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August 17, 2009

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IN DEPTH

Suicide by Train: Understanding Leading to Prevention
BY SUSAN R. PAISNER, Senior Managing Editor

Every year, nearly 30,000 Americans commit suicide. The methods vary, but the choices are always personal, individual, and specific. As A. Alvarez, author of The Savage God: A Study of Suicide, wrote: “A man who has decided to hang himself will never jump in front of a train.”

Understandably and yet unfortunately, whenever there is a death connected to trains, the immediate public assumption is that the operator or the agency or the train itself is at fault. Compounding this problem are two more elements: it can at times be very difficult to determine whether a death is a suicide, and authorities may be reluctant in certain circumstances to declare that someone has taken his or her life.

Investigating Suicides by Train
About five years ago, Operation Lifesaver, Inc.—a pre-eminent rail safety organization—reached a conclusion that many of the “trespass deaths” they had documented were suicides. Because neither the Federal Railroad Administration (FRA) nor the Federal Transit Administration (FTA) requires systems to report suicides—and because suicide comes under the category of “death by trespass”—the agencies issued grants to the American Association of Suicidology (AAS) to investigate these deaths and to try to develop some prevention methods for the future.

There exists no one comprehensive set of data. For example, FRA collects fatality statistics for freight, Amtrak, and commuter rail lines, but not for heavy or light rail. AAS looks solely at trespass deaths, but only those statistics that railroads provide them.

This lack of a standardized database notwithstanding, AAS estimates that of those 30,000 suicide victims, a minimum of 300 of them use trains—both freight and passenger—which translates to not quite one suicide by rail every day of the year, according to Dr. Ramya Sundararaman, research director of the FRA/FTA Suicide Countermeasures Project. According to FRA data, 70 percent of these trespass deaths are freight-related and 30 percent are passenger-rail related. Noting that the AAS data came only from railroads that kept records and decided to provide their information, “this may not be the whole universe because railroads are not required to keep this information,” she said. She added: “I would say it’s an underestimate rather than an exact number.”

According to the FTA Office of Safety and Security, the agency shares the desire of AAS to discern how many suicides occur on the systems because this information is not always captured in the various kinds of reporting formats agencies use.

While they don’t occur frequently, said FTA Senior Public Affairs Officer Paul Griffo, “they have a huge impact on both customers and employees, not only because it’s a very traumatic experience for everyone involved, but also because they can cause part of the system, or even an entire system, to shut down for hours on end.”

AAS’ Karen Marshall, director of this project, agrees. “The impact is much larger than the one death,” said Marshall. “Look what it does to the crews and the people on the trains.”

Finding a Connecting Link
Currently, according to Andrea Price, the grants’ project manager, “there’s no data [on why people use trains to commit suicide]. But the public needs to understand that this does happen.” She added that families are frequently in denial, saying the rail system should have had a fence or a better station platform, but they need to realize that people who kill themselves this way “made a suicide plan for themselves—and when data is kept accurately, it exonerates the companies and the drivers who are not responsible.”

To understand what methods might work best, AAS first tried to understand the motivation and background of the people who have died by suicide on both freight and passenger rail systems. The process they have been using is called a “psychological autopsy,” where staff interview the families of the people who died.

What were they trying to find out? “What leads a person who dies by suicide to be on the tracks at that time to kill themselves?” asked Marshall. If we can begin to get to the bottom of this as a method of choice, then we can begin to design prevention programs around it.” In other words, they are looking for a connecting link.

AAS is writing the FTA portion of the report now. Once it goes through that agency’s clearance process, it will be posted on the FTA web site. The report will cover three elements:
* Retrospective Prevalence. This is a demographic snapshot of the people who have decided to die in this manner. Taking into account age, sex, and race, said Price, the researchers are trying to develop a picture of which groups are at highest risk.
* Causal Analysis. These are the psychological autopsies.
* Physical Site. In looking at rail stations, researchers are examining what structures exist—or don’t—and whether certain structures might impede or prevent access to the tracks, such as increased fencing or planting thorn bushes.

