State Means Restriction Programs Other Means Restriction Activities
Examples of State Means Restriction Programs
(Download a PDF of this document)
Contact: Elaine Frank
The Counseling on Access to Lethal Means Project (CALM) is the result of a partnership between the state Suicide Prevention Council, Injury Prevention Center (Children’s Hospital at Dartmouth), and New Hampshire Department of Health and Human Services, with additional funding from the Gutin Family Foundation. Its goal is to train mental health care providers to conduct firearm safety counseling with parents of their young clients, and to reduce at-risk youth’s access to firearms and medications as a preventive strategy for suicide. During the two-hour training workshop, mental health care providers are introduced to 1) the public health approach to suicide prevention; 2) the epidemiology of suicide and 3) the importance of reducing at-risk youth’s access to firearms and medications as a prevention strategy. Upon completing the training, participants 1) have substantial knowledge of the association between access to lethal means and youth suicide; 2) understand the importance of and have positive attitudes toward counseling parents about reducing access to lethal means; 3) understand how counseling on reducing access to lethal means relates to state and national objectives for suicide prevention. The training includes a video depicting a reenactment of family counseling scenario. The Harvard School of Public Health has evaluated the training, and plans are currently underway to expand CALM trainings to emergency department and primary care health providers.
The Connect Suicide Prevention Project, a best practice developed by NAMI NH, also focuses on restricting access to lethal means as part of their training and protocols. Visit www.theconnectproject.org for more information.
Lastly, Means Matter is a member of New Hampshire’s Firearm Safety Coalition, which consists of firearm owners and public health professionals working together to keep suicidal individuals away from firearms. Our products are geared towards firearm retailers and range owners as well as their customers. As of early 2012 over half of NH gun shops have our products on display! For more information visit www.nhfsc.org.
Contact: Lori Lovett
The Indiana Violence Prevention Partnership (IVPP) is a program of the Indiana University School of Medicine in Indianapolis formerly funded by the Joyce Foundation. They utilize their data surveillance system to plan their educational/prevention programs around suicide and injury prevention. The majority of their means reduction activities are firearm focused as Indiana has a high rate of gun ownership. IVPP completed a four-year project to educate faith leaders about firearm injury, suicide, and domestic violence prevention. This program helped provide faith leaders with resources to enhance their ability to more effectively intervene with families on these topics. In addition, IVPP has produced and conducted a medical resident training curriculum around counseling patients and their families about firearm safety. This is done with 4th year pediatric residents at Indiana University Medical School. It is a one-hour program that is now a mandatory part of their curriculum.
Contact: Cheryl DiCara
Maine’s means reduction activities focus on guns, pills and rope. In 1996 7/10 suicides were the result of firearm and last year 5/10 suicides were from guns. In the early 2000’s they created a video titled “Kids and Guns: Making the Right Choice” which addresses suicide prevention and means reduction. The video is geared towards 6th-8th graders, but can be used for a wider audience. The video has been widely distributed to police, schools, health educators, hospitals and child care providers. It is often distributed at health fairs, and the Suicide Prevention Coordinator often promotes the video and means reduction at health fairs. There is a brochure on means reduction (developed with the “5-minutes can save a life” model) that accompanies the video as well. They have conducted two firearm safety conferences in the past couple of years, which were well-received. In 2005 their lethal means committee met to discuss goals and activities. Members of this committee are from various backgrounds including law enforcement, doctors, child care providers, hunting & fishing officials and survivors. Their goals include the following:
- Provide education to ED staff about counseling on lethal means (guns, pills, ropes) in the house. The feedback the committee has gotten from providers is that ER doctors are reluctant to do means reduction counseling because it is not a billable service.
- Conduct grand rounds on means reduction as a form of suicide prevention.
- Develop a protocol for law enforcement to remove guns from the home if a person is suicidal or making suicidal threats.
- Develop a program similar to CALM for elderly.
Over the past year, there has been much organizational restructuring in Maine’s injury prevention program, and the lethal means committee has not been meeting. Currently, Maine is planning to reconvene this committee and develop a protocol for law enforcement at local, county and state levels regarding the removal of lethal means.
Contact Person: Karl F. Rosston
Phone: (406) 444-3349
The Montana Department of Public Health and Human Services provide gun locks via hunter safety courses, home health care visits, child care organizations, and community events such as health fairs, music performances, and tribal events. Over the past three years, nearly 3,000 high quality combination locks have been distributed to at least half of their county health departments as well as to Planting Seeds of Hope, a project that works with Native American youth in Montana and Wyoming. The target populations are families with children who have unprotected firearms in the home. In 2010, the state Attorney General convened a task force to reduce prescription drug abuse (MT is #2 in teen abuse of prescription drugs). The task force is working with pharmacies to increase disposal of old prescription medications, and is pushing for legislation to create a statewide electronic database monitoring prescription drug use. Montana includes state data on firearm suicides and information on safe storage in its QPR (Question, Persuade, Refer) Program.
