Brian L. Mishara, Ph.D., Director Centre for Research and Intervention on Suicide and Euthanasia...
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Railway Suicides in Canada and Around the World: Agendas for Prevention and Research 23 rd International Rail Safety Conference, Vancouver, 7 October 2013 Brian L. Mishara, Ph.D., Director Centre for Research and Intervention on Suicide and Euthanasia Professor, Psychology Department [email protected]& Cécile Bardon, M.S., Project Coordinator Centre for Research and Intervention on Suicide and Euthanasia Université du Québec à Montréal www.railwaysuicideprevention.com
Brian L. Mishara, Ph.D., Director Centre for Research and Intervention on Suicide and Euthanasia Professor, Psychology Department [email protected]
Brian L. Mishara, Ph.D., Director Centre for Research and
Intervention on Suicide and Euthanasia Professor, Psychology
Department [email protected] & Ccile Bardon, M.S., Project
Coordinator Centre for Research and Intervention on Suicide and
Euthanasia Universit du Qubec Montral
www.railwaysuicideprevention.com
Slide 2
Slide 3
IMPOSSIBLE TASK: CRITICALLY SUMMARIZE RAIL SUICIDE PREVENTION
in 25 MINUTES
Slide 4
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
Slide 5
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
Slide 6
Slide 7
Slide 8
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.
Slide 9
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
Slide 10
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
Slide 11
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 -
Slide 12
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 re- think plans)
Slide 13
Overview of the global project PeriodPhaseObjectivesResults
2009- 2010 1Detailed 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) 2009- 2010
2Analysis 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)
2010-20113aLiterature review on railway suicide preventive measures
Review of preventive strategies around the world and their
effectiveness (report Phase 3a) 2010-20113bLiterature 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)
20114Development 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)
2012-20145Knowledge 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 suicide prevention strategies. Seek funding
for pilot programmes.
Slide 14
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
Slide 15
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)
Slide 16
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
Slide 17
Circumstances of incidents Geographical location Accidents
occur more often at crossings and suicides on open tracks 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
Slide 18
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
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
Slide 20
Prevention of railway suicide 20 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 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) A railway suicide prevention strategy should
be local and combine several activities
Slide 21
Providing access to help in the community Identifying at risk
people in the community Providing access to help on and around
railway property Identifying at risk persons on railway property
Discouragin g trespassing Monitoring track trespassing Limiting
access to tracks Reducing risk of injury Technical
approachPsychosocial approach Preventing impact Preventing suicide
attempts Preventing injury Classification of activities for railway
suicide prevention
Slide 22
Proposals for pilot testing of railway suicide prevention
adapted to the Canadian context 22 1. Telephones & signs
(expensive) 1b. Signs only (much less expensive and potential
partners, less probable impact) 2. Training for mental health
institutions (less expensive)
Slide 23
23 Overall assessment of feasibility (telephones and signs)
Advantagesdifficulties Technical feasibility Public telephone and
signage technologies are well established throughout all concerned
provinces 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 Financial feasibility Public telephone companies seem
willing to help share costs of installing dedicated telephones
through their community involvement programmes 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. Potential to prevent railway suicides Direct and easy access
to help has proved to be a good means to prevent suicide attempts,
when distressed persons in proximity to a means to kill themselves.
By placing telephones in strategic places along the tracks, it is
possible to increase help seeking behaviour and reduce the number
of attempts It is not possible to install telephones at every
access point to tracks, therefore, the effect will necessarily be
limited, especially outside of urban areas. 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
Slide 24
Overall assessment of feasibility (training programme) 24
AdvantagesDifficulties Technical feasibilityThis project does not
involve any specific technical equipment or ability that the
research team does not already possess 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 feasibilityThe project has a
relatively low cost. Parts of the training could potentially be
financed by local mental health governing bodies such as CSSS in
Qubec. 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 areasTraining 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.
Slide 25
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
Slide 26
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.
Slide 27
Conclusions 3) Substance abuse (mostly alcohol) is involved in
73% of accidents and 46% of suicides.
Slide 28
Conclusions 4) Since older adults (>60) and children are
more likely to be accident victims, they could be specific target
populations for prevention activities.
Slide 29
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.
Slide 30
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.
Slide 31
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.
Slide 32
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
Slide 33
Slide 34
The DANGER of being focussed on our own narrow interests
Slide 35
Some untested ideas inspired from research findings needing
evaluation 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?