Means Reduction and Suicide Prevention
Explain that reducing access to lethal means is an evidence-based strategy for suicide
prevention
Explain the reasons why reducing access to lethal means can prevent suicide
Identify clients for whom lethal means counseling is appropriate
Describe strategies for raising the topic of lethal means, and feel more comfortable and
competent applying these strategies with clients
Advise clients on specific off-site and in-home secure storage options for firearms and
on strategies to limit access to dangerous medications
Work with your clients and their families on developing a specific plan to reduce access
to lethal means and follow up on that plan over time
Lesson 1: Why Does Reducing Access Make A Difference?
➔ Acute Suicidal Crisis: Period when a person transitons from being at risk /
considering suicide to being ready to actually make a attempt
◆ It can come on rapidly
◆ It can be difficult to predict
◆ It can lead to an unplanned suicide attempt - 48% within 10 minutes or less
of first thinking about it
◆ It is often brief - the impulse often fades, and may never recur or may flare
up episodically
◆ The best time for a clinical to counsel at-risk clients on reducing access to
lethal means is before the client experiences an acute suicidal crisis
★ Putting time and distance between people at risk and lethal methods can save lives
➔ Long-Term Survival
◆ More than 90% of people who attempt suicide and survive do NOT
eventually kill themselves
● About 22% of people who attempt suicide made another nonfatal
attempt over a 5-year period
, ◆ Approximately 60% in the U.S. die on their first attempt
Lesson 2: Who Needs Lethal Means Counseling?
● Talking about suicide does not create or increase risk, in fact, it can reduce the risk
of suicide.
● Don’t solely rely on disclosure of suicidal thoughts, behaviors, and plans … lethal
means counseling makes sense for anyone at risk.
○ Individuals who struggle with mental health and/or substance use issues,
and who are experiencing major crisis, stress, or trauma, are also at risk of
suicide and should receive lethal means counseling.
■ The best time to discuss a plan for reducing access to lethal means
with clients is before they experience an acute suicidal crisis.
Lesson 3: What Are the Lethal Means?
● The most common method of suicide deaths in the U.S. : firearms
○ 51% of suicide death rates in the US is done by firearms, while 26% is done
by suffocation/hanging, and 12% by poisoning/overdose
➔ A method is considered lethal if a high proportion of attempts by that method end
in death
◆ A method’s lethality is also referred to as its “case fatality rate”
● Approximately 80%-90% of intentional, self-inflicted gunshot
wounds are fatal
○ Self-inflicted wounds from sharp instruments, like a razor, are
not a highly lethal method (only 1%-2% are fatal), however, it
is the second most commonly used method in attempts
○ Medication overdoses are the most common method of
suicide attempts, however, only 1%-2% of intentional
, overdoses or poisonings are fatal.
◆ Many people think these two methods (cutting and
overdosing) are far more deadly than they are actually,
thus, this misperception may save a lot of lives.
● ⚠ Recommended to not share the low lethality with
clients
★ Means Matter
○ If the method a person wants to use for suicide is not available when they
are actually ready to go through with an attempt, one of two things is likely
to happen:
■ They will delay the attempt
● The greater the delay, the greater the chance the suicidal crisis
will pass
■ They will substitute another method
○ Which suicide methods are amenable to a means reduction approach
depends on the following criteria:
1) Number of Deaths: the number / percent of suicide deaths caused by
a specific method
2) Lethality: the proportion of attempts by a given method that end in
death
3) Irreversibility: the inability for someone attempting suicide to stop
once it has begun or to be rescued
a) More people stop an attempt than carry through with it
4) Accessibility: the immediate availability of the method. Access is
particularly important when attempts occur rapidly with little or no
planning
5) Acceptability: cultural and/or individual tolerance or preference for
using a particular method to kill oneself
, Firearms Used in more suicide deaths in the U.S.
than all other methods combined.
They are also highly lethal, irreversible,
and easily accessible in many homes with
guns (⅓ of homes have guns).
Since gun owners can voluntarily
undertake steps to reduce access, you will
want to discuss safe firewarm storage with
all clients at risk of suicide
Medication Overdoses Are not as lethal as firearms (though some
meds, poisons and combos are very
lethal).
It is also usually possible for someone to
stop an overdose mid-attempt or to be
rescued.
However, this means is by far the most
frequent attempt and medications are
easily accessible in almost every home.
It is recommended to routinely advise
at-risk clients to dispose of unnecessary
meds and keep accessible only quantities
that do not pose a lethal threat
Lesson 4: What Are Some Ways to Reduce Access?
