23.1 Gatekeeper training for front line staff

Description

What does this measure refer to and what is its objective?

Gatekeeper programmes include a range of interventions focused on community or Organisational gatekeepers (e.g. railway personnel, security personal, local charity workers) whose contact with potentially vulnerable populations provides an opportunity to identify at-risk individuals and to engage in preventive action. The gatekeeper training teaches specific groups of people to identify people at high risk for suicide by recognising suicidal risk factors, to assess the levels of risk, and to manage the situation appropriately by employing adequate approaching tactics. Gatekeepers are those who come into frequent contact with members of the community on a regular basis, usually, but not exclusively, on account of their professional status. Gatekeepers interact with community members in natural and often non-medical environments and can be trained to recognize risk factors for suicide.

Recommendations

Best practice and lessons learned

• Education of gatekeepers covers awareness of risk factors, policy changes to encourage help-seeking and availability of resources.
• In order to be effective, gatekeeper training must be a continuous, sustained effort with close monitoring and evaluation, ideally as part of a professional training curriculum.
• It can take the shape of a training of voluntary staff to first contact the person at risk of suicide.
• Training should be implemented into gatekeeper inductions to ensure all new staff are covered.
• Training staff to know how to sensitively resolve a contact with a potentially suicidal person is very important, particularly ensuring they are referred onto the appropriate care (e.g. police force, mental health or friends and family). Failure to do this may see the suicidal person travel to another location to try again.
• Training should be developed in collaboration with experienced partners (e.g. department for health, suicide prevention/mental health charities).
• Training should ideally be at least a day in length and tailored for the rail industry to improve effectiveness and to better equip attendees with the skills and confidence to put what they have learned into practice.
• In Great Britain and the Netherlands this is a one day briefing on how to start a conversation when you suspect that someone is contemplating suicide. The Samaritans Managing Suicidal Contacts course delivered in the UK focuses on training attendees with speaking and listening skills, tips for identifying a potentially suicidal person and effective referral of the individual to help improve ongoing care and reducing the chance the individual will return to the station again.

Warning points

Expected difficulties and issues you should pay attention to

• For a franchised rail network with multiple train operators it can be difficult to get gatekeepers the time away from work to do the training. The benefits of the training need to be communicated at a senior level.
• Health and safety policies should be taken into consideration with the training development. Gatekeepers should be clear on how much risk they should take.
• Trainers need to be aware – more so than with other courses - of possible emotional reactions from the participants by past experiences.
• Not everyone is fit for this task. For example, ProRail reported that 25% of all trained employees reported mental problems after an intervention.

Observations

Other points that you should not forget

• Evaluation of actual decrease in suicide numbers as a consequence of this measure can be difficult.
• You should establish an effective means of reporting interventions made at stations as they can be an effective indicator of an area of high risk. Such statistics can complement suicide and attempted suicide statistics and can ensure resources are allocated to the right places.
• Related campaigns were implemented to stimulate engagement of passengers at stations. For example, in the UK the Small Talk Saves Lives campaign or the Hub of Hope which is a website/app that connects individuals with a wide range of services that may help them identify a strategy to address issues related to mental health.

Study results

Data or other evidence supporting the measure's effectiveness

• RSSB (2013): General positive attitude about the training (an average of 4.8 out of 5 on a satisfaction scale): 63.1% of respondents appreciated that the training may decrease the number of suicides, 5.5% rated that it might increase the number of suicides and 31.4% thought it would have no effect either way. Attitude about suicide prevention: participants reported an increased likelihood of taking actions seen to be ’desirable’ upon encountering a potentially suicidal person. Participants had a lower rating in terms of viewing suicide being a long-lasting issue, indicating they were more likely to believe that once a person has had suicidal thoughts, these can be overcome. Confidence: staff felt more confident following training in making an intervention. The majority of front line staff are generally willing to use the programme activities. Evidence in terms of changing staff behaviour: 14% of participants returning evaluation feedback sheets (n = 66) reported that they had engaged with a potentially suicidal person and used the skills they had learnt.
• In Ireland, the "TaxiWatch" action involves taxi drivers as life savers and represents a good example community gatekeeper programme. Similarly, in the UK, Network Rail is training bus and taxi drivers about intervening, with the goal of pushing the prevention as upstream as possible.
• Gatekeeper training was tested by HMGU in Germany and by ProRail and NS in the Netherlands as part of RESTRAIL pilot tests conducted in 2014.
• A follow-up evaluation of the the Dutch programme performed by ProRail in 2018 showed positive effects of the training: the staff’s self-perceived competence for intervention and their knowledge of useful behaviour improved after the training.
• A follow-up evaluation of the the Dutch programme performed by ProRail in 2018 also showed that 85% of the persons approached by trained gatekeepers were actually suicidal.