Suicide prevention actions

Reducing risk of injury

Anti Suicide Pits
 

• Background and justification

The idea is to prevent suicide by reducing the risk of fatality or injury to people who jump or descend in front of a train from a platform. An anti suicide pit allows the person to fall between the rails and under the train, thus reducing the risk of being struck by the train, hence mechanically reducing the risk of injury after an attempt.
 

• Description of measure

This measure applies mainly to stations, whether they are in a subway system or on an open line.

An anti suicide pit is a gap dug between the rails that is wide enough for a person to fall into without being hit by the train. It also insulates the person from electric live wiring.

 

• Areas of existing trials and implementations

These measures have been implemented in several metro or subway systems in the world. They also have been installed in commuters train stations.
 

• Implementation and effectiveness studies

In London, stations with so-called “suicide pits” (suspended rails so the train can pass over a person who has fallen) have fewer deaths among those who attempted suicide (O’Donnell & Farmer, 1994). Coats and Walker (1999) reported that the presence of a pit reduces overall mortality by 57%.  This technical modification appears to save lives and could be incorporated into many more metro systems and areas at high risk of railway suicides. 
 

• Efficiency or cost-effectiveness

It has been noted that it is extremely costly to equip existing stations with anti-suicide pits. However, they can more easily be incorporated in new stations. They might be particularly useful in identified high risk areas, such as stations within walking distance from mental health facilities.
 

• Feasibility in Canada

Anti suicide pits may be an interesting measure in the context of subway or metro suicides that take place from platforms and suicides that take place in commuter train stations. However, in Canada, only 2.2% of intercity railway suicides occur in stations. Nevertheless, station suicides are likely to cause more traumas, since there are more people witnessing the event who may be affected.

It is also important to note that this measure is not preventive in the sense that it does not prevent people from acting out their suicidal intention, it only reduces the risk of serious injury once they have done so. This means that such measures help prevent injury after the attempt occurs. The impact on crew members and bystanders therefore remains traumatic after witnessing the suicide attempt, whether there is a lethal outcome or not.

This station specific measure may not be the best preventive strategy in Canada for intercity rail lines..
Other less costly strategies can be implemented in stations to try to reduce the number of suicides, such as providing access to help by dedicated telephones and training railway personnel and employees in mental health facilities near stations as gatekeepers.

Limiting access to tracks

Barriers

• Background and justification

This measure is based on the knowledge that people who have a suicide plan and are confronted with obstacles in the course of their attempt are very likely to change their minds and subsequrntly do not end up commiting suicide then, nor, according to research, is there a high risk of using a different method once they cannot complete the suicide attempt on the railway. Suicides occur during a crisis situation and often when the victim is under the influence of alcohol or drugs. If the attempt is delayed, the acute crisis may dissipate over time, the effects of the substances will diminish and the person may decide to get help. Most people will not try again. Therefore, making access to tracks difficult if not impossible to those who have planned to kill themselves by train is likely to reduce significantly the number of railway suicide and suicides in general.

• Description of measure

Preventing access to tracks by installing barriers. There are two types of barriers :

1. Along the tracks

 

 

 

 

 

 

 

 

 

 A barrier installed on a commuter train platform in Hamburg (left) and an open track barrier in an urban environment (right)

 

 

2. In Stations (mostly subway- metro stations)

 

 

 

 

 

 

 

 

 

 

 

Lower barrier installed in a Chinese subway station (left) and a full size barrier installed on a subway platform in Hong Kong (right)

   

• Areas of existing tests and implementation

Barriers have been mostly installed in urban transportation systems, such as subways and commuter trains in a number of cities, including Bangkok, Barcelona, Beijing, Copenhagen, Dubai, Guangzhou, Hong Kong, Kuala Lumpur, Lille, London, Paris, Rome, Saint-Petersburg, Seoul, Singapore, Taipei, Torino and Toulouse.

Stations are rarely retrofitted with platform barriers but such systems are more often installed in newly built stations.
Barriers along tracks present different problems. Since they are placed on open terrain, they are more easily vandalised by trespassers. Therefore, a fencing programme cannot be implemented without a comprehensive analysis of the surroundings and the placement of fences should consider the design of alternative routes for pedestrians.
 

• Implementation and effectiveness studies

Effectiveness studies have been conducted in Hong Kong and have shown that the number of suicides was reduced and there was no substitution (use of unprotected stations).
 

