A total of 2,611 calls to 14 helplines were monitored to observe helper behaviors and caller characteristics and changes during the calls. The relationship between intervention characteristics and call outcomes are reported for 1,431 crisis calls. Empathy and respect, as well as factor-analytically derived scales of supportive approach and good contact and collaborative problem solving were significantly related to positive outcomes, but not active listening. We recommend recruitment of helpers with these characteristics, development of standardized training in those methods that are empirically shown to be effective, and the need for research relating short-term outcomes to long-term effects.
Models of telephone crisis intervention in suicide prevention and best practices were developed from a literature review and surveys of crisis centers. We monitored 2,611 calls to 14 centers using reliable behavioral ratings to compare actual interventions with the models. Active listening and collaborative problem-solving models describe help provided. Centers vary greatly in the nature of interventions and their quality according to predetermined criteria. Helpers do not systematically assess suicide risk. Some lives may have been saved but occasionally unacceptable responses occur. Recommendations include the need for quality assurance, development of standardized practices and research relating intervention processes to outcomes.
The review summarizes current scientific knowledge on the effects of railway critical incidents on railway workers and the associated risk and protective factors. Diagnosable traumatic reactions sometimes occur after a serious incident. However, the most frequent effects are long-term impairments that do not meet diagnostic criteria but can still profoundly affect people's lives. Risk factors that can increase the negative effects of incidents include characteristics of the employee, coping mechanisms, the type of incident, and the support and care received. Prevention and intervention programs should consider the diversity of reactions to develop relevant support programs.
BackgroundSuicides incur in all public transit systems which do not completely impede access to tracks. We conducted two studies to determine if we can reliably identify in stations people at risk of suicide in order to intervene in a timely manner. The first study analysed all CCTV recordings of suicide attempters in Montreal underground stations over 2 years to identify behaviours indicating suicide risk. The second study verified the potential of using those behaviours to discriminate attempters from other passengers in real time.Methods
First study: Trained observers watched CCTV video recordings of 60 attempters, with 2–3 independent observers coding seven easily observable behaviours and five behaviours requiring interpretation (e.g. “strange behaviours,” “anxious behaviour”). Second study: We randomly mixed 63 five-minute CCTV recordings before an attempt with 56 recordings from the same cameras at the same time of day, and day of week, but when no suicide attempt was to occur. Thirty-three undergraduate students after only 10 min of instructions watched the recordings and indicated if they observed each of 13 behaviours identified in the First Study.Results
First study: Fifty (83%) of attempters had easily observable behaviours potentially indicative of an impending attempt, and 37 (61%) had two or more of these behaviours. Forty-five (75%) had at least one behaviours requiring interpretation. Twenty-two witnesses attempted to intervene to stop the attempt, and 75% of attempters had behaviours indicating possible ambivalence (e.g. waiting for several trains to pass; trying to get out of the path of the train). Second study: Two behaviours, leaving an object on the platform and pacing back and forth from the yellow line (just before the edge of the platform), could identify 24% of attempters with no false positives. The other target behaviours were also present in non-attempters. However, having two or more of these behaviours indicated a likelihood of being at risk of attempting suicide.ConclusionsWe conclude that real time observations of CCTV monitors, automated computer monitoring of CCTV signals, and/or training of drivers and transit personnel on behavioural indications of suicide risk, may identify attempters with few false positives, and potentially save lives.
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