I’ve been writing about the Safety Plan as a brief suicide intervention, Tear up that no-harm/no-suicide contract, and we are ready to explore the final step, Reducing the Potential for Use of Lethal Means.
This final step in the Safety Plan is particularly important when someone considering suicide has developed a plan. Once someone has selected a method – gunshot, hanging, cutting, etc. – the probability of suicide increases the more they refine their plan – when, where, how, etc.
Thus an important follow-up question to “Have you been thinking of hurting or killing yourself?” is “Have you developed a plan for how you will end your life?” A broader question would be, “Which means to end your life are available to you and would you consider using during a suicidal crisis?”
We ask the question as part of the ongoing assessment process (Is their plan available, lethal, and accessible?), but we also ask it as an intervention tool as well. Namely, can we eliminate or limit their access to those named lethal means for a temporary time?
This is based on the belief that once people select a method to end their life, they are unlikely to switch to another method. Please note I did not say they will not switch – I said they are unlikely to switch. Means restriction is not fool proof or guaranteed, but it is a useful intervention step, especially in the short term.
Barber & Miller (2014), in their article on reducing access to lethal means, suggest several potential avenues of approach: 1) physically impeding access (e.g., gun locks, bridge barriers, restricting access to car keys); 2) reducing the lethality or toxicity of a given method (e.g., reducing carbon monoxide content of motor vehicle exhaust); or 3) reducing “cognitive access,” that is, reducing a particular method’s appeal (e.g., discouraging media coverage of an emerging suicide method).
In my next post, we’ll look at practical ways to implement reducing access to lethal means.