Drs. Blaustein and Fleming Reply

To the Editor: We would like to thank Dr. Jacobs for his observation and comments. The picture of the out-of-order telephone is a reminder of the suicide prevention campaign in the 1990s (the 7th since construction of the bridge in 1937) that led to the installation of phones as well as scooter patrols and video cameras on the Golden Gate Bridge. At first, the phones were only connected to suicide prevention centers but have since been routed to the California Highway Patrol, whose officers are dispatched to the scene of an attempted suicide. Callers are taken to the San Francisco General Hospital with the notation "BIP" (brought in by police) from "GGB" (Golden Gate Bridge). Nevertheless, despite these well-intended interventions, the suicide rate continues at approximately two attempts/completions per month. The Marin Coroner's Office recently released data revealing that 31 people jumped to their death from the bridge in 2009 (1). The ongoing loss of lives and the evidence presented in our article indicates that a barrier would be the most effective deterrent.

A final note—not as detailed in the article as we would like but hopefully understood by readers of the Journal—is the most important part of the story—the tragic loss of lives and the heartbreak and devastation experienced by surviving families, friends, and the community. In our article, we could not address all the aspects of prevention and focused on three case studies of people who died at the bridge. Illustrative of the importance of the human factor is the story told by one of less than 30 jump survivors. Intent on suicide, he tearfully bypassed the phones but told himself that if one person showed concern he would not jump. When a German tourist approached him but requested only that he take her picture, he complied, muttered under his breath, walked away, then threw himself over the railing. He later reported how thankful he was to be alive, confirming that many suicides are impulsive and preventable.