An evaluation of a national suicide
prevention programme
Dr Ann Mills
Head of Human Factors, RSSB, UK
D. Hill (The Tavistock Institute)
S. Stace, S Burden (Samaritans)
T. Luke, A. Monk, S. Pitman, M.Dacre, A. Moor, K. Thompson (RSSB)
Historical railway fatalities
Comparing suicides to trespass fatalities
5 times
80% of
more
recorded
fatalities
attempted
as a result
suicides
of suicide
resultattempt
in a fatality
than trespass
350
Number of fatalities
300
250
Suicides
200
Trespass
150
Accidental fatalities:
passenger
100
Accidental fatalities:
workforce
50
0
2006-7 2007-8 2008-9 2009-10 2010-11 2011-12
The national picture in relation to railway suicides
• Estimated that there were 6,045 suicides in the UK in
2011, or one every 87 minutes
• Twice as likely to die by suicide as in a road traffic
accident
• More men than women take their own lives
• Around 80% of railway suicides are by men
• Men aged 30-55 are the highest risk group
Programme details
Partnership working
• National Suicide Group
• Identification of priority locations
• Joint suicide prevention plans
• Development of guidelines and polices
• Wider third part engagement
Prevention
• Managing suicide contacts training (MSC)
• Public awareness campaign (posters, leaflets & contact cards, signs)
• Physical measures (barriers)
• Outreach (ESOB)
Postvention
• Suicide trauma support training (TST)
• Post incident support
• Guidance to rail staff/industry on responding to media enquiries
In Stations
At Level Crossings
Posters
Programme & Evaluation challenges
• Complex, evolving programme, involving lots of parties
• Programme gaining momentum & impact – delay in
results
• Level of engagement influenced by views on whether it
is a societal issue or railway issue to manage,
experience, number of manned stations…..
• Challenges in consistent delivery of programme
• Impact being felt not just at priority locations
• Other parties undertaking activities that are not formally
‘part of programme’
• Changes in suicide rates – too crude a measure?
Example Theory of Change map
Issues
Actions
Route and TOC
reps appointed
Priority locations
identified
Anticipated rise in
suicides
Proven
interventions not
being used
Staff training
developed
Managing Director instructs
Station Managers
Route Reps send info on
courses
Head of Stations nominate
staff
Staff recruited
for training (in
sufficient
numbers)
Outcomes
Staff proactive
in identifying
other risks
Change in
staff attitudes
and
confidence to
intervene
Impacts
Other interventions
put in place (physical
measures, links to
other local initiatives)
(More) staff
identify potential
suicides and
intervene
Number of
rail suicides
reduced
Network rail
team site visits
Folders, cards
and posters
distributed
Sources
of data
Outputs
Interviews
with
Samaritan
team and
trainers
Staff use
folders and
other materials
Samaritan data
on
numbers/roles/
location of
attendees
Data on referral
patterns of
network rail and
TOC reps
(interviews)
Increased
understanding of
Samaritan’s role
Post course
questionnaires
Staff survey
(WP6) for
evidence of
changes in
knowledge,
attitudes and
confidence
Staff proactive in
ensuring posters
displayed/using
call out service
Data on staff
interventions WP2
and WP6
Data on
partnership
working at a local
level WP4
More people
aware of and
using
Samaritans
Data on rail
suicides WP1
identifies any
connections
between suicides
and programme
interventions
Evaluation methods
1.
2.
3.
4.
5.
Analysis of number of suicides
Analysis of delay minutes, costs and staff absenteeism
Survey of partners
Station/Intervention case studies
Front line staff survey
Programme roll-out
Y1
2010/11
Y2
2011/12
Y3
2012/13
Priority locations
175
237
254
Priority locations with posters
105
191
152
Priority locations with ESOB capability
63
159
251
ESOB activations
0
1
7
MSC courses
91
130
159
Staff trained - MSC
940
1315
1211
Staffed trained - TST
N/A
187
631
Staff interventions
10
25
22
Post incident support - offered
172
253
Post incident support - accepted
78
42
Reduction?
