When and where do suicides occur

• Suicides occur more often on open tracks (66.7%) than at crossings (29.1%) or in stations (2.2%). 
• This means that prevention strategies aimed at identifying at risk people in stations and promoting help by posters placed in stations will not have much impact in Canada. However, the situation is different in urban metro and subway systems where the only easy access to tracks is in stations and trains enter stations at a much higher speed.
• Suicides occur more often in urban areas (85%) than in rural areas (15%) which accurately reflects the population density. Railway suicides are an urban phenomenon because more people have access to the tracks there than in rural areas.
• Most of the Canadian railway suicides occur in Ontario (56.1% of all rail suicides), which also is the most populated province of Canada
• Commuter lines seem to be more at risk of having suicides. Passenger trains are also often involved in suicides. There are 3 explanation of this : Passenger trains trains are more likely to run in more densely populated areas, they are faster so they may be more attractive to suicidal people and they run on a schedule so they are easier to access.
• Class one companies and urban trains are more likely to be involved in rail suicides
• Suicides occur when weather conditions are mild
• This may be explained by the fact that people may not want to venture to uncomfortable environments to commit suicide
• 40% of suicides occur at night
• Critical incident that occurs at night may have a stronger impact on crew members
• There are no clear hotspots in Canada. However, we were able to identify sensitive areas where more than one suicide occurred during the period covered by the study. A large portion of suicides took place in a sensitive area (45.2%). These areas were often located near a mental health facility (35.3%).
• Strategies that would limit access to a specific area or which target a specific area will not be useful.

Who commits suicide by train

There are several well researched risk factors for suicide in the general population, including mental health issues, substance abuse, social isolation and critical events occurring in the previous days. People who committed suicide by train show similar characteristics. However, due to the inconsistencies in data collection, we have to be careful in interpreting some of the findings.

• Railway suicide is an adult phenomenon. Our sample only contains 6.9% adolescents.
• This means that most of railway suicide prevention should be concerned with adult mental health and support systems.
• Railway suicides vary according to gender. There are more men who commit suicide (3.3 men for 1 woman). However, when we compare the number of suicides among overall fatalities by gender, we observe that the percentage of female suicide among female fatalities is similar to the men’s (47.8% and 44.3%).
• Women usually tend to use less violent methods than men, such as medications and men more often use more violent methods, such as a gun. A train suicide is considered to be a violent method.
• Suicidal people are more likely to be living in delicate living situations. A relatively high proportion of suicides either lived alone (17.9%), in communal living (6.9%), in institutions (7.5%) or in temporary living situations (2.3%), for a total of 34.6%.
• They are less likely to be employed (43% out of work)
• They live with a partner as often as the general population, which is not the case for other suicidal populations. It is also interesting to note that men and women who committed suicide do not have the same pattern of marital status in our sample. As we find in the general population of people who die by suicide, more women who commit suicide by train are in a relationship (45.9%) than men (40.0%).
• They do not live alone as much as the general population.
• This means that there are people close to the individual at risk who may be able to identify a suicidal crisis, whether it is in a family or an institutional context.
• People who commit suicide often live either very close to the tracks (less than 1km for 27.8%) or very far (more than 15km for 24.6%)
• It is difficult to make sense of this data, because people who live further away may also be familiar with the area for other reasons
• As is the case with most suicides, people who commit rail suicide usually experience problem situations in the day preceding their suicide, most often relationship problems, conflicts with parents and family, justice and police, financial difficulties, and substance abuse.
• Mental health issues are often present, although probably underestimated as data on mental health problems is not systematically collected. Only 22% of individuals were under care for a mental health problem at the time of death.
• A promising prevention strategy may be to provide better training of mental health professionasl to help them better identify patients at risk of suicide. Since there are more suicides when tracks are near mental health facilities, those facilities should be the focus of educational prevention efforts.
• A high proportion of suicide victims made threats to kill themselves in the days before their death, of which almost half had said they would do it by train. A significant number of victims had made a previous attempt by train.
• People who die by railway suicide resemble people who die by suicide using other methods. Therefore, universal suicide preventive strategies that target all suicidal persons should impact railway suicides. Since Canadian journalists have been exercising great restraint in reporting on railway suicides, in Canada the choice of a train as a suicide means probably is related to the accessibility of this method more than anything else.

