How to incorporate means
restriction into your community
suicide prevention efforts
Debbie Rueber
Kenosha County Division of Health
Amy Schlotthauer
Injury Research Center at the Medical College of WI
Means Restriction/Reduction
• Activities designed to reduce access or
accessibility to the means and methods of
deliberate self-harm in order to reduce the
odds that an attempter will use a highly lethal
means, thus lowering the case fatality ratio of
suicides/suicide attempts
• Reducing the odds that an attempter will use
highly lethal means
Examples of Means Restriction
2000-2010 Suicides in Kenosha
County
35
30
30
26
25
22
23
20
19
20
26
25
21
17
17
15
10
5
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Define the suicide problem
in your area
2000-2010 Suicides in Kenosha
County by Method
80
73
75
70
60
50
39
40
30
18
20
10
0
Hanging
Gun Shot Wounds
Drug Overdose
Carbon Monoxide
Poisonings
When do people take their lives?
• Some take their lives after careful planning &
deliberation but many act impulsively
• 1/3 of youths who died by suicide had faced a
crisis within the past 24 hrs
• Among people who nearly died in a suicide
attempt, 24% said less than 5 minutes elapsed
between deciding on suicide and making the
attempt
How do people most commonly
complete suicide?
• Firearms are used more than every other
method combined
• Most non-fatal attempts are overdoses
followed by cutting
Why firearms?
 They are quick
 They are irreversible
 They are more lethal
85% of youth under 18 who died by firearm
suicide used a family member’s gun, usually a
parent’s
What did Kenosha County Do?
1. Education on firearm safety - What
resources were out there?
Project ChildSafe
www.projectchildsafe.org
Harvard Means Matter
Anatomy of a Firearm
Hammer
Frame
Butt
Muzzle
Barrel
Cylinder
Trigger
Grip
CABLE GUN LOCK
What it is: A device that blocks the chamber to prevent a cartridge from being fired.
How it works: Chamber locks are inserted in or through the magazine well or chamber, or are
inserted through the gun barrel and chamber to block a cartridge from moving into position.
A combination lock or key opens the lock.
Features: Metal cylinders, vinyl covered wire cables, or other designs. Locks may be "universal" or
may only fit certain revolver or pistol models. Some models have anti-tamper alarms.
Advantages:
• Long cables may be threaded through several guns.
• Inexpensive
Disadvantages:
• Thin cables could be cut
Message
Store guns
• Locked
• Unloaded
• Ammunition locked and stored separately
*Most teens know where their parents keep
their guns.
What did Kenosha County Do?
1. Education on firearm safety - What resources
were out there?
2. Is there evidence-based practice for this
initiative?
QPR
• SPRC Best Practice Registry
• Added means restriction component
• Offer cable gun locks at presentations
Evidence Based Practice
C.A.L.M. Training
Take A Few Minutes to
C.A.L.M.
Counsel on Access to Lethal Means
Three specific CALM steps:
•Explain that you believe that they or a family
member is at risk for suicide and why you
have made this determination
•Explain that they can reduce the risk by
reducing access to lethal means, particularly
firearms.
•Discuss specific steps they can take to
remove or at least reduce access to firearms
and other lethal means
A 90 minute workshop for Primary Care and ED
Providers
A one hour workshop for a general audience
For more information contact Elaine Frank at
elaine.frank@dartmouth.edu
CALM has been accepted into the
SPRC/AFSP Best Practices Registry for
Suicide Prevention
Sample CALM Training Agenda
I.
The Problem—Youth Suicide and Access to Lethal
Means
A review of data on youth suicide focusing on
means used
II. Introduction to Firearms and Their Operation
A basic introduction to the operation and safety
features of firearms
III. Negotiation of Means Restriction-Video
Presentation
A video demonstration of a family intervention wherein
means restriction is presented and negotiated
IV. Strategies for Securing and Removing Firearms and
Other Lethal Means
A review and discussion of ways to secure or remove
lethal means as necessary to restrict access
What did Kenosha County Do?
1. Education on firearm safety - What resources
were out there?
2. Is there evidence-based practice for this
initiative?
3. Who are the key partners?
Partners
•
•
•
•
•
•
Medical Examiner
Law Enforcement
Medical Community
Gun Clubs
Duck Unlimited
Media
Age of patient
Gender of patient
Race
Ethnicity
M
F
White
African American
Asian
American Indian
Hawaiian Pac. Islander
Other
Unknown
Hispanic
Non-Hispanic
Date handed out
Injury/Reason for being at ED
# of Cable Locks
What’s next?
• Prevent Suicide Wisconsin
• Funding – Charles E. Kubly Foundation
• Continue to foster relationships
Medication Collection Day
• Events have been done in April/May &
October
• Locations
• Partnered with surrounding communities and
other agencies
• Volunteers
• Paid staff
• Funding
Partners
•
•
•
•
•
Pharmacist(s)
Law Enforcement
Emergency Management
Greener Kenosha
Concerned Citizens Coalition Drug Free
Communities
• Businesses
• Disposal Company
Prior to event
•
•
•
•
•
•
•
•
•
•
Contact Environmental Services - Veolia
Recruit volunteers
Order postcards
Press release
Ads in newspaper*
Post on business website
E-mail announcement to address book
Questionnaire
Confirmation phone call/e-mail to volunteers
Gather items needed for event
Volunteers
•
•
•
•
•
•
Questionnaires
Runners
Sorters
Traffic Control
Pharmacist
Law Enforcement
Medicine Collection Day for Households
a prescription for clean water & safe kids
NEVER FLUSH or pour unused medicine down the drain.
Bring it to the FREE Medicine Collection Day.