• Efficiency or cost-effectiveness

Barriers are effective when planned from the start because adding fencing in stations after the construction is more expensive. This solution is very effective, howeverit it may be very expensive (with high installation and maintenance costs).
 

• Feasibility in Canada

Population density does not justify installing barriers along the 40,000 miles of tracks in Canada. Also, there are no hot spots in the Canadian railway network. Finally, few suicides occur in stations so barriers in stations would not be useful enough to justify their cost of installation.
However, with a careful geographical analysis of incidents and risks, certain areas could be fenced to maximise effectiveness. For example, there are indications that more suicides occur on tracks in walking distance from mental health facilities. Also, several areas of tracks have been identified as at greater risk, such as areas where  there is easy access from car parks, green areas, railway bridges and walking paths along the tracks. These characteristics are more associated with suicides in urban areas than rural areas.

Fencing is a good solution as long as it is properly maintained and this results in extra costs. However, there may be other fencing solutions that could be considered. Since we know that railway suicides occur more often in nicer weather conditions, vegetation could be a cheaper alternative. We also know that when access is difficult or the situation uncomfortable, people are more likely to renounce their plan. Limiting access to track by planting thorny vegetation in sensitive areas could be a solution worth pilot testing.

Overpasses

 

ProRail in The Netherlands experimented in 2005 with replacing metal fences near a mental institution near Eindhoven with a flyover.

They reported that “the number of suicides in the area declined, but elsewhere there was an increase”, but did not report specific data or statistical tests of significance.

 

Monitoring Trespassing

Use of surveillance cameras

• Background and justification

This measure was developed from the notion that suicidal people display recognisable behaviour prior to their attempt and that properly trained operators can identify them and send appropriate help or signal to trains to slow down or stop.
 

• Description of measure

This measure consists of using surveillance cameras installed in stations, on platforms, and on railway property to identify at risk people in order to direct proper and quick help, or to slow the railway traffic if needed.
 

• Implementation and effectiveness studies

To our knowledge, there have not yet been evaluation studies of the use of video surveillance to reduce railway suicides.
 

• Efficiency or cost-effectiveness

The effectiveness of surveillance in preventing suicides depends upon the availability of vigilant observers monitoring the video screens and the potential to dispatch help to the scene or notify train drivers in time to prevent the suicide.  A metro or railway system with hundreds of cameras to monitor requires many people available throughout the day.  At the present time, this solution does not seem feasible. However, an ongoing project by the authors of this report involves reviewing video recordings of suicides in the Montreal Metro subway system in order to try to identify behavioural patterns which may be identified by a computer programme, which would signal personnel to investigate when an individual exhibits potentially “at risk” behaviours. We are conducting a study in which trained observers try to identify suicide attempters from videos of the same stations when there was a future attempter present and when no attempt was to occur.
 

• Feasibility in Canada

Two third of suicides occur away from stations and crossings. There are no hotspots where several suicides occur in the same area. It is not feasible to install surveillance cameras on the overall network. There would not be enough operators to analyse them and there would not be enough available help to be dispatched quickly enough to the scene.

However, there are some urban areas where more suicides take place on the tracks. These areas could be subject to video surveillance, once behaviour patterns have been described accurately, and potentially included in automated image analysis.
 

Discouraging Trespassing

Removing hiding places

• Background and justification

If there are fewer places to hide, then drivers should be better able to see potential suicide attempters earlier and are more likely to be able to slow or stop the train before impact.
 

• Description of measure

Eliminate places where people can hide near tracks and ensure that train drivers have a clear view of areas near the tracks from as great a distance as possible.
 

• Areas of existing trials and implementations

ProRail in The Netherlands experimented in 2005 with removal of trees and shrubs to eliminate hiding near the tracks (Anonymous, 2010).  They reported that “the number of suicides in the area declined, but elsewhere there was an increase”, but did not report specific data or statistical tests of significance. This measure was also combined with an overpass and fencing. It is therefore difficult to know which of these measures helped reduce the number of railway suicides in this specific area.
 

• Implementation and effectiveness studies

There have been no studies which have analyzed the implementation and effectiveness of removing hiding places to date.

