Brian L. Mishara, Ph.D., Director
Centre for Research and Intervention on Suicide and Euthanasia
Professor, Psychology Department
mishara.brian@uqam.ca
&
Cécile Bardon, M.S., Project Coordinator
Centre for Research and Intervention on Suicide and Euthanasia
Université du Québec à Montréal
www.railwaysuicideprevention.com
IMPOSSIBLE
TASK:
CRITICALLY
SUMMARIZE
RAIL
SUICIDE
PREVENTION
in 25
MINUTES
Plan
1. Not quite everything you
wanted to know about suicide and
suicide prevention in 5 minutes
2. Where train suicides fit in
3. Some results from our recent
studies in Canada
4. Conclusions
5. Recommendations for research and evaluation
Thanks to our sponsor: Transport Canada, our Steering
Committee as well as the railways and union and rail
personnel in Canada who collaborated in our research
Not quite everything you wanted to know about
suicide and suicide prevention
• Suicide exists in every country in the world and there
have always been suicides everywhere
Not quite everything you wanted to know about
suicide and suicide prevention
• Over 1,000,000 suicide deaths/year, more than in all wars,
terrorist attacks and homicides combined
• People who kill themselves in Europe and North America
generally have serious mental health and/or alcohol/drug
abuse problems
• Suicide is the result of a complex interaction between risk
and protective factors – there is never just one simple
cause
• Over half of suicides in Western countries occur under
the influence of alcohol or drugs that compromise the
ability to make reasonable decisions. Also, mental illness
and being in a crisis situation make for poor choice of
suicide as a solution to problems.
Not quite everything you wanted to know about
suicide and suicide prevention
• It takes more than having a mental health problem to
commit suicide – most people with serious problems
never attempt suicide and most seriously suicidal people
get help and change their minds (prevention usually
works)
• No matter how «serious» attempters appear, they are
usually happy to be saved
• If « acceptable » means are not available, the risk is
greatly diminished (e.g. controlled access to bridges,
firearms, drugs)
• Media reports on suicides, no matter how well
intentioned, increase the risk of « copy cat » deaths in
vulnerable people who are already at risk
Where train suicides
fit in the picture
- The accident - suicide blur: reliable data not always
available, but Europe and Canada have some of the best
data
- Why railway suicide?
-
Easy access
High lethality
Can result in quick death
Violent means – can be attractive to some or repulsive to others
- Impact on train drivers and personnel: severe
Where train suicides fit in the
picture
 People choose methods which





Are readily available
They think is a « good » method for them
They learn that others use (from media or
conversations or knowing someone who used that
method)
Are the « in » methods – you read about it a lot
In the case of Metro-subway suicides:



They think they will certainly die, they will die quickly and
painlessly (Weisman et al and our current study)
(In Montreal this is not true – most survive with handicaps)
However, people hit by open track trains rarely survive
Where train suicides fit in
Attempters often tell others about their plans or
give identifiable signs
 May be seen as a « cry for help »
 Threats are often ignored or not taken seriously – even
in psychiatric institution

Sometimes « because » threats occur often
When an attempt is imminent, people often do
not proceed with their plans when
 Help is offered (e.g. posters & phones near bridges,
interventions by rail personnel)
 It is difficult to access the means, it is painful, too
uncomfortable, disgusting or embarassing
 They are frustrated at least temporarily in completing
their plan (buys time to get help, sober up and rethink plans)
Overview of the global project
Period
Phase
Objectives
Results
20092010
1
Detailed analysis of all
railway suicides over 10
years in Canada
Comprehensive database of railway fatalities ( 1999-2008)
Analysis of railway suicides and comparison with accidents
(report Phase 1)
Production of a Google map layer (2011)
20092010
2
Analysis of the impact of
suicides on train crew
members
Interview study and qualitative analysis of the impact of railway
fatalities
Recommendations for support to employees (report Phase 2)
2010-2011
3a
Literature review on railway
suicide preventive
measures
Review of preventive strategies around the world and their
effectiveness (report Phase 3a)
2010-2011
3b
Literature review of
measures to reduce the
impact of fatalities on train
crew members
Review and evaluation of strategies and treatments
implemented throughout the world to reduce the impact of
fatalities and critical incidents on crew members (Report Phase
3b)
2011
4
Development of proposals
for intervention for the
Canadian railway network
Identification of 3 potentially effective strategies to reduce
railway suicide and 2 strategies to reduce the impact of fatalities
on crew members (report Phase 4)
2012-2014
5
Knowledge application
strategy
Develop and implement a comprehensive knowledge application
strategy to promote the new information gathered with
stakeholders and help the industry and its partners implement
Study of suicides & accidents by rail in
Canada over 10 years:
 Objectives:
 Determine the prevalence of railway fatalities in Canada
 Better understand:




Circumstances surrounding suicides and accidents by rail
Characteristics of victims
Characteristics of train fatalities (description of incidents)
Identify hot spots and clusters of incidents
Behaviour (N of people displaying these behaviours – information available for
671 cases)
 Accidents