“In order for us to create the political and public will around the subject of suicide, in order to understand and research and create preventive practices for suicide prevention, we need to know the scope of the problem,” said Brian Altman, director of public policy and program development for the Suicide Prevention Action Network USA. “And better reporting will lead to better preventative services,” he added.

Calling this “an issue that is plaguing all transit subway systems,” Vijay Khawani, director of corporate safety for Los Angeles Metro, who has been interviewed for this project, said: “if we can prevent suicide deaths, I think that’s definitely a worthwhile effort to pursue.”

So far, one result from the study is a set of guidelines for media on how to cover these events in such a way so as not to encourage copycats.

“While it’s always tragic when someone decides to end his or her life—it’s doubly tragic when individuals do it in a way that impacts other people—that causes them grief and turmoil. That’s one of the biggest impetuses to do this study: to see if we can avoid that as much as possible,” Griffo said.

A Partnership in Massachusetts
In the greater Boston area, the Massachusetts Bay Transportation Authority (MBTA) has teamed up with Samaritans, a suicide prevention agency in eastern Massachusetts, to try to prevent suicides in its stations by prominently placing signs telling where people can go to receive help.

Scott Farmelant, spokesman for the Massachusetts Bay Commuter Railroad Company (MBCR), which provides commuter rail services for MBTA, initiated the partnership.

“Every so often you see a ‘trespasser fatality’—and these often are suicides,” said Farmelant, who has served on the Samaritans’ board since 2003. “Sometimes it takes a long time to establish that fact, but these instances have a real emotional impact on the staff who are required to respond.”

MBTA has posted the signs; MBTA and MBCR are picking up the cost of production and placement; all design was donated by Cole Creative of Boston. The idea is to give people the tools to understand the warning signs and be able to respond appropriately and effectively.

“It’s an area where you could see both parties benefiting from coming together,” Farmelant said. “Suicide is one of the most prevalent public health problems in the U.S. Because of the unfortunate stigma associated with it, however … it often doesn’t get the public attention it deserves. It isn’t talked about, it isn’t discussed—it’s swept under the rug.”

Samaritans Executive Director Roberta Hurtig echoed those sentiments: “There are so many myths that surround suicide and so little understanding of this public health issue.” She added: “Even though I’ve been in this field for 7 years, until I sat down with the MBTA folks, I hadn’t fully appreciated how many deaths happened this way and how traumatizing it is for the personnel involved with it.”

Hurtig sees the MBTA/Samaritans partnership as a way “to help people who might be involved in this understand why people get to such a place of desperation.” Employees will not only better understand the statistics about this issue and some of the prevention work going on in the field; they will also find out about resources available for them should they be involved in a traumatizing incident.

Suicide Prevention in Toronto
In the late 1960s and early 1970s, the Toronto subway system experienced a dramatic increase in the number of suicides and suicide attempts, a situation that became “very alarming” to management, according to Toronto Transit Commission (TTC) Chief Safety Officer John O’Grady. Because each suicide was subject to a coroner’s inquest, that made it newsworthy, and “we began to suspect a correlation between the coverage and a copycat syndrome,” he said.

Management convened publishers, news directors, and the coroner and said—in the interest of public safety—“This has got to stop,” O’Grady recounted. So they forged a verbal agreement: the coroner would cease conducting an inquest because there was no real purpose (the cause of death was evident), and the news media agreed to stop covering these events. As a result, the number of suicides decreased.

Several years ago, however, the system experienced “a rash” of suicide events, said O’Grady, at which point he worked with a hospital to provide training to TTC staff. The program targeted two groups: those who intervene, such as constables and supervisory staff, and operators—who clearly can’t intervene since they are driving the train, but who may see patrons on the platform who might be agitated.

