I recently participated in Suicide Prevention Resource Center’s (SPRC’s) Counseling on Access to Lethal Means training module. I can’t recommend this free resource enough to mental health professionals. As the website describes it, you’ll, “Learn how to counsel people at risk for suicide—and their families—on reducing access to lethal means.”

What is Lethal Means Counseling?

If you’re not familiar with the phrase, “lethal means” refers to methods a person may employ in a suicide attempt. Examples include firearms, overdose, cutting…etc.

Essentially, lethal means counseling entails assessing a client’s risk for access to lethal means, determining which methods they may be considering, and working with the client and their families or supportive significant others to limit their access.

It sounds straightforward to me, but I had no idea how little I understood about lethal means counseling until I took this training.

My Misconceptions

Misconception 1: Means Don’t Matter

The biggest misconception I had was that it didn’t matter whether a patient had access to means - that if they were driven to attempt suicide, they had infinite ways to do so right in their own home.

My belief that access didn’t matter was 100% false and based on a misunderstanding of suicidality. There are several reasons access matters:

1. People tend to have a preferred method in mind, so while there are other means a client could use, they are not as likely to do so. Therefore, reducing access to the preferred method lowers the probability of a suicide attempt.

   • With this in mind, it is always crucial to discuss firearms in the home, regardless of whether this is a client’s preferred method. This is because firearms are nearly always lethal and irreversible and account for the majority of successful attempts.

2. Most suicide attempts occur in the home. Therefore, reducing access at home drastically reduces the chances someone will make an attempt.

3. Roughly half of suicide attempts are unplanned and occur during an acute suicidal crisis, making them difficult to predict. This means it’s crucial to reduce access when someone shows any signs of risk for suicide and not wait until the risk is very high.

There are additional reasons why access to means matters, but these are some big ones.

Misconception 2: Take Everything at Face Value

Throughout the module, there are case studies in which the lessons are demonstrated through “conversations” between a therapist and a client. One of these contained a conversation in which the patient, when asked about whether he was struggling with suicidal ideation, responded, “Not really.”

In the past, I would have taken that at face value and moved on with our assessment. This might be in part because I didn’t know what to do if someone said “yes,” and was therefore grateful to move on. Now I know to dig deeper.

There are several reasons a patient might not disclose suicidal thoughts or past attempts: shame due to the stigma associated with suicide in our culture, lack of trust or therapeutic alliance (I ask most patients during our first meeting), they don’t think you can do anything, they minimize their symptoms (thinking they’re not that bad)… the list goes on. Now I have my antenna up for hesitation, vocal changes, or partial denials (anything besides a clear, firm “no”), which makes me better able to have these difficult conversations with patients.

Misconception 3: Most Attempts Are Planned

Many attempts are in fact unplanned, as mentioned earlier. This means there is less time to detect and prevent an attempt.

The rule of thumb is this: the more time and distance you can put between a patient and lethal means, the greater their chances of changing their mind.

For example, I have had a mother say, “Well that’s not even how she’s attempted before,” regarding firearms in the home. I now have research-backed ways to explain that an attempt may be an impulsive decision, and in that heightened emotional state, the patient may reach for any means available. Increasing time and distance between a patient and lethal methods gives them time to come out of that state or fall back onto a coping skill or even just to give up for the moment.

Take the Training

I learned many other important lessons from this module. There are so many helpful scripts for talking to both patients and family members. In addition, there are guidelines for best practices regarding lethal means (ex: where to store guns if you're trying to remove them from the home).

You can access the module here: https://training.sprc.org/

It took me several hours to complete, but was well worth it. I am already so much better able to support the patients I serve. The quality of our conversations regarding suicidality has risen significantly, along with the information they’re willing to disclose.

In fact, I had a patient come up with her own method for reducing access to her preferred means. Guiding patients toward safety and allowing them to take those steps in ways that they have control over gives them ownership, and I believe will increase the likelihood of follow through on the plan.

If you have other resources for professional education or resources for patients struggling with suicidality, please share them in the comments below!

Resources

If you or a loved one is struggling with suicidal thoughts or attempts, please contact the National Suicide Prevention Lifeline at 1-800-273-8255.

In addition, please make an appointment with a mental health professional near you. I know what you are going through is incredibly difficult, but it is hopefully impermanent. If it feels permanent, a psychologist or therapist may be able to help you figure out a way to change that, or at least help you deal with it in a safe way.