Driving across the tracks (97)
Walking or running across the tracks (45)
Does not move when train whistles (33)
Walking on track facing away from train
(32)
Facing away from train (32)
Lying on track (26)
Stands or sits on track (21)
Tried to get out of the way (13)
Runs suddenly in front of the train (12)
Sleeping on track (12)
Going around barriers (11)
Wearing a hoody or walkman (11)
Walking along the track (11)
Made contact with the side of train (10)
 Suicides













Runs out suddenly in front of the train (99)
Lying on the track (80)
Stands or sits on track (79)
Facing the train (57)
Does not move when train whistles (53)
Head on rail (40)
Facing away from train (35)
Looking at the driver / train engine (33)
Placing arms out (22)
Walking along track (19)
Walking on track facing train (14)
Driving across track (10)
Gesturing towards crew (10)
• Characteristics of train fatalities
– By type of trains
•
Accidents occur more often with
freight trains and suicides more with
passenger trains
– By type of collision
•
•
Suicides mostly involve pedestrians
Accidents are more evenly spread
between vehicle and pedestrian
collisions
Circumstances of
incidents
 Geographical location
percentage
Proportion of incidents by
geography
70
60
50
40
30
20
10
0
Accident
Suicide
Undetermined
Missing data
Rural area
Accidents occur more often at
crossings and
suicides on open tracks
urban area
Accidents occur more often in
rural areas and
suicides in urban areas
Accidents tend to be at crossings in rural areas
Suicides are more often open trackrack in
urban areas
 No very high frequency hotspots
in Canada
 Out of 278 incidents in clusters,
only 15 clusters with 5+ incidents
over 10 years (max 11 incidents)
 Hotspots
 Suicide clusters are more
common in urban areas
 Accident clusters are more
common in rural areas
 Suicide clusters (35.3%) are more
likely to be close to a psychiatric
hospital than accident clusters
(10.0%) - (Chi2 = 4.54, df=1,
p<.033)
Table 42
Clusters by location
Suicide clusters
N
%
Crossing
22
Open Tracks
23
Station
46.8
Accident
clusters
N
%
Total
N
12
70.6
34
48.9
5
29.4
28
1
2.1
0
0.0
1
Yard
1
2.1
0
0.0
1
Total
47
17
64
Costs associated with train fatalities
 Traffic is stopped an average of 3 hours (from 91 min.
in BC to 207 min. in ON)
 No variation with manner of death, type of incident,
type of train, crossing or track, rural or urban
 Time off and health care
 3 days off : Average of 119 fatalities / year = 357 work days
minimum lost
 Workers compensation : over 51 incidents = 2 workers
stopped completely, 8 took >3days (mean = 77.25 days
off)
 Therapy – costs difficult to assess
Prevention of railway suicide
 Review : Several strategies have been implemented in different countries
 With no proof of effectiveness to date


Public education on safety
Changing desirability of train as a method of suicide
 With minimal proof of effectiveness






Television surveillance
Gatekeepers in stations
Signs (without telephones)
Media education (works sometimes)
Charging families for clean-up
Blue Lighting
A railway suicide
prevention
strategy should
be local and
combine several
activities
 Promising (several studies have shown an effect)




