Reducing Access to Lethal Means - …zerosuicideinlandnw.org/pdf/Panel3-ElaineFrank.pdf · Borges...
Transcript of Reducing Access to Lethal Means - …zerosuicideinlandnw.org/pdf/Panel3-ElaineFrank.pdf · Borges...
Reducing Access to Lethal Means
A Suicide Prevention Role for Everyone
Presented by [email protected]
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
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!
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
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!