In this guest blog, Professor Kamaldeep Bhui writes on the issue of railway suicides, and what can be done to address the issue.
There are 350 fatalities on the railways a year, according to the British Transport Police (BTP). Of these, 84% are believed to be suicides and 41% of the deceased had a mental health history. In a month, there are 1,700 incidents involving mental health issues and 2,700 incidents of suicidal behaviour each year.
Such is the concern that the Cultural Consultation Service (CCS) and Careif were commissioned by NHS England to do a review and produce a report, Railways Suicides in the UK: Risk factors and prevention strategies. Launched in October at a one-day conference hosted by CCS, there were presentations from the BTP, Samaritans, Network Rail, NHS England, and colleagues from the NGO and professional sectors.
There is a lot of work to be done. The BTP opened 680 suicide prevention plans in one year as a response to manage the risk. From a smaller area analysis, in a 3-month period, only 5 out of 11 people involved in suicidal incidents in the London Borough of Camden lived in the locality, suggesting that in-migration and travel hotspots face more incidents than is usual for the levels of staffing and resourcing at stations currently.
Suicide involves a tragic loss of life and the trauma impacts on friends, relatives and families. With railway suicides, there is the additional burden of a very violent end, leaving train drivers and fellow commuters to witness the event, creating a wider traumatic impact.
The question is how can those at risk of suicide be identified earlier? One recommendation to come out of our research is to transform railway stations – the location of most railways suicides – into public health hubs to allow screening for health problems among passengers to take place. This approach will appeal to the public health functions of transport venues.
It is believed that the reason railway stations are selected for suicide attempts is because they are so remote. Although many people are present in train stations, very few are engaged in a shared activity or connected to each other through a meaningful relationship or shared objectives. This reflects what social psychologist Emile Durkheim called an ‘anomie’ or the sense of isolation, lack of belonging or lack of a place in the world.
While recommendations often suggest training for police officers or mental health practitioners, with railway suicides concerns arise because there isn’t a single emergency care pathway where all emergency services and statutory agencies have an agreed role. Such a pathway would enable them to act in a complementary manner, irrespective of the service, borough or locality. Ambulance staff, accident and emergency departments, and even passengers and the wider public, need to be consulted and involved in this issue. It will help to deter inappropriate behaviour and encourage cautious and safe alerts to the BTP and mental health services.
For this approach to materialise in practice there has to be a greater sharing of information between the relevant agencies, including using technologies to identify those already in contact with mental health services and who are seen as at risk. Risk might mean past suicide attempts, or specifically past railway-related suicide attempts or hospital sites located near to railway stations.
The reality is that millions of people pass through these transport hubs every day, providing ample opportunity to disseminate positive health messages more generally. For example, informing commuters about safety, nutrition, lifestyles and physical activity, or about where to seek help for health problems such as cancer, heart disease and mental illness, including self-harming behaviour and thoughts about suicide.
Based on the worrying railway suicides statistics, we need to come to a decision on the way forward, sooner rather than later.
Professor Kamaldeep Bhui is director of the Cultural Consultation Service at the Wolfson Institute of Preventive Medicine, Queen Mary University of London. www.culturalconsultation.org.uk