should be discussed throughout the industry, in partnership with the unions:  Should railways develop recruitment strategies to only hire people they think will not be affected by critical incidents or should railway invest more in support programmes to help employees?  Several approaches are being tried across the world and the railway industry can learn from what is being done in terms of recruitment and support in emergency services organisations.

Providing immediate help and care should be a priority for employers after a critical incident. An offer for help should also be made to witnesses of incidents (passengers and bystanders).

Peer programmes and training of employees to care for themselves and others should be encouraged.

Desensitisation training was mentioned as a potentially useful strategy to educate workers to face critical incidents

-          However, there were questions on the potential negative side effects of such strategies

Education and training should be a key component of any support programme for employees and managers.

All railway stakeholders should have a protocol for traumatic events.

Returning to work should occur only when the employee feels ready and it should be discussed and supervised by an outside evaluator to avoid all possible pressure.

Three days off work is becoming a common practice after a critical incident. However, it may not be enough for everyone and some people do not take more time off for fear of appearing inadequate if they need more time. Also, during these 3 days off work, the  employee’s condition and needs should be evaluated and an intervention plan should be made with professionals that can continue after the employee has returned to work.

After a critical incident, employees need the support of their employer and personal support network.

Police departments are often the first on the scene after a critical incident. They need to be more involved in supporting crew members; they should behave with them as they do with victims and be trained to use incident report forms developed by the industry.

A third party should be involved at various steps to provide support and evaluate return to work; someone neutral should drive the crew back home, an outside professional should assess the ability to return to work and provide additional therapeutic help if needed.

Problems, obstacles and potential solutions

Here again, financial resources are a problem.  However, a comprehensive cost-benefice analysis should show the financial benefits of support programmes.

Vonsistency in the delivery of support programmes across a large company such as a railway carrier is a challenge, as is consistency in medical practices. Mandatory programmes and monitoring of implementation would increase consistency (enforcement).

In many cases, claims to Workers Compensation Boards are challenged by the employer, which creates tensions and distrust, and may damage work relations on the long term.

It is important that research teams and railway stakeholders share their practices and knowledge on support programmes. However, copyrights may be an issue and this should be addressed. Raising trauma and critical incidents issues in international conferences is a promising strategy. The issue should also be included more systematically in the agenda of international, national and internal meetings.

There is a major problem throughout the railway industry in their culture and attitudes towards critical incidents, incident management, help seeking and support. Education and emphasizing positive experiences are necessary to help these cultures and attitude evolve.

Front line managers play a key role in the mitigation of post-incident negative consequences. They need support and proper training to be able to properly support their employees and manage incidents in ways that will reduce negative consequences.

The level of trust between employees, managers and the union needs to be reinforced to help the implementation and use of support programmes.

There is a need to standardise and regulate support and care practices throughout the industry to improve consistency and reduce challenges in accessing and using support. The development of standards can take inspiration from other industries (emergency services, army, airplane pilots, etc).

The issue of confidentiality is important. When help is provided via the employer and EAP, employees do not always trust that their privacy is going to be respected and therefore do not use the help.

Mobilisation to work on the reduction of negative consequences of railway critical incidents

Mobilisation can only be maintained through continuous education of staff and managers on mental health issues (education about  suicide and the impact of critical incidents).

It is important to start recognising crew members as victims of critical incidents, in order to implement consistent minimal standards of care.

It is important that companies develop and engage in providing comprehensive, consistent and harmonised support programmes.

Evaluation of the long term effectiveness of practices and the identification of good practices to reduce the negative consequences of critical events is a key to convincing employers and employees that it is worth investing in and using support programmes.

Encouragements are not seen as sufficient to mobilise stakeholders to develop more consistent support practices. It is recommended that improvement and standardisation of practices should be “forced” through regulations, union negotiations and employment contracts.

 

Follow-ups and further steps

It is important to mobilise stakeholders on the issue of railway suicide prevention and reduction of negative consequences. A comprehensive cost effectiveness analysis is a powerful tool to reach this goal.

Pressure is another useful tool. However, it remains to be determined the type and amount of pressure to be exerted (and that there exists the means to exert) as well as the ones who should lead this pressure.

A grassroots approach can be considered, as it has proved effective with other public health issues.

A good strategy would probably be to invite the railway industry to join in a discussion and work group led by suicide prevention specialists, rather than expecting them to start something new by themselves.

 

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