The suicidal person's behaviour before impact

Information on the individuals behaviour around the tracks prior to putting themselves in front of a train could help devise strategies to limit access to tracks or identify at risk people in the areas around tracks and access points (legal and illegal crossings). However, this data is not available at the present time and may be very difficult to obtain in the future. Our description of behaviours immediately before impact does not suggest specific prevention strategies since the time between people putting themselves in front of the train and the time of impact is too short for effectively avoiding the impact.

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.

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.

Feelings of being chosen by the victim

This factor was identified from the crew members’ analysis and understanding of the event in the hours or days after the event, from information they collected or from their perception of the situation. This feeling of being chosen can induce:

Knowing that the death could have been prevented

In their analysis of the event, crew members often feel that the fatality in which they had been involved in could have been prevented, both accidents or suicides.

Ability to make sense of the event

Being able to understand why things happened seemed to play a part in lessening the trauma.

Cumulative effect

Cumulative effects can be considered both as an effect of fatalities and as a risk factor for increased symptoms. In this section, we will explore the role of accumulation of events as a risk factor (click here to access the description of symptoms of accumulation). In our sample, people experienced between one and more than 20 fatalities in their careers (mean number of fatalities: 4.5), with varied impacts.

 Cumulative effects are not always easy to identify. They may appear as long term mood shifts, in changing perceptions about life or work, flash backs in varied circumstances, general edginess, as well as fatigue and long recovery periods for minor incidents. Another sign of a cumulative effect is loss of commitment to work and hope that they will live to retire.

Cumulative effects have been documented before (Malt et al;., 1993, Karlehagen et al., 1993, Theorell et al., 1992), but they were limited to their assessments of acute stress and PSTD. In this study, we found that the cumulative effect can be insidious for crew members, affecting them in more subtle ways in the long term (for example in changing moods, fatigue, etc.) that do not necessarily appear when only Acute Stress Disorder (ASD and post Traumatic Stress Disorder (PTSD) are measured.

Working the same route

After they return to work, most crew members have to drive trains along the tracks where the incident took place.

Knowing about the victim's circumstances

In some cases, crew members obtained information about the victim, either because it was available on site or because they looked for it. The effects of this knowledge varies according to the story and the crew member.

Implementation of the Critical Incident Response Programme (CIRP)

Some actions take place after the crew members returned to their home terminals. These activities vary from employer to employer but also by region.

This is a major issue for railway employees and ultimately for companies. When people feel they have to fight their employer for recognition of their work related hardship, and that they should make sacrifices to accommodate the productivity demands of their employer, this combination makes for poor work relations that can have a long term effect on both personnel and employers.

Work relations

During the course of the study of the impact of critical incidents on crew members in Canada, there was a generalised complaint from crew members that their employers did not seem to care about their difficulties in handling the fatalities. They felt pressure to come back to work as soon as possible. They felt that they were sometimes blamed for incidents and for their difficulties in dealing with them. They often did not feel supported in their ordeal. That provoked anger and resentment. This feeling of being “betrayed” by their employer remained for a very long time after the incident, and may be the factor that has the longest negative impact on the employees over the years.

Lack of empathy, concentration on productivity, lack of knowledge of what happened and lack of hands-on experience of train driving were seen as the main reasons why managers did not offer the needed support when incidents occurred.

Some workers felt that they had to fight for the support they needed from their employer, who did not want to spend money to help them overcome work-related trauma. This perception damaged their trust and their relationship with their employer in the long term.

The way professional regulations are handled can upset employees. The consequences of taking some time off or going to see a doctor may not be clear. In the context of difficult work relationships, and when people feel they are not supported by their employer, those regulations were seen as a nuisance and a way to hurt them more. Here again, this feeling of being mistreated lasts for a very long time and negatively colours all subsequent dealings with the employer, making recovery even more difficult.

The feeling a lack of support from the employer at the different stages of incident management is one of the strongest predictors of a long-term negative impact from an incident. Indeed, 22 of the 35 incidents where management was said to be inadequate were accompanied by mid-term effects that lasted in 17 out of 35 cases for more than 3 months. All seven persons who had PTSD felt no support from their employer in the aftermath of the incident.

Co-occurring personal events

Co-occurring personal events do not seem to be very frequent in our sample. However, they can play a part in the long term effects of critical incidents on crew members.

Being isolated

Train crew may find themselves isolated, whether geographically (being away from a road or housing) or in the middle of the night just after an impact and with a dead or injured person.

Seeing the victim prior to impact

Some people reported seeing the face or the eyes of the victims in the seconds before the incident occurred.

