In 2013 I met with the Deputy Mayor and proposed to Council a suicide prevention program involving anti-suicide infrastructure to be erected at the The Skillion, at Terrigal, NSW. This is in response to the results from my research on suicides on the Central Coast. From these results I identified clusters of suicide death modes and locations which are described as suicide hot spots.

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The proposal was rejected in 2014.  More people died. Then the good news is in 2016, funding was found and two tall poles have recently been erected with CCTV surveillance cameras fitted to them. Plus Lifeline crisis help signs have been erected at the The Skillion. These signs are important not just for people about to take their lives. My research revealed some people would visit The Skillion before choosing elsewhere, therefore suicide signs can communicate help to those people too. 

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The supporting report I wrote is below. 

The Skillion Hotspot – A Suicide Prevention Solution. By Dr Myfanwy Webb Report for Central Coast Council, 2013.

SUMMARY

The Central Coast has a higher than National suicide rate. The primary aim of this community suicide prevention intervention is to reduce the number of suicide deaths at The Skillion, Terrigal. I have identified this site as a suicide Hotspot from an audit of coronial files.  A secondary aim is to reduce suicide deaths overall in our community. The methods I recommend in order to achieve a reduction in suicide deaths include three aspects. Firstly, construction of a barrier than blocks total access to the edge of the high cliff. Secondly, provide well lit signage that directs suicidal people to access help and thirdly target the use of the media with this project specifically to help the effectiveness of this initiative. I have found evidence that this site is an important place for people contemplating suicide to visit. This means it may be a very effective location to communicate to these people how to access help to save their lives. Investment in people who are thinking of taking their own lives reduces the emotional and financial toll on our community.

Introduction

Suicide is the tragic ending of life for many people in our community. For each individual person who dies by suicide each year, it is estimated that there are often at least six close family and relatives who are left to grieve and suffer the aftermath of the loss of their loved one. Between 1996 and 2009 the average number of deaths by suicide annually on the Central Coast is 41 people. This equates to around 258 new people (family and relatives) annually who begin their lifelong years of bereavement plus the actual one who died resulting in around 300 new people adversely affected each year. Another way of measuring the costs of suicide is examining the number of lost years behind every life cut short. When a thirty year old person who has a life expectancy of 80 years, dies by suicide, then 50 years of that person’s life is lost forever. In fiscal terms, suicide is expensive.  According to a report prepared by ConNetica Consulting (2009) entitled “Estimating the Economic Cost of Suicide in Australia”, a ‘conservative’ estimate for the economic cost of suicide and suicidal behavior on the Australian community is $17.5B every year.

The local region is comprised of Gosford and Wyong local government areas. These deaths are not confined to local residents. People who reside outside the region also choose the Central Coast to end their lives.

Each year around, 2300 people are registered as deaths from suicide in Australia, a rate of around 10 per 100,000. The 2009 census for Gosford and Wyong local government areas, estimated the population to be 316,008 people. An annual average of forty one people dying by suicide equates to 12 deaths per 100,000 people (assuming estimated population now 350000 people). This is higher than the national rate for of 10 per 100,000.

Suicide rate accuracy

The number of suicide deaths officially recorded each year is likely to represent an underestimate of the actual number of people who take their own lives (Elnour & Harrison 2009).  Explanations for this data problem include the collection of information for Coroners to use, difficulties in determining the intent of a deceased person, and data entry inconsistencies at the later stages of statistical collection. The level of underestimates is thought to be 20 to 30% in Australia. This means that only a very significant change in annual totals can indicate a real trend of increase or decrease in our local suicide death rates. So, a small number of suicide deaths above or below the usual recorded total cannot accurately demonstrate a change in rate.

Profile

A typical profile of an individual on the Central Coast who ended their life in the past few years is that of a male aged in their 50s, in a married or defacto relationship, who was unemployed or retired. They had previously attempted to take their life. They experienced depression and relationship problems, used alcohol or drugs and they had contact with mental health professionals within less than a year of their death.

The Skillion Hotspot

I have identified a significant suicide ‘hotspot’ of the Central Coast from an audit I conducted on 153 cases of people who died from suicide during 2000 to 2009. This Hotspot is The Skillion at Terrigal. There were at least 387 suicide deaths recorded between 2000 to 2009 in total on the Central Coast.  I audited 154 of the total 387 = 40%. The audit consisted of coronial files.

During the last decade between 2000 and 2009 at least five people took their life by jumping from the cliff at the top of the Skillion (See Figure 1). At least two people have died recently.  In addition, at least three suicidal people visited the Skillion before taking their life at another location.

Figure 1 Memorial located at The Skillion.

Antisuicide Measures

Typical anti-suicide measures used around the world include;

• Reducing access to hotspot sites of for example prominent cliffs, and bridge edges in the form of physical barriers. A local successful example is the Mooney Mooney Bridge anti-suicide barrier.
• Signs directing people to help in the form of text stating the phone numbers of suicide crisis and emergency assistance, location of the nearest phone booth.
• Provision of a phone on site.
• CCTV of site.
• People patrols.

International research suggests crisis hotlines can reduce suicidal thinking, with some users reporting that calls to hotlines prevented them from killing themselves (Gould, Kalafat, Munfakh & Kleinman, 2007, Cox et al 2013). Car parks in the New Forest in southern England attracted a large number of non-local people as a site for suicide between 1993 and 1997. A New Forest Suicide Prevention Initiative involving multiple agencies erected signs displaying the Samaritans’ national telephone number in the 26 car parks in which 50% of the car park suicides had occurred. During the 3-year intervention period the number of car park suicides fell significantly from 10/year, 1988-1997, to 3.3/year. The average annual total number of suicides in the New Forest area also decreased. Comparable forest areas recorded no significant changes in suicide rates. It appears this intervention lasted during the 2 years following the evaluation (King & Frost 2005).

