Lethal Means Counseling for Suicidal Adults in the Emergency Department: A Qualitative Study

Abstract

Introduction Lethal means counseling (to reduce access to firearms or other suicide methods) is a recommended critical yet challenging component of care of suicidal patients. Questions remain about communication strategies for those in acute crisis. Methods This qualitative study was an analysis of semi-structured interviews with English-speaking, community-dwelling adults with a history of lived-experience of suicidal ideation or attempts in themselves or a family member. We used a mixed inductive and deductive approach to identify descriptive themes related to communication and decision-making. Results Among 27 participants, 14 (52%) had personal and 23 (85%) had family experience with suicide ideation or attempts. Emergent themes fell into two domains: (1) communication in a state of high emotionality; and (2) specific challenges in communication: initiating, maintaining engagement, considering context. Conclusion Engaging suicidal individuals in lethal means counseling may be more effective when messaging and approaches consider their emotional state and communication challenges.

Stakeholder perceptions of lethal means safety counseling: A qualitative systematic review

“…Nineteen eligible papers were identified (Figure 1), of which 16 addressed LMSC exclusively for firearms, 1 addressed LMSC exclusively for medications (40), and 2 addressed LMSC for both firearms and medications [ (41,42); Table 1]. Given the paucity of medication-related data, we briefly summarized findings on medication-related LMSC and focused our main analyses on firearm-specific LMSC.…”

“…In fact, securing firearms increased the chance of not having access to them when needed for personal or household protection. Firearm owners stated that their valuation of safety motivated them both to have easy access to firearms for protection and to practice responsible ownership (20,42,45,46,51,52,55). Responsible ownership included preventing unauthorized access to firearms and practicing safe handling (46,52,55), as well as introducing firearms to children and teaching them to respect firearms and handle them safely (20,46).…”

“…Third, patients noted that conventional locks, particularly trigger and cable locks, were inconvenient to use and might hamper self-defense efforts. Some reported that these locks were often unused or disposed of when they were provided (20,42,46,52). Although biometric storage devices were perceived as less problematic, their cost was a deterrent (20).…”

“…Relevant patient characteristics included veterans, individuals who live in rural versus urban settings, and women. Veterans wanted providers to acknowledge their expertise with firearms, and those familiar with veterans noted that their camaraderie with one another may make it easier for them to trust other veterans when discussing firearms (42,47,48,51,52,54,55). Patients and providers stated that in some rural communities, firearm ownership is very common, firearms are often used for hunting, and both privacy and the right to own firearms are highly valued (21,44,45,50,55).…”

“Lock to Live” for firearm and medication safety: Feasibility and acceptability of a suicide prevention tool in a learning healthcare system

“…Initial testing of L2L with a tablet in an emergency department setting showed that it was highly acceptable across a broad range of provider roles (physicians, nurses, social workers). L2L addresses the lack of provider knowledge for different firearm and medication storage options ( 20 ). A survey showed that clinicians thought L2L would help them counsel suicidal adult patients on safe firearm storage options ( 21 ).…”