Saving Lives at Suicide Hotspots
Research shows effectiveness of different types of deterrent efforts.
Posted Mar 04, 2016
Some of the most beautiful places to visit are also sadly known as suicide hotspots, where people are drawn to end their lives at unexpectedly high rates. Perhaps the most famous of these in America is the Golden Gate Bridge in San Francisco where I recently visited. According to the book The Final Leap, over 1700 hundred people have died by suicide there since 1937. Across the world, there are many other of these suicide hotspot locations often at high bridges or cliffs.
The communities around these sites are of course motivated to try and prevent more suicides, but there remain some legitimate questions about how effective deterrent efforts can be. Some argue that blocking access to one spot will just cause determined people to go somewhere else, while others counter that suicide can be a impulsive act that is preventable under the right circumstances. In addition, there are also concerns over spoiling the access or view for many people who gain benefit from being in these often gorgeous places.
In my home state of Vermont, there is now a bill going through the legislature about making some sort of prevention effort at the Quechee George Bridge, where there have been 8 suicides since 2008 (more than all other Vermont bridges combined).
Consequently, people want to learn what is actually known about the value of trying to deter suicides at these particular places. To help, a recent study attempted to provide a more definitive answer by combining a number of studies that have tracked the effectiveness of suicide prevention efforts at sites across the world. In framing their study, the authors point out one common misconception about suicide hotspot prevention which is that deterrents all involve restricting access or view through the building of fences or nets. While these methods are indeed commonly used, there also exist other types of interventions such as efforts to encourage help-seeking (e.g. placing suicide help lines at the site) and doing things to increase the likelihood of intervention by a third party (e.g. having more personnel near the site).
When examining whether or not suicide prevention works, the authors divided the studies they found based on these different types of intervention that were used (although some places had more than one). Of primary interest were statistics related to the change in number of suicides after the intervention was introduced compared to before the intervention, looking at intervals that ranged widely from 5 months to 22 years.
A total of 18 studies were identified, most of them related to efforts designed to prevent suicides at bridges and cliffs. By far the most common type of intervention were those that did restrict access. Across all measures, suicide rates dropped from 5.8 suicides per year to 2.4. In looking at intervention type, restricting access and increasing the possibility of third party involvement were both significantly related to suicide reduction. Measures that encouraged help-seeking also appeared promising.
The authors concluded that interventions at suicide hotspots do indeed appear to be effective. Furthermore, they argue that the fact that they found effectiveness for means other than restricting access suggest these reductions are not simply the result of individuals substituting one place for another.
This paper adds to the growing literature showing that preventing easy access to lethal means can be lifesaving for some suicidal individuals and may not require “spoiling” a beautiful location to be effective. Of course not everyone will be deterred, but it is important to remember that for some people, suicide is indeed impuslive. Giving these individuals an opportunity for pause and reflection, and reminding them that people care and are prepared to listen, may result in the difference between life and death.
Pirkis J, et al. Interventions to reduce suicides at suicide hotspots: a systematic review and meta-analysis. Lancet Psychiatry 2015 Nov;2(11):994-1001
@copyright by David Rettew, MD
David Rettew is author of Child Temperament: New Thinking About the Boundary Between Traits and Illness and a child psychiatrist in the psychiatry and pediatrics departments at the University of Vermont College of Medicine.