➔ Access can feasibly be reduced for these two methods:
◆ Firearms: Used in roughly half of all suicide deaths, are highly lethal, and
are very accessible if they are kept at home
Explain that reducing access to lethal means is an evidence-based strategy for suicide
prevention
Explain the reasons why reducing access to lethal means can prevent suicide
Identify clients for whom lethal means counseling is appropriate
Describe strategies for raising the topic of lethal means, and feel more comfortable and
competent applying these strategies with clients
Advise clients on specific off-site and in-home secure storage options for firearms and
on strategies to limit access to dangerous medications
Work with your clients and their families on developing a specific plan to reduce access
to lethal means and follow up on that plan over time
Lesson 1: Why Does Reducing Access Make A Difference?
➔ Acute Suicidal Crisis: Period when a person transitons from being at risk /
considering suicide to being ready to actually make a attempt
◆ It can come on rapidly
◆ It can be difficult to predict
◆ It can lead to an unplanned suicide attempt - 48% within 10 minutes or less
of first thinking about it
◆ It is often brief - the impulse often fades, and may never recur or may flare
up episodically
◆ The best time for a clinical to counsel at-risk clients on reducing access to
lethal means is before the client experiences an acute suicidal crisis
★ Putting time and distance between people at risk and lethal methods can save lives
➔ Long-Term Survival
◆ More than 90% of people who attempt suicide and survive do NOT
eventually kill themselves
● About 22% of people who attempt suicide made another nonfatal
attempt over a 5-year period
, ◆ Approximately 60% in the U.S. die on their first attempt
Lesson 2: Who Needs Lethal Means Counseling?
● Talking about suicide does not create or increase risk, in fact, it can reduce the risk
of suicide.
● Don’t solely rely on disclosure of suicidal thoughts, behaviors, and plans … lethal
means counseling makes sense for anyone at risk.
○ Individuals who struggle with mental health and/or substance use issues,
and who are experiencing major crisis, stress, or trauma, are also at risk of
suicide and should receive lethal means counseling.
■ The best time to discuss a plan for reducing access to lethal means
with clients is before they experience an acute suicidal crisis.
Lesson 3: What Are the Lethal Means?
● The most common method of suicide deaths in the U.S. : firearms
○ 51% of suicide death rates in the US is done by firearms, while 26% is done
by suffocation/hanging, and 12% by poisoning/overdose
➔ A method is considered lethal if a high proportion of attempts by that method end
in death
◆ A method’s lethality is also referred to as its “case fatality rate”
● Approximately 80%-90% of intentional, self-inflicted gunshot
wounds are fatal
○ Self-inflicted wounds from sharp instruments, like a razor, are
not a highly lethal method (only 1%-2% are fatal), however, it
is the second most commonly used method in attempts
○ Medication overdoses are the most common method of
suicide attempts, however, only 1%-2% of intentional
, overdoses or poisonings are fatal.
◆ Many people think these two methods (cutting and
overdosing) are far more deadly than they are actually,
thus, this misperception may save a lot of lives.
● ⚠ Recommended to not share the low lethality with
clients
★ Means Matter
○ If the method a person wants to use for suicide is not available when they
are actually ready to go through with an attempt, one of two things is likely
to happen:
■ They will delay the attempt
● The greater the delay, the greater the chance the suicidal crisis
will pass
■ They will substitute another method
○ Which suicide methods are amenable to a means reduction approach
depends on the following criteria:
1) Number of Deaths: the number / percent of suicide deaths caused by
a specific method
2) Lethality: the proportion of attempts by a given method that end in
death
3) Irreversibility: the inability for someone attempting suicide to stop
once it has begun or to be rescued
a) More people stop an attempt than carry through with it
4) Accessibility: the immediate availability of the method. Access is
particularly important when attempts occur rapidly with little or no
planning
5) Acceptability: cultural and/or individual tolerance or preference for
using a particular method to kill oneself
, Firearms Used in more suicide deaths in the U.S.
than all other methods combined.
They are also highly lethal, irreversible,
and easily accessible in many homes with
guns (⅓ of homes have guns).
Since gun owners can voluntarily
undertake steps to reduce access, you will
want to discuss safe firewarm storage with
all clients at risk of suicide
Medication Overdoses Are not as lethal as firearms (though some
meds, poisons and combos are very
lethal).
It is also usually possible for someone to
stop an overdose mid-attempt or to be
rescued.
However, this means is by far the most
frequent attempt and medications are
easily accessible in almost every home.
It is recommended to routinely advise
at-risk clients to dispose of unnecessary
meds and keep accessible only quantities
that do not pose a lethal threat
Lesson 4: What Are Some Ways to Reduce Access?
➔ Access can feasibly be reduced for these two methods:
◆ Firearms: Used in roughly half of all suicide deaths, are highly lethal, and
are very accessible if they are kept at home
