Public Involvement in Suicide Prevention II: The Stranger on the Bridge

人们普遍认为“预防自杀是每个人的事”，但大多数研究都集中在卫生专业人员在临床环境中识别和管理自杀风险方面的作用。公众（没有接受过医疗保健培训）所能做出的贡献，或者他们为此所需要的资源，却很少受到关注。在MRC之前资助的一个项目中，我们研究了家庭成员和朋友的角色。我们使用定性的方法来揭示他们在试图解释自杀危机的迹象并决定采取什么行动（如果有的话）时所面临的困难。然后，我们与所有主要的自杀预防慈善机构建立了合作关系，开发和评估简单的公共教育材料，以解决这些困难。这些资源是为那些担心亲近的人可能有自杀倾向的人设计的。我们现在希望用同样的方法来解决一个非常不同的场景，即“桥上的陌生人”。这是2015年英国第四频道播出的一部广受好评的纪录片的标题，该片讲述了约翰尼·本杰明（Jonny Benjamin）前往滑铁卢桥自杀的故事，一位路人的好意阻止了他的跳楼行为。在英国每年发生的6000起自杀事件中，大约三分之一发生在公共场所。其中许多包括从桥上、悬崖上和高楼上跳下去，或者使用铁路网。其中一些死亡可以通过设置物理屏障来预防，但人为干预将始终发挥至关重要的作用。这很可能来自一个路过的陌生人，但很少有人知道如何识别处于危险中的人，或者愿意参与其中。我们希望能有更多的人能够在公共场所识别并帮助那些可能正在考虑自杀的人。首先，我们需要从“救援者”和“被救者”的角度，深入理解桥上陌生人的场景。我们将在主流媒体和社交媒体上同时做广告，目标是采访10位左右有被救经验的人和20位有介入经验的人，其中包括一些铁路工作人员。我们的目标是发现：a)考虑自杀行为的人可能会表现出哪些迹象和信号；B)路人如何解读这些信号并理解正在发生的事情；C)人们对干预有什么恐惧以及他们如何决定是否这样做；D)外行人有效干预的核心组成部分（包括语言和非语言）是什么。我们还将采访一些没有经历过这种情况的人，以了解更广泛的公众态度和恐惧。根据调查结果，我们将与一系列非学术合作伙伴合作，制定关键信息，并开发一套用于教育活动的资源。我们会先制作一份简单的单张，分发给市民，并制作网上版本。我们还将为员工制定一个90分钟的面对面培训课程，培训地点包括桥梁、多层停车场、屋顶餐厅、悬崖和海岸小径以及铁路等容易发生自杀的地点。我们将在以后的研究中对这些进行评估，并希望在以后使用不同的介质继续开发其他材料。我们强大的项目小组包括埃克塞特大学的学者，纪录片制作人约翰尼·本杰明（Jonny Benjamin），他的自杀事件多亏了一个陌生人，以及自杀预防慈善机构、英国公共卫生、网络铁路和RNLI的代表。

It is widely accepted that "suicide prevention is everybody's business," but most research has focused on the role of health professionals in identifying and managing suicide risk within clinical settings. Much less attention has been paid to the contribution that members of the public (with no healthcare training) can make, or the resources they need in order to do so. In a previous project funded by the MRC, we examined the role of family members and friends. We used qualitative methods to shed light on the difficulties they face in trying to interpret signs of a suicidal crisis and decide what action, if any, to take. We then formed a partnership with all the leading suicide prevention charities to develop and evaluate simple public education materials that address those difficulties. Those resources are designed for people who are concerned that someone close to them may be suicidal.We now wish to use the same approach to address a very different scenario, namely the 'Stranger on the Bridge'. This was the title of a highly-acclaimed Channel 4 documentary, broadcast in 2015, which told the story of Jonny Benjamin, who went to Waterloo bridge to take his own life and was prevented from jumping by the kindness of a passer-by. Of the 6,000 suicides that occur in the UK each year, around a third take place in a public location. Many of these involve jumping from bridges, cliffs and high buildings, or use of the railway network. Some of these deaths may be prevented by the installation of physical barriers, but human intervention will always play a vital role. This is most likely to come from a passing stranger, but few people know how to recognise someone at risk or are willing to get involved. We want to increase the number of people who are able to recognise and reach out to someone in a public place who may be contemplating suicide.First we need to gain an in-depth understanding of the Stranger on the Bridge scenario from the point of view of those who have been involved, both as 'rescuers' and 'rescued'. We will advertise for both through adverts in mainstream and social media, aiming to interview around 10 people with experience of being rescued and 20 people with experience of intervening, including some railway staff. We aim to discover: a) what signs and signals a person contemplating a suicidal act is likely to exhibit; b) how passers-by interpret those signals and understand what is happening; c) what fears people have about intervening and how they decide whether or not to do so; d) what are the core components (both verbal and non-verbal) of an effective intervention by a lay person. We will also interview some people who have no experience of this situation to find out about wider public attitudes and fears.Using the findings, we will work collaboratively with a range of non-academic partners to formulate key messages and develop a set of resources to be used in an educational campaign. We will start by developing a simple leaflet for distribution to members of the public, and an online version of the same. We will also develop a 90-minute face-to-face training session for staff at the sort of locations that are used for suicide, e.g. bridges, multi-storey car parks, rooftop restaurants, cliffs and coastal paths, and railways. We will evaluate these in a later study, and hope to go on to develop other materials using different media at a later date.Our strong project group includes academics from the University of Exeter, the documentary-maker Jonny Benjamin, who survived his own suicidal episode thanks to a stranger, together with representatives of the suicide prevention charities, Public Health England, Network Rail and the RNLI.