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Myths and facts about Lethal Means Safety and suicide prevention
The Myth: A common myth in suicide prevention is that individuals who want to die will always find a way to do so. The Facts: This is not the case. Increasing the time and distance between someone with suicidal intent and lethal means can reduce suicide risk. When adopting lethal means safety counseling (LMSC) within your clinical practice, you should know these 4 key points:
1. Nine in ten of those who survive a suicide attempt do not go on to die by suicide. Link to reference
2. Not all methods are equal with respect to lethality. For example, 90% of suicide attempts made with a firearm result in death, compared with around 1% of suicide attempts made by ingestion or using sharp instruments. Link to reference
This graph shows that firearms are the most lethal method of attempting suicide.
3. Patients may not have access to or consider multiple means of suicide and will often choose a method that is readily available. Thus, reducing access to one method might be critical.
4. Suicidal crises are often brief and temporary. Among 153 survivors of nearly lethal suicide attempts, 24% said it look less than five minutes for them to act on a suicidal impulse. Increasing the time and space required to readily access a lethal method can save lives. Link to reference
This figure from the VA Office of Mental Health and Suicide Prevention highlights that 24% of those who attempted suicide said it look less than five minutes for them to act on a suicidal impulse.
Firearms and safety
Firearm injury is the most common method of suicide among Veterans. In 2019, firearms were the method of suicide in 70.2% of male Veteran suicide deaths and 49.8% of female Veteran suicide deaths, according to the 2021 National Veteran Suicide Prevention Annual Report. Find the latest national Veteran suicide data and reporting. Link to reference
Firearm injury is the most common method of suicide among both male and female Veterans.
Though the female Veteran suicide rate (unadjusted) decreased by nearly 13% in 2019 and the male Veteran suicide rate decreased by nearly 4%, female and male Veterans alike continue to die by firearm-related suicide at notably higher proportions than their non-Veteran peers. [page 8 of the 2021 National Veteran Suicide Prevention Annual Report]
2. Increased risk for suicide among firearm owners is not explained by differences in mental health, suicidal ideation, or other suicide risk factors between households with and without firearms. Link to reference
3. Firearm ownership is common among Veterans—nearly half of Veterans reside in a household with a firearm. Link to reference
4. One in three Veteran firearm owners stores at least one firearm loaded and unlocked. Link to reference
5. A 2019 study of U.S. Army service members found that owning a handgun and storing a firearm loaded were associated with increased risk of suicide. Link to reference
Owning a handgun is associated with a two-fold increase in suicide risk. Storing a firearm loaded is associated with a four-fold increase in suicide risk.
LMS firearms population case study
This study illustrates that limiting access to firearms reduced suicide rates among service members in the Israeli military. Link to reference.
Medications, inhalants and suicide
1. Access to toxins, such as carbon monoxide (CO) or potentially hazardous medications (e.g., acetaminophen, opioids, benzodiazepines), is associated with increased suicide risk. Link to reference
2. In the United Kingdom (U.K.), legislation that encouraged blister packing of analgesics and limitations on dispensed pill quantities led to reductions in overdose suicide. Link to reference
Medication in blister packaging.
LMS inhalants population case study
A 1976 study showed that reducing access to a common but lethal poisonous gas led to significantly reduced suicide rates. This study reported a decline in carbon monoxide (CO)-related suicides in parallel with the decreasing concentrations of CO in burned fuels in the U.KLink to reference.
Other lethal means and suicide
1. Data on reducing suicide via access to bridges or tall buildings. Link to reference
The Suicide Risk Management Consultation Program (SRM) provides free consultation, support, and resources that promote therapeutic best practices for both VA and community providers who treat Veterans at risk of suicide.Visit the SRM page.