300
Other locations
Level crossing
250
In stations
225
234
225
207
Fatalities
200
189
150
96
20
25
20
73
77
72
85
119
25
25
100
94
97
23
33
26
22
50
75
105
100
100
18
102
113
203
107
131
238
218
193
123
238
90
94
80
0
2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13
Rail vs national picture
400
8000
On railway property
All suicides
350
5826
5731
5850
6045
5671
5554
5377
5706
5675
6000
5608
245
250
206
200
184
196
206
204
207
219
4.4%
3.2%
3.4%
225
5000
214
4000
150
3.5%
7000
3.8%
3.6%
3.6%
3.9%
3000
4.0%
3.5%
100
2000
50
1000
0
0
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
National suicides
Railway suicides
300
Railway suicides as % of national total
Impact at priority locations
90
81
80
74
68
70
57
60
50
40
79
49
45
43
56
56
53
39
30
20
10
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Priority locations 2012
Cost and Disruption
TRUST delay costs and SMIS delay minutes:
TRUST
Costs (£)
SMIS delay
(mins)
2009 / 10
19,841,000
298,143
2010 / 11
11,033,000
227,860
2011 / 12
20,716,000
391,267
2012 / 13
2009 2 hours 44 mins
296,112
2012 1 hour 59 mins
Partnership working
Establishment of National Suicide Prevention Steering
Group & Working Group
87% felt programme improved partnership working
77% felt programme reduced staff distress
77% felt programme had reduced service disruption
37% felt good practice effectively implemented nationally
Perceived effectiveness of programme activities
Perception of how effective each programme activity is at reducing suicides
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Physical barriers
Samaritans Metal signs
MSC training
Posters
Local suicide prevention plans
External engagement
Samaritans info for staff
ESOB
Risk assessments
Memorials policy
Would increase the number of suicides
Don’t know
Would decrease the number of suicides
Perceived effectiveness of programme activities
at reducing staff distress
Perceived effectiveness of programme activities at reducing staff distress
0%
10%
20%
30%
40%
50%
60%
70%
Trauma support training
ESOB
Samaritans information for staff
MSC training
Increases distress
No effect
Decreases distress
80%
90% 100%
Effect of the programme on relationship between
your organisation and other organisations
Perceived effect of programme on relationships with different
organisations
0%
10%
20%
30%
40%
50%
Samaritans
Own organisation
Train Operating Companies
BTP
Network Rail
Worse
No effect
Better
60%
70%
80%
90% 100%
Willingness to participate in programme activities
Staff willingness to take part in programme activities
0%
10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
TST
Local suicide prevention plans
MSC
Samaritans info for staff
External engagement
Station risk assessment
ESOB
Would/might refuse to take part
Don’t know
Willing/keen to take part
Introduction to the ATTS
• 24 item survey
• Respondents rate agreement with attitude statements
e.g. ‘It is a human duty to stop someone taking his/her
life’
• Factors:
–
–
–
–
–
–
–
Obligation to prevent
Acceptance of suicide
Unpredictability of suicide
Suicide as a long lasting issue
Suicide as a taboo subject
Reasons why people take their own life
Preventability of suicide
Effect of MSC training on attitudes
Participation in MSC training and attitudes
Average attitude score (max 5)
0
0.5
Yes
No
1
Obligation to prevent
Attitude factor
Preventability
Openness/acceptance of suicide
Reasons why people take their own life
Unpredictability of suicide
Suicide as a long-lasting issue*
Suicide as a taboo subject to talk about
Overall
1.5
2
2.5
3
3.5
4
4.5
Frontline staff attitudes compared to
‘management’ attitudes
Oganisational level and attitudes
0
0.5
1
Average attitude score (Max = 5)
1.5
2
2.5
3
3.5
4
Obligation to prevent*
Attitude factor
Preventability*
Openness/acceptance of suicide*
Suicide as a long-lasting issue*
Suicide as a taboo subject to talk about*
Unpredictability of suicide*
National level respondents (N ~ 52)
Local level respondents (N ~ 670)
4.5
5
Recognition of people who might be suicidal
Participation in MSC training and whether staff have seen someone
they suspected of being suicidal
Seen someone once or more than once
Never seen anyone
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Participation in MSC No
Participation in MSC Yes
MSC training and interventions
Whether an intervention has been made if someone
was suspected of suicide
Attended MSC
Not attended MSC
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
No
Yes once or more than once
Effect of MSC training on intervention actions
Average likelihood to take an action (Max = 5)
Tell them you know how they feel*
Give advice about how to solve problems
Physically restrain them
Request Samaritans ESOB service
Ask for permission to pass contact details to Samaritans*
Approach and ask how they are*
Provide Samaritans contact details*
Encourage the person to talk and listen*
Introduce yourself and ask their name*
Try to show empathy and understanding*
Contact BTP
Offer safe place to go to talk*
0
Attendance at MSC training Yes (N ~ 83)
0.5
1
1.5
2
2.5
3
3.5
4
Attendance at MSC training No (N ~ 212)
4.5
5
Summary of findings
•
•
•
•
•
•
•
•
•
Evaluation of a programme of this nature is challenging
Partnership working had improved as a result of the programme
Wide variations in level of implementation
No evidence to date to suggest programme has led to reduction in
number of suicides, reduction in delays or cancelations
BUT Improvement in response times.
Staff willingness to be involved is high
Programme activities are perceived as being effective at reducing
suicides and staff distress.
MSC training has had a positive effect on the ability of staff to
recognise when someone is suicidal and on the quality of the
interventions.
The rate of interventions when someone is recognised as potentially
suicidal is high regardless of MSC training.
Thank you
Dr Ann Mills
ann.mills@rssb.co.uk