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Means Removal

All people who are thinking of suicide are suffering and deserve support, but not every person who is thinking of suicide is in an immediate physical crisis.  For someone to be at risk of dying by suicide, they need to have access to a lethal method of ending their own life.  Conversely, to protect someone from suicide you need to restrict access to the method of ending one’s own life.

This may come across as both intuitive and unintuitive: Sure, it makes sense that you’d need a method, but how would restricting access to one method protect people from all of the other lethal means?  This perspective fails to acknowledge the different cognitive state inherent to a suicidal crisis.  People so upset that they’re considering ending their own lives have difficulty ‘problem-solving’, and they rely on processes and plans put into place when they were less escalated.

While building up to a suicidal crisis, people may start thinking about how they’d kill themselves if things got too bad, if the moment of impulse hits.  They may keep the method accessible, or study how to use it in preparation, so once they’re in crisis they don’t have to figure out the complex logistics.  The best way to protect people who have a plan is to make it so the plan isn’t accessible when they are at their most impulsive.  In an impulsive, suicidal state it’s very unlikely they will come up with another plan unless it’s something extremely accessible, extremely easy to use, and extremely lethal.  The best example of this is firearms.

How to deactivate or remove access to means

After completing a suicide assessment you may want to help identify ways to deactivate or remove access to means.  Depending on the means chosen, here are some recommendations for how to help protect someone if they say they have one of these specific plans:

  • Firearms: In the state of California it’s tricky to legally remove a firearm from the home.  It’s illegal to transfer the possession of a firearm without registering it in the new owner’s name.  If the person-at-risk is willing, this is the optimal process, but may be difficult.  Instead, try removing access to ammunition (by seizing it or disposing of it safely), and using a gun lock for the duration of the suicidal crisis.  For more information about gun safety and suicide, read here.
  • Overdose: It may be difficult to protect someone from overdosing on medication if they also require regular use of this medication to stay alive and well.  If someone is at risk of suicide, encouraging them to tell their prescribing physician about their risk is best.  The physician may choose to lower dosages or changing prescriptions to one that has the lowest risk of lethality.  Many people-at-risk fear that by telling their physician they’re suicidal they may be ‘locked up’ or put under an involuntary psychiatric hold.  As long as the person-at-risk is transparent about wanting to stay safe, the doctor will do their best to prevent hospitalization.  It’s in the best interest of not only the patient to maintain their freedom, but the medical system as well.
  • Hanging: Asphyxiation by hanging is an increasingly common method of suicide, and requires a careful assessment of available tools to protect the person-at-risk.  During the suicide assessment if the person says they are planning on hanging themselves, always ask what they plan on using.  If it’s some tool acquired specifically for this task, like a rope, it may be easy to dispose of.  But some other tools like bedsheets may be more complicated.  Whatever the tool, come up with a method for temporary replacement.  For example, if they choose bedsheets, help identify ways to remove the bedsheets temporarily by replacing them with a sleeping bag.
  • Jumping: Unfortunately it may be difficult to remove access from high places.  Always identify which place they’re considering jumping from.  If from their own home, you can help protect the person-at-risk by installing locks on windows.  If they’re considering another elevated point, you may need to focus on reducing access to this point.  If it’s somewhere distant, perhaps removing access to their vehicle, or transit pass.  If someone is considering jumping from the Golden Gate Bridge and you have received word they’re on their way, you can call the bridge police with an identifying description of the person-at-risk at this phone number: 415-921-5858

If a person is in an immediate state of crisis call 911 to initiate emergency services to help protect them.  Please call 415-781-0500 to speak to a live counselor if you’d like to discuss means removal with a trained counselor.