Both groups received training that sensitized them to suicide issues, increased their awareness, and improved their approach, skills, and knowledge about suicide and suicide prevention. The officers and supervisors also received training on how to approach people: “what to say, what to look for,” said Dr. Paul Links, the Arthur Sommer Rotenberg University Chair in Suicide Studies at St. Michael’s Hospital in Toronto.

One module sensitized the participants to suicide issues, making them aware of the underlying problems and community resources, and teaching them how to develop empathy for the victim, while another taught intervention skills. Part of any intervention, permitted by Canada’s Mental Health Act, enables security to arrest a potential suicide victim, remove that individual from the platform, and stay with that person until he or she is transported to a hospital.

A key part of the training is to approach someone who is exhibiting suicidal behavior (such as letting several trains pass, or removing external clothing like a coat or hat) and ask that person directly if he or she is contemplating suicide. “Some of the people trained were quite helped by knowing they could approach the person very directly,” said Links. “They weren’t comfortable doing that prior to the training, but now they had a greater awareness that suicide was preventable.”

The program was a huge success on a number of fronts, O’Grady related. “The operators loved it—saying, finally someone is paying attention to us,” he said. A Ph.D. candidate in Suicide Studies, working under Links, wrote her dissertation on an evaluation of the program, finding that staff’s attitudes and skills had not only changed after training, but six months later had remained stable. “So the program worked,” he added. “We have seen a long-term decline—about 30 percent, until 2007, where the numbers rose slightly.”

The next stage, he said, is the automatic train control system. TTC will receive a new fleet of trains in 2010 and 2011 that can operate in a driverless mode, so the train will stop in exactly the same place every time. TTC is also re-signaling the line so the train doors will line up with the platform doors. With that degree of precision and control, the agency can put a glass wall at the platform edge. Once the train enters the station, access to the tracks will end.

Balancing Risk and Access
“The risk of public transportation is that it’s accessible and, if people are determined to take their lives, it has a high fatality index,” said John P. Hogan Jr., MBCR’s director of safety and security. He added: “In the moment when people are overwhelmed by feelings and impulsivity, what can we do to help them take a pause, to try to interrupt it, to try to intervene?”

Experts note that officials can place suicide prevention barriers on bridges, but “what can you do with tens of thousands of miles of railway tracks?” he asked.

“You never know what is the thing that will make someone pause—and realize that maybe there is in fact another way, maybe there is hope,” Hogan continued. “We’re trying to create an inspiration of hope—and let people know that they’re not alone when they are struggling.”


Guidelines for Media
The American Association of Suicidology has developed a guide for media because it can play a powerful role in educating the public about suicide prevention.

Some of the guide’s recommendations focus on what language to use when writing about a suicide, including:
* In the body of the story, it is preferable to describe the deceased as “having died by suicide,” rather than as “a suicide,” or having “committed suicide.”
* Contrasting “suicide deaths” with “non-fatal attempts” is preferable to using such terms as “successful,” “unsuccessful,” or failed.”

For more information, visit the web site and click on “recommendations for media coverage.”


Quick Facts
* More than 32,000 Americans die by suicide each year.
* There is 1 suicide every 16 minutes and 88 suicides per day.
* Suicide is the 11th leading cause of death overall in America.
* There are an estimated 1.4 million attempts per year in the U.S.
* More than 90 percent of people who die by suicide have depression or another diagnosable mental or substance abuse disorder.

Links/Resources
* American Association of Suicidology: 202-237-2280.
* National Suicide Prevention Lifeline: Help is available 24/7 at 1-800-273-8255.
* Operation Lifesaver. Read Common Sense to learn about Operator Lifesaver’s new rail safety trespass prevention campaign. For more information, call 1-800-537-6224, or visit the web site.
* Get involved in suicide prevention and education at the state level. Find out more here.
* View and download educational brochures about older adult suicide, mental health resources for military families and more.
* Additional resources on suicide prevention and mental health can be found online.

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