• Efficiency or cost-effectiveness

Costs of maintaining low vegetation can vary from place to place and necessitate regular work. However, these clean-ups can be performed in high risk areas, such as hotspots and high trespassing areas, to increase visibility from crew members and also reduce the attractiveness of the place to trespassers.  Elimination of buildings and other manmade constructions near tracks that can provide a hiding place may not be practical of cost-effective, depending upon the nature of the construction and its use.
 

• Feasibility in Canada

Eliminating hideaways can be useful although most suicides take place away from crossings and people are rarely said to be hiding before jumping in front of the tracks. This measure may not be the most useful in Canada at the present time.

Signage and warnings

 

Roadsign promoting help seeking posted along Caltrain tracks in California (left) and a Samaritan poster in the UK (right)

• Background and justification

This measure is based upon the knowledge that suicidal people are likely to attempt suicide because they want to stop their suffering. Although they may think they have exhausted all their support options and see death as their only option,  If help is offered, most people who call will not go through with their attempt. Therefore, reminding people that help is available and providing access to help can be a good strategy to prevent attempts.
 

• Description of measure

This measure promotes resources that can offer crisis support to persons feeling suicidal. These signs are installed in sensitive areas, such as crossings, platforms and other points of contact between railway property and the public.
 

• Areas of existing trials and implementations

Such measures have been evaluated in various contexts, outside of the railway network, such as a car park where people used to come to kill themselves using car exhaust, or on bridges (Seattle, San Francisco, New York, New Jersey).

They also have been tried in some railway environments, such as a Caltrain section of tracks, several Japanese metro networks, NUTransit in NJ, the UK railway network (by the Samaritan) and the Montreal Metro.
 

• Implementation and effectiveness studies

To date, there are not enough data in the scientific literature to convincingly prove that signage alone has an impact on reducing suicides, although partial findings indicate that this may prove to be a potentially effective intervention.  Please see the section on signage and telephones for research on including telephone access to help along with signage.
 

• Efficiency or cost-effectiveness

This measure is not expensive to implement, particularly in a context where the geography of rail suicides has been well described. Indeed, this analysis would allow for the identification of sensitive areas where a higher density of signage could be useful.
 

• Feasibility in Canada

Signage is a potentially good strategy to help reduce railway suicides, especially in urban areas, where the population is more dense and the risk of rail suicide is higher.

Mood altering lights

 

Blue lights installed on platforms, Tokyo

• Background and justification

This measure was developed from the field of color psychology, asserting that colors in our environment have a strong influence on our affective state, mood, and behaviour.
 

• Description of measure

It consists of putting up blue lights on platforms and at crossings, with the hope that it will alter negative mood, have a calming effect, and prevent people from committing suicide at these locations.
 

• Areas of existing trials and implementations

This measure has been implemented in Japan, where 94 crossings and 29 station platforms have been equipped from 2006 to 2010.
 

• Implementation and effectiveness studies

An empirical evaluation has been carried out recently where areas with blue lights have been compared to areas without blue lights on the Japanese railway network. The results are very promising. A sharp decrease in suicides was observed, with a reduction of 84% of suicides in the lighted stations. However, the study does not include an analysis of suicide trends in the areas surrounding the railways affected. It is therefore impossible to know if there was a substitution of suicide method.

Although it seems very promising, to be categorised as an effective strategy to reduce railway suicide, this measure should be evaluated in various cultural contexts, because color plays a different role in different cultures.  Also, it is important to determine if there is an impact in preventing suicides or if suicidal people simply choose other means.
 

• Efficiency or cost-effectiveness

This measure is very cost effective, since artificial lighting is already in place in stations, platforms and crossings.
 

• Feasibility in Canada

This measure could be tested in Canada in metro and subway stations, where a number of suicides occur from platforms.

However, on the Canadian railway network, suicides occur more often on open tracks (66.7%) that in stations (2.2%) or crossings (29.1%). Even if 1/3 of suicides occur at crossings, there are no clusters at specific crossings where installing blue lighting could have a definite influence on behaviour.

 

Identifying at risk persons on railway property

Gatekeepers

• Background and justification

These measures are based upon the idea that people at risk of suicide display specific behaviours or are likely to show some sort of identifiable distress before attempting suicide. When suicidal people enter railway property, they could possibly be identified by specially trained employees who would also be equipped to react properly and call for professional help.
 

