Abstract
Over 800,000 completed suicides occur globally each year. Impulsivity and preference for one lethal method over another often characterize suicide attempts. Politics, cultural acceptability, and economic factors of a given region play an important role in an individual’s lethal means selection. Obtaining information on a given patient’s likelihood to use a particular means can provide a vital advantage to a clinician’s risk assessment and safety planning efforts. Importantly, research has shown that lethal means preferences vary around the world. Although some methods have been used throughout the history of suicidal behaviour, new methods continue to emerge and levels of frequency for specific means vary globally. Specifically, methods gaining in popularity include self-poisoning and self-immolation. The ever-changing nature of lethal means frequencies compiled with the efficacy of informed safety planning suggests the need for continued research into lethal means restriction so that professionals can adequately assess and intervene during behavioural emergencies. This chapter will provide the clinician with an overview on current lethal means restriction data to better-inform risk assessment procedures for patients from diverse backgrounds. Further, current limitations in lethal means research as well as future directions will be discussed.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsNotes
- 1.
Using firearms as an example demonstrating the differences among these three methods of means restriction, physically preventing access would involve removing a firearm from an individual's possession; reducing lethality of certain means could include installing a gunlock or not having access to ammunition; reducing cognitive access would involve providing mental health treatment and means restriction counseling preventing planning harm by using the firearm.
- 2.
See discussion regarding the Method Substitution Hypothesis.
- 3.
Many states have strengthened the federal regulations. The federal laws pertaining to firearm ownership provides the bare minimum for state regulation. Unless developing legislation or intervention at a federal level, always investigate state-specific regulations before engaging in means restriction.
References
Ajdacic-Gross, V., Weiss, M. G., Ring, M., Hepp, U., Bopp, M., Gutzwiller, F., & Rossler, W. (2008). Methods of suicide: International suicide patterns derived from the WHO mortality database. Bulletin of the World Health Organization, 86(9), 726–732.
American Knife & Tool Institute. (n.d.). The American Knife & Tool Institute Supports Knife Preemption Laws to Protect Law-Abiding Citizens. Retrieved from http://www.akti.org/legislation/about-knife-preemption/.
Anestis, M. D. (2016). Prior suicide attempts are less common in suicide decedents who died by firearms relative to those who died by other means. Journal of Affective Disorders, 189, 106–109.
Barber, C. W., & Miller, M. J. (2014). Reducing a suicidal person’s access to lethal means of suicide. American Journal of Preventative Medicine, 47(3), 264–272.
Beautrais, A. L. (2008). Effectiveness of barriers at suicide jumping sites: A case study. Australian and New Zealand Journal of Psychiatry, 35(5), 557–562.
Betz, M. E., Miller, M., Barber, C., Miller, I., Sullivan, A. F., Camargo, C. A., & Boudreaux, E. D. (2013). Lethal means restriction for suicide prevention: Beliefs and behaviours of emergency department providers. Depression and Anxiety, 30(10), 1013–1020.
Brady Handgun Violence Prevention Act. (1993). Retrieved from http://www.gpo.gov/fdsys/pkg/BILLS-103hr1025enr/pdf/BILLS-103hr1025enr.pdf.
Bryan, C. J., Stone, S. L., & Rudd, D. M. (2011). A practical, evidence-based approach for means-restriction counseling with suicidal patients. Professional Psychology: Research and Practice, 42(5), 339–346.
Chang, S. S., Lu, T. H., Sterne, J. A. C., Eddleston, M., Lin, J. J., & Gunnell, D. (2012). The impact of pesticide suicide on the geographic distribution of suicide in Taiwan: A spatial analysis. BMC Public Health, 12, 260–270.
Child-Access Prevention. (2013). Retrieved from https://www.congress.gov/bill/113th-congress/house-bill/65.
Clarke, R. V. (1989). Crime as opportunity: A note on domestic gas suicide in Britain and The Netherlands. British Journal of Criminology, Delinquency and Deviant Social Behaviour, 29(1), 35–46.
