Public Involvement in Suicide Prevention II: The Stranger on the Bridge

Lead Research Organisation: University of Exeter
Department Name: University of Exeter Medical School

Abstract

It is widely accepted that "suicide prevention is everybody's business," but most research has focused on the role of health professionals in identifying and managing suicide risk within clinical settings. Much less attention has been paid to the contribution that members of the public (with no healthcare training) can make, or the resources they need in order to do so.

In a previous project funded by the MRC, we examined the role of family members and friends. We used qualitative methods to shed light on the difficulties they face in trying to interpret signs of a suicidal crisis and decide what action, if any, to take. We then formed a partnership with all the leading suicide prevention charities to develop and evaluate simple public education materials that address those difficulties. Those resources are designed for people who are concerned that someone close to them may be suicidal.

We now wish to use the same approach to address a very different scenario, namely the 'Stranger on the Bridge'. This was the title of a highly-acclaimed Channel 4 documentary, broadcast in 2015, which 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. Of the 6,000 suicides that occur in the UK each year, around a third take place in a public location. Many of these involve jumping from bridges, cliffs and high buildings, or use of the railway network. Some of these deaths may be prevented by the installation of physical barriers, but human intervention will always play a vital role. This is most likely to come from a passing stranger, but few people know how to recognise someone at risk or are willing to get involved. We want to increase the number of people who are able to recognise and reach out to someone in a public place who may be contemplating suicide.

First we need to gain an in-depth understanding of the Stranger on the Bridge scenario from the point of view of those who have been involved, both as 'rescuers' and 'rescued'. We will advertise for both through adverts in mainstream and social media, aiming to interview around 10 people with experience of being rescued and 20 people with experience of intervening, including some railway staff. We aim to discover: a) what signs and signals a person contemplating a suicidal act is likely to exhibit; b) how passers-by interpret those signals and understand what is happening; c) what fears people have about intervening and how they decide whether or not to do so; d) what are the core components (both verbal and non-verbal) of an effective intervention by a lay person. We will also interview some people who have no experience of this situation to find out about wider public attitudes and fears.

Using the findings, we will work collaboratively with a range of non-academic partners to formulate key messages and develop a set of resources to be used in an educational campaign. We will start by developing a simple leaflet for distribution to members of the public, and an online version of the same. We will also develop a 90-minute face-to-face training session for staff at the sort of locations that are used for suicide, e.g. bridges, multi-storey car parks, rooftop restaurants, cliffs and coastal paths, and railways. We will evaluate these in a later study, and hope to go on to develop other materials using different media at a later date.

Our strong project group includes academics from the University of Exeter, the documentary-maker Jonny Benjamin, who survived his own suicidal episode thanks to a stranger, together with representatives of the suicide prevention charities, Public Health England, Network Rail and the RNLI.

Technical Summary

BACKGROUND: Suicide is an important public health problem, accounting for over 6,000 UK deaths each year. Approximately one third of these take place in a public place, many involving jumping from bridges and high buildings or use of the railway network. Previous research on preventing suicides in public places has measured the effectiveness of installing physical barriers at particular sites. Little attention has been paid to human behaviour and the potential for a passing stranger to offer emergency life-support to a suicidal person. 'The Stranger on the Bridge' was a 2015 Channel 4 documentary, which told the true story of one such successful intervention. Our aim is to equip more members of the public to recognise and respond to someone who is contemplating suicide in a public place.

OBJECTIVES:
i) Gain an in-depth understanding of the situation from the point of view of 'rescuers' and 'rescued'
ii) Identify tell-tale signs of suicidal intent, public fears about intervening and core components of an effective intervention by a lay person
iii) Translate the knowledge into simple, safe and memorable messages, and work with non-academic partners to co-create educational materials.

INTERVENTION: Initially,
i) a simple leaflet for distribution to members of the public, and an online version of the same,
ii) a brief face-to-face training session for staff at locations that are used for suicide, e.g. bridges, cliffs and railways.
We will evaluate these in a later study.

METHOD: Qualitative interviews with those who have been rescued (n=10) and those who have intervened (n=20) about their experiences. Qualitative interviews using a video vignette with those who have never been involved (n=20) about their attitudes and fears. Thematic analysis of all data. Using the findings, we will provisionally formulate educational messages and draft materials and invite interview participants and non-academic partners to refine and test successive versions.

