Lincolnshire Police’s John Manuel undertook research into suicide prevention as an EMPAC Fellow at Nottingham Trent University and has now helped shape national guidance on designing out suicide risk in car parks. John’s research and expertise has been utilised by the British Parking Association via the publication of a new national Factsheet to provide practical steps for a suicide prevention strategy.
You can read all about John’s high impact research here.
Preventing the Means to Access to Reduce Opportunities for Suicide at Places of Height.
Previously, there has been very little guidance or regulation in the UK to require builders or developers to design and build neither preventive measures nor specific guidance as to materials or operational practice.
Suicide is a significant health concern within the United Kingdom and takes the life of over 6,000 people in England each year killing more people than road traffic accidents, (ONS 2016). This report will focus on a contributory element to the taking of an individual’s life from a place of height and will examine the way in which restricting this means of access can significantly reduce those opportunities and reduce the inherent loss of life, (Skegg, and Herbison,2009). Where access can be restricted evidence strongly indicates that an individual is less likely to continue on with the act of suicide and allow the opportunity for intervention but equally is less likely to take their life at another location of height or indeed employ other methods, (Beautrais 2007; Bagley 1970). Understanding the psychology and chosen method is critical to understanding the relationship between the physicality and choice of a location and act itself, the selection of the place is important. Suicide can be an act of the moment and intervention through restriction of access to the means can buy time for the moment to pass and help to be given or obtained, (Daigle 2005).
Often disruption, demand management and economic impact can be considerable and may involve the closure of areas or facilities. There are several known ‘jump sites’ within different force areas that include Multi-storey car parks and iconic places of worship, defensive measures at these sites vary and include retro-fitted barriers, signage and innovative operational systems and in some cases none of these measures. Many varied measures can be employed such as netting, additional fencing telephone hotlines and signage (the installation of telephones with a direct link to a charitable organisation such as the Samaritans in isolated car- parks in the New Forest area of the UK, together with signage following an increase in car- exhaust related suicides followed by a three-year evaluation which showed a reduction in such suicides (Draper 2017) and specific design features such as the adaption of vehicle exhaust pipes to make it difficult if not impossible to connect with hose attachments, some measures can be as simple as fitting restraining devices on upper storey windows (Chen 2016) that reduce the opportunity of access and what Beautrais describes as ‘muted media reporting’, (Beautrais 2007) the significance of this 2007 paper should not be lost against the growth and use of social media which can be beneficial but may provide an adverse insight into methods and suicide trends. In a Parliamentary debate in the House of Commons in July of 2015 the member for Bridgend Mrs Madeline Moon stated that “Police officers are estimated to spend 40% of their time dealing with mental health problems, including suicide” (Hansard 2015).
Whilst there is a close and significant correlation between mental health issues and suicide the percentage of suicides and suicidal attempts that can be attributed to mental health associated issues are not clear. Whilst the characteristics and profile of those who jump from height vary there are a number of studies that indicate that many of those who do jump from height as opposed to any another method suffer from mental illness particularly schizophrenia and severe depression, (Beautrais 2001; Chen et al 2009).
The emotional and devastating impact of a suicide to families and witnesses is not in question but there is a significant economic cost resulting from both a suicide attempt and an actual suicide, the closure of main roadways, shopping facilities, critical rail lines and police resource management provide a tangible economic cost together with the ongoing legal processes such as a coroner’s investigation can take the estimated costs to around a million pounds (Hansard 2015). Mcdaid’s review of the economic cost of suicide in Birmingham and Solihull puts the cost at £1.7 million as a national figure with £539,000,000 as a collective cost for that demographic area over a three-year period (Mcdaid 2011), the Samaritans place the figure at £61,000 per year per suicide at a rate of 200 suicides, each year (Samaritans 2006). There are no statistics on the direct or indirect cost to police forces however it is considered that between 30% and 40% of incidents reported to or dealt with by the police may have an element of mental health associated to that incident and this has a considerable detrimental impact on a police forces demand management systems. The mental health issues associated with dealing with suicide in its generality is not ascribed a cost nor should it be, but in individual wellbeing it is likely to be significant.
A common response to the suggestion of improved restriction of access to places of height (or indeed other locations) is that of displacement. That is a person attempting the suicide attempt simply moves to another location and possibly another method of suicide, or a view expressed is that there is nothing we can do, they are going to do it anyway. Whilst this may apply to small group it is not the case in the majority of incidents and intervention and positive help can be given at various stages. Beautrais quotes Hawton which is worth quoting in full,
“In addition, studies that have explored subsequent suicidal behaviour among persons who have survived near fatal suicide attempts have found that most of those who survive near fatal suicide attempts do not go on to make further attempts by the same or alternative method” (Hawton 2007).
Restrictions by physical and administrative means at sites has been shown as the most effective ‘evidence based method’ of suicide prevention at places of height (Goldney 2008: Pelletier 2007: Bennewith 2007). The Conservative member for Pendle, Andrew Stephenson highlighted and raised the issues of barriers at places of height during a debate on suicide prevention in the House of Commons,
“In January, suicide proof fencing was installed at a multi-storey car park in Nelson in my constituency, from which eight people have died in the past ten years and a further eighteen people have been talked down by police, yet it still took the car park owners years to act” (Hansard 2013).
The research and outcome of the implementation of a suicide net at the Bern Munster Terrace in Switzerland was quite definitive in its conclusion having moved from a suicide by jumping rate of 28.6% in 1998 it was found that after installation of the suicide nets was significantly lower. It was also, established that there had not been any movement to other sites the area.
Whilst the principle of site specific advice and guidance must remain there are some overarching elements of advice that might be considered by professional designers who may identify applications or locations where there is a perceived or actual risk of suicides. The inclusion of generic advice as part of a national strategy publication will enable professionals to help design out suicide in the future. That has now been achieved thanks in no small part to John Manuel’s research.