Lethal Means Safety Recommendations - MIRECC / CoE
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Lethal Means Safety Recommendations

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What is an "evidence-based" Lethal Means Safety recommendation?


LMS recommendations are informed by studies analyzing suicide risk. Some research compares risk among those with and without household access to a specific suicide method, while other studies look at population-level changes.
Recommendations to remove access to a specific method have the strongest evidence for preventing suicide.
Recommendations to reduce (limit but not eliminate) access are still important and protective.

Firearm-specific LMS


Putting time and space between a suicidal person and a gun may save a life.

     
  This Firearm Suicide Prevention Training Video (5 minutes) talks about a different side of firearm safety – suicide prevention. Lock, limit, and remove access when someone you love is at risk for suicide.  
Recommendation #1: Temporarily remove firearms from the household and adjacent area, including garages and vehicles.
How?
• Have a trusted family member, friend, or fellow Veteran hold on to the firearm(s).*
• Rent a personal storage unit.
• Contact local resources to inquire about storage options:
     - Shooting ranges, firearm clubs, or firearm retailers
     - Law enforcement
     - Pawn shops
• Sell or pawn the firearm.
• Remove ammunition from the household.
 
*When recommending that a Veteran transfer his or her firearm to another individual, it is important to remember two issues:
1. Firearms should not be transferred to other individuals who themselves are at risk of suicide or unintentional injury, nor to individuals who reside in households with those at risk of injury.
2. U.S. state and federal laws prohibit personal firearm transfers under some circumstances. Providers should not recommend transferring firearms to a specific person without a full understanding of firearm transfer laws. Link to reference
 
 Recommendation #2: Increase the safety of firearms stored within the household. 
How?
• Lock firearms within the household.
     - There are various options for locking up household firearms. Firearm owners may have strong preferences for how their firearms are stored. Link to reference
   
  Consider “enhanced” safe storage. Ask a trusted family member, friend, or fellow Veteran to temporarily change the number combination or hold on to the key.  
• Store firearms unloaded.
• Lock up the ammunition.
• Disassemble the gun. Considering locking up or storing specific parts elsewhere (e.g., firing pin, slide).
 
   
  A handgun secured with a cable lock.
 
 
Special considerations in firearm-specific Lethal Means Safety Counseling (LMSC):
• For some Veterans, there is a sociocultural value to owning and using firearms. Recognizing the importance and value of firearms in some Veterans’ lives is a foundation for initiating these discussions. Link to reference
• Two-thirds of Veterans own firearms for personal or household protection. In many cases, effective LMSC may include a discussion about balancing the short-term risk of self-injury against the long-term risk of victimization from others. Link to reference

Medication-specific LMS


When providing LMSC, keep in mind that medications vary in their toxicity. Use this tool to guide your LMSC decisions.

Medication-specific LMSC flow chart

   
View a text only version of the Medication-Specific Lethal Means Safety Counseling flow chart.    
Special considerations in medication-specific LMSC:
• Access to the opioid medications (e.g., oxycodone, morphine) of family members is an important risk factor for suicide. When possible, household members should increase the safe storage of their own potentially lethal medications. Link to reference
• Opioids are a common cause of medication-related suicide and self-injury among U.S. Veterans. Naloxone (either nasal spray or auto-injector) is a reversal medication that is effective in preventing opioid overdose. Link to reference 1 | Link to reference 2
• Consider providing naloxone to patients who use prescribed or unprescribed opioids and teach them and their family members how to use it in case of an overdose. VHA pharmacists can be very helpful in accessing this medication for patients. Trainings are available for opioid overdose education & Naloxone distribution. Link to reference

Ask questions or get help

 Suicide Risk Management Consultation Program

   
  Get free consultation, support and resources for treating Veterans at risk of suicide. Visit the SRM page.  

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Last Updated 19 August 2021