1. Policing Mental Health and Suicide Risk in BTP Mark Newton – Assistant Chief Constable Mark Smith - Head of suicide prevention and mental health

2. The Rail Network A draw for the vulnerable Transient population Equality Issues (access to services) –Immigration status –Homelessness –Learning difficulties –Alcohol & substance misuse –Race and culture

3. Suicide & Mental Health 2014/15 7, 387 SPMH incidents 1,773 detentions under S136 Mental Health Act (includes S297 in Scotland) 1,334 people tried to take their own lives on the railway 327 were killed 72 survived with serious injury 935 physically prevented from taking their own lives 1,156 people subject of joint police/health Suicide Prevention Plans 289 calls to the BTP Suicide Prevention Hot Line

4. Impact of fatalities 350 – 400 lives lost each year £60m cost to the rail industry each year 12,646 police deployment hours 2012/20132013/20142014/2015 TotalFatalSuicideTotalFatalSuicideTotalFatalSuicide Fatal & Injury Events 443354296475384325478406327 NR Lost Minutes 387,521472,655425,830

5. Developing our approach - 1 2007 academic review 2008 literature review Established rail suicide prevention advisory group with national Government strategy lead and academic representation PIER plan approach being developed on London North 2010 First BTP SOP on suicide prevention produced based on literature review Training and RA tool devised by Oxford University Centre for Suicide Research (OUCSR) – collaboration with Kent Police Training product subject to “before and after” review by OUCSR and results currently being published

6. Developing our approach - 2 2013 BTP engaged with DoH and Home Office task and finish group to develop the Crisis Care Concordat. Academic literature review into rail suicide prevention up to 2010 (K Bhui et al 2013) BTP applies to DoH for £200k street triage funding to replicate London Unit in Birmingham and C Division. Team launched in early 2014. 2014 further literature review 2010 onwards (B Mishara 2014)

7. Key Research findings Suicidal Ideation – preventing access to intended means can prevent further attempts Limited displacement at locations where effective barriers are used Intervention during the suicidal window can break the suicidal cycle Known risk and protective factors Suicidal behaviour can be temporary and connected to stressful life events Suicide contagion and impact of the media Self harm a significant indicator of future suicide attempts Those bereaved by suicide at significantly higher risk of suicide themselves Impulsiveness in rail suicide

8. SPMH Teams Divisional Units in London Birmingham & Glasgow London & Birmingham units have NHS staff working in them (Industry/NHS funded ) They use joint risk management processes to concentrate activity against high risk cases FHQ Unit has policy and analysis role and strong links with Rail, NPCC, COP, Health, PHE, Government and 3 rd Sector

9. Key prevention themes Capture data and analyse to inform activity –People –Places –Times Target harden the most vulnerable parts of the railway Promote effective primary care for depression and anxiety Public messaging - lethality of the railway Effective intervention, risk assessment & case management Multi agency safeguarding

10. Suicide Mitigation Model Vulnerability to suicide Suicidal ideation about the railway Spontaneous motivation Suicidal Intent Suicidal window Access to means Community Health & Social Care Perfect Depression Care Scheme Family and peer support Vulnerability Profiles 3 rd Sector Support Bereaved Support Undermine concepts of lethality Reduce media reporting Intelligence links with Health Suicide Prevention Hotline Multi Agency Cluster Systems Prevent Contagion Engineering & design solutions Psychological & physical barriers Reduce lethality of means Restrict passenger/train interface Location Vulnerability Profiles Training & Interventions Negotiation Samaritans products Operation Avert/patrol teams Bystander interventions CCTV technologies Responding to self harm Undermine concepts of lethality Reduce lethality of means Reduce access to means Reduce media reporting Suicide Prevention Hotline AWOL reports Missing Person Reports Other Intelligence Vulnerable Possible Planning Impulsive Active Capable MJ Smith British Transport Police May 2015

