Lethal Means Counseling for Parents of Youth Seeking Emergency Care for Suicidality

Abstract

IntroductionA youth’s emergency department (ED) visit for suicidal behaviors or ideation provides an opportunity to counsel families about securing medications and firearms (i.e., lethal means counseling).MethodsIn this quality improvement project drawing on the Counseling on Access to Lethal Means (CALM) model, we trained 16 psychiatric emergency clinicians to provide lethal means counseling with parents of patients under age 18 receiving care for suicidality and discharged home from a large children’s hospital. Through chart reviews and follow-up interviews of parents who received the counseling, we examined what parents recalled, their reactions to the counseling session, and actions taken after discharge.ResultsBetween March and July 2014, staff counseled 209 of the 236 (89%) parents of eligible patients. We conducted follow-up interviews with 114 parents, or 55% of those receiving the intervention; 48% of those eligible. Parents had favorable impressions of the counseling and good recall of the main messages. Among the parents contacted at follow up, 76% reported all medications in the home were locked as compared to fewer than 10% at the time of the visit. All who had indicated there were guns in the home at the time of the visit reported at follow up that all were currently locked, compared to 67% reporting this at the time of the visit.ConclusionThough a small project in just one hospital, our findings demonstrate the feasibility of adding a counseling protocol to the discharge process within a pediatric psychiatric emergency service. Our positive findings suggest that further study, including a randomized control trial in more facilities, is warranted.

Hospital Emergency Department Lethal Means Counseling for Suicidal Patients

“…37 Even with political sensitivities about guns, 38 patients are receptive to receiving guidance, 19,39–41 and counseling can improve storage practices. 17,19,42 ED-SAFE chart reviews found that although 11% of patients reported having firearms only 50% of those patients had medical record notes indicating lethal means counseling. 22 Other evidence indicates that providing safety devices with counseling enhances results.…”

“…11–14 Limiting access to firearms during crises is an important strategy, 15,16 showing success through ED-based education with parents of suicidal youth. 17–19 Lethal means counseling may be underutilized by EDs, 20–22 as many providers do not routinely assess lethal means access, despite recommendations. 9,10,23–26 …”

Social Work Practice and Gun Safety in the United States

“…Although research is sparse, there is some evidence that counseling on restricting access can reduce incidence of suicide as well as homicide in IPV relationships (Barber & Miller, 2014;Vigdor & Mercy, 2006). A recent study on an intervention designed to encourage parents to reduce access to guns for adolescents with suicide ideation found that 100% of parents with guns in the home had locked them away by follow up (Runyan et al, 2016).…”

Suicide Risk Screening in Healthcare Settings: Identifying Males and Females at Risk

“…There is substantial evidence that limiting or restricting access to lethal means is an effective strategy for suicide prevention (e.g., Beautrais et al, 2007; Betz et al, 2016a; Bryan, Stone, & Rudd, 2011; Mann et al, 2005). Lethal means restriction counseling significantly increases the probability that lethal means restriction, or limited access to lethal means, is put into place for at-risk individuals (e.g., Kruesi et al, 1999; McManus et al, 1997; Runyan et al, 2016). The Suicide Prevention Resource Center (2015) recommends discussing lethal means restriction as an important action step in patient care for adults discharged from the ED with reported suicidal ideation.…”