Custodial Sentences and Weapons Act. (2007). Retrieved from http://www.legislation.gov.uk/asp/2007/17/contents.
Daigle, M. S. (2005). Suicide prevention through means restriction: Assessing the risk of substitution: A critical review and synthesis. Accident Analysis and Prevention, 37(4), 625–632.
Drum, D. J., Brownson, C., Denmark, A. B., & Smith, S. E. (2009). New data on the nature of suicidal crises in college students: Shifting the paradigm. Professional Psychology: Research and Practice, 40(3), 213–222.
Eddleston, M. (2000). Patterns and problems of deliberate self-poisoning in the developing world. Quarterly Journal of Medicine, 93(11), 715–731.
Federal Gun Control Act of 1968. (1968). Public Law 90–618. Retrieved from http://www.gpo.gov/fdsys/pkg/STATUTE-82/pdf/STATUTE-82-Pg1213-2.pdf.
Frattaroli, S., McGinty, E. E., Barnhorst, A., & Greenberg, S. (2015). Gun violence restraining orders: Alternative or adjunct to mental health-based restrictions on firearms? Behavioural Sciences & the Law, 33(2–3), 290–307.
Giacco, D., & Prieve, S. (2016). Suicidality and hostility following involuntary hospital treatment. PLoS ONE, 11(5), 1–13.
Grossman, D. C., Mueller, B. A., Riedy, C., Dowd, M. D. Villaveces, A., Prodzinski, J., … Haruff, R. (2005). Gun storage practices and risk of youth suicide and unintentional firearm injuries. The Journal of the American Medical Association (JAMA), 293(6) 707–714.
Gunnel, D., & Eddleston, M. (2003). Suicide by intentional ingestion of pesticides: A continuing tragedy in developing countries. International Journal of Epidemiology, 32(6), 902–909.
Gunnell, D., Eddleston, M., Phillips, M. R., & Konradsen, F. (2007). The global distribution of fatal pesticide self-poisoning: Systematic review. BMC Public Health, 7(1), 357.
Gunnel, D., Middleton, N., & Frankel, S. (2000). Method availability and the prevention of suicide---A re-analysis of secular trends in England and Wales 1950–1975. Social Psychiatry and Psychiatric Epidemiology, 35(10), 437–443.
Harvard T. H. Chan School of Public Health. (2016). Means reduction saves lives. Retrieved from http://www.hsph.harvard.edu/means-matter/means-matter/saves-lives/.
Hawton, K. (2002). United Kingdom legislation on pack sizes of analgesics: Background, rationale, and effects on suicide and deliberate self-harm. Suicide and Life-Threatening Behaviour, 32(3), 223–229.
Horwitz, J., Grilley, A., & Ward, K. (2016). Preventing gun violence. In L. H. Gold & R. I. Simon (Eds.), Gun violence and mental illness (pp. 317–338). Arlington, VA: American Psychiatric Association.
Johnson, R. M., Frank, E. M., Ciocca, M., & Barber, C. W. (2011). Training mental healthcare providers to reduce at-risk patients’ access to lethal means of suicide: Evaluation of the CALM Project. Archives of Suicide Research, 15(3), 259–264.
Knives Act. (1997). Retrieved from http://www.legislation.gov.uk/ukpga/1997/21/crossheading/stopping-and-searching.
Krietman, N. (1976). The coal gas story: United Kingdom suicide rates, 1960–1971. British Journal of Preventive & Social Medicine, 30(2), 86–93.
Law Center to Prevent Gun Violence. (2012). Universal Background Checks & the Private Sale Loophole Policy Summary. Retrieved from http://smartgunlaws.org/universal-gun-background-checks-policy-summary/#footnote_33_5949.
Lester, D. (1988). Why do people choose particular methods for suicide? Activitas Nervosa Superior, 30(4), 312–314.
Lin, J. J., & Lu, T. H. (2011). Trends in solids/liquids poisoning suicide rates in Taiwan: A test of the substitution hypothesis. BMC Public Health, 11, 712–719.