Publications

10 25 50
 
Description Membership of Highways England Expert Advisory Group (Suicide Prevention on the Strategic Road Network)
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description Beachy Head 
Organisation East Sussex County Council
Country United Kingdom 
Sector Public 
PI Contribution Expertise and intellectual input to inform decisions on how to manage suicide risk at a key location.
Collaborator Contribution The partner did not contribute to the research. We are in discussion about implementation of findings.
Impact none as yet
Start Year 2018
 
Description Highways England training 
Organisation Department of Transport
Department Highways Agency
Country United Kingdom 
Sector Public 
PI Contribution We supplied pre-publication findings (under the terms of an NDA), together with intellectual input to inform the development of a training module for Highways England traffic officers. This is currently being rolled out to 2,000 traffic officers and Asset Delivery staff (Highways Inspectors etc) nationwide.
Collaborator Contribution These partners did not contribute to the research itself. They are implementing the findings and delivering impact.
Impact Development of training module for Highways England traffic officers.
Start Year 2019
 
Description Highways England training 
Organisation The Centre for Crisis Psychology
Country United Kingdom 
Sector Private 
PI Contribution We supplied pre-publication findings (under the terms of an NDA), together with intellectual input to inform the development of a training module for Highways England traffic officers. This is currently being rolled out to 2,000 traffic officers and Asset Delivery staff (Highways Inspectors etc) nationwide.
Collaborator Contribution These partners did not contribute to the research itself. They are implementing the findings and delivering impact.
Impact Development of training module for Highways England traffic officers.
Start Year 2019
 
Description National Trust: suicides from coastline and cliffs 
Organisation National Trust
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution Expertise and intellectual input to inform decisions on how to manage suicide risk at key locations and stretches of land owned by the National Trust. So far activity has consisted of: An initial meeting and site visit; A written report of site visit with recommendations, including recommendations for routine data gathering and research.
Collaborator Contribution The partner initiated the partnership, and, since the site visit, has won funding for a preliminary study.
Impact None as yet
Start Year 2019
 
Description University of Middlesex 
Organisation Middlesex University
Country United Kingdom 
Sector Academic/University 
PI Contribution We supplied pre-publication findings and intellectual input to inform the design and conduct of a further study. Played key role in Advisory Group, attended meetings, advised on study design and commented on findings. Plan to collaborate on development and implementation of public education messaging.
Collaborator Contribution Invitation to join expert advisory group and collaborate on further funded research.
Impact none as yet
Start Year 2018
 
Description University of Middlesex 
Organisation Network Rail Ltd
Country United Kingdom 
Sector Private 
PI Contribution We supplied pre-publication findings and intellectual input to inform the design and conduct of a further study. Played key role in Advisory Group, attended meetings, advised on study design and commented on findings. Plan to collaborate on development and implementation of public education messaging.
Collaborator Contribution Invitation to join expert advisory group and collaborate on further funded research.
Impact none as yet
Start Year 2018
 
Description University of Middlesex 
Organisation The Samaritans
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution We supplied pre-publication findings and intellectual input to inform the design and conduct of a further study. Played key role in Advisory Group, attended meetings, advised on study design and commented on findings. Plan to collaborate on development and implementation of public education messaging.
Collaborator Contribution Invitation to join expert advisory group and collaborate on further funded research.
Impact none as yet
Start Year 2018
 
Description Highways England Suicide Prevention Strategy Group 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Industry/Business
Results and Impact Gave presentation to above group. Resulted in invitation to contribute to writing of Highways England (HE) Suicide Prevention Strategy and join expert advisory group. Also resulted in decision to commission development and delivery of suicide intervention skills training to all HE traffic officers. We are contributing to the development of this module currently.
Year(s) Of Engagement Activity 2018
 
Description Presentation to Samaritans/Network Rail training team 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Supporters
Results and Impact Gave talk at Samaritans head office. Audience included members of their Network Rail training team. The talk sparked questions and lively discussion, especially in relation to some controversial areas.
Year(s) Of Engagement Activity 2018
 
Description Presentation to South of England Mental Health Collaborative 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Approx 150 mental health practitioners and service users attended a two-day learning event. We gave a presentation of research findings and their implications, which sparked lively discussion. We received very positive feedback but it is not possible to identify specific outcomes.
Year(s) Of Engagement Activity 2018
 
Description Presentation to TASC 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Supporters
Results and Impact Gave talk to members of The Alliance of Suicide Prevention Charities.
Year(s) Of Engagement Activity 2018
 
Description Presentation to full-day workshop, 'Suicide Prevention: Working Together in Devon' 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Gave a presentation of research findings and their implications, which sparked questions and lively debate and informed subsequent group activity.
Year(s) Of Engagement Activity 2018
 
Description Talk organised by University of Exeter Mental Health Society 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact Gave an invited and publicly advertised talk to Exeter University students and members of the general public on how to recognise a person at risk of suicide in a public place and make an effective last-minute intervention.
Year(s) Of Engagement Activity 2019
 
Description Talk organised by University of New England, Armidale, NSW, Australia 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Gave talk to university staff, students, healthcare practitioners and members of the general public.
Year(s) Of Engagement Activity 2019
 
Description University of Exeter Students Guild presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Undergraduate students
Results and Impact Gave an invited talk to large group of University of Exeter students, organised by the Students Guild as part of a mental health awareness campaign. Sparked questions and very lively discussion. Several students asked if they could get involved in future research.
Year(s) Of Engagement Activity 2019