Firearms and Lethal Means Safety
Article in review: Stanley, I., Hom, M., Sachs-Ericsson, N., Gallyer, A., & Joiner, T. A (2020). Pilot Randomised Clinical Trial of a Lethal Means Safety Intervention for Young Adults with Firearm Familiarity at Risk for Suicide, Journal of Consulting and Clinical Psychology, 88(4), 372–383.
Summary: Firearms are the most common method of suicide in the United States, and 90% of suicide attempts using firearms prove to be lethal. The provision of lethal means safety intervention is considered best practice for people who are recognised as being at risk of suicide. Yet we understand little about the best way to deliver firearm specific interventions to people at risk. Discussing the safe storage of firearms with suicidal people is critical. This study has sought to determine the best approach to this conversation; on a topic that is politically charged and which often runs deep within a person’s culture and opinions.
Lethal Means interventions
While firearm ownership and access are not related to the presence of psychiatric disorders or suicide ideation, but we do know that firearm ownership and access is associated with an increased risk of death by suicide. People who live in a house where firearms are kept are more likely to die by suicide than those who live in a home without firearms.
In homes where firearms are kept, the safe storage of these firearms has been proven to be a protective factor. There has also been evidence to suggest that providing people at chronic risk of suicide with information about the safe storage of firearms safety interventions should be considered even when they do not have access to or own a firearm but report an intention to obtain one.
Providing lethal means safety interventions are an important step towards mitigating the risk of suicide and protecting at-risk patients who have access to firearms. However, one study has found only around half (51.6%) of clinical psychologists actually deliver lethal means of safety counselling to patients at risk. One of the reasons cited for this is a lack of familiarity with the best way to approach firearm specific counselling.
Lethal means safety interventions, including lethal means discussions and counselling, and psycho-educational approaches are recommended for individuals who have been identified as having an increased suicide risk. Lethal means safety interventions outline steps that will place distance and reduce the opportunity to access firearms. This may include locking the firearm or passing it to a loved one or law enforcement. The study tested four different psycho-education based lethal means safety interventions that had slightly different approaches.
Study participants and approaches
The study involved 96 college students from the USA, with a lifetime history of suicide ideation who owned, had access to or were intending to obtain a firearm (described as “firearm familiarity).
- Age range 18-31 years, identifying as males (42), female (53) and other (1)
- A majority were Caucasian and heterosexual
- A mix of religious and political affiliations among the group
The study tested the following four approaches to firearm-specific lethal means safety interventions, which had varying levels of fear appeals and emphasis on temporariness:
- Low fear- low temporariness
- Low fear- high temporariness
- High fear- low temporariness
- High fear- high temporariness
The study tested hypotheses that the group allocated to the low fear- high temporariness group would:
- be the most likely to adhere to advice about limiting access to firearms
- be the most likely to encourage loved ones to assist them to restrict access to firearms
- experience more engagement in firearm safety thoughts and behaviours
- rate the intervention as more acceptable
There were no significant differences between the four groups in engagement in thoughts and behaviours about firearm safety and in fact all four of the approaches tested were rated as highly acceptable. However, the low fear- high temporariness group was significantly more likely to report their intention to adhere to the clinician’s recommendations to limit access to firearms at one month follow up.
The findings provide initial evidence that an emphasis on temporariness might be the most operative ingredient of the lethal means safety interventions undertaken. The low fear- high temporariness group produced the best outcomes but both groups with an emphasis on temporariness fared better overall than the two groups without this indicator. The focus on temporariness helped communicate the idea that firearm lethal means safety does not mean the permanent removal of guns, but stresses the notion of placing distance between the person and the firearms at times of heightened risk.
“A new form of cultural competence”
While it may not be comfortable or a familiar topic for clinicians to discuss during safety and suicide planning interventions, many young people at risk of suicide in the USA have familiarity with and access to firearms. Clinicians need to give a clear guidance about the best ways to frame discussions about firearms in the context of safety. The key message is that clinicians should emphasise the point that removal of access to firearms during at-risk periods, and for only a temporary period until the risk of suicide abates. These conversations require what has been called “a new form of cultural competence” because the clinician needs to understand both the statistics and the individual context around how an individual at risk of suicide might access firearms.