Madge, N., Hewitt, A., De Wilde, E. J., Corcoran, P., Fekete, S., Van Heeringen, K., … Ystgaard, M. (2008). Deliberate self-harm within an international community sample of young people: Comparative findings from the Child & Adolescent Self-harm in Europe (CASE) study. Journal of Child Psychology and Psychiatry, 49(6), 6667–6677.
Matsubayashi, T., Sawada, Y., & Ueda, M. (2013). Does the installation of blue lights on train platforms prevent suicide? A before-and-after observational study from Japan. Journal of Affective Disorders, 147(1–3), 385–388.
Mishara, B. L. (2007). Railway and metro suicides: Understanding the problem and prevention potential. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 28(S1), 36–43.
National Action Alliance for Suicide Prevention. (2014). A prioritized research agenda for suicide prevention: An action plan to save lives. Retrieved from http://actionallianceforsuicideprevention.org/sites/actionallianceforsuicideprevention.org/files/Agenda.pdf.
Owens, D., Horrocks, J., & House, A. (2002). Fatal and non-fatal repetition of self-harm. The British Journal of Psychiatry, 181(3), 193–199.
Pirkis, J., Too, L. S., Spittal, M. J., Krysinska, K., Robinson, J., & Cheung, Y. T. D. (2015). Interventions to reduce suicides at suicide hotspots: A systematic review and meta-analysis. The Lancet Psychiatry, 2(11), 994–1001.
Protection of Lawful Commerce in Arms Act. (2005). Retrieved from http://www.gpo.gov/fdsys/pkg/BILLS-109s397enr/pdf/BILLS-109s397enr.pdf.
Renzetti, C. M., & Edleson, J. L. (2008). Encyclopedia of interpersonal violence. Thousand Oaks: Sage Inc.
Schuster, M. A., Franke, T. M., Bastian, A. M., Sor, S., & Halfon, N. (2000). Firearm storage patterns in US homes with children. American Journal of Public Health, 90(4), 588–594.
Switchblade Knife Act. (1958). Retrieved from http://www.gpo.gov/fdsys/pkg/USCODE-2011-title15/html/USCODE-2011-title15-chap29.htm.
Spicer, R. S., & Miller, T. R. (2000). Suicide acts in 8 states: Incidence and case fatality rates by demographics and method. American Journal of Public Health, 90(12), 1885–1891.
United Nations Office of Drugs and Crime. (2013). Global study on homicide 2013: Trends, Context, Data. Retrieved from http://www.unodc.org/documents/gsh/.
US Department of Health and Human Services. (2014). Results from the 2013 national survey on drug use and health: Mental Health Findings. Retrieved from http://www.samhsa.gov/data/sites/default/files/NSDUHmhfr2013/NSDUHmhfr2013.pdf.
Violent Crime Reduction Act. (2006). Retrieved from http://www.legislation.gov.uk/ukpga/2006/38/section/66#.
World Health Organization. (2006). Pesticides are a leading suicide method. Retrieved from http://www.who.int/mediacentre/news/notes/2006/np24/en/.
World Health Organization. (2009). Guns, knives and pesticides: Reducing access to lethal means. Retrieved from http://www.who.int/violence_injury_prevention/violence/lethal.pdf.
World Health Organization. (2014). Suicide, fact sheet. Retrieved from http://www.who.int/mediacentre/factsheets/fs398/en/.
Yip, P. S., Caine, E., Yousuf, S., Chang, S. S., Chien-Chang Wu, K., & Chen, Y. Y. (2012). Means restriction for suicide prevention. The Lancet, 379(9834), 2393–2399.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Bongar, B., Lockwood, D., Spangler, D., Cowell, W. (2017). Lethal Means Restriction: Historical, International, and Professional Considerations. In: Kumar, U. (eds) Handbook of Suicidal Behaviour. Springer, Singapore. https://doi.org/10.1007/978-981-10-4816-6_11
Download citation
DOI: https://doi.org/10.1007/978-981-10-4816-6_11
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-10-4815-9
Online ISBN: 978-981-10-4816-6
eBook Packages: Behavioral Science and PsychologyBehavioral Science and Psychology (R0)