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Cited by 14Suicide and Self-Harm StudiesCardiac Arrest and ResuscitationInjury Epidemiology and Prevention

Intervening to prevent a suicide in a public place: A qualitative study of effective interventions by lay people

Open access
Owens, Christabel, Derges, Jane, Abraham, Charles·2019·BMJ Open
DOI 10.1136/bmjopen-2019-032319PMC PMC6887022
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Abstract

OBJECTIVES: Many suicides take place in public locations, usually involving jumping from high places or use of transport networks. Previous research has largely focused on the effectiveness of physical barriers at frequently used locations. There have been no studies of human intervention to prevent suicides in public places. The aim of this study was to identify the core components of an effective intervention by a member of the public. DESIGN AND METHODS: We conducted in-depth qualitative interviews with people who have either been prevented by a stranger from taking their own life in a public location (n=12) or intervened to prevent a stranger from taking their own life in a public location (n=21). Collectively, the two groups narrated 50 incidents of suicide rescue. We analysed interview transcripts using inductive thematic analysis. RESULTS: Suicidal people typically displayed no visible distress, describing themselves as being dissociated or 'in a bubble'. Intervention was seen to involve three main tasks: 'bursting the bubble' (reconnecting with self, others and everyday world); moving to a safer location, and summoning help. We show how interveners accomplished these tasks in a range of ways, using both verbal and non-verbal communication and different degrees of restraint. CONCLUSIONS: This is the first empirical study to examine the role of passing strangers in preventing suicides in public places. It shows that no specialist skills are needed. Interveners were ordinary people, distinguished only by a high level of social awareness, combined with a readiness for social action. The findings also suggest that people do not need a script and should not be afraid of saying 'the wrong thing.' What interveners said was much less important than how they made the suicidal person feel, namely safe, connected and validated ('I matter'). Interveners did this simply by being themselves, responding with authenticity, calmness and compassion. Members of the public need to be encouraged to recognise and reach out to those who may be at risk of suicide in public locations, but should be prepared for a prolonged and intense encounter that may leave them with troubling emotions.

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  • Cognitive constriction/dissociation ("focus on death") in the transition phase can also be softened by lay people with the help of small measures - speaking up, being present and showing sympathy.

    “Initiatives such as the British Samaritans’ “Smalltalks save lives” campaign (www.samaritans.org/support-us/campaign/small-talk-saves-lives/) focus on the fact that cognitive constriction/dissociation (“focus on death”) in the transition phase can also be softened by lay people with the help of small measures – speaking up, being present and showing sympathy (68).”

    From Ambivalence model of suicidality [ABS-model]: an orientation model for the treatment of suicidal individuals (2024) · cites this paper as [68]

    The Results (Recognition; Three intervention tasks) describe suicidal people as dissociated or ‘in a bubble’ and say that an intervener’s presence, warmth, compassion, and even exchanging names could help ‘burst’ it. The Discussion says survivors felt that interveners broke through their dissociative state. The paper does not, however, characterize that state as cognitive constriction or a ‘focus on death.’ (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • A peaceful exit from the transition phase is possible, but it often depends on coincidence: something happens that "bursts the bubble" the suicidal individual is captured in.

    “A peaceful exit from the transition phase is nevertheless possible, however, it often depends on coincidence: the phone rings, the cats scratch at the door, one is approached by a by-stander; or, to put it differently: something happens that “bursts the bubble” (68) the suicidal individual is captured in.”

    From Ambivalence model of suicidality [ABS-model]: an orientation model for the treatment of suicidal individuals (2024) · cites this paper as [68]

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Authors
Owens, C., Derges, J., & Abraham, C.
Affiliations
  • University of Exeter (GB)
  • The University of Melbourne (AU)
Corresponding author
Owens, Christabel
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2019-11
Volume
9
Issue
11
Pages
e032319
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2019-032319
PMC
PMC6887022
OpenAlex
W2987266241
Cited by
14
References
24
Citations by year
2026: 4 · 2025: 4 · 2024: 2 · 2022: 1 · 2021: 3
FWCI
1.17
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • BMJ Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Explore Bristol Research (publishedVersion, other-oa)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Deakin Research Online (Deakin University) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
  • HighWire Press Open Archive (submittedVersion)
  • Open Research Exeter (University of Exeter) (submittedVersion, cc-by)
  • Bristol Research (University of Bristol) (submittedVersion, other-oa)
Funders
Medical Research Council (MR/P01707X/1)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Injury Epidemiology and Prevention
Keywords
suicide prevention, bystander intervention, lay rescuers, dissociation, social connectedness, validation, verbal and nonverbal communication, restraint, social awareness
MeSH terms
Suicide Prevention, Adult, Female, United Kingdom, Humans, Interviews as Topic, Male, Middle Aged, Police, Public Sector, Survivors, Young Adult, Suicidal Ideation

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