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Reducing Access to Lethal Means
A Suicide Prevention Role
for Everyone
Presented by
[email protected]
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
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
●
But Does It Work?
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
1995.
• 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.
Gunnell 2007. Int’l J of Epidemiology.
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
●
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!
E Wash/Idaho/W Montana
2013 Suicide Deaths by Method
Comparative Lethality, U.S.
Suffocation
Poison
24%
17%
Jump 2%
Sharp 2%
Other 4%
Poison
83%
Firearm
51%
Sharp
11%
Suffocation 1%
Firearm 1%
Suicide
Other 4%
Nonfatal Self-harm
Sources
Inpatient: HCUP-NIS (2005). Suicide: CDC WISQARS www.cdc.gov/ncipc/wisqars (2009)
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!
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
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
Suicide Plans Among Attempters
Had a Suicide Plan?
People who
attempted
suicide in past
12 months
No plan
43%
Plan
57%
Borges et al. Risk factors for twelve-month suicide attempts in the
National Comorbidity Survey Replication (NCS-R). Psychol Med.
2006
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
Gun Shop Project: A Role for Firearm
Dealers and Ranges
www.nhfsc.org or [email protected]
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)
Recent-purchase Suicides
• About one in ten (8%)
firearm suicides in NH
are with recentpurchase 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
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
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
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?
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!
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)
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!
Resources
CALM on-line course at SPRC.org
Click on Training Institute, click on Online
Training, click on CALM
Gun Shop Project – www.nhfsc.org
Lok-It-Up
www.meansmatter.org – Harvard School of
Public Health