Creating Safe Environments
A key strategy to preventing suicide is ensuring the physical safety of the environment. There are many ways to create safe environments, including activities, policies, and protocols that minimize access to lethal means. These can be implemented at the healthcare, community, or state level.
Healthcare organizations can create standard protocols that reflect best practices in suicide care. One best practice is counseling patients on access to lethal means to support them in preparing a safe environment in the event of a suicidal crisis, as outlined in the Safety Planning Guide, an evidence-based resource for clinicians. Training in safety planning, counseling on access to lethal means, and firearm injury prevention and patient safety will help clinicians build skills to collaboratively develop a plan with their patients that may include safe storage or temporary removal of lethal means during a suicidal crisis.
Communities can take measures to make the environment safe of lethal means, including firearms and medication. Firearms are the most lethal means of suicide and the most common method used in rural areas. Therefore, reducing access to firearms during a suicidal crisis is a highly impactful suicide prevention strategy. Communities can implement this strategy by providing free gun locks with Lifeline and Crisis Text Line numbers and delivering education and training on how, why, and when to use gun locks.
Community strategies to address medication access can include prescription take-back days at readily accessible locations in the community, safe medication disposal at pharmacies, training of pharmacists to identify suicide risk and educate customers about safe storage of medications, and community-wide efforts to reduce alcohol and other drug use.
Other examples of community strategies include structural changes to certain areas, such as building bridge barriers, to prevent suicides from occurring on bridges.
State policies play a role in creating safe environments through regulation of access to firearms and prescription medications. There are many state policies around access to prescription drugs including time and dosage limits, physical examination requirements, monitoring to prevent doctor shopping, tamper-resistant prescription forms, pain management clinic regulations, and safe haven laws that grant those who call 911 in response to an overdose either immunity or mitigation of prosecution.
There are also many policies that dictate firearm ownership, access, and storage. These include universal background checks, permit-to-purchase laws, waiting periods, child access prevention, and extreme risk protection orders, otherwise known as red flag laws, which allow family or police to petition for the temporary removal of firearms for those exhibiting signs of risk. Some states have more of these laws in place or have stricter enforcement, both of which are associated with lower rates of suicide. Policy-level efforts such as these have the potential for significant impact in preventing suicide.
Environmental strategies to reduce access to firearms are highly controversial and can be met with resistance. As many firearms have been passed down through generations of family members, firearm suicide prevention efforts should acknowledge and be mindful of the deep emotional and cultural connection rural communities may have with firearms. This can be approached in a culturally appropriate and sensitive manner, by clearly explaining the purpose, rationale, and plan for temporary removal or safe storage of firearms. Communities can also involve gun shop owners, others from the gun-owning community, and those that gun owners trust in efforts to communicate about and implement safe firearm storage initiatives.
Involving the gun-owning community in suicide prevention efforts can be achieved in multiple ways. For example, firearm retailers and gun ranges can share information on suicide prevention, be trained to identify someone who is at risk, and partner with mental health providers so they are positioned to refer those identified to care and to delay the sale of firearms until a time that is safe and appropriate. There are specific training programs and resources geared toward gun retailers and firearm instructors to help them develop these skills and familiarize themselves with available resources.
Program Clearinghouse Examples
- American Foundation for Suicide Prevention
- Colorado Gun Shop Project
- Lewis County Public Health and Lewis County Community Services
- New Hampshire Firearm Safety Coalition
- Seneca County Mental Health Department and Racker Centers
Resources to Learn More
Access to Means of Suicide
Presents information about limiting access to lethal means of suicide, including firearms and medications, as a part of a comprehensive approach to suicide prevention. Identifies actionable steps that people and organizations can take to reduce or prevent access to lethal means.
Organization(s): Suicide Prevention Resource Center
Safer Homes, Suicide Aware: Fire-Arms Safety Course 7.27
Webinar addressing firearm safety training for those who are first-time firearm buyers, and includes an overview of firearm suicide.
Author(s): Bass, B. & North, Z.
Organization(s): Safer Homes Suicide Aware, Forefront Suicide Prevention