11. People – Academic Research BTP, NR, Samaritans and RSSB collaboration Data review by Tavistock Institute Literature review by Professor Brian Mishara looking at material post K Bhui review Leads to commissioning of Middlesex University London and Westminster University to explore;- –Why chose the railway? –Why not chose the railway? –The impact of the media –CCTV examination to identify preliminary behaviours –Methodolgy includes internet survey, interviews with respondents and survivors

12. People – Why the Railway? Perceived lethality Enhanced lethality Lethality & privacy Impulsivity Familiarity – and knowing about fast trains Environment: impersonal, easy to access, private Drivers trained/supported to deal with suicides Simulating an accidental death Influence of the media

13. People - Why not the Railway? Greater likelihood of intervention impact on/potential harm to train drivers and others Lack of access to fast trains

14. Places - Escalation Process Locations that have three or more suspected suicide or injury attempts in a rolling 12 months Heightened level of activity from BTP, Network Rail and Samaritans –Local profile completed –Site visits and engineering options considered –Meeting with local Public Health/NHS to consider connected local issues and potential solutions –Proactive patrols with BTP, Rail Security and volunteers –Ensure Samaritans Posters in place and local staff have MSC training and BTP Hotline number

15. Places – Engineering Solutions Platform Edge DoorsMid Platform Fencing Installation of physical barriers most effective at hotspots ( Cox et al.,2013) Limited displacement to other sites ( Pirkis et al.,2013) Successful implementation across a number of railway sites but expensive

16. Life saving interventions 2014/15 935 potential life saving interventions 725 to hospital, 103 to Custody (BTP 6) 526 by police (BTP 224) 236 by rail staff 129 by public, family or friends

17. SPMH - how does it work? Real time advice, intel’ & liaison with local health Review previous 24 hrs incidents Joint risk based decisions Suicide Prevention Plans for relevant cases GP letters, referrals & sign-posting Post incident follow ups Support and enforcement - Acceptable Behaviour Contract (ABCs) Situational prevention visits and PSGs Awareness meetings, focus groups, joint training Referrals to MASH/MARAC/SAB CRISIS TO CARE

18. SPMH results 2014/15 1156 SPPS opened 1442 info/locate markers on PNC 10 subjects went on to take their own life (7 on the railway) Represents 0.86% fatality rate (0.6% on rail)

19. Costs 2014/15 Fatal & injury attempts cost Network Rail;- £60m Fatal and injury attempts will have cost London Underground:- £4m Total rail operating Costs:-£64m BTP fatality deployment costs:-@£760k Total annual BTP SPMH staff Costs:- @ £900k Total annual external SPMH funding:- @ £736k Total BTP operational cost:- @ £2.4m 327 suicides UK whole community cost (1) :-£474.2m TOTAL COST RAIL SUICIDE£540.6m 1. Knapp M, McDaid M, Parsonage M (eds) (2011) Mental Health Promotion and Mental Illness Prevention: The economic case. PSSRU, LSE and Political Science

20. Cost avoidance 2014/15 848 Life saving interventions on Network Rail represents a potential saving of;- £140m 87 Life saving interventions on LU represents a potential saving of :- £8.7m 935 suicide interventions – UK whole community cost prevented:- £1.36b Total Costs GB Rail/BTP £66.4m Total Saving to GB Rail £148.7m (£82.3m) TOTAL COST RAIL SUICIDE£540.6m TOTAL SAVING RAIL SUICIDE£1.5b (£0.96b)

21. Early warning system Distributed to: Network Rail Train Operators Mental Health Trusts NHS Confederation Voluntary Sector 1 call a day to the Hotline since February 2014

22. Zero suicide ambition Depression and Suicide How do we treat depression in the UK? Why don’t many suicidal people get detained in Hospital? Announced by previous Government “Pursuing Perfect Depression care” model Restricting Access to Means Pilot Schemes in our high demand areas – East Anglia, Merseyside, South West A chance to intervene with those who have yet to attempt rather than those who have Our ambition Zero Suicides amongst our SPP subjects C. Ed Coffey MD CEO Behavioural Health Services Henry Ford Institute Detroit “If Zero is not the right goal, then what is?”