Pharmacists and community healthcare and mental health providers play a critical role in encouraging safe storage of potentially lethal products. Safe storage of medications, firearms, and other household products can reduce the risk for suicide by separating vulnerable individuals from easy access to lethal means.
Firearms should be kept unloaded in a gun safe or lock box. In a case-control study of firearm-related events in 37 counties in Missouri, Oregon, and Washington, and five trauma centers in Washington and Missouri, researchers found that firearms being stored unloaded, separate from ammunition, and in a locked place (or secured with a safety device) was protective of suicide attempts among adolescents (CDC, 2022).
Medicines should be kept in a locked cabinet or other secure location away from people who may be at risk or who have made prior attempts (CDC, 2022). Medications are a particular concern because of the potential for abuse, accidental poisonings, and use in suicide attempts. Safer Homes Suicide Aware recommends:
- Lock up prescription medications.
- Limit the supply of in-home, over-the-counter medications.
- Return unused medications.
- Dispose of medications in cat litter or coffee grounds and place in the trash.
Campaigns such as Safer Homes, Suicide Aware focus on simple steps to prevent suicide attempts and deaths before a crisis occurs. These types of public health programs help educate family members, community healthcare providers, and mental health providers about potential hazards in the home.
Source: Safer Homes Suicide Aware Training Materials. Used with permission.
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Case Example: Julio Is Facing a Divorce
Background
Julio is a 50-year-old police/firefighter who is facing an unwanted divorce from his wife of 25 years. He has been a client of ABC Dental Services for more than 10 years and is well-known to everyone who works in the office. He has an appointment with Javier, the dental hygienist for a teeth cleaning. Keisha, the office manager has asked Julio to fill out a short questionnaire while he is waiting for Javier.
After a short wait, Javier escorts Julio into his treatment room. Javier notices that Julio is very quiet and asks him how he’s doing. Julio tells him that he’s a little depressed because he was recently arrested for drunk driving, and he’s been suspended without pay from his job. He says his wife (also a client of ABC Dental) has asked him for a divorce.
As Javier is prepping for the teeth cleaning, Julio thanks him for the excellent dental care he’s received over the years and asks Javier to tell the dentist how much he appreciates everyone at the clinic. He tells Javier that he’s planning a hunting trip and isn’t sure when he’ll be back.
Screening
The ABC Clinic uses the PHQ 2 to screen all clients at each visit and employees have received specialized training in screening and referral for suicidal ideation and behaviors. The clinic maintains a list of pre-screened referral services in case a referral is needed for one of their clients.
Javier excuses himself and asks the office assistant for the results of Julio’s waiting room screen. Keisha lets Javier know that Julio marked “3” on both questions on the waiting room questionnaire (little interest or pleasure in doing things and feeling down, depressed, or hopeless). Because of Julio’s screening answers, Javier decides to discuss the results with Julio.
Javier: You mentioned that you feel depressed. On the waiting room questionnaire, you filled out in the waiting room you indicated that that you also feel hopeless and have little interest in anything anymore. Is this true?
Julio: Yes, I’m losing everything that’s important to me—my wife, my job, my driver’s license—even my kids are mad at me.
Javier: You sound very unhappy.
Julio: I am—I just want to get away for a while—get away from all this pressure and try to get my head straight.
Javier: Sometimes, when people feel hopeless and depressed, they don’t see any reason to go on living. Have you thought about suicide?
Julio: Well, sometimes I do—I have guns and sometimes think it isn’t worth it anymore. But I don’t think I could really pull the trigger—I’m not that kind of guy.
Javier: Have you ever tried to hurt yourself in the past?
Julio: Well, about 10 years ago, when I failed the firefighter training exam, I was so depressed I downed a bottle of Vicodin and passed out. My roommate at the time called an ambulance and I had to have my stomach pumped. I didn’t really want to die—I just wanted to turn off my brain for a while.
Javier: I want to thank you for sharing all of this with me. Right now, I’m concerned that you might try to hurt yourself when you leave the office. Are you planning to go back home before you go on your trip?
Julio: Yes, I want to say goodbye to my wife and kids.
Javier: Would it be okay with you if I called your wife and let her know what’s going on? I’d like to have her remove your guns and medications from the house. Is that okay with you? I’d also like to have you talk to some people who can help you with your depression and thoughts of suicide. Is that okay? I can ask someone to come over to the clinic right now to talk to you.
Julio: Yes, I would appreciate that.
Discussion
Javier stays with Julio in a private room while the office manager contacts social services. She also informs the dentist. The office assistant also calls Julio’s wife to let her know the situation and to ask her to remove any guns and narcotic medication from the house. Julio’s wife agrees to do this but refuses to come to the clinic.
The fact that Julio tried to harm himself 10 years ago by overdosing on a narcotic pain medication is a red flag. Javier discusses the situation with the dentist, and they decide that Julio should be seen immediately for a more thorough assessment. The clinic has a list of pre-screened mental health providers who are willing to come to the clinic talk to Julio. Javier reaches a social worker who agrees to meet with Julio. Javier stays with Julio in a private room until the social worker arrives.
When Javier follows up the next day, he learns that Julio has voluntarily admitted himself to the local hospital’s mental health ward.