Suicide on the railways in Great Britain: a multi-disciplinary analysis

As part of wider efforts to reduce suicide on the railways, Network Rail commissioned a programme of research and consultation focusing on railway suicide messaging and communications. The aim of this work was to generate new multi-disciplinary insights and actionable intelligence for the rail industry. The secondary analysis of existing interview and survey data , taken alongside the analysis of online environments , previous ethnographic and anthropological work , and consultations with academic, rail industry and lived experience experts, has enabled us to generate a fairly full and clear picture of how people who are contemplating (or who have contemplated and attempted) suicide on the railways engage with and express the idea of railway suicide, and the types of associations made about that method / location. In short, by bringing together the findings from different studies, and looking for overlaps, common themes, as well as differences, we have been able to develop a good sense of the cultural scripts and discourses that together form ‘railway suicide’ as a knowable and available means of ending one’s life. More specifically, from these sources we have been able to draw out the factors that seemingly attract people to the method/location (quick, lethal, accessible, commonly used method), and also what dissuades them (impact on others - especially the driver, possibility of surviving with injuries, possibility of intervention, fear-inducing method). The logic, in terms of a messaging / communications strategy, would therefore be to challenge the ‘attractors’ (because many are misunderstandings or myths) and try to reinforce or amplify the ‘dissuaders’. There are complexities and difficulties to be considered, though, particularly around risks, possible unintended consequences, and the nuances needed to communicate to different audiences

Cultures of caste and rural development in the social network of a south Indian village

Cultures of caste in much of rural India have become entangled with institutions of rural development. In community-driven development, emphasis on “local resource persons” and “community spokespersons” has created new opportunities for brokerage and patronage within some villages, which interact with existing forms of authority and community afforded by caste identity and intra-caste headmanship. In this article, we study how these entangled cultures of caste and development translate into social network structures using data on friendship ties from a south Indian village. We find that although caste continues to be important in shaping community structures and leadership in the village’s network, its influence varies across different communities. This fluidity of caste’s influence on community network structures is argued to be the result of multiple distinct yet partially overlapping cultural-political forces, which include sharedness afforded by caste identity and new forms of difference and inequality effected through rural development

Implementation of the Crisis Resolution Team model in adult mental health settings: a systematic review.

Crisis Resolution Teams (CRTs) aim to offer an alternative to hospital admission during mental health crises, providing rapid assessment, home treatment, and facilitation of early discharge from hospital. CRTs were implemented nationally in England following the NHS Plan of 2000. Single centre studies suggest CRTs can reduce hospital admissions and increase service users' satisfaction: however, there is also evidence that model implementation and outcomes vary considerably. Evidence on crucial characteristics of effective CRTs is needed to allow team functioning to be optimised. This review aims to establish what evidence, if any, is available regarding the characteristics of effective and acceptable CRTs

First-person accounts of the processes and planning involved in a suicide attempt on the railway

Background The processes and planning involved in choosing and attempting to die by a particular method of suicide are not well understood. Accounts from those who have thought about or attempted suicide using a specific method might allow us to better understand the ways in which people come to think about, plan and enact a suicide attempt. Aims To understand from first-person accounts the processes and planning involved in a suicide attempt on the railway. Method Thematic analysis was conducted of qualitative interviews (N = 34) undertaken with individuals who had contemplated or attempted suicide by train. Results Participants explained how they decided upon a particular method, time and place for a suicide attempt. Plans were described as being contingent on a number of elements (including the likelihood of being seen or interrupted), rather than being fixed in advance. Participants mentally rehearsed and evaluated a particular method, which would sometimes involve imagining in detail what would happen before, during and after an attempt. The extent to which this involved others (train drivers, partners, friends) was striking. Conclusions By giving people free reign to describe in their own words the processes they went through in planning and undertaking a suicide attempt, and by not interpreting such accounts through a lens of deficit and pathology, we can arrive at important insights into how people come to think and feel about, plan and enact a suicide attempt. The findings have implications in terms of understanding suicide risk and prevention more broadly

Can the Experience of Participatory Development Help Think Critically about ‘Patient and Public Involvement’ in UK Healthcare?

The expansion of spaces for ‘patient and public involvement’ (PPI) in health systems in the UK is a relatively recent phenomenon, and yet ‘participation’ as a principle for planned interventions in international development is well established as a field of practice and controversy. Development workers and scholars have passed through moments of enchantment and disenchantment with the idea that the true source of innovation, expertise and workable (and sustainable) solutions is to be found not in the professionals but in communities of experience. Making ‘local knowledge’ the basis of interventions has proved unexpectedly problematic. How could incommensurable forms of knowing, across steep gradients of power be bridged? This article describes a decade-long experiment in participatory development in a remote Adivasi (tribal) region of western India in order to suggest the relevance of this experience for the very different context of PPI in healthcare settings. In particular, it highlights some general points about knowledge practices at the interface, and the human tendency to adjust, mirror, mimic, loop and in other ways make the ‘patient-professional’ interface itself hard to navigate. The article suggests that self-reflective insight into these social processes is necessary for effective ‘engagement’ by professional and lay actors alike

Randomised feasibility trial of the helping families programme-modified: an intensive parenting intervention for parents affected by severe personality difficulties

