Blocking the means of suicide can buy time and lives

Installing barriers and safety nets at public sites with a high incidence of suicide can reduce the number of deaths at these sites by more than 90%, according to new research we published today in The Lancet Psychiatry.

More than 2,500 Australians died by suicide in 2013 and more than 20,000 are admitted to hospital every year as a result of self-harming behaviours. Suicide also affects those who are left behind – the bereaved, who often struggle with guilt, social stigma, and the question of why.

Our study investigated interventions to prevent suicide at public sites that gain a reputation as places where people have taken their own lives. These are usually easily accessible sites, such as bridges, tall buildings, cliffs, or isolated areas, such as woods.

We pooled the findings from 18 international studies, including one from New South Wales and one from Queensland, which reported the number of deaths before and after introducing three measures at these sites:

• putting up barriers and installing fences
• actively encouraging help-seeking by installing emergency phones or providing information about available help and crisis support
• increasing the likelihood of intervention by a third party through surveillance and training of staff, such as police.

These interventions have the potential to complement each other. Restricting access can “buy time”, allowing the person at risk to seek help and giving others the opportunity to intervene.

In total, looking at the three types of interventions and their combinations, the number of suicides decreased from 863 (5.8 per year) before the intervention to 221 (2.4 per year) after the intervention.

Restricting access to means was associated with a 91% reduction in the number of suicides per year; encouraging help-seeking was associated with a 51% reduction; and increasing the likelihood of intervention by a third party was associated with a 47% reduction.

Restricting access may not always be a viable option. It may be relatively expensive, at least in the short term (although cost-effective in the longer term), or may be not feasible. There may be community opposition, with arguments that barriers will spoil the view. For these reasons, it’s important to have additional effective lower-cost options.

An issue frequently raised in the context of limiting access to lethal methods of suicide and sites is the possibility that people at risk will use alternative methods or find other locations: method/location substitution.

Studies in Australia and internationally generally show no evidence of this phenomenon. Close monitoring of suicide locations and trends in methods, as well as timely interventions at emerging popular suicide sites, can effectively prevent method/location substitution. People seem to prefer a particular suicide method and limited access and/or decreased lethality can prevent a fatal outcome.

People experiencing a suicidal crisis may be ambivalent about their wish to live and the wish to die, and impulsivity plays a significant role in suicidal behaviour. Hindering access to the preferred location or method may provide the much needed time to reduce the intensity of a suicidal crisis, to see other available solutions again, and to seek help.

These interventions fit into a broader strategy to prevent suicide, which includes restricting access to lethal suicide methods such as firearms and pesticides, and promoting responsible suicide reporting.

If you or someone you know needs help, contact Lifeline’s 24-hour helpline on 13 11 14, SANE Australia on 1800 18 7263 or the beyondblue Info Line on 1300 22 4636.

Jane Pirkis receives an NHMRC Senior Research Fellowship which is funding a program of work on suicide prevention interventions. She has received funding from the Commonwealth Department of Health and the Woollahra Council for work on suicide prevention at public sites.

Karolina Krysinska does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.