Means Restriction Counseling for Prevention of Suicide

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.

Reference:
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.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Dave Clark Jr.

    Dave Clark Jr.

    September 9th, 2011 at 10:06 PM

    Means restriction seems to be an excellent way to stop patients from committing suicide even if they can’t be talked out of doing it through therapy. Is this meant as a last ditch effort in order to help save lives? I can see with ease, how effective this method would be. From what I understand thoughts of attempting suicide doesn’t last long and can go away in a few hours. So removing all devices, objects etc that could be harmful, the suicidal person would have to seek a plan to commit suicide outside of the house. This method should be implemented by many more hospitals, it will save lives.

  • Peyton

    Peyton

    September 10th, 2011 at 11:49 AM

    But to have real means restriction you have to be aware that someone is even thinking about killing himself.

    there are plenty of people who hide this plan pretty well and really take others by surprise when they go through with the act.

  • Delia L.

    Delia L.

    September 10th, 2011 at 3:53 PM

    “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.”

    Talk about blinding them with science. Couldn’t they have simply said “don’t have easy access to guns”? That would be much clearer.

  • R.Lee

    R.Lee

    September 10th, 2011 at 4:35 PM

    Is it really our business to prevent another from taking their own life? I’m a firm supporter of right-to-die and those who have been pushed this far from my perspective have been ignored by everybody else until that point, so why involve yourselves suddenly now and pretend you care?

    If an individual wants to take their own life, then the consequences of that act are between them and God.

  • T. D. Denny

    T. D. Denny

    September 10th, 2011 at 5:05 PM

    @R.Lee– Suicide is often a means to escape from all the suffering that the poor soul is going through instead of trying to resolve it. Resolving it is often wrongly seen to be beyond them. Suicides take their lives over the deaths of another, extreme stress, high debt, home or work pressures, unrequited love, bullying…you name it.

    It’s a permanent solution to a temporary problem and no, we shouldn’t stand by and do nothing. We should do everything we can to help them find that solution.

  • Nicki Carter

    Nicki Carter

    September 10th, 2011 at 5:46 PM

    @T.D. Denny : Sometimes those who feel suicidal don’t say they feel it, or are keeping the whole thing quiet and waiting for somebody, anybody, to notice. There have been spontaneous suicides in the past nobody saw coming (or at least appeared spontaneous to the families. The suicide could have been premeditated).

    That’s why taking away or storing any tools they could use to commit the act in a not so accessible place is smart. Even if you don’t know for sure they are considering it, why take that risk?

  • daniel

    daniel

    September 10th, 2011 at 11:38 PM

    “many clinicians misinterpret the suicide attempt as an effort to kill oneself rather than an effort to decrease psychological pain.”

    A very good analysis of suicide-effort to decrease psychological pain. I have tried ending my life many years ago and although I ended up in the hospital, all that treatment did was make me fit again. It did not end my psychological pain, the pain inside me that actually make me think that ending my life is the only way!

    But what did help me was counseling, a lot of it. I am very grateful to my family for having sent me to counseling because had they not done that I am pretty sure I would have attempted suicide again and maybe even ended my life at that young age.

    And for those of you contemplating suicide-please wait for a minute and tell yourself-this is not the only way. Try talking to someone and see how best you can eliminate your problems, your reasons for actually contemplating suicide. You can live again, you can get over things, it will be hard and not easy but you will make it.

  • BRYAN

    BRYAN

    September 11th, 2011 at 7:26 PM

    If a person wants the means to do something horrible,he or she will procure the same somehow, don’t you think?! Instead of trying to keep things away it would be better to teach the person not to use them for something negative, don’t you think?!

  • katy

    katy

    September 12th, 2011 at 6:41 AM

    it can be very tough to have a family member who has attempted suicide in the past.I have been in such a situation and trust me its not good!

    you can never be sure when that idea has left their mind.you’re always scared that they may try it again…even having the person being alone is scary sometimes..so this kind of a therapy would be mighty helpful for such people and families.

  • Dario Johnson

    Dario Johnson

    September 12th, 2011 at 2:35 PM

    Allow me to name everything in my bathroom that I can use to kill myself. Bleach, pills, shaving razor, a bathtub, ammonia, toilet cleaner… you get the point.

    If a man or woman’s determined they want to take their own life right there and then, they will find a way to kill themselves very easily and quickly. Even if gun control can reduce suicides, what stops all the other methods?

  • Sherri Greene

    Sherri Greene

    September 12th, 2011 at 4:08 PM

    @Dario Johnson: It takes tremendous effort to drink bleach and it would sooner make you throw up and just do nasty internal damage than outright kill you. With a gun, you only have to point it at your temple and pull the trigger. It’s over in under a second and takes very little effort on your part. The longer it takes to do it, the higher the chance you’ll think twice about killing yourself.

  • S. Chandler

    S. Chandler

    September 12th, 2011 at 4:21 PM

    I would be broken in two if my son were to commit suicide. We butt heads often but I love him deeply. Lord, I hope he knows…I would never, ever get over that. He has his troubles and I have mine. Neither one of us is perfect. All I ever want is for us to get along and him to grow into a fine, caring man.

    Yes by all means, don’t place temptation in their way for sure. My heart goes out to any mother or father who loses a child to suicide. It’s so needless.

  • J. Lewis

    J. Lewis

    September 12th, 2011 at 4:46 PM

    @Sherri–And that’s exactly why you don’t want to keep such things within easy reach of one with suicidal thoughts.

    Say I wanted to kill myself. If I knew I’d have to go up my loft (which means getting the ladders out the shed first) and then dig through a dozen boxes to find my gun, instead of simply reaching into my bedside drawer, is it beyond the realms of possibility that I might-MIGHT-rethink it? I don’t think it is.

    My opinion is that impulsiveness kills suicides as much as their weapons of choice do.

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