An evaluation of a national suicide p revention programme

1. 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)

2. Historical railway fatalities

3. Comparing suicides to trespass fatalities 5 times more fatalities as a result of suicide attempt than trespass 80% of recorded attempted suicides result in a fatality

4. 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

5. Programme details Partnership working • National Suicide Group • Identification of priority locations • Joint suicide prevention plans • Development of guidelines and polices • Wider third part engagement Prevention • Managing suicide contacts training (MSC) • Public awareness campaign (posters, leaflets & contact cards, signs) • Physical measures (barriers) • Outreach (ESOB) Postvention • Suicide trauma support training (TST) • Post incident support • Guidance to rail staff/industry on responding to media enquiries

6. In Stations

7. At Level Crossings

8. Posters

9. 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?

10. Outputs Outcomes Impacts Managing Director instructs Station Managers Route Reps send info on courses Head of Stations nominate staff Staff proactive in identifying other risks Other interventions put in place (physical measures, links to other local initiatives) Route and TOC reps appointed Priority locations identified Anticipated rise in suicides Change in staff attitudes and confidence to intervene Staff recruited for training (in sufficient numbers) (More) staff identify potential suicides and intervene Number of rail suicides reduced Staff training developed Proven interventions not being used Network rail team site visits Staff use folders and other materials Increased understanding of Samaritan’s role Staff proactive in ensuring posters displayed/using call out service More people aware of and using Samaritans Folders, cards and posters distributed Sources of data Post course questionnaires Staff survey (WP6) for evidence of changes in knowledge, attitudes andconfidence Samaritan data on numbers/roles/ location of attendees Data on referral patterns of network rail and TOC reps (interviews) 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 Interviews with Samaritan team and trainers Example Theory of Change map Issues Actions

11. Evaluation methods • Analysis of number of suicides • Analysis of delay minutes, costs and staff absenteeism • Survey of partners • Station/Intervention case studies • Front line staff survey

12. Programme roll-out

13. Reduction?

14. Rail vs national picture

15. Impact at priority locations

16. Cost and Disruption TRUST delay costs and SMIS delay minutes: 2009 2 hours 44 mins 2012 1 hour 59 mins

17. 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

18. Perceived effectiveness of programme activities

19. Perceived effectiveness of programme activities at reducing staff distress

20. Effect of the programme on relationship between your organisation and other organisations

21. Willingness to participate in programme activities

22. 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

23. Effect of MSC training on attitudes

24. Frontline staff attitudes compared to ‘management’ attitudes

25. Recognition of people who might be suicidal

26. MSC training and interventions

27. Effect of MSC training on intervention actions

28. 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.

29. Thank you Dr Ann Mills ann.mills@rssb.co.uk