Lethal means safety counseling

The 988 Colorado Mental Health Line is available for free, immediate, and human support 24/7. If you or someone you know is struggling with an emotional, mental health, or substance use concern, call or text 988, or live chat with a counselor online.

Overview

Lethal means safety (LMS) is when a person voluntarily reduces access to potentially dangerous items, like firearms, to prevent suicide. LMS helps to reduce firearm-related harms by increasing time and space between a person in crisis and a dangerous item while they get the support and care they need.

Lethal means safety counseling (LMSC) encourages people at risk of suicide to voluntarily reduce access to lethal means, such as firearms. In a clinical setting, LMSC is a patient-centered approach to promoting safety behaviors that aligns evidence-based recommendations with patients’ preferences and values. This often means health care providers and their patients talk about access to firearms in the home, how firearms are stored, and ways to improve secure storage, especially when someone is at risk of suicide.

Health care providers are uniquely positioned to provide LMSC because they are trusted sources of information about health and safety. In 2023, nearly 3 in 4 (74%) adults in Colorado reported that it was at least sometimes appropriate for doctors and health care providers to talk to their patients (or their parents/guardians) about how firearms are stored in a home.

How to implement LMSC

• Learn more about LMSC and how it can prevent firearm-related harms, such as suicide.
  • The Physician’s Role in Promoting Firearm Safety is an online module from the American Medical Association to help clinicians talk to patients about firearm safety. 
  • The BulletPoints Project offers guidelines for clinicians on how to counsel patients about firearm safety and includes different scenarios a provider might encounter.
  • The American College of Surgeons has a guide for firearm safety and patient health.
  • Counseling on Access to Lethal Means is a free, self-paced, online course for mental health care providers from Zero Suicide. It teaches providers how to reduce access to firearms and other lethal means in situations where there is a risk of suicide.
  • Collaborative Assessment and Management of Suicidality  (CAMS) is an evidence-based, suicide-focused treatment framework backed by 30 years of clinical research and 5 randomized controlled trials. The Office of Suicide Prevention has partnered with the CAMS team to offer free training to clinicians and other mental health professionals in Colorado who provide ongoing behavioral health treatment. If you are a behavioral health provider interested in participating, you may sign up on the CAMS Interest List to receive information about future training dates.
• Talk to patients about LMS in a non-judgmental, respectful, and collaborative way.
  • It is important to understand that lived experiences, cultural values, and personal beliefs may influence a person’s attitude toward owning and storing firearms. Clinicians can learn more about firearms and secure firearm storage options to support their patients’ safety. 
  • Talking About “Firearm Injury” and “Gun Violence”: Words Matter offers ideas for respectfully and appropriately communicating about firearms and firearm injury prevention.
  • The BulletPoints project created Guns 101, a resource for understanding the basics of firearms to support informed conversations.
  • The Veterans Health Administration provides a guide on talking to Veterans about firearm safety.
• Implement changes in health care administration processes to promote LMSC.
  • Health care administrators can incorporate screening procedures for firearm access in the electronic health record, LMSC decision aids such as Lock to Live, and referrals and organizational resources so health care providers can easily integrate LMSC into their patient interactions.
  • Health care administrators can prioritize resources to allow clinicians to provide locking devices to patients at highest risk of firearm-related harm.
• Provide resources to patients that encourage secure firearm storage.
  • Lock to Live is a decision aid that can help clinicians talk with patients about their firearm storage practices. It can also be provided to an individual to use on their own.
  • The Firearm Life Plan is a tool that families can use to talk about firearm ownership and plans for firearms as people age.
    Pause to Protect offers a checklist to help assess and track household firearm practices.
  • Secure Their Future, a program of Colorado’s branch of the American Academy of Pediatrics, sends free firearm cable locks and educational materials to pediatric health care clinics to distribute to families with firearms in the household. 
  • Secure Firearm Storage is a brief fact sheet on different options for in-home storage.
  • If able, health care providers can distribute firearm locking devices such as cable or trigger locks based on their patients’ needs and values identified through LMSC.

Evidence supporting LMSC

A 2024 review found that patients who received LMSC were more likely to store their firearms securely, especially when given a firearm locking device. However, the studies in the review were different in size, quality, and setting, so more research is needed to fully understand how effective LMSC is in different settings. Additionally, one study showed that adding a prompt in electronic health records led to more screenings for firearm access and LMSC for adolescents.