Most individuals who attempt suicide unsuccessfully will only do so once and make that decision within the hour preceding the attempt. “To kill oneself, one must have the means for doing so,” said researchers from the University of Texas Health Science Center at San Antonio and the University of Utah. “It is because of this very simple and undisputable fact that means restriction is often recommended as a risk management strategy.” Means restriction involves limiting access to items that could cause self-harm. Means restriction counseling, which differs significantly from means restriction, is a process by which a therapist educates the suicidal individual and their family members about the hazards of having access to harmful items and encourages limiting availability to them.
The researchers believe that physical means restriction, specifically as it relates to firearms, the leading method of suicide, is critical and has been proven to be effective. They said, “One particularly well-known example is the District of Columbia’s Firearms Control Regulations Act, which was associated with a 38% decrease in firearm suicide rates in the District of Columbia and a total suicide rate decrease of 22%, with no effect on neighboring counties unaffected by the law.”
Despite these facts, less than one quarter of clinicians in emergency settings offer means restriction counseling. The researchers believe this is due in part to the fact that many clinicians misinterpret the suicide attempt as an effort to kill oneself rather than an effort to decrease psychological pain. “It is therefore recommended that clinicians present means restriction as a method for maximizing environmental safety to accomplish the shared goal of pain remediation,” said the team. To avoid conflict with the client, the researchers recommend utilizing a “Means Receipt” which provides a plan for limiting the client’s access to lethal means, commitment of a supportive ally to ensure the plan is enacted, and the conditions which must be met in order to lift those restrictions.
Bryan, C. J., Stone, S. L., & Rudd, M. D. (2011, August 29). A Practical, Evidence-Based Approach for Means-Restriction Counseling With Suicidal Patients. Professional Psychology: Research and Practice. Advance online publication. doi: 10.1037/a0025051
© Copyright 2011 by By Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to GoodTherapy.org.
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