1. Reducing Access to Lethal Means
A Suicide Prevention Role
for Everyone
Presented by

2. Reducing Access to Lethal Means
Make highly lethal means less accessible
Attempt suicide with less lethal means or
Delay suicide attempt
Either way, s/he is more likely to survive

3. Why do it?
Proven effective if you focus on the MOST LETHAL means – firearms - and the MOST FREQUENT for attempts - medications
● Most suicidal people are undecided about choosing death versus choosing life. These are the ones that can be prevented.
The actual act of suicide is often made very quickly - particularly among young people – without a plan
So, putting time and distance
between a suicidal person and lethal means
MAY save their life
Ambivalence – survivors of suicide often report thinking something like: all the reasons I just jumped off the bridge can be fixed except that I just jumped off the bridge
“quickly rather than impulsively” – debate over whether there are impulsive suicide acts

4. But Does It Work?

5. Pesticides – Sri Lanka
Pesticides are the leading suicide method in Asia, with an estimated 300,000 deaths annually worldwide.
In Sri Lanka, suicide rates rose 8-fold from 1950 to
Restrictions were placed on sales of the most highly human-toxic pesticides in the late ‘90s.
Suicide rates dropped 50% from 1996 to 2005.
In the US that would be 16,000 lives a year
Nonfatal poisonings and other
suicides did not.
1995 WHO Class I toxicity pesticides restricted; Endosulfan restricted. 20,000 fewer deaths 96-’05 than if old rates had applied.
Gunnell Int’l J of Epidemiology.

6. Long term Prevention
● Many people who survive a nearly lethal attempt say something like: As soon as my hand left the railing, I knew that everything that made me jump could be fixed, except that I had just jumped off the Golden Gate Bridge
● 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
This means however that 10% do go on to die by suicide. So a suicide attempt is a major risk factor for suicide. 10% = 10:100 Suicide rate for the general population is 11: 100,000

7. But we are anti-suicide!
Why Focus on Firearms?
They are:
The leading method for suicide deaths in this region and in the US. More than all other methods combined.
Highly lethal.
Fast and Irreversible. No chance for rescue or change of heart once the trigger is pulled.
Very Accessible – many homes have firearms
We’re not anti-gun
But we are anti-suicide!

8. E Wash/Idaho/W Montana 2013 Suicide Deaths by Method

9. Comparative Lethality, U.S.
Suffocation
24%
Poison
17%
Jump 2%
Sharp 2%
Other 4%
Poison
83%
Firearm
51%
Sharp
11%
We will also add a slide showing suicide method in Colorado for youth and for all ages.
Other 4%
Suffocation 1%
Firearm 1%
Suicide
Nonfatal Self-harm
Sources
Inpatient: HCUP-NIS (2005). Suicide: CDC WISQARS (2009)

10. Decision Time 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
Putting time and distance
between a suicidal person and a gun may save their life!
Survey of 15 – 34 year olds. Doesn’t mean they had never thought about it before but on this occasion…
Simon TR et al, Characteristics of impulsive suicide attempts and attempters. SLTR 2001: 32 (supp) 49 – 59.

11. Ambivalence Suicidal Behavior Among College Students
Among the 5% who seriously considered attempting, past 12 mos
n=1321
Began attempt, then reconsidered
15%
Carried through an attempt
12%
Drum, Brownson, Denmark, Smith. Professional Psychology: Research & Practice, 2009

12. Firearm Availability
85% of youths who die by firearm suicide use a firearm obtained from their home
Parents underestimate the likelihood that their children have or could obtain their firearms
Kids know where we keep the alcohol, the Christmas presents AND the firearms

13. Suicide Plans Among Attempters
Had a Suicide Plan?
People who attempted suicide in past 12 months
No plan
43%
Plan
57%
And plans aren’t always the best predictor of future suicidal behavior. The National Comorbidity Survey asks if you’ve ever thought about suicide, ever made a suicide plan, and ever attempted suicide. 43% of the people who said yes to “attempted” said no to “made a plan.”
Borges et al. Risk factors for twelve-month suicide attempts in the National Comorbidity Survey Replication (NCS-R). Psychol Med

14. Steps to Take
If suicide (or homicide) is or could become a concern for someone, you should:
- Express it directly using the word SUICIDE
- Ask about access to guns (most lethal) and meds (most frequent) and any other indicated means
- Inform them that reducing access reduces risk
- Take specific steps to remove firearms from the home or reduce access to guns and other lethal meds
- Document what you have said and done orally and/or in writing, if acting in a professional role

15. Gun Shop Project: A Role for Firearm Dealers and Rangesor

16. Project Impetus
Three suicide deaths in six days within hours of gun purchase from a single NH gun shop
Gun shop owner, firing range instructor, suicide prevention and firearm advocates and public health researchers meet to determine if there is an effective way to respond
Builds on previous collaborative work of the
NH Firearm Safety Coalition (EF and gun shop owner
were members)

17. Recent-purchase Suicides
About one in ten (8%) firearm suicides in NH are with recent- purchase guns
“Recent purchase” = buying or renting firearm within one week of suicide (usually within hours)
8% is likely a slight underestimate; in two-thirds of cases interval between acquisition and death was not noted
Source: Medical examiner reports on all 144 firearm suicides in NH over two-year period ending 6/30/09

18. Mission
Enlist gun shop owners in efforts to prevent suicides with either recently-purchased firearms or existing household firearms
Educate gun shop owners about steps to avoid selling a firearm to a suicidal customer
Educate their customers about making firearms less accessible if a friend or family member is suicidal
Promote National Suicide Prevention Lifeline to link with local crisis centers and other emergency services

19. Project Launch
Gun Shop Packets mailed out to “all” independent gun shops (63) and firing ranges (2)
They included:
Cover letter signed by recognized gun advocate
Tip Sheet on avoiding sales to suicidal customers
11th Commandment Brochure
Suicide Prevention Poster and Lifeline Cards
DVD made for firearm retailers by firearm retailers

20. Tip Sheet Your vigilance could save a life!
Signs that a buyer could be suicidal
Options for responding to a potentially suicidal buyer
What else can I do?

23. Evaluation Results ● 48% were using at least one of the items
● Beliefs about preventability predict material use.
- Removing access to lethal means can save a life
YES - 69% display vs NO - 41% display
- Belief that suicides are planned in advance
YES - 45% display vs NO - 86% display
● Little negative feedback from customers
● Many states are working on adapting the project
● Good feedback from gun shop owners!

24. Examples of Other Projects
State Gun Dealers Assn mailing and website (MD)
Bringing materials to Gun Shows (Nevada)
Working with Firearm Instructors (N.E., TX)
Placemats during hunting season (MI)

25. Conclusions
Suicide prevention is a natural for the gun community building on gun safety concerns
There are 4.8 suicides for each homicide in these three states
Whether people are pro-gun or anti-gun almost everyone is ANTI-SUICIDE
Getting across the idea that suicide is (mostly) preventable is essential!

26. Resources CALM on-line course at SPRC.org
Click on Training Institute, click on Online
Training, click on CALM
Gun Shop Project –
Lok-It-Up
– Harvard School of Public Health