• Description of measure

Gatekeepers are trained persons (employees or members of the community) who can recognise, ask questions to assess suicide risk and provide help when they feel a person may be a danger to themselves or others. They act as gatekeepers during the normal course of their activities or work on the railway.
 

• Areas of existing trials and implementations

Gatekeepers programmes have been implemented in metro and commuters systems, such as in Washington, Toronto and Montreal.
They have not, to our knowledge, been tried by open tracks railway companies.
 

• Implementation and effectiveness studies

The Washington Metropolitan Area Transit Authority approved the testing of a suicide prevention progra based upon training employees to better identify persons who are potentially at risk of attempting suicide and developing a safety assistance programme for persons identified as being at risk (Customer Service. Operations and Safety Committee. Washington Metropolitan Area Transit Authority, 2010).

The Toronto Transit Commission, in collaboration with the University of Toronto Arthur Sommer Rotenberg Chair in Suicide developed a “Gatekeeper” training programme to train personnel to better identify distressed and at-risk persons using the Toronto Transit Commission trains (Fortin, 2008). The effects of this programme, which began in 2008, have not yet been reported.
Several years ago, the Montreal metro initiated a somewhat controversial poster campaign encouraging passengers to use the red emergency phones in metro stations to report when someone seemed disturbed. This publicity campaign did appear to result in an increase in suicide prevention interventions.  However, the campaign was contested by groups concerned with the rights of mental patients who were concerned that targeting disturbed people would stigmatize the mentally ill. This concern was not evident in the reports of the interventions in which the “disturbed” individuals often said that they appreciated the help from the metro employee who expressed concern for their wellbeing when they arrived and talked to them about their feelings and intentions. However, this programme was discontinued before its impact could be evaluated
There are not yet any data on the effectiveness of gatekeepers programmes to reduce railway and metro suicide numbers.

• Efficiency or cost-effectiveness

A gatekeepers programme may be cost effective in densely populated areas where there are hot spots or at least known at risk populations, such as within walking distance of a mental health service.
 

• Feasibility in Canada

The patterns of railway suicide in Canada show that people access the tracks mainly from streets, legal walking paths, trespassing routes and crossings. Therefore, a gate keeping programme may not be an efficient strategy to reduce rail suicide on the Canadian railway network. 

Providing access to help on and around railway property

Telephones and posters / signs

 

 Sign and phone installed on the Golden Gate bridge, known as a hotspot, before barrier was installed

Sign on a New York bridge, indicating distance to phone

Sign installed in the Toronto metro with a dedicated button on public phones

• Background and justification

This measure is based upon the knowledge that suicidal people are likely to attempt suicide because they want to stop their suffering, but always have some ambivalence and will not proceed with an attempt if they find some way of feeling better. They might think they have exhausted all their support options and see death as their only option, but when telephone help is offered people who call most often do not proceed with their attempt. Therefore, reminding people that help is available can be a good strategy to prevent suicide attempts. However, suicidal people are frequently unemployed and less often have a cellular (portable) telephone. This means that putting up a sign promoting help without providing the means to access it may not be as useful. Combining signs with public phones may increase access to help by people in distress who need it, at the location where they need it.
 

• Description of measure

The telephone and signs strategy combines promoting help seeking and providing direct access to help. It is composed of signage that indicates that resources for distressed people are available and provides access to a public phone directly linked to a crisis line.
 

• Areas of existing trials and implementation

This measure has been tried and evaluated in sensitive areas known to be used by suicide attempters, such as selected car parks in England, high cliffs in New Zealand and bridges in New York. A system of signs and telephones has been implemented in the Toronto Metro in 2010.
 

• Implementation and effectiveness studies

Evaluation has shown that those who used the available phone on a New York bridge did not commit suicide from this location and suicides on that bridge declined dramatically. After the installation of a phone and posters in a car park regularly used by suicidal people in England, there was a dramatic drop in car exhaust suicides but also in general suicide numbers in the area decreased.

The Toronto metro experience has yet to be evaluated. To our knowledge, there has not yet been an evaluation of signs and telephones to prevent railway suicides, but this measure has proven effective with other geographically imbedded suicide methods.
 