 Help protect Lake Michigan
 Prevent childhood poisonings
 Reduce substance abuse
Ointments, sprays, inhalers, creams, vials and pet medications are acceptable.
 Keep all medication in original bottles
 Cross out your name but leave the name of the medication visible
 Put all medication in a sealed bag
Do NOT Bring:
Illegal Drugs, Biohazardous Material, Needles/Sharps, Personal Care Products
(shampoo, soaps, lotions, sunscreens, etc.)
You Can Bring:
Location
8600 Sheridan Rd, Entrance D
(Kenosha County Job Center)
Prescription Medication & Over the Counter Medication.
Saturday, April 16th, 2011
9:00 a.m. to 1:00 p.m.
For more information contact:
Kenosha County Division of Health (262) 605-6700
Kenosha County Medication Collection Day
Kenosha County Job Center
April 16, 2011
Municipality: KENOSHA
BRIGH
BRIS
RAND
SAL
SOM WHEAT
GEN CY
PL PR
SLV LK TW LK
Other
PARIS
PAD LK
How many bottles/medications are you dropping off?
1-2
3-5
6-8
9-12
13+
How did you hear of this drug collection?
NEWSPAPER AD
POSTCARD
TV
FLYER
Without this collection site, how would you get rid of your
medications?
 Flush in a toilet
 Other
 Put in trash
 Future collection
Items needed for event
•
•
•
•
•
•
•
•
•
•
•
Reflective vests
Clipboards
Pens
Markers
Gloves
Goggles
Hand sanitizer
Bleach wipes
Cones
Signs
Tables (2-4) chairs
• Resources to dispose
of sharps
All Aurora Pharmacies will accept sharps and needles. They must be in sharps containers. The pharmacies sell the
containers. If you are an Aurora customer, you may turn in your filled container and receive a new one at no charge.
Other pharmacies also sell the sharps containers and exchange full ones for empty containers if you purchased the
container at their store.
The following facilities are current for the collection of sharps containers in Kenosha/Racine Counties as of January 1,
2011.
Facility
Address
Phone
Aurora
($5 charge if not a customer)
7540 22nd Avenue
Kenosha
262-605-3674
10400 75th Street
Kenosha
262-948-7040
7014 Green Bay Road
Kenosha
262-697-4011
25320 75th Street
Paddock Lake
262-843-2373
700 N. Lake Avenue
Twin Lakes
262-877-2234
Hours
M-Th 8:30am-5pm
Fri 8:30am-4:30pm
No weekends
M-Th 8:30am-5pm
Fri 8:30am-4:30pm
No weekends
M-Th 8:30am-5pm
Fri 8:30am-4:30pm
No weekends
M-Th 8:30am-5pm
Fri 8:30am-4:30pm
No weekends
M-Th 8:30am-5pm
Fri 8:30am-4:30pm
No weekends
Other (Kenosha)
th
Good Value Pharmacy
($5 charge if not a customer)
3401 80 Street
Kenosha
Good Value Pharmacy
($5 charge if not a customer)
9916 75th Street
Kenosha
RACINE
Aurora
($5 charge if not a customer)
262-697-5744
262-925-0201
3900 Erie Street
Racine
262-639-1611
8348 Washington Avenue
Racine
262-884-4030
4310 67th Drive
Union Grove
262-878-1171
210 S. Pine Street
Burlington
262-763-7177
M-F 9am-9pm
Sat 9am-6pm
Sun 9am-5pm
M-F 9am-6pm
Sat 9am-3pm
M-F 9am-7pm
Sat 9am-3pm
Sun 9am-1pm
M-F 9am-7pm
Sat 9am-3pm
Sun 9am-1pm
M-F 8am-8pm
Sat 8am-5pm
Sun 9am-1pm
M-F 8:30am-7pm
Sat 8:30am-5pm
Sun 9am-1pm
Other (Racine)
Walgreens
Hedata/Medicine Collection/Sharps II
Hwy 11 & Green Bay Road
rev. 01/17/11
nlr
262-554-6116
M-F 8am-10pm
Sat & Sun 9am-6pm
Day of Event
•
•
•
•
•
•
Set up cones and signs
Set up tables
Set up food/beverage station
Greet volunteers
Fill in for volunteers needing a break
Be available to answer question by
participants and volunteers
After the event
• Calls from those who missed the event
• Report
• Thank you notes
Other Resources
• University of Wisconsin Extension
– Melissa Boehm
414-227-3344
• Drug Enforcement Agency (DEA)
• Walgreens
Funding
• Dept of Agriculture, Trade & Consumer
Protections (DATCP) grant $3,700
• HWPP grant
• Permanent Site
Lessons Learned
•
•
•
•
Be prepared for opposition
Definitions are important
Examples aren’t necessary
Dump out medications – DON’T REACH IN
BAGS
• No company/business drop offs
Medication Lockbox
Resources
• Harvard Injury Control Research Center Means Matter Campaign
– Means Matter Booklets
– www.meansmatter.org
• ASK campaign
– http://www.paxusa.org/ask/index.html
• Suicide Prevention Resource Center
– www.sprc.org
• Project Childsafe
– www.projectchildsafe.org
• Washington State Department of Health
– www.lokitup.org
• MedReturn Drug Collection Unit
– www.medreturn.com
• Lock Med
– www.lockmed.com
Questions?
Debbie Rueber, B.S. , C.H.E.S
Kenosha County Division of Health
262-605-6722
Debbie.rueber@kenoshacounty.org
Amy Schlotthauer, MPH
Injury Research Center at the Medical College of
Wisconsin
414-955-7667
aschlott@mcw.edu