an evaluation of a national suicide prevention programme dr ann mills head of human factors, rssb,...
TRANSCRIPT
An evaluation of a national suicide prevention programme
Dr Ann Mills
Head of Human Factors, RSSB, UK
D. Hill (The Tavistock Institute)
S. Stace, S Burden (Samaritans)
T. Luke, A. Monk, S. Pitman, M.Dacre, A. Moor, K. Thompson (RSSB)
Historical railway fatalities
Comparing suicides to trespass fatalities
2006-7 2007-8 2008-9 2009-10
2010-11
2011-12
0
50
100
150
200
250
300
350
SuicidesTrespassAccidental fatalities: passengerAccidental fatalities: work-force
Num
ber o
f fat
aliti
es
5 times more fatalities as a result of suicide attempt than trespass80% of recorded attempted suicides result in a fatality
The national picture in relation to railway suicides
• Estimated that there were 6,045 suicides in the UK in 2011, or one every 87 minutes
• Twice as likely to die by suicide as in a road traffic accident
• More men than women take their own lives• Around 80% of railway suicides are by men• Men aged 30-55 are the highest risk group
Programme details
Partnership working• National Suicide Group• Identification of priority locations• Joint suicide prevention plans• Development of guidelines and polices • Wider third part engagement
Postvention• Suicide trauma support training (TST)• Post incident support• Guidance to rail staff/industry on responding to media enquiries
Prevention• Managing suicide contacts training (MSC)• Public awareness campaign (posters, leaflets & contact cards, signs)• Physical measures (barriers)• Outreach (ESOB)
In Stations
At Level Crossings
Posters
Programme & Evaluation challenges
• Complex, evolving programme, involving lots of parties• Programme gaining momentum & impact – delay in
results• Level of engagement influenced by views on whether it
is a societal issue or railway issue to manage, experience, number of manned stations…..
• Challenges in consistent delivery of programme• Impact being felt not just at priority locations• Other parties undertaking activities that are not formally
‘part of programme’• Changes in suicide rates – too crude a measure?
Example Theory of Change map
Actions
Anticipated rise in suicides Staff recruited
for training (in sufficient numbers)
Priority locations identified
More people aware of and using Samaritans
Staff training developed
Folders, cards and posters distributed
Proven interventions not being used
Change in staff attitudes and confidence to intervene
Staff proactive in identifying other risks
Outputs Outcomes Impacts
(More) staff identify potential suicides and intervene
Increased understanding of Samaritan’s role
Number of rail suicides reduced
Samaritan data on numbers/roles/location of attendeesData on referral patterns of network rail and TOC reps (interviews)
Post course questionnairesStaff survey (WP6) for evidence of changes in knowledge, attitudes and confidence
Data on staff interventions WP2 and WP6 Data on partnership working at a local level WP4
Data on rail suicides WP1 identifies any connections between suicides and programme interventions
Sources of data
Other interventions put in place (physical measures, links to other local initiatives)
Interviews with Samaritan team and trainers
Route and TOC reps appointed
Staff use folders and other materials
Staff proactive in ensuring posters displayed/using call out service
Network rail team site visits
Managing Director instructs Station ManagersRoute Reps send info on coursesHead of Stations nominate staff
Issues
Evaluation methods
1. Analysis of number of suicides
2. Analysis of delay minutes, costs and staff absenteeism
3. Survey of partners
4. Station/Intervention case studies
5. Front line staff survey
Programme roll-out
Y12010/11
Y22011/12
Y32012/13
Priority locations 175 237 254
Priority locations with posters 105 191 152
Priority locations with ESOB capability 63 159 251
ESOB activations 0 1 7
MSC courses 91 130 159
Staff trained - MSC 940 1315 1211
Staffed trained - TST N/A 187 631
Staff interventions 10 25 22
Post incident support - offered 172 253
Post incident support - accepted 78 42
Reduction?