Background: Specialist parenting intervention could improve coexistent parenting and child mental health difficulties of parents affected by severe personality difficulties. Objective: Conduct a feasibility trial of Helping Families Programme-Modified (HFP-M), a specialist parenting intervention. Design: Pragmatic, mixed-methods trial, 1:1 random allocation, assessing feasibility, intervention acceptability and outcome estimates. Settings: Two National Health Service health trusts and local authority children’s social care. Participants: Parents: (i) primary caregiver, (ii) 18 to 65 years, (iii) severe personality difficulties, (iv) proficient English and (v) capacity for consent. Child: (i) 3 to 11 years, (ii) living with index parent and (iii) significant emotional/behavioural difficulties. Intervention: HFP-M: 16-session home-based intervention using parenting and therapeutic engagement strategies. Usual care: standard care augmented by single psychoeducational parenting session. Outcomes: Primary feasibility outcome: participant retention rate. Secondary outcomes: (i) rates of recruitment, eligibility and data completion, and (ii) rates of intervention acceptance, completion and alliance (Working Alliance Inventory-Short Revised). Primary clinical outcome: child behaviour (Eyberg Child Behaviour Inventory). Secondary outcomes: child mental health (Concerns About My Child, Child Behaviour Checklist-Internalising Scale), parenting (Arnold-O’Leary Parenting Scale, Kansas Parental Satisfaction Scale) and parent mental health (Symptom-Checklist-27). Quantitative data were collected blind to allocation. Results: Findings broadly supported non-diagnostic selection criterion. Of 48 participants recruited, 32 completed post-intervention measures at mean 42 weeks later. Participant retention exceeded a priori rate (HFP-M=18; Usual care=14; 66.7%, 95% CI 51.6% to 79.6%). HFP-M was acceptable, with delivery longer than planned. Usual care had lower alliance rating. Child and parenting outcome effects detected across trial arms with potential HFP-M advantage (effect size range: 0.0 to 1.3). Conclusion: HFP-M is an acceptable and potentially effective specialist parenting intervention. A definitive trial is feasible, subject to consideration of recruitment and retention methods, intervention efficiency and comparator condition. Caution is required in interpretation of results due to reduced sample size. No serious adverse events reported. Trial registration number: ISRCTN1457323

Anaplastic lymphoma kinase (ALK) inhibitor response in neuroblastoma is highly correlated with ALK mutation status, ALK mRNA and protein levels

Background In pediatric neuroblastoma (NBL), high anaplastic lymphoma kinase (ALK) levels appear to be correlated with an unfavorable prognosis, regardless of ALK mutation status. This suggests a therapeutic role for ALK inhibitors in NBL patients. We examined the correlation between levels of ALK, phosphorylated ALK (pALK) and downstream signaling proteins and response to ALK inhibition in a large panel of both ALK mutated and wild type (WT) NBL cell lines. Methods We measured protein levels by western blot and ALK inhibitor sensitivity (TAE684) by viability assays in 19 NBL cell lines of which 6 had a point mutation and 4 an amplification of the ALK gene. Results ALK 220 kDa (p=0.01) and ALK 140 kDa (p= 0.03) protein levels were higher in ALK mutant than WT cell lines. Response to ALK inhibition was significantly correlated with ALK protein levels (p<0.01). ALK mutant cell lines (n=4) were 14,9 fold (p<0,01) more sensitive to ALK inhibition than eight WT cell lines. Conclusion NBL cell lines often express ALK at high levels and are responsive to ALK inhibitors. Mutated cell lines express ALK at higher levels, which may define their superior response to ALK inhibition

The impact of migration on the sexual health, behaviours and attitudes of Central and East European gay/bisexual men in London

Extensive social psychological research emphasises the importance of groups in shaping individuals' thoughts and actions. Within the child sexual abuse (CSA) literature criminal organisation has been largely overlooked, with some key exceptions. This research was a novel collaboration between academia and the UK's Child Exploitation and Online Protection Centre (CEOP). Starting from the premise that the group is, in itself, a form of social situation affecting abuse, it offers the first systematic situational analysis of CSA groups. In-depth behavioural data from a small sample of convicted CSA group-offenders (n =3) were analysed qualitatively to identify factors and processes underpinning CSA groups' activities and associations: group formation, evolution, identity and resources. The results emphasise CSA groups' variability, fluidity and dynamism. The foundations of a general framework are proposed for researching and assessing CSA groups and designing effective interventions. It is hoped that this work will stimulate discussion and development in this long-neglected area of CSA, helping to build a coherent knowledge-base

A Decolonial Critique of the Racialized “Localwashing” of Extraction in Central Africa

Responding to calls for increased attention to actions and reactions “from above” within the extractive industry, we offer a decolonial critique of the ways in which corporate entities and multinational institutions propagate racialized rhetoric of “local” suffering, “local” consultation, and “local” fault for failure in extractive zones. Such rhetoric functions to legitimize extractive intervention within a set of practices that we call localwashing. Drawing from a decade of research on and along the Chad-Cameroon Oil Pipeline, we show how multi-scalar actors converged to assert knowledge of, responsibility for, and collaborations with “local” people within a racialized politics of scale. These corporate representations of the racialized “local” are coded through long-standing colonial tropes. We identify three interrelated and overlapping flexian elite rhetoric(s) and practices of racialized localwashing: (a) anguishing, (b) arrogating, and (c) admonishing. These elite representations of a racialized “local” reveal diversionary efforts “from above” to manage public opinion, displace blame for project failures, and domesticate dissent in a context of persistent scrutiny and criticism from international and regional advocates and activists