Talking with Patients About Lethal Means Safety
Practical Guidance for Health & Mental Health Providers
Why It Matters
Suicide can be an impulsive act, and access to highly lethal means (such as firearms or medications) greatly increases the risk of death from an attempt. Reducing access to lethal means, especially during times of crisis, can save lives and give people time to get more support.
When to Discuss
– Any time a patient has suicidal thoughts, plans, or significant risk factors.
– During routine visits for at-risk patients, especially those with a history of attempts or mental illness.
How to Start the Conversation
– Use a nonjudgmental, collaborative tone:
You’re important to me, and I want to make sure you stay alive to see things get better in your life.
– Normalize the topic as part of overall safety planning:
One part of improving safety from suicide is about removing or reducing access to items or objects that can be used in a suicide attempt.
– Acknowledge respect for their rights while focusing on temporary safety:
I want to make sure it’s clear that this would be temporary and that it doesn’t infringe on your rights.
Key Questions to Ask
Do you have access to firearms at home?
Do you keep any medications or other potentially dangerous substances unlocked?
How are these kept in the home?
Practical Safety Strategies
Firearms:
– Store unloaded in a locked safe or lockbox.
– Store ammunition separately or remove from the home.
– Consider temporary off-site storage with trusted individuals or law enforcement (for Washington law on firearm transfers see RCW 9.41.113 ).
Medications:
– Keep only small quantities at home.
– Use locked medication boxes.
– Dispose of unused or expired medications safely.
Phrases That Work Well
– “Many people find it helpful to make their environment safer during tough times.”
– “This is about getting through the crisis — not about taking away your rights.”
– “Let’s make a plan together so you have time and space to heal.”
Document & Follow Up
– Document the discussion and safety steps in the patient’s chart.
– Revisit the topic regularly during follow-up appointments.
Examples from Firearms Organizations
Some patients might appreciate examples from firearms organizations explaining the importance of lethal means safety. Videos discussing this include:
Utah Suicide Prevention Coalition: https://www.youtube.com/watch?v=zLJuDz7sGDE
National Shooting Sports Foundation: https://www.youtube.com/watch?v=L8NC96VUft0
Examples of lethal means conversations from Forefront
This role play is an example of a pharmacist showing concern for a patient who may be considering suicide by medication.
These role play videos show how a firearms dealer intervenes with a customer considering suicide by firearm.
Adapted from best practices by the Harvard Means Matter Campaign, VA Suicide Prevention Guidelines, and Forefront Suicide Prevention resources.