Suicide prevention by means reduction

By: Jennifer Miller Kass, MSW, LCSW

Suicide is a serious public health crisis. Suicide is a complex behavior involving the intentional termination of one’s own life. According to Mental Health American four percent of adults have suicidal thoughts. More locally, per year: Grant County has 15.8-19.8 suicides per 100,000 people, Iowa County has 19.9-38.1 suicides per 100,000 people and Lafayette County has 13.5-15.7 suicides per 100,000.

Impulsive suicide attempts are defined as, “acts of self-harm involving little preparation or premeditation.” Non-impulsive suicide attempts are characterized by preparation and planning ahead. Impulsive suicide is a response to extreme fluctuations in an individual’s psychological state. There is an opportunity that presents itself for preventing impulsive suicide. For those that have not pre-meditated or thought of a plan, we can restrict access to lethal means of suicide, which is also called “means reduction.”

Means reduction is an important thing we can do to prevent suicide. Keep loaded guns, medication and alcohol out of the hands of individuals who might use them for self-harm. Means reduction doesn’t change the underlying suicidal impulse, rather it saves lives by reducing the lethality of the attempt. Suicidal ideation may quickly pass and remain unfulfilled if the means of suicide is not easily available. For a person in a suicidal state of mind, problem-solving skills are often poor, making it difficult to produce a different means of suicide when their initial choice isn’t available.

What we mean by reducing the lethality of the attempt is some suicide methods are more deadly than others. In a study of case fatality rates in the northeastern United States, it was found that 91% of suicide attempts by firearms resulted in death. By comparison, the mortality rate was 84% by drowning and 82% by hanging; poisoning with drugs accounted for 74% of attempts but only 14% of fatalities. Many studies have shown the vast majority of those who survive a suicide attempt do not go on to complete a suicide at a later time.

Restriction of lethal means in the United States has focused on firearms because of their ease of access, common usage, and high mortality rate in suicide attempts. Means reduction helps prevent suicide attempts and deaths; the goal is to slow the impulsivity, allowing more of a chance for rescue, and it buys time. Someone might use another method, but it will be a less lethal one since firearms are the most lethal.

Making a difference with guns can reduce the risk of impulsive suicides by firearms. Family and friends can protect a suicidal person by temporarily storing all firearms away from home. Have a trusted person outside the home hold onto them until the situation improves. Use storage facilities, gun shops, or police departments to store them safely. If off-site storage isn’t an option consider locking the guns at home with new locks or combinations, keep ammunition out of the home or locked separately, or consider removing a key component of the gun, ie: the blot.

Reducing a suicidal person’s access to medication is also important. Routinely discard all unused medication safely at local medication drop box sites. Don’t keep lethal doses of medication at home. Lock up prescription medications, especially narcotic pain medications. Use a locked box and safeguard the key or combination from the at-risk person. Monitor quantities of unused medications and refill orders.

Reduce risk by reducing the at-risk person’s access to alcohol. Alcohol use can increase impulsive decisions. Alcohol mixed with intentional drug overdose increases the chances the person will die. Keep only small quantities of alcohol at home and keep it locked up when necessary.

How do you know if someone is suicidal? Listen for direct verbal cues such as “I wish I were dead.”  Indirect verbal cues may be present also such as “Who cares if I’m dead anyway.” Behavioral cues may also be seen, such as acquiring a gun or stockpiling meds, relapse after a period of alcohol or drug recovery, giving away prized possession or putting affairs in order. Be aware of situational clues such as a sudden unexpected loss of freedom, loss of any major relationship, being fired or fear of becoming a burden to others, for example. When in doubt don’t wait, ask the question, “Are you thinking about taking your own life? Are you suicidal?” Talk to the person in a private setting and allow them to talk freely. If they are reluctant, be persistent.

If you or someone you love is feeling suicidal, there is help available. You can call or text anytime:

National Suicide Prevention Lifeline:1-800-273-TALK(8255)

TrevorLifeline LGBTQ+: 1-866-488-7386  – or – Text “Trevor” to 1-202-304-1200

Farmers Hotline: 1-800-942-2474

Crisis Text Line: Text “HOME” to 741741

Grant & Iowa County Crisis Phone Number: 1-800-362-5717

 Lafayette County Crisis Phone Number: 1-800-552-6642

Remember, suicide is not the problem, only the solution to a perceived insoluble problem.  It’s OK to not be OK.  Help is available.  Please ask.

Jennifer Miller Kass, MSW, LCSW, Behavioral Health Administrative Director at Southwest Behavioral Services. She is a Licensed Clinical Social Worker, trained as a generalist to provide quality mental health services to all age groups. Currently Kass is providing individual and family therapy for adults. Treatment approaches include cognitive-behavioral therapy techniques, solution-focused brief therapy and motivational interviewing. She teaches cognitive restructuring, effective communication skills, relaxation strategies, stress management, and other positive coping skills. Kass uses strengths-based and family systems approaches to enhance sense of identity, self-esteem, confidence and help patients move forward.

Southwest Behavioral Services (SBS) is the mental health service line at Southwest Health. SBS has been part of Southwest Health since 1998 and has grown and developed around the community’s needs. SBS includes

• Inpatient Geriatric Psychiatry serving people 55 and older
• Outpatient psychiatric care for people six and up including medication management and psychotherapy for those 13 and older
• Memory Diagnostic Clinic.

If you have questions about SBS or want to schedule an appointment please call (608) 348-3656.