Abstract
BACKGROUND: Despite increasing recognition of the crucial role of lived/ing experience in shaping suicide prevention policy and practice, the perspectives of people who have considered or attempted suicide by train are seldom captured in analyses of what could reduce suicides on the railways. The aim of this study was to explore lived/ing experience perceptions of what types of approaches are effective or ineffective in this context, and why. METHODS: We carried out 1) in-depth qualitative interviews with 34 individuals who had attempted or contemplated suicide on the railways; 2) an online survey investigating lived/ing experiences of suicidality at rail locations (N = 269); 3) an online ethnography of content relating to train/rail suicide from different online spaces including 'pro-choice' forums and reddit (254 posts and 1228 associated comments). RESULTS: Several measures to prevent suicide on the railways were identified-and critiqued-in lived/ing experience accounts. These included strategies to challenge dominant cultural narratives around railway suicide (e.g. by shifting the focus from the lethality of this method to its impact on train drivers and others); environmental measures to restrict access to means and/or create a safer and more positive atmosphere; and increasing opportunities for help-seeking and 'helpful' third-party interventions. However, considering what works for whom, and when, emerged as crucial. The challenges of preventing rail suicides against a backdrop of severely stretched mental health services were also repeatedly highlighted. CONCLUSIONS: The perspectives of people with lived/ing experiences, whilst far from homogenous, provide crucial insights into the potential value and unintended consequences of different measures to prevent suicides on the railways. Our findings reiterate the need for comprehensive suicide prevention strategies, targeting different stages of the suicidal process.