Prevention of metropolitan and railway suicide

Abstract

Railway suicides account for a minority of <10 per cent of all suicides, although they are considered a major public health issue because of their tremendous consequences on functioning of the transportation system and their deteriorating impact on the mental health of staff and bystanders. Railway suicide is a particularly violent method, and case fatality is 90 per cent of all attempts. However, case fatality in metro systems of >60 per cent are rare. More men than women choose the track as a means of suicide with a trend towards a balanced distribution in metro systems. Victims are predominately young with a median age stratum in the range of 25–34 years. For men, a prevalence peak in April and a low in December has been observed. The weekly distribution shows a peak at the beginning of the week and a low on weekends. Railway suicide behaviour patterns include jumping, lying and wandering, some individuals present deviant behaviour prodromal to the attempt. Attractiveness of the method derives from high levels of opportunity and low levels of self-perceived costs. Prevention may rely on a package of different structural and communicative tools. Inhibiting access to the track, by providing barriers at places of advanced risk and surveillance systems, are among structural means. Inhibiting media coverage and education of gatekeepers to increase awareness and skilfulness in contact with potentially vulnerable subjects on station platforms are among communicative tools. Railway suicide prevention is a realistic option: however, enhancement of research in this field is urgently needed.

A systematic review of the literature on safety measures to prevent railway suicides and trespassing accidents

“…For example, Brown et al (2012) and RSSB (2012) distinguish between 'situational' and 'influential' measures, while Offler et al (2009) and Thompson et al (2012) separate 'technical' deterrents from 'non-technical' (social) ones in the prevention of vandalism and graffiti in the railway industry. Similarly, Ladwig et al (2009) refer to 'structural' means and 'communicative' means in prevention of suicides. Focussing on the nature of preventative measures and the targeted stage in the suicide process, Rådbo et al (2012a,b) have published a theoretically derived and detailed set of railway suicide prevention strategies, organised around five barrier themes: (1) measures reducing the attractiveness of railways as a means of suicide, (2) measures obstructing accessibility to the track area, (3) measures influencing the victim's determination while awaiting the train, (4) early warning systems, enabling the train to brake sufficiently for the victim to be removed before collision, and (5) measures to make the collision less violent.…”

“…It encompasses several principles or goals that might be achieved thanks to such collaboration. Planning and development of psychiatric facilities at a distance within a circle of about 2-3 miles from a railway line should be prevented by law and the visibility of railway tracks from psychiatric facilities should be strictly inhibited (Ladwig et al, 2009). In addition, communication to mental health professionals in psychiatric hospitals near railways should raise awareness about the devastating effects of suicides on train drivers and promote measures that these hospitals can take to prevent their patients' access to the nearby railway track (Kerkhof, 2003) such as actions to monitor in-patient whereabouts and suicidal intent (Ratnayake et al, 2007).…”

“…Public communication should be tailored more precisely to the need of specific locations (Dinkel et al, 2011). For example, inhospital communication (Ladwig et al, 2009) may help increase awareness in psychiatric units (Mishara, 1999) on the identification of suicide risk and the need to educate patients about the false beliefs that rail suicides provide for a certain, painless, and immediate death (Mishara, 2007). A public health campaign may have a dual role to play in simultaneously raising public awareness of mental health concerns, while also reducing the possibility of copycat suicides (Bhui et al, 2013).…”

“…In addition to the front geometry (Routley et al, 2004), this can be achieved through smooth surfaces, shock absorbing structures, deflecting devices (Rådbo et al, 2008), or trains with more ground clearance (Coats and Walter, 1999). Specific examples include nets on trains (Ladwig et al, 2009), the redesign of the axel box dampers along the sides of the rolling stock (Rådbo et al, 2012a), and inflatable airbags mounted in front of trains (Beskow et al, 1994;Kerkhof, 2003;Rådbo et al, 2012a). An airbag, which inflates after the use of an emergency brake, can cushion and reduce the impact of collision between a body and a train, and a rigid skirt can prevent the body from falling underneath the train (Clarke and Poyner, 1994).…”

“…One recommendation is to place the third electric rail further from the platform (Hawton, 2007) to decrease the chances of electrocution, but it is yet unknown if this measure would really make a difference. Nevertheless, the most common and effective measure is to deepen the space between the rails at stations in order to create a pit (Hawton, 2007;Holdaway et al, 2012;Ladwig et al, 2009;Mishara, 2007;Ratnayake et al, 2007;Rådbo et al, 2008;Routley et al, 2004;van Houwelingen, 2011). This pit has the same length as the platform (Coats and Walter, 1999) and is usually Significant increase in rail suicide, and higher than the general increase in German suicide.…”