Limiting access to tracks
Phones and signs (effective with bridges and parking areas)
Suicide pits (raised rails) in stations
Preventive education in mental health facilities near tracks (not directly tested on rail suicides, but
can prevent suicides in general)
20
Classification of activities for
railway suicide prevention
Preventing suicide
attempts
Preventing
impact
Preventing
injury
Technical approach
Psychosocial approach
Reducing
risk of
injury
Limiting
access to
tracks
Monitoring
track
trespassing
Discouragin
g trespassing
Identifying
at risk
persons on
railway
property
Identifying
at risk
people in
the
community
Providing
access to help
on and around
railway
property
Providing
access to
help in the
community
Proposals for pilot testing of railway suicide prevention
adapted to the Canadian context
 1. Telephones & signs (expensive)
 1b. Signs only (much less expensive and potential partners, less
probable impact)
 2. Training for mental health institutions (less
expensive)
22
Overall assessment of feasibility (telephones and signs)
Technical
feasibility
Advantages
Public telephone and signage technologies are well
established throughout all concerned provinces
difficulties
The maintenance of telephones equipment might be a
challenge
Vandalism on telephones and signs may be an issue that
would reduce access to help. It may also be a problem for
the telephone service provider who might be reluctant to
be associated with a suicide prevention project if a suicidal
person died after trying to use a damaged telephone to call
for help
Public telephones are currently being withdrawn
everywhere. Therefore, the use of existing telephones to
implement a direct line may prove ineffective
The costs are very high and maintenance costs very difficult
to anticipate
It is financially not possible to install telephones in more
remote rural areas.
Financial
feasibility
Public telephone companies seem willing to help share
costs of installing dedicated telephones through their
community involvement programmes
Potential to
prevent railway
suicides
Direct and easy access to help has proved to be a good
It is not possible to install telephones at every access
means to prevent suicide attempts, when distressed
point to tracks, therefore, the effect will necessarily be
persons in proximity to a means to kill themselves. By
limited, especially outside of urban areas.
placing telephones in strategic places along the tracks, it is
possible to increase help seeking behaviour and reduce the
number of attempts
Potential effects
in other areas
The signs and telephones may increase overall public
access to a helpline, not just potential rail suicide victims.
This may increase help seeking by distressed people in
general and reduce global rates of suicides and suicide
attempts by other means than train
23
Overall assessment of feasibility (training programme)
Advantages
This project does not involve any specific
technical equipment or ability that the
research team does not already possess
Difficulties
It will be difficult to monitor the number of
cases of railway suicide risk that will be
identified by trained staff. Monitoring in such
contexts is notoriously difficult.
Financial feasibility
The project has a relatively low cost.
Parts of the training could potentially be
financed by local mental health governing
bodies such as CSSS in Québec.
An unexpected cost may be associated with
the relatively high turnover rate that mental
health and community services face. More
training sessions than expected may have to be
conducted.
Potential to prevent railway
suicides
Identifying at risk patients is a well
recognised way to improve suicide
prevention.
The present project also aims at training
professionals from psycho-social and
community services, increasing the
chances of reaching suicidal people who do
not seek medical help.
Since not all suicide victims consult a mental
health professional prior to their death, a
prevention strategy that targets mental health
services will not identify of all potentially
suicidal people.
Potential effects in other areas
Training professionals, and offering
refresher sessions helps renew and
maintain their attention to the problem of
evaluating suicide risk in patients. This
increased awareness will apply to all
patients, and should benefit all suicidal
persons, whether or not railway suicide is
of concern.
Technical feasibility
24
Conclusions
 1) There are significant differences between TSB,
Railway Police and Provincial Coroner and Medical
Examiner data. It would be worthwhile to develop a
mechanism to better communicate between the 3
levels to ensure that all have a complete portrait of rail
deaths (suicides and accidents) in Canada
Conclusions
 2) Surprisingly, both suicides and accidents occur
generally when visibility is good, and at any time,
although accidents are more likely in snowy and icy
conditions and suicides are more likely during gloomy
overcast weather. There are however more accidents at
night and early, before 5 am, suggesting that fatigue
may play a role. Fatalities occur near home. Accidents
are more likely at crossings in rural areas and involving
freight trains. Suicides more often occur on open
tracks in urban areas and involve passenger trains.
Conclusions
 3) Substance abuse (mostly alcohol) is involved in 73%
of accidents and 46% of suicides.
Conclusions
 4) Since older adults (>60) and children are more
likely to be accident victims, they could be specific
target populations for prevention activities.
Conclusions
 5) In the case of accidents, a portrait of impairment in
victims is common:
 impaired judgement or
 ability to get out of the way






children
older persons
alcohol and substance abuse
risk taking
late at night or early morning with possible fatique
recent conflicts or problems that may preoccupy victims
 This suggests that more intense warnings to
compensate for impairments may be warranted.
Conclusions
 6) As found in England, a significant number of
suicides were near psychiatric facilities and 35% of
suicide clusters were within 2 miles of a psychiatric
facility. This suggests the possibility of targeting
psychiatric institutions near accessible railway
tracks with prevention activities.
Conclusions
 6) The scene of railway deaths can be very gory:
 66% of cases the body is in more than one piece;
 1 out of 20 cases the body was decapitated
 “blood everywhere” in 88% of fatalities.
 The impact on railway personnel and observers, as well
as emergency personnel who arrive on the scene can
be traumatic. One should also be concerned about the
impact upon onlookers and emergency personnel
called to the scene.
What we need to know



More about who, where, when (including hot spots)
Motivations and beliefs of attempters
WE NEED TO EVALUATE THE IMPACT OF
PREVENTION STRATEGIES USING RIGOROUS
SCIENTIFIC METHODS
We are currently interviewing attempt survivors in
hospital to understand why they chose rail-metro
suicide
We are analysing video tapes of Montreal Metro suicides
to identify behavioural patterns in stations and
testing the validity of our identification methods
We are proposing and plan to evaluate best practices to
reduce the impact on railway personnel
The DANGER of being focussed on our own narrow interests
Some untested ideas inspired from
research findings needing evaluation







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Because of the impaired abilities of accident victims (elders,
children, intoxicated, fatigue, etc.), , MUCH MUCH more
intrusive warnings at crossings and of trains approaching on
open tracks (visual, auditory, sensual (trembling ground?) could
help avoid accidents.
Computerized video surveillance to identify at risk behaviours
and precursors (e.g. our Metro Montreal study)
Emergency phones and posters at hot spots (effectiveness and
what type of image and message is best needs to be determined)
Anti-suicide train bumpers (psychological effects)
Suicide Prevention protocols in mental health facilities that have
multiple train suicides (near hot spots).
Decreasing sensational media reports on railway suicides
Making it embarassing, disgusting, undignified or hurtful to
access tracks
and your ideas?