RECOGNIZE and CONNECT

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Take A Few Minutes to C.A.L.M. Counsel on Access
to Lethal Means Elaine Frank Elaine.frank_at_dartmou
th.edu
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Reducing Access to Lethal Means

• Make highly lethal means less accessible
• Attempt suicide with less lethal means
• or
• Delay suicide attempt

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CALM Goals and Objectives

• Project Goal Increase the number of mental
  health and, primary care professionals and other
  gatekeepers who counsel those at risk for suicide
  about reducing access to lethal means
• Learning Objectives
• 1. Understand what "lethal means" are
• 2. Recognize the contribution reducing access to
  lethal means has for preventing suicide
• 3. Develop skills and confidence to counsel on
  reducing access to lethal means
• 4. Identify how you can use this information in
  your professional and personal lives

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Why do it?

• Proven to be an effective intervention
• many people will not switch to another means
  (Means Substitution)
• Part of the National Strategy for Suicide
  Prevention and many state plans
• Most suicidal people are ambivalent about death
  as they are about life
• The actual act of suicide is often highly
  impulsive - particularly among young people
• WHY NOT?

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A few facts before we go on

• ? 90 of those who die by suicide suffered from
  some form of mental illness and/or substance
  abuse often undiagnosed but often treatable
• ? 90 of those who survive a nearly lethal
  attempt do not go on to die by suicide
• ? 92 of those prevented from jumping off the
  Golden Gate Bridge did not die by suicide

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What Means to Focus On?

• Frequency
• Lethality
• Impulsivity
• Availability
• Feasibility

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Suicide Methods by Age
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U.S. Suicides Deaths per 100,000 population
Total Firearm Poison Suffocation Other
The decline in the suicide rate has largely been
due to a decline in firearm suicides,
particularly in the 1990s.
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U.S. Youth Suicide, 15-24 year-olds
Total Firearm Suffocation Poison Other
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Relative Lethality of MeansOhio - 1999 - 2005
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Self-Harm Case Fatality Rates
1-2 fatal
85-90 fatal
98 nonfatal, ED-treated
15 nonfatal, ED-treated
Firearms
Cutting Poisoning
Source CDC WISQARS lthttp//www.cdc.gov/ncipc/wisq
ars/gt
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Moving Attempters Down the Ladder
High Case Fatality Rate Low Case
Fatality Rate

• Firearm
• Jump from great height
• Carbon monoxide
• Hanging/suffocation
• Overdose/poisoning
• Cutting

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Impulsivity

• Among survivors of near fatal suicides,
• when asked about time from their decision
• to complete suicide and the attempt
• ? 24 said less than 5 minutes
• ? 47 more said an hour or less

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Firearm Availability As A Suicide Promoter

• Suicide rates vary with rates of firearm
  ownership
• Case control studies show greater prevalence of
  guns and less securely stored guns in homes of
  those who suicide than in controls
• 85 of youths who die by suicide using a firearm
  obtained it from home
• Parents underestimate the likelihood that their
  children have or could obtain their firearms.

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Feasibility(in order of lethality)

• Firearms can limit access at home, some
  opportunity to impact purchase. Particularly
  feasible for those under 18 and those who are not
  primary owners
• Bridges/other high places requires public
  policy and political will but highly effective
• Hanging too many means, remove the obvious ones
  and focus on connectedness and supervision
• Medications can limit quantity of prescription
  and OTC medications at home
• Cut/pierce again, too many means but low
  lethality

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Natural (Gas) Case Study Self-asphyxiation by
domestic gas, Great Britain

• Pre-1957 Proportion of suicides 40
• 1957-1970 Transition from coal to natural gas
  CO content went from 12 2
• 1971 Proportion of suicides 10
• Overall suicide rate 26

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Steps to Take

• Express your concern directly to client/family
  and explain that you believe the individual is at
  risk for suicide
• Inquire about access to firearms and other lethal
  means
• Inform the client/family that restricting access
  reduces risk
• Discuss how to accomplish this as well as the
  need for ongoing supervision, treatment and
  follow up