A rapid review of interventions to reduce suicide ideation, attempts, and deaths at public locations

Suicide deaths are tragic events and those that occur in public places have an impact not only on the deceased person and their family and friends, but also on members of the public. Having up-to-date information about the effectiveness of interventions allows policymakers and organisations managing locations of concern to choose the most appropriate evidence-based suicide prevention strategies for specific locations. This rapid review was conducted to help inform the development of Welsh national guidance. The review included literature published since 2014. 24 studies were identified, and these were conducted in the UK, Australia, South Korea, Canada, USA, Denmark and Japan. The studies covered railway or underground stations, bridges, cliffs or other natural heights, tall buildings, and other types of locations. Surveillance technologies as a means of increasing opportunity for third-party intervention showed the most promise, although the evidence of their effectiveness was limited. In one study, having more closed-circuit television (CCTV) units was associated with fewer suicides at railway stations. Another study that tested a set of interventions including CCTV, infrared security fences, and a suicidal behaviour recognition and alert system, provided some promising initial descriptive data that showed an increase in the number of prevented suicides. Three other studies showed that there was no change in outcomes following the installation of interventions including surveillance technologies. Based on the assessment of the overall body of the evidence, there is a low level of confidence in the findings related to surveillance technologies because of the quality and designs of the studies. Promotion of suicide helplines as an intervention aimed at increasing opportunities for help seeking was examined in seven studies. Two studies reported that the number of suicides increased after the introduction of the intervention. Three studies, of which two examined a set of interventions including helplines, observed no change. In two studies the effect could not be determined. There is a low level of confidence in the evidence for this outcome. Other interventions evaluated included staff training; deployment of specialist staff; campaigns encouraging bystanders to intervene; a crisis cafe; blue lights at railway stations; suicide prevention messages, memorials, or notes other than official crisis line signage; spinning rollers at the top of fences that prevent gripping; and others. The effect of these interventions could not be determined with certainty but some of them appeared promising and warrant further research. More robust evaluations are needed before any of the interventions reviewed here can be recommended for implementation. To create a better evidence base, high-quality evaluations should be supported and encouraged. Future research should examine which interventions work for who and in what circumstances.