Overview of railway suicide prevention
This section describes preventive measures that may help reduce the risk for railway suicides. These measures have been described in the published literature or in unpublished reports. Some have been evaluated, others have only been described but not yet implemented or have been tried but never evaluated scientifically. Besides differences in the availability of scientific data proving their effectiveness, some measures may be more or less feasible in different countries and railway contexts. Prevention measures have been classified according to two dimensions which may be of use in choosing what is more appropriate in specific situations:
- Technical – Psychosocial dimension:
This dimension describes the nature of the interventions in terms of their level of involvement of technology versus human resources. Interventions can be mostly technical, involving primarily equipment and the use of technological solutions. Interventions can also be primarily psychosocial, based on principles of psychological interventions that consider suicide attempts from a socio-behavioural perspective.
- Purpose dimension:
We have divided potential objectives of the measures into three categories:
- Preventing injury: This set of measures aims at reducing the physical risks once the suicidal gesture has been made
- Preventing impact: These measures aim at stopping people from accessing the tracks when they intend to commit suicide
- Preventing attempts: These measures aim at identifying at risk people and acting before they plan or carry out their suicide attempt
Each type of measure is described in terms of its background, components, implementation, studies of its effectiveness, efficiency, cost-effectiveness, and feasibility in Canada.
Dealing with the potential substitution of suicide methods
One of the frequent objections to the installation of measures to limit access to a suicide method, such as barriers in stations, is the concern that suicidal persons will choose other substitute methods. Within the railway context, this translates to the potential scenerio that if not all stations have barriers, potential victims may simply go to stations where barriers have not been installed. If all tracks are not fenced, people will go where there is no fencing. However, a study by Law and colleagues in Hong Kong (2009) showed that between 1997 and 2007, when 30 of the 38 stations on the MTR Line had sealed doors installed on all platforms, but the remaining 8 MTR stations and all stations on the KCR network had no barriers, there was an overall reduction of 59.9% in suicides with no indication of substitution by potential attempters using the unprotected stations. This is an indication that if the access reducing measure is well planned and implemented in the proper high risk areas, there may be little or no substitution of method. Suicide attempts will not be displaced elsewhere. This phenomenon has been observed in several contexts, with several different suicide methods, such as limiting access to paracetamol and other analgesics, pesticides, bridges, high rise buildings, etc. However, there are some cases where displacement was observed. So far, those cases remain rare. Therefore research to date indicates that preventing access to a suicide method not only reduces suicides by that method, but can prevent suicides in general.