Using engineering and designing infrastructure as way to prevent suicide. This case study was done jointly with the National Suicide Prevention Alliance and forms part of our suicide prevention resource.
We wanted to tackle the role of bridges in suicides in Devon through a combination of small-scale interventions and engineering modifications, ensuring suicide prevention remained at the heart.
South West England has the highest rate of suicide in England. Suicide prevention is a priority for the Safer Devon Partnership, where Public Health Devon is leading on the delivery of a Devon Suicide Prevention Implementation Plan in partnership with the Devon and Torbay Suicide Prevention Alliance.
We know that there have previously been 72 reported suicide-related incidents in one year on one specific bridge which had a considerable impact on the local economy as all traffic must be stopped for each incident. There is also a considerable impact on the local community and so a clear need to address this issue for all concerned.
Devon Highways Bridge Office was approached about a specific bridge by the MP for North Devon, who had been contacted by a constituent with lived experience. This prompted a multi-agency group meeting between the police, ambulance services, fire service, the RNLI and Public Health England which was also attended by members of the Suicide Prevention Alliance.
Devon has the largest stock of bridges in the UK, some of which are large structures associated with suicide. We have previously implemented interventions such as the Letters of Hope and Samaritans signs, as well as limiting physical access to bridges with barriers at each end. Traditionally, larger scale bridge work has been viewed as engineering work and not been seen as a suicide prevention solution, which is widely considered to be work for health professionals and the police.
Engaging with partners to increase their knowledge about mental health and suicide prevention was essential. The Devon Highways team initially felt that a smaller scale approach was appropriate due to the limitations and high costs of engineering solutions. However, once they learnt that 95% of people who have survived a suicide attempt regret their actions, they felt the need to take more significant action. The multi-agency group agreed on undertaking engineering solutions, primarily raising the height of the parapets of the bridge.
Devon Highways and Public Health Devon have continued an open dialogue with a representative of the National Suicide Prevention Alliance and the local police force which enables better reporting and understanding of incidents and attempts and where they take place, this allows us to consider these in our ongoing plans.
The major alteration work is ongoing and so we cannot fully evaluate the impact however the small-scale works previously carried out have reduced access to the bridge for less fit or athletic people. It is felt this has had a positive reduction in suicide attempts.
Looking ahead, this work will set a precedent and deliver some tangible evidence of what amendments can be made to make similar bridges that pose a known risk safer.
Our local authority has in-house bridge engineers and the capability to make the decisions needed, which isn’t always the case. This also meant we had control over the budget and could modify and adapt to allow for this (expensive) work. The numerous bridge closures required to deal with incidents was having a large impact on the local economy which helped with the business case. The work falls under the umbrella of capital maintenance activity which meant there were no planning requirements and public consultation wasn’t needed.
It was a galvanising force to have a local MP pushing for change, as it helped to bring all the agencies together.
It was also vital to share research and data about suicide with the multi-agency team. Once they understood that suicide is preventable, and if a bridge is made safe it will save lives because research shows that people don’t simply go elsewhere, it made a big difference to their willingness to support more expensive work.
We also made use of existing knowledge from other regional bridge teams such as Lincolnshire County Council, who had carried out suicide prevention work on a high-risk bridge and have had no incidents since 2009.
The ownership of bridges and related budgets can be a challenge, we were fortunate it wasn’t for us in this instance, but some bridges are privately owned which can complicate the issue of bridge improvement.
One issue we came up against was around modifying the parapet fence. There were concerns that if they were changed to serve a different purpose they may not work as intended (as prevention of vehicles falling) and could cause injury to motorists on the bridge in the event of a collision. We carefully weighed up the risks of any potential engineering amendments versus the impact in preventing suicides and were able to come to a solution.
We currently have plans to modify a second high risk bridge. At present, no other bridges have yet been identified as high risk but if they are, we will now know what to do to drive suicide prevention engineering work forward.
As illustrated through working with our partners there is a need to demonstrate the role that engineering can have in suicide prevention and how widening the original purpose of engineering solutions can be beneficial. We are publicising our work by attending conferences to show what we are doing and to answer questions about the role of engineering interventions in suicide prevention.
Advice for other local areas
- Don’t be afraid to do an engineering intervention – it is an evolving approach to a long-term public health issue
- Look at options such as signage and options to prevent people getting to the outside of the bridge. Increasing the parapet is the most expensive bit. Stopping access to the bridge can certainly help in the meantime
- Speak to someone who has done this, seek advice and learn from each other – we spoke with other regional bridge teams who have tried new approaches – you are welcome to speak to Devon County Council’s bridge engineers.
Nicola Glassbrook and Kevin Dentith, Devon County Council