Contact: Donna Noonan
Oregon’s means reduction activities generally focus on all lethal means as opposed to just firearms. They promote means restriction on an individual level as opposed to family or school level. One activity includes promoting information for health care providers on screening for access to lethal means among their potentially suicidal patients. They are currently collaborating with Oregon Health Sciences University to produce written materials geared towards white males. They also hope to get educational information on lethal means restriction to health care providers of the elderly. Their website is extensive and includes means restriction information.
Contact: Adam Lesser
Georgia’s Department of Behavioral Health and Developmental Disabilities offers health professionals a one day “Train the Trainer” extended CALM workshop that will provide attendees with the tools to train their staff in preventing suicide by routinely assessing at-risk youth for access to lethal means and teaching families how to safely secure or dispose of firearms and poisons. They personally invite teams of staff from hospital emergency rooms, CFR teams, and community mental health clinics.
Contact: David Miers
The Nebraska State Suicide Prevention Coalition has developed tip sheets on lethal means restriction for emergency departments and families. Download these from their website:http://www.suicideprevention.nebraska.edu/
Contact: Debbie Ruggles
The state of Washington’s health department has developed a training curriculum for ER doctors on reducing access to lethal means. Contact Debbie Ruggles for a copy of the curriculum.
Contact: North Carolinians Against Gun Violence
Minutes Matter is a prevention program focused on educating North Carolinians on the link between safe storage of firearms and preventing adolescent suicide deaths. Through Minutes Matters we reach families across the state with the information they need to protect their loved ones. In addition to our training and materials – a key element of the programming is distributing gun trigger locks. When used properly these locks can save a teen’s life.
Contact: Allison Dickin
The Center to Prevent Youth Violence has partnered with The Rhode Island Department of Health to develop The Suicide-Proof Initiative, a comprehensive public information campaign to educate parents about the risks of keeping firearms and other lethal means of suicide accessible to adolescents in the home.
This program informs parents about the simple steps they can take to reduce the risk that a youth suicide will occur in their home. Parents are encouraged to reduce the likelihood of suicide by securely locking or removing lethal means.
Click here to learn the simple steps you can take to suicide-proof your home. It’s easy, and it could save a child’s life.
Examples of Other Means Restriction Programs
(Note: Some are state-based, but not based in a suicide prevention program)
This intervention was a community based program to improve firearm storage in rural Alaska. Firearm storage devices (i.e., gun safes and trigger locks) were distributed to forty randomly selected homes with two or more guns. Three months after distribution, unannounced visits were made to the homes to see if residents were using their storage and safety devices. At baseline, 85% of guns in the homes of participants were stored unlocked throughout the residence. Three months post-intervention, 86% of the gun safes were locked with guns inside. Only 30% of trigger locks were in use. You can listen to an interview with the study director here.
Firearm ownership is common in Norway, with greater than 30% of households owning firearms. New legislation introduced a delay of two weeks from the purchase of a gun to its actual acquisition and mandated safe storage in locked compartments in private homes. Suicide prevention education was provided to hunter organizations and included in training courses for new hunters. The Armed Forces reduced the substantial number of guns placed in the homes of members of the home guard and military reserve. Between 1987 and 2003, after the introduction of the legislation, the rate of firearm suicide in males dropped from 11.0 per 100,000 to 5.2. The overall suicide rate for males also dropped by close to a third. Females continued to have very low firearm suicide rates throughout the period.
The goal of this intervention was to educate parents of youth at high risk for suicide about limiting access to lethal means for suicide. Education took place in emergency departments and was conducted by department staff. Lethal means covered included firearms, medications (over the counter and prescribed), and alcohol. Results found that family members of at-risk youth who received means restriction counseling were more likely than those not exposed to remove or lock up firearms and medications.
Conducted in 2001-2003, this quality improvement project focused on driving and gun safety for veterans with dementia. A questionnaire and educational pamphlets for use in VA outpatient settings were pilot-tested. The two pamphlets are available online (see links above). The VA also designed pop-up reminders that appear in the electronic record when a provider enters a diagnosis in the “dementia” range. These pop-ups remind the provider to assess for firearm access and to provider lethal means counseling to family members.
This campaignis the result of a partnership between theHarborview Injury Prevention Research Center, Children’s Hospital & Regional Medical Center, city and county departments of Public Health, and Washington State Department of Health. Its goal is to prevent unintentional firearm deaths and injuries to young children and firearm suicides by adolescents by promoting the use of a gun lockbox that will provide the owner quick and easy access to the weapon, but prevent children from accessing it by changing community standards and norms to promote personal and community responsibility for the safe storage of guns. The target audience consists of: parents of children and adolescents, family practitioners, public health departments and the general public in Washington State. A key component of the program is the education of family practitioners on how to deliver safe gun storage messages to families. The website contains information specific to health care providers and parents, discount coupons for lockboxes, and other resources for safe storage.
6. ED-SAFE Emergency Department Study
Means Matter has been working with a large, multi-site emergency department study–the ED-SAFE study–that is evaluating the impact of screening for, and more comprehensively treating and referring, suicidal patients. We are assisting them in formalizing a lethal means counseling component of their intervention, training providers, and assessing the impact on provider and patient/family behavior.
(Download a PDF of this document)