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Theme: CLAHRC - Mental Health & Dementia
Suicide accounts for over 6,000 UK deaths each year, a third of which take place in a public place. Whilst every suicide is an unnecessary tragedy, those that occur outside the home are of particular concern because their impact extends beyond the usual circle of relatives, friends and acquaintances. They can be highly traumatising for bystanders, as well as those who inadvertently play a part in the death, e.g. train drivers. These types of suicide are also more likely to attract harmful media attention and often incur high incident-management costs.
Preventing suicides in public places occupies a key place in the national suicide prevention strategy. In 2015 Public Health England published new guidance designed to help local authority public health teams identify sites and structures that could be used for suicides and to take action to prevent deaths at those locations. These typically include bridges, cliffs and other sites that provide the means of suicide by jumping from a height, along with sections of the road and railway networks.
Alongside installing physical barriers to restrict access to the means of suicide, the guidance emphasises the need for a broad community approach and highlights the key role that can be played by members of the public. There is compelling anecdotal evidence that lives can be saved by passing strangers acting on the spur of the moment. Broadcast in 2015, The Stranger on the Bridge was a highly-acclaimed documentary that told the story of Jonny Benjamin, who went to Waterloo Bridge to take his own life and was prevented from jumping by the kindness of a passer-by. Human contact will always be the best defense against the isolation and hopelessness that drives a person to suicide but few know how to respond to a mental health crisis or are willing to get involved. This study seeks to address the public health challenge of supporting members of the public to recognise and respond to possible suicidal intent in an unknown person in a public setting.
This early-phase study will underpin the development of an educational campaign, designed to meet the needs of two audiences: (a) the general public, who may encounter a person contemplating a suicidal act and need to react quickly and have the confidence to reach out and offer help; and (b) staff in non-health agencies working at locations that are used for acts of suicide (e.g. bridges, multi-storey car parks, rooftop restaurants, cliffs and coastal paths). We anticipate that there will be a core set of messages that are relevant to both audiences but that some tailoring will be possible for specific staff groups and settings.
We will develop the following intervention elements:
A leaflet will be our starting point. We deliberately chose this format so as to be able to focus on getting the content right without the distraction of technology. Evaluation of our previous work found that, even in a digital world, many people really valued the tactile nature of the paper leaflet, its simplicity and accessibility. In consultation with local public health teams we will disseminate the leaflet via a range of statutory and voluntary community agencies, focusing initially on areas with frequently-used locations, e.g. East Sussex (Beachy Head).
An online version of the above.
The script for a 90-minute face-to-face training session for staff who are likely to encounter vulnerable individuals in the course of their work. A prototype has already been developed and piloted with the RNLI and Coastguard Agency based on our original leaflet, but the content of that leaflet does not fit the ‘stranger on the bridge’ scenario.
Outside the scope of this work, possibly with charity funding, we envisage also being able to develop the script for a television film, following on from the original Stranger on the Bridge documentary and presenting a more detailed picture of the tell-tale signs of suicidal intent, what people’s fears are about intervening and, critically, what people need to know in order to intervene safely, based on research evidence.
To gain an in-depth understanding of the ‘stranger on the bridge’ scenario from the point of view of both ‘rescuer’ and the ‘rescued’, we will conduct qualitative interviews with both groups. Those with experience of being ‘rescued’ will be recruited through mental health recovery networks and adverts in mainstream and social media. Those with experience of intervening will include both members of the public and experienced staff at high-risk locations, e.g. railway staff recruited through Network Rail. To shed light on wider public attitudes, fears and readiness to intervene, we will also interview people who have never been involved, i.e. neither rescuers nor rescued, using a video vignette as a prompt.
Data collection and analysis will be carried out at the same time to allow for progressive focusing and exploration of emerging themes and theories. Once the main findings are clear, we will provisionally formulate core educational messages and produce first drafts of the materials. We will then invite interview participants and other partners to refine and test successive versions, working with us through a series of iterations until we have products that are fully acceptable, appropriate and fit for purpose. This method of co-creation was used effectively in our previous work.
The desired outcome is that lay people (not trained in mental healthcare) will be able to:
Recognise a person who may be contemplating an act of suicide in a public location
Acknowledge and deal with their fears about intervening
Feel confident to approach the person and open a conversation
Know how to get the person to safety or summon professional help if needed.
An equally important outcome is that the campaign does not increase the use of public sites as a means of suicide by advertising their potential to vulnerable individual
A previous MRC-funded project led Professor Owens, Public involvement in suicide prevention: Understanding and strengthening lay responses to distress, focussed on the role of family members and friends. The findings showed how emotional attachment may make it difficult to interpret signs of an impending suicidal crisis and why, within the context of an intimate relationship, any form of crisis intervention may be deemed too risky. Within their close personal relationships people are not rational actors, and the implications of this may be fatal. We concluded that there was a need for a re-framing of public education messages to address specific social contexts and the fears that arise within them.
Using our findings and working in partnership with The Alliance of Suicide Prevention Charities (TASC), Devon County Council and people with lived experience, we produced a simple public education leaflet for concerned family and friends - 'It’s safe to talk about suicide’. An initial 15,000 copies distributed via frontline agencies and community groups proved inadequate. Formal evaluation identified substantial unfilled demand and a desire by agencies to use it in a wide variety of ways, in particular it is being used as a basis for training frontline staff in local authorities and emergency services.
The content was reproduced online by Campaign Against Living Miserably (CALM) as part of their ‘#BiggerIssues’ campaign, sponsored by Lynx. This campaign culminated in a ‘thunderclap’ message to over 23 million people on the 19th November 2015 via social media. The success of the campaign in reaching the public was evident in YouGov polling that found awareness of male suicide had increased by 45%. The leaflet has been endorsed by Public Health England and is being made available nationally via the National Suicide Prevention Alliance (NSPA).
We are still working with the charities to develop further resources for family members and friends and have received funding to allow these resources to be accessed electronically to ensure wider availability.
Christabel Owens and Nigel Charles. Development and evaluation of a leaflet for concerned family members and friends: "It's safe to talk about suicide". Health Education Journal (2017)
Christabel Owens, Rebecca Hardwick, Nigel Charles and Graham Watkinson. Preventing suicides in public places: a practice resource. Public Health England (2015)
Public Health England
The National Suicide Prevention Alliance
The Alliance of Suicide Prevention Charities
James Wentworth-Stanley Memorial Fund
The Matthew Elvidge Trust
Judi Meadows Memorial Fund
Royal National Lifeboat Institution (RNLI)
Jonny Benjamin MBE
Dr Jane Derges, Research Fellow