Suicide was the second leading cause of death for people ages 15 to 34 in Indiana in 2015, and a leading cause of death for individuals of all ages. We know that many attempters are as ambivilant about suicide as they are about life. Preventing these suicides is a very complex puzzle that requires all of us to work collaboratively to complete the picture. One piece of the puzzle that has proven to be effective is to reduce access to lethal means - particularly firearms and medications.
The CALM workshop addresses why and how to do this, focusing on the steps below. The workshop includes a PowerPoint presentation regarding why CALM is important, a model videotaped counseling session, and lots of time for discussion and/or role plays. It was developed by Elaine Frank and Dr. Mark Ciocca in New Hampshire.
Three specific steps:
Step 1
Tell the individual and/or family directly that you believe that they may be at risk for suicide, and why you have determined that.
Step 2
Explain that they can reduce the risk by reducing their access to lethal means, particularly firearms, but also lethal medications.
Step 3
Discuss specific steps they can take to remove, or at least reduce, access to firearms and other lethal means.
Firearms
The use of a firearm leaves very little possibility for intervention or rescue. Firearms are the method used in more than 50% of all suicide deaths in the U.S. All U.S. studies have found that a firearm in the home increases the risk of suicide two- to five-fold compared to a home without a firearm.
Police Departments
• Most will accept firearms that you want to have destroyed.
• Some will accept firearms on a temporary basis.
• ALWAYS check the department's policies and NEVER bring a firearm to the police without talking to them first.
Removing the Firearm
• The MOST EFFECTIVE means for reducing suicide with a firearm is to remove all firearms from the home and environment while someone is at risk
• DON'T believe that the suicidal person does not know if or where guns are kept.
• When discussing these issues, focus on the risk, not the firearm.
• Discuss this as a temporary move for a specified period of time.
• Friends or family are often the best option. If moving firearms to someone else's home, provide specific instructions regarding who, when and how the firearms may be returned, and be sure they are legally allowed to hold your guns.
• Self-storage units, shooting clubs, gun shops or pawn shops may be good options.
If removal is not an option, make the following suggestions:
• Move all firearms to new locations.
• Store all firearms unloaded and locked.
• Change lock combinations or where keys are kept.
• Any ammunition should be stored locked and separate from the firearms.
• Remove a key component such as the firing pin or bolt.
Medications & Poisons
• Any medications or other poisons not being used should be safely disposed of.
• Prescription and over-the-counter medications should be limited in number to non-lethal doses.
• Combining medications, drugs and alcohol can increase the toxicity.
• If uncertain regarding the toxicity of specific medications or other products, contact the Poison Center at 1.800.222.1222.
• Any other potentially lethal products should be removed from the home or moved and kept locked.
Other Means
It may be more difficult to limit access to other means. However, it is important to take whatever steps are indicated to reduce access when feasible if the individual talks about using any of these.
• Access to cars or other vehicles
• Access to ropes or ligatures (hanging is the leading means for those under 15)
• Access to sharp objects
• Access to alcohol and drugs
Supervision
Due to the difficulties in limiting access to lethal means, those considered actively suicidal are perhaps best protected by not being left alone. This requires having a number of caregivers available to share this difficult role, along with the support and guidance of professionals regarding when to initiate and terminate this close supervision.
You are not alone and help is always available! If you're struggling or concerned about someone else, call the free National Suicide & Crisis Lifeline at 988 or the 24-Hour Local Southwestern Crisis Hotline at 812.422.1100.
