Intended for healthcare professionals

Rapid response to:


Strategies to prevent suicide

BMJ 2010; 341 doi: (Published 06 July 2010) Cite this as: BMJ 2010;341:c3054

Rapid Response:

Hotspot Signage reduces calls to police negotiators

In response to Gunnell D, Miller M: Strategies to prevent suicide,
BMJ 2010, 340:c3054, doi:10.1136/bmjc3054.

We would support Gunnell and colleagues' suggestions that the targeting of
Hot-Spots per-se may not significantly impact on suicide rates given the
relatively small numbers of deaths that occur from methods such as jumping
and that a focus on methods, accessibility and restriction is most likely
to have the biggest impact.

However such strategies can have additional benefits for organisations.
As part of a local NHS mental health trust initiative in partnership with
multi-agencies in the North East of England (Newcastle, Gateshead, South
Tyneside, North Tyneside and Northumberland ); signage with the Samaritans
contact number "In Despair please contact" was erected at a number of
known landmarks.

These landmarks in particularly bridges were identified by Northumbria
Police as being associated not only with actual suicides but also with
individuals threatening suicide. Newcastle city for example has 7 bridges
spanning the River Tyne over a small geographical area.

There is evidence based on hard data from Northumbria police that
since the erection of the signage in 2007/8, calls to the police
negotiators from incidents involving suicidal individuals at recognised
landmarks have reduced overall. The most significant change has involved
the Tyne Bridge in Newcastle where from a baseline of 131 calls made to
the negotiators in 2007, year end to year end in 2008 negotiators were
called to 47 incidents, this fell in 2009 to 30 and to August 2010 there
have been 19 calls.

Unfortunately it is not possible to determine whether calls to the
Samaritans have increased due to the way the calls are disseminated.

Of the 173 police negotiator incidents, 89 incidents involved people
who were previously known to mental health services or who were
subsequently involved with services. Of these there were 24 individuals
who were involved in more than one suicidal incident and two individuals
accounted for 10 incidents over the 3 years.

The collaboration between Northumberland, Tyne and Wear NHS
Foundation Trust and Northumbria police has led to formal information
sharing agreements being ratified by both legal departments. This
agreement allows for key risk information to be shared with on-scene
police at high risk situations for those individuals known to mental
health services locally (most commonly the 24 hour Crisis Teams are the
police first point of contact for this information).

As a reciprocal arrangement the police negotiators supply copies of their
negotiator de-briefs to the Trust for those individuals in contact with
services. This ensures that treating psychiatric or community teams are
aware of any high risk incidents and are able to adapt risk minimisation
plans accordingly. In some cases particularly for those individuals who
are considered to be repeat attendees strategy meetings involving other
services such as the police can be arranged. It has also broadened the
police awareness of mental health and the premise that individuals can
remain unpredictable despite the best efforts of all services.

It must also be acknowledged that when an incident occurs at a high
profile location such as a busy traffic thoroughfare it can have
significant economic and social costs including disruption to the public
and the closing of roads. Data supplied by Northumbria police suggests
that Fire service call out alone is based on a cost of ?1000/hour - at an
incident on the Tyne Bridge, fire tenders , police, ambulance, river
police and police negotiators will be called. The cost of such incidents
inevitably falling to the tax payer.

Hard data from this initiative suggests that there may be a process in
action that is leading to a change in behaviours and at the very least it
has improved overall risk sharing information and treatment strategies for
suicidal individuals. There is a need for further study and this
information sharing could be copied elsewhere.

Competing interests: No competing interests

19 November 2010
Steve Taylor
Lead Clinician
Superintendant Jim Napier, Northumbria Police,Professor Douglas Turkington, Consultant Psychiatrist Mr Antony Gray, Head of safety ,Ms Kirsty Hume RMN
NTW NHS Foundation Trust