How to incorporate means restriction into your community suicide prevention efforts

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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

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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

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Examples of Means Restriction
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2000-2010 Suicides in Kenosha County
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Define the suicide problem in your area
2000-2010 Suicides in Kenosha County by Method
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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

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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

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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 members gun, usually a parents

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What did Kenosha County Do?

• Education on firearm safety - What resources were
  out there?

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Project ChildSafe www.projectchildsafe.org
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Harvard Means Matter
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Anatomy of a Firearm
Hammer
Frame
Butt
Muzzle
Barrel
Cylinder
Grip
Trigger
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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

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Message

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

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What did Kenosha County Do?

• Education on firearm safety - What resources were
  out there?
• Is there evidence-based practice for this
  initiative?

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QPR

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

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Evidence Based Practice C.A.L.M. Training

• Sample CALM Training Agenda
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• I. The ProblemYouth 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_at_dartmouth.edu
• CALM has been accepted into the SPRC/AFSP Best
  Practices Registry for Suicide Prevention

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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?

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Partners

• Medical Examiner
• Law Enforcement
• Medical Community
• Gun Clubs
• Duck Unlimited
• Media

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Whats next?

• Prevent Suicide Wisconsin
• Funding Charles E. Kubly Foundation
• Continue to foster relationships

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Medication Collection Day

• Events have been done in April/May October
• Locations
• Partnered with surrounding communities and other
  agencies
• Volunteers
• Paid staff
• Funding

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Partners

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

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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

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Volunteers

• Questionnaires
• Runners
• Sorters
• Traffic Control
• Pharmacist
• Law Enforcement

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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

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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

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After the event

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

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Other Resources

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

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Funding

• Dept of Agriculture, Trade Consumer Protections
  (DATCP) grant 3,700
• HWPP grant
• Permanent Site

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Lessons Learned

• Be prepared for opposition
• Definitions are important
• Examples arent necessary
• Dump out medications DONT REACH IN BAGS
• No company/business drop offs

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Medication Lockbox
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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

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Questions?

• Debbie Rueber, B.S. , C.H.E.S
• Kenosha County Division of Health
• 262-605-6722
• Debbie.rueber_at_kenoshacounty.org
• Amy Schlotthauer, MPH
• Injury Research Center at the Medical College of
• Wisconsin
• 414-955-7667
• aschlott_at_mcw.edu