Reducing Access to Lethal Means

A Suicide Prevention Role for Everyone

Presented by elaine.m.frank@dartmouth.edu

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

Nonfatal Self-harm Suicide

Comparative Lethality, U.S.

Sources

Inpatient: HCUP-NIS (2005). Suicide: CDC WISQARS www.cdc.gov/ncipc/wisqars (2009)

Poison 83%

Poison 17%

Firearm 51%

Suffocation 24%

Sharp 11%

Other 4%

Jump 2% Sharp 2% Other 4%

Suffocation 1% Firearm 1%

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

Drum, Brownson, Denmark, Smith. Professional Psychology: Research & Practice, 2009

Among the 5% who seriously considered attempting, past 12 mos n=1321

Began attempt, then reconsidered 15%

Carried through an attempt 12%

Suicidal Behavior Among College Students

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

Borges et al. Risk factors for twelve-month suicide attempts in the National Comorbidity Survey Replication (NCS-R). Psychol Med. 2006

Had a Suicide Plan?

People who attempted

suicide in past 12 months

No plan 43%

Plan 57%

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 elaine.frank@dartmouth.edu

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 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

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