How to incorporate means restriction into your community suicide prevention efforts

1. How to incorporate means restriction into your community suicide prevention efforts Debbie Rueber Kenosha County Division of Health Amy Schlotthauer Injury Research Center at the Medical College of WI

2. Means Restriction/Reduction • Activities designed to reduce access or accessibility to the means and methods of deliberate self-harm in order to reduce the odds that an attempter will use a highly lethal means, thus lowering the case fatality ratio of suicides/suicide attempts • Reducing the odds that an attempter will use highly lethal means

3. Examples of Means Restriction

4. 2000-2010 Suicides in Kenosha County

5. Define the suicide problem in your area 2000-2010 Suicides in Kenosha County by Method

6. When do people take their lives? • Some take their lives after careful planning & deliberation but many act impulsively • 1/3 of youths who died by suicide had faced a crisis within the past 24 hrs • Among people who nearly died in a suicide attempt, 24% said less than 5 minutes elapsed between deciding on suicide and making the attempt

7. How do people most commonly complete suicide? • Firearms are used more than every other method combined • Most non-fatal attempts are overdoses followed by cutting

8. Why firearms? • They are quick • They are irreversible • They are more lethal 85% of youth under 18 who died by firearm suicide used a family member’s gun, usually a parent’s

9. What did Kenosha County Do? • Education on firearm safety - What resources were out there?

10. Project ChildSafe • www.projectchildsafe.org

11. Harvard Means Matter

13. Anatomy of a Firearm Hammer Frame Butt Muzzle Barrel Cylinder Grip Trigger

14. CABLE GUN LOCK What it is: A device that blocks the chamber to prevent a cartridge from being fired. How it works: Chamber locks are inserted in or through the magazine well or chamber, or are inserted through the gun barrel and chamber to block a cartridge from moving into position. A combination lock or key opens the lock. Features: Metal cylinders, vinyl covered wire cables, or other designs. Locks may be "universal" or may only fit certain revolver or pistol models. Some models have anti-tamper alarms. Advantages: • Long cables may be threaded through several guns. • Inexpensive Disadvantages: • Thin cables could be cut

15. Message Store guns • Locked • Unloaded • Ammunition locked and stored separately *Most teens know where their parents keep their guns.

16. What did Kenosha County Do? • Education on firearm safety - What resources were out there? • Is there evidence-based practice for this initiative?

17. QPR • SPRC Best Practice Registry • Added means restriction component • Offer cable gun locks at presentations

18. Evidence Based Practice C.A.L.M. Training Sample CALM Training Agenda I. The Problem—Youth Suicide and Access to Lethal Means A review of data on youth suicide focusing on means used II. Introduction to Firearms and Their Operation A basic introduction to the operation and safety features of firearms III. Negotiation of Means Restriction-Video Presentation A video demonstration of a family intervention wherein means restriction is presented and negotiated IV. Strategies for Securing and Removing Firearms and Other Lethal Means A review and discussion of ways to secure or remove lethal means as necessary to restrict access Take A Few Minutes to C.A.L.M. Counsel on Access to Lethal Means Three specific CALM steps: • Explain that you believe that they or a family member is at risk for suicide and why you have made this determination • Explain that they can reduce the risk by reducing access to lethal means, particularly firearms. • Discuss specific steps they can take to remove or at least reduce access to firearms and other lethal means A 90 minute workshop for Primary Care and ED Providers A one hour workshop for a general audience For more information contact Elaine Frank at elaine.frank@dartmouth.edu CALM has been accepted into the SPRC/AFSP Best Practices Registry for Suicide Prevention

20. What did Kenosha County Do? • Education on firearm safety - What resources were out there? • Is there evidence-based practice for this initiative? • Who are the key partners?

21. Partners • Medical Examiner • Law Enforcement • Medical Community • Gun Clubs • Duck Unlimited • Media

23. What’s next? • Prevent Suicide Wisconsin • Funding – Charles E. Kubly Foundation • Continue to foster relationships

24. Medication Collection Day • Events have been done in April/May & October • Locations • Partnered with surrounding communities and other agencies • Volunteers • Paid staff • Funding

26. Partners • Pharmacist(s) • Law Enforcement • Emergency Management • Greener Kenosha • Concerned Citizens Coalition Drug Free Communities • Businesses • Disposal Company

27. Prior to event • Contact Environmental Services - Veolia • Recruit volunteers • Order postcards • Press release • Ads in newspaper* • Post on business website • E-mail announcement to address book • Questionnaire • Confirmation phone call/e-mail to volunteers • Gather items needed for event

29. Volunteers • Questionnaires • Runners • Sorters • Traffic Control • Pharmacist • Law Enforcement

34. Items needed for event • Reflective vests • Clipboards • Pens • Markers • Gloves • Goggles • Hand sanitizer • Bleach wipes • Cones • Signs • Tables (2-4) chairs • Resources to dispose of sharps

36. Day of Event • Set up cones and signs • Set up tables • Set up food/beverage station • Greet volunteers • Fill in for volunteers needing a break • Be available to answer question by participants and volunteers

37. After the event • Calls from those who missed the event • Report • Thank you notes

38. Other Resources • University of Wisconsin Extension • Melissa Boehm 414-227-3344 • Drug Enforcement Agency (DEA) • Walgreens

39. Funding • Dept of Agriculture, Trade & Consumer Protections (DATCP) grant $3,700 • HWPP grant • Permanent Site

40. Lessons Learned • Be prepared for opposition • Definitions are important • Examples aren’t necessary • Dump out medications – DON’T REACH IN BAGS • No company/business drop offs

41. Medication Lockbox

43. Resources • Harvard Injury Control Research Center Means Matter Campaign • Means Matter Booklets • www.meansmatter.org • ASK campaign • http://www.paxusa.org/ask/index.html • Suicide Prevention Resource Center • www.sprc.org • Project Childsafe • www.projectchildsafe.org • Washington State Department of Health • www.lokitup.org • MedReturn Drug Collection Unit • www.medreturn.com • Lock Med • www.lockmed.com

44. Questions? Debbie Rueber, B.S. , C.H.E.S Kenosha County Division of Health 262-605-6722 Debbie.rueber@kenoshacounty.org Amy Schlotthauer, MPH Injury Research Center at the Medical College of Wisconsin 414-955-7667 aschlott@mcw.edu