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

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.

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.