Suicide Prevention in Toronto

There has been a lot of discussion about the Toronto Public Health Board’s recent report to city council on suicide prevention. For some, it may be surprising to learn that suicide is the cause of more deaths in Toronto than motor vehicle accidents and homicide (about three and four times as many, respectively). In 2009, this translated to 243 deaths by suicide in Toronto. The effect of these 243 deaths on those individual’s families and friends, not to mention any passersby, first responders, and the community at large are difficult to overstate. The Health Board’s report is thorough, well researched, and sensitive, and it includes a range of recommendations to help reduce the incidence and impact of suicide. Interestingly, the part of the report that seems to have really gotten thrust into the spotlight is the call for barriers on TTC subway platforms.

The report documents how Platform Edge Door (PED) barriers have been implemented on public transit networks in 35 major cities around the world, and have been shown to be effective in preventing suicides by train. Some argue that people who want to commit suicide will just find another way, and so all these barriers do is displace the problem. I think about the impulsivity that is part of many attempted and completed suicides. When it comes to risk factors, it's those dynamic and changing ones (acute mental illness, substance use, emotional turmoil, financial and employment stressors, hopelessness, etc) that often seem to tip people over the edge and so it does stand to reason that barriers could serve to prevent vulnerable people from killing themselves long enough to get help or for their present circumstances to improve, if only slightly. It seems logical that barriers could help, but is it really the case? Do these barriers reduce suicide overall or simply push the problem elsewhere?

This is the question that was undoubtedly asked when the Bloor Viaduct suicide barrier was being decided upon in the late 1990s. Its also the question that Edmonton city council recently asked itself when deciding whether or not to install a barrier on its iconic High Level Bridge. Researchers have asked this question as well. A recent meta-analysis and systematic review both suggested that the overall suicide rate is reduced when barriers are installed at what are called suicide ‘hot spots’ (Cox et al., 2013; Pirkis et al., 2013). These are iconic structures that seem to draw vulnerable people to end their lives. Think of the Golden Gate Bridge as a classic example. The Bloor Viaduct has been argued to be a similar hot spot, and so we would expect to be able to look back and see a reduction in overall suicides in the city in the years following the installation of The Luminous Veil (as it came to be known) in 2003. Though it was the recipient of a Canadian Architect Award of Excellence, research suggests that the barrier only reduced deaths from the bridge itself and not overall in Toronto, suggesting that it only displaced these suicides (Sinyor and Levitt, 2010). It is difficult to reconcile this finding with the more recent studies that suggest that these barriers do make a difference. It’s possible that the Bloor Viaduct is not the iconic hot spot that it was assumed to be. It’s possible that the suicide rate in Toronto rose for other reasons during those years, seeming to erase any benefit from the veil. Edmonton decided to go ahead with its barrier on the High Level Bridge and if what happened in Toronto is any indication, Edmonton citizens will be questioning its value for a long time to come.

Returning to subway barriers in Toronto – will installing them reduce suicide attempts and save lives? They will no doubt save lives on the TTC subway network. Unfortunately, the evidence to suggest that these barriers will help to reduce the overall incidence of suicide in the city is not strong. At an estimated system wide cost of 1 billion dollars, one can’t help but wonder how that money might be better spent. For instance, deaths by subway, train, and car collision (combined) make up just 7.7 percent of the total suicides completed in Toronto between 1998 and 2011. What would subway barriers do for the other 92.3 percent, even assuming that the 7.7 percent will truly be avoided? Of course, to someone who has lost a loved one to suicide, there is likely no monetary cost too great to prevent tragedies of this sort. But if our spending priority is on physically preventing a (relatively) small number of people from attempting suicide in one particular way, how will we pay for the services needed to help those considering where else they might end their lives?

And herein lies the problem. Physical barriers are tangible and real. We can touch them. We can understand how they work and we can be assured that suicide at a given train station will end the day they are installed. Helping those vulnerable to suicide feel less isolated, ill, and without options or even just recognizing them is an altogether different task for our city. The material nature of barriers seems to imply a sense of confidence about tackling this issue whereas other facets of suicide are obviously much more complex. Of course, there may be other transit efficiency-related reasons to install these barriers, and these reasons will be debated elsewhere. My worry is that the sense of confidence that physical barriers imply about reducing suicide is a false one.