75 73 77 72 85 90 94 80100 94
18 20 25 2220 23
3326
25 25
96 100
123 131 102105
107
97
113 119
189 193
225 225
207218
234
203
238 238
0
50
100
150
200
250
300
2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13
Fata
litie
s
Other locations
Level crossing
In stations
Rail vs national picture
2002 2003 2004 2005 2006 2007 2008 2009 2010 20110
50
100
150
200
250
300
350
400
0
1000
2000
3000
4000
5000
6000
7000
8000
4120
36803920 4080
4900
4120 41404380 4500
4280
5826 5731 58505671 5554 5377 5706 5675 5608
6045
10607.6%9631.8%10051.3%10791.7%
13233.7%11493.4%10883.3%11577.1%12036.4%
10620.3%
On railway property
All suicides
Railway suicides as % of national to-tal
Ra
ilwa
y s
uic
ide
s
Na
tion
al s
uic
ide
s
Impact at priority locations
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120
10
20
30
40
50
60
70
80
90
4945 43
39
57 56
7481 79
68
56 53
Priority locations 2012
Cost and Disruption
TRUST delay costs and SMIS delay minutes:
TRUST Costs (£)
SMIS delay (mins)
2009 / 10 19,841,000 298,143
2010 / 11 11,033,000 227,860
2011 / 12 20,716,000 391,267
2012 / 13 296,112
2009 2 hours 44 mins 2012 1 hour 59 mins
Partnership working
Establishment of National Suicide Prevention Steering Group & Working Group
87% felt programme improved partnership working
77% felt programme reduced staff distress
77% felt programme had reduced service disruption
37% felt good practice effectively implemented nationally
Perceived effectiveness of programme activities
Physical barriers
Samaritans Metal signs
MSC training
Posters
Local suicide prevention plans
External engagement
Samaritans info for staff
ESOB
Risk assessments
Memorials policy
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Perception of how effective each programme activity is at reducing suicides
Would increase the number of suicides Don’t knowWould decrease the number of suicides
Perceived effectiveness of programme activities at reducing staff distress
Trauma support training
ESOB
Samaritans information for staff
MSC training
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Perceived effectiveness of programme activities at reducing staff distress
Increases distress No effect Decreases distress
Effect of the programme on relationship between your organisation and other organisations
Samaritans
Own organisation
Train Operating Companies
BTP
Network Rail
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Perceived effect of programme on relationships with different organisa-tions
Worse No effect Better
Willingness to participate in programme activities
TST
Local suicide prevention plans
MSC
Samaritans info for staff
External engagement
Station risk assessment
ESOB
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Staff willingness to take part in programme activities
Would/might refuse to take part Don’t knowWilling/keen to take part
Introduction to the ATTS
• 24 item survey• Respondents rate agreement with attitude statements
e.g. ‘It is a human duty to stop someone taking his/her life’
• Factors:– Obligation to prevent– Acceptance of suicide– Unpredictability of suicide– Suicide as a long lasting issue– Suicide as a taboo subject– Reasons why people take their own life– Preventability of suicide
Effect of MSC training on attitudes
Obligation to prevent
Preventability
Openness/acceptance of suicide
Reasons why people take their own life
Unpredictability of suicide
Suicide as a long-lasting issue*
Suicide as a taboo subject to talk about
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5
Participation in MSC training and attitudes
Overall No Yes
Average attitude score (max 5)
Atti
tud
e fa
cto
r
Frontline staff attitudes compared to ‘management’ attitudes
Obligation to prevent*
Preventability*
Openness/acceptance of suicide*
Suicide as a long-lasting issue*
Suicide as a taboo subject to talk about*
Unpredictability of suicide*
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5
Oganisational level and attitudes
Local level respondents (N ~ 670) National level respondents (N ~ 52)
Average attitude score (Max = 5)
Atti
tud
e fa
cto
r
Recognition of people who might be suicidal
Never seen anyone
Seen someone once or more than once
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100%
Participation in MSC training and whether staff have seen someone they suspected of being suicidal
Participation in MSC No Participation in MSC Yes
MSC training and interventions
Not attended MSC
Attended MSC
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Whether an intervention has been made if someone was suspected of suicide
No Yes once or more than once
Effect of MSC training on intervention actions
Offer safe place to go to talk*
Contact BTP
Try to show empathy and understanding*
Introduce yourself and ask their name*
Encourage the person to talk and listen*
Provide Samaritans contact details*
Approach and ask how they are*
Ask for permission to pass contact details to Samaritans*
Request Samaritans ESOB service
Physically restrain them
Give advice about how to solve problems
Tell them you know how they feel*
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5
Average likelihood to take an action (Max = 5)
Attendance at MSC training Yes (N ~ 83) Attendance at MSC training No (N ~ 212)
Summary of findings
• Evaluation of a programme of this nature is challenging• Partnership working had improved as a result of the programme• Wide variations in level of implementation• No evidence to date to suggest programme has led to reduction
in number of suicides, reduction in delays or cancelations • BUT Improvement in response times.• Staff willingness to be involved is high• Programme activities are perceived as being effective at reducing
suicides and staff distress.• MSC training has had a positive effect on the ability of staff to
recognise when someone is suicidal and on the quality of the interventions.
• The rate of interventions when someone is recognised as potentially suicidal is high regardless of MSC training.