Authors, Cox et al 2013, in a review of interventions to reduce suicides at suicide hotspots, state; “There is relatively strong evidence that reducing access to means can avert suicides at hotspots without substitution effects. The evidence is weaker for the other approaches, although they show promise”. They also suggest media can be beneficial if used correctly.

Recommendations

Three relevant measures that are likely to reduce the attractiveness of The Skillion for suicide are;

1. A physical barrier to block access to Skillion cliff edge.
2. Anti-suicide signage directing people how to access help.
3. Use of media to further taint the attractiveness of this site for suicide.

Barrier

A heavy duty non-scalable barrier positioned at the cliff edge rather than at the lookout itself would block access to the site. An important consideration is that if the barrier is too low and can be climbed over, it will undermine the intervention completely as it will fail to block access to the suicidal means of the cliff edge. According to topographical mapping, most of the cliff edge is at a 34m contour level, three metres lower than the lookout at 37m.  Thus, a high fence preventing people from climbing over is unlikely to significantly impact on the aesthetic qualities of the ocean views. Considerate design of the fence type would be of benefit (See Figure .1 for an example).

Figure 2. Anti-suicide barrier on a bridge in Toronto.

Another requirement is that the barrier encompasses the entire length of sheer cliff access. A barrier too short will, (like inappropriate height), allow access to the cliff edge and undermine the usefulness of the barrier blocking access to means. This means the barrier would need to extend down the length of the rampart- grass slope for a longer distance than the perimeter fence that exists there on both sides. See Figure 3.

 Figure 3 North facing existing fence. Barrier would need to extend length of cliff edge.

There is a, non functional, unsightly, rusted and broken metal fence in existence along some of the perimeter of The Skillion (See Fig 4 and 5 and 6).  There is also a low pine fence along the sides of the rampart. In my view, these two styles of fence in addition to the third style of the lookout metal fence at the top provide a hotpotch of landscaping objects are not functional and they detract from the scenery. The sandstone path, rails, seating and lookout fence upgrade are beautifully done and the extraneous old fences look tired next to the new features.

Figure 5. Inadequate suicide prevention fence

In addition to preventing suicide deaths, a secure perimeter barrier will act to prevent accidental deaths from falls over the cliff.

Signage

An anti-suicide sign at the start of the path up the rampart may prevent suicides if it contained phone numbers to help lines and directions to the nearest phone box.  Figure 7 shows current infrastructure.

Figure 7. Base of The Skillion and suggested location of sign and light near the beautiful  sandstone stairs.

Bright lighting is necessary as most of the deaths occurred at night. Lighting may also alert other people to a person contemplating a suicidal act and bystanders may then act to save them. Illuminating The Skillion at night and may increase it’s attraction to tourists visiting the area and may reduce nocturnal drug dealing in the nearby car parks. It is an impressive natural icon of the coast and encouraging visitation after sunset and promoting it by lights may boost the park’s recreational value.

The sign should state the basic information of Suicide Crisis phone number of Lifeline, Emergency OOO. It should also include a map showing the location of the nearest public phone and the location of Terrigal Police Station. A few words to encourage people to seek help may be effective too.  See Figure 8 and 9 for examples of help signs.

Media

I recommend the specific use of media to communicate to the wider community how the Council cares about our suicidal people in the community and the aims and outcomes expected from this intervention. I expect any support but especially local council’s support, for people with a mental illness on the Central Coast is very much valued by both people with an illness but also their friends and family.  If used correctly, the media can educate and inform about suicide today and hopefully reduce the overall local suicide rate.

Evaluation

After implementation of the intervention, I expect to see a reduction in the rate of suicides at The Skillion and everywhere on the Central Coast. We may also see an increase in calls to the designated Help line from Central Coast residents.

Conclusion

This intervention is a targeted cost-effective measure in combating our tragic suicide rate on the Central Coast.

References

Australian Bureau of Statistics, Measures of Australia’s Progress, 2010. Family, community and social cohesion, Suicide.  Catalogue no. 1370.0, Canberra: ABS, 2010.

Australian Bureau of Statistics, Causes of Death, Australia, 2009, Catalogue no. 3303.0, Canberra: ABS, 2010.

Cox GR, Owens C, Robinson J, Nicholas A, Lockley A, Williamson M, Cheung YT, Pirkis J (2013)  Interventions to reduce suicides at suicide hotspots: a systematic review. BMC Public Health.Mar 9;(13):214.

Estimating the cost of Suicide in Australia.  ConNetica Consulting (2009).

Gould MS, Kalafat J, Harrismkh JL, & Kleinman M, (2007) An evaluation of crisis hotline outcomes. Part 2: Suicidal callers. Suicide Life Threat Behav. Jun;37(3):338-52.

King E, & Frost N, The New Forest Suicide Prevention Initiative (NFSPI) (2005) Crisis.26(1):25-33.

Crisis helplines
Lifeline: 13 11 14
Suicide Call Back Service – 1300 659 467
Kids Helpline (for young people aged 5 to 25 years): 1800 55 1800

CLICK HERE for info on my book STAGES OF SUICIDE – HOW TO HELP YOUR MIND

CLICK HERE to read how to Optimise Your Mind and CLICK HERE for free printable tools.

CLICK HERE  to read the first in my life writing series of SOURCING STRENGTH Story 1 How my ancestors gave me strength – 2 min read