Communication Strategies with Patients and Supporters about Lethal Means The CALM (Counseling on Access to Lethal Means) program helps clinicians work with patients and families to reduce access to lethal means to prevent suicide. Highlights of this program include the following actions 77 : • Speak with the patient and family, friends, or with other key persons in his/her support system. If the patient is an adult, be sure to obtain releases for permission to speak with members of the patient’s support system. • Discuss suicide risk and how escalation of such risks may lead to a suicide attempt. • Ask the patient whether there are firearms in the home and if the patient has access to firearms outside the home as well. • Recommend that all firearms be removed from the home and from patient’s access until such time as the situation improves. • If handling firearms is too dangerous for the patient, enlist the support of others to remove the firearms. Law enforcement may temporarily hold firearms and most will dispose of such weapons upon request. • If the family is unwilling to remove firearms from the home, the firearms should be unloaded and locked in a place that is not easily accessible. Ammunition should be stored in a separate locked container.
• Potentially lethal prescription medications and alcohol should be removed from the home, and only left in small amounts, if at all. • Monitor the patient’s reactions to the reduction plan. Opposition may suggest a strong commitment to using lethal means to die by suicide. If the patient is overly eager to comply it may indicate that he/she has chosen another means (e.g., deliberate car accident) to attempt suicide. Strategies to Reduce Access to Lethal Means Limiting or reducing a person’s access to lethal means effectively prevents suicides. The conceptual model of reducing access includes means restriction, which results in the individual either substituting or delaying the attempt. This substitution or delay results in fewer fatal attempts, and often the suicidal crisis may even pass, ultimately resulting in a drop in the overall suicide rate 15 . Individuals at risk for suicide need firearms, medications, means to hang themselves, or poisonous substances restricted or made less accessible. Statistically, an individual who does not have access to lethal means is more likely to delay the attempt, and fewer attempts with less lethal means will prove less fatal. The individual who attempts suicide generally does so during a crisis; if that attempt is delayed, generally, the crisis is averted, and 89-95% of attempters do not go on to die by suicide 15 . If lethal means are restricted, the suicide rate will decline over time.
Creating a safe environment within a healthcare facility is essential to reduce access to lethal means to suicidal patients. Hospitals, prisons, and detention facilities can prevent suicide by using collapsible shower heads, light fixtures, doorknobs, and specially designed bedding that does not tear. 78 Healthcare providers should educate patients on how to make their family members and homes safer by reducing access to medications and firearms 78 : Medications: • Never keep lethal doses of any medication on hand. • Consider keeping medications locked in a safe place. • Properly dispose of medications that are no longer needed. Firearms: • Keep firearms locked and unloaded in a safe and ammunition stored in a separate location. • Ask a friend or family member to store a firearm for a while. • Unloaded firearms can also be secured with a gun-locking device making them unusable.
PLEASE COMPLETE CASE STUDY 6.
Case Study 6
Instructions: Spend 5-10 minutes reviewing the case below and considering the questions that follow. (Rationale and discussion is displayed at the bottom of this exercise)
Ella is a 16-year-old high school student. She requests to see a school counselor after a difficult breakup with her boyfriend of three months. During her initial consultation with the counselor, she reports that she has had suicidal ideations and a plan and intent. She reports that she has a plan to swallow a bottle of Tylenol to “make the pain go away.” When asked if she had access to Tylenol, she reported that she bought a bottle a few days ago and was waiting to find the right time. The school counselor promptly contacts Ella’s parents, who come in to meet with her. Ella’s mom reports that Ella tended to be dramatic and that she had made such threats after her previous three breakups and all Ella needed to do was stop being distracted by boys and focus on her future. At the counselor’s insistence, the mother promised to report the counselor’s findings to her pediatrician. The following week, Ella was found dead by her best friend on her bathroom floor.
1. What was the trigger that led to the death by suicide in this case? A. Ella’s mom not listening. B. Romantic Breakup. C. Ella has always had suicidal ideations. D. School counselor’s confrontation.
2. Based on the information regarding restricting access to lethal means, which action could have been taken by an individual in the scenario to reduce the risk of suicide? A. Notify the pediatrician. B. Meet with the parents and Ella together. C. Ask Ella to meet with her regularly. D. Remove access to the Tylenol. 3. Based on the information provided regarding lethal means, who does not need education to raise awareness of Ella’s risk for suicide? A. Educators. B. Mother. C. Lay gatekeeper. D. The school counselor.
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