Type of incident

Accidents and suicides were compared. Participants were asked to reflect upon the difference it made to be involved in a suicide versus an accident. Whatever the type of incident, the initial reactions are of shock and pain. However, after these initial, almost physical reactions, crew members developed different attitudes, sometimes quite contradictory.

Dealing with the victim(s)

After a collision occurred, the conductor must check on potential victims, provide first aid help if necessary and guide first responders to the scene. During these actions, they have to see, touch and interact with injured or fatally wounded people, while they are themselves in a state of shock.

Perceiving the helplessness of the victim

In the context of railway CI, vulnerable victims are young, elderly or disabled people, car passengers, people who could not be aware of the danger or get out of the way, people whose distress crew members could relate to. This helplessness increases the perception of victim’s vulnerability.

Interactions with police

Local police officers are usually the first on the scene after a fatality. They are often the first people the crew sees after the initial shock of the accident. They therefore play an important part in the way the crew deals with the event. We have to be very careful not to generalize about interventions by the police at the time of the incident and their impact on crew members. The incidents described are spread over a 35-year time frame and police protocols have changed during that time. Things have improved over time, to the benefit of train crews.

Implementation of the Critical Incident Response Programme: Interactions with local managers

This interaction occurs at different levels:

• Interpersonal contact
• Implementation of the Critical Incident Response Programme
• Follow-up

The local manager is the representative of the company and embodies the company’s attitude and expectations towards the crew members during and after the critical incident.  At this particularly sensitive time all interactions are important and can have profound long term effects.

A more detailed analysis shows that in 35 of the 103 accidents and suicides (34%), crew members clearly stated that they experienced inadequate support from their employer. Most of these crew members (24/35) displayed strong symptoms in the short-term and this group also include all of those with long term symptoms (7 PTSD).

Therefore, the mishandling of incidents appears to have long-term effects. People tended to generalise their perception of bad management to other aspects of their work and remember incidents longer when they had to deal with poor management. This, in turn, undermined their trust in their employer and made it more difficult for them to come back to work comfortably.

Age and Senioriy

The mean seniority of the participants to our study was 28.6 years at the time of interview and seniority was calculated at the time of each incident. It is difficult to analyse the effect of age or seniority on the impact on incidents because they are correlated, the older people had more seniority and had more opportunities to experience incidents.

In general, we found that those who have only one incident later in their career suffer from the same intensity of reactions as those who had incidents when they were younger and at an earlier stage of their carriers.

Masculinity

The railway business is a very masculine environment. It carries a lot of the stereotypes associated with strong masculinity. These stereotypes are known to play an important part in emotional problems and help-seeking (Connel, 1995, Galdas et al., 2005, Chagnon et al., 2008). Masculine stereotypes define social behaviours for men and include suppression of emotions, violence, competitiveness, risk taking, physical strength, control, stoicism, substance use and abuse, being a provider, intolerance to helplessness, fear of failure and fear of being controlled by others. Men who adhere to these stereotypes tend to minimise their problems, think they can solve them on their own, do not share feelings with others, self medicate with alcohol, do not seek medical or psychological help when they need it and do not persevere in help seeking when their first attempt is not successful.

Area perceived as dangerous

Accident sites may have an impact on the effects experienced by involved crew members.

Develop and train managers for critical incident response programme (CIRP)

A Critical Incident Response Programme (CIRP) is important to reduce the negative impact of railway critical incidents on crew members. A proposal for a comprehensive Incident management protocol is described in section "Framework to reduce the impact of critical incidents".

Knowledge from previous events

People learn from past experiences with critical incidents and situations. This also applies to railway critical incidents. Some participants said that because they had experienced incidents before, they knew what to expect from incident management and from themselves when subsequent incidents occurred. This knowledge lessened their sense of helplessness.

Training

Although in our sample, people never received training on the impacts of critical incidents, possible reactions, CIRP and procedures, some participants were trained as peers for peer support programmes. Others told about their wish for proper critical incident training.

Other work related incidents

• Non fatal incidents occur when there was an impact but nobody died on site. There may have been injuries or not. Non fatal incidents may involve co-workers or trespassers.

• Close calls occur when the crew members expected an impact that did not finally happen.

During the course of the interviews, we did not discuss in depth the number and nature of non-fatal incidents and close-calls because there were too many. We have no way to quantify this problem. People told us about the incidents that were most relevant for them throughout their careers.

The inclusion of non-fatal and close call events in the definition of critical incidents should be discussed within the context of the railway medical rule handbook and by the Railway Association of Canada (RAC), in order to reflect results from research on traumatic events.