• Efficiency or cost-effectiveness

The modification of existing public telephones or the installation of new dedicated telephones is very expensive. Also, one has to be careful when choosing the locations to install these phones. Location is a key component of success. Railway stations, platforms and busy crossing (yet away from the tracks themselves) are relevant areas to install phones.
Because of important changes in the telecommunication industry, public telephones are being decommissioned in many areas. This makes the telephone and sign strategy more difficult to implement.
However,  suicidal people also often have socio-economical difficulties and a study showed that many of them do not own a cell (portable) phone. Therefore, installing signs to offer access to help without providing the means to reach this help reduces the chances of success.

• Feasibility in Canada

A proposal for a railway suicide prevention strategy in Canada by telephones and posts / Signs.

Identifying and treating at risk people in the community

Identification by itself does not constitute a preventive measure but it makes it possible to target the proper vulnerable persons for dedicated interventions. This section covers both aspects of community intervention, identification and offers of help.
 

• Background and justification

This measure is based on the findings that:

• a large number of railway and Metro suicides are committed by people with diagnosed mental health problems (For more details on the presence of mental health problems, see section “Railway suicide in the world”)
• people committing suicide by train are often under psychiatric care (For more details on the involvement in psychiatric care by railway suicide victims, see section “Railway suicide in the world”)
• a disproportionately large proportion of railway suicides take place near mental health institutions
• offering access to help to people before or during a suicidal crisis can reduce the number of suicides.

Therefore, increasing the awareness and competence of mental health professionals and institutions in areas near tracks to better identify at risk persons and provide help may be an effect suicide prevention strategy..
 

• Description of measure

Mental health professionals can be trained to better understand the risks associated with being located near railway tracks, and to better assess suicide risk in their patients. Mishara (1999) found that most metro suicide victims threatened to commit suicide beforehand and they were often not taken seriously by psychiatric personnel. This would imply that it is important that staff in psychiatric institutions be well educated in the assessment of the suicide potential of their patients and be well equipped to act upon this assessment.

Although it has been suggested that potential victims could be informed of the devastating effects of suicide on train drivers (Kerkhof, 2003), one would have to provide some empirical evidence of the dissuasive effect of such a programmer before recommending its implementation.
 

• Areas of existing trials and implementations

To our knowledge, this strategy has not yet been used specifically to prevent railway suicides. However, training of mental health professionals has been implemented and tested in a general context (not related to a specific suicide method).
 

• Implementation and effectiveness studies

To our knowledge, there are no implementation or effectiveness studies on the training of mental health professionals to better identify and care for at risk persons in the context of railway suicides.  However, there is research indicating that training in suicide prevention can improve attitudes, increase knowledge and improve the clinical skills in suicide prevention of mental health workers in a variety of contexts.
 

• Efficiency or cost-effectiveness

This kind of community intervention can be very cost-effective because it can have important positive side effects. Mental health professionals trained to better identify patients at risk on railway suicide will also be trained at better identifying suicide risk in general.

Even if this measure goes beyond the scope of the responsibility of the railway industry, they can participate in the identification of at risk areas and provide information about the impact of railway suicide on their employees to mental health professionals.
 

• Feasibility in Canada

A proposal for railway suicide prevention in Canada by the training of mental health professionals

 

Media Impact

Several studies have shown that the way railway suicides are portrayed in the media can have a large influence on subsequent suicide rates. In Germany, where railway suicides are an important problem, Kunrath et al. (2011) have observed a sharp increase in the incidence of railway suicides after a suicide had been widely covered by the media. Also, Hergel et al. (2012) and Ladwig et al. (2012) examined the effect of the railway suicide that was extensively publicized of afamous German football player. In the following weeks and months, railway suicide numbers sharply increased in the country.

The media can help reduce the number of railway suicides by following suicide reporting guidelines provided by suicide prevention organisations around the world and promoted by the World Health Organization and the International Association for Suicide Prevention:

• Do not report details about the suicide method.
• Emphasise the difficulties the person was experiencing and the fact that if this person had asked for help they could have found other solutions to their problems.
• Mention available suicide or crisis prevention services.
• Do not glamorise the suicide. It is never a brave thing to do, it is a desperate act.
• Do not include a photo of the victim.
• Do not use a title or include in the report a conclusion about why the person committed suicide.  Suicide is the result of a complex interaction of risk and protective factors and no single “cause” can explain why an individual committed suicide.  Citing a “cause” can result in “copycat” suicides by persons, often with mental health problems, who experienced similar circumstances.