AAS Lethal Means Restriction 4 — Questions and Answers
Question 1: When discussing means restriction with a veteran who is reluctant to give up his firearms, which approach aligns with best practice?
- Mandate surrender or refuse to continue treatment
- Avoid the topic to preserve therapeutic alliance
- Use motivational interviewing to explore ambivalence and collaborate on temporary storage (Correct answer)
- Refer immediately to the VA without further discussion
Correct answer: Use motivational interviewing to explore ambivalence and collaborate on temporary storage
Motivational interviewing techniques allow clinicians to explore a veteran's ambivalence respectfully while working toward a safety plan that addresses firearms.
Question 2: Which statement about the relationship between firearm access and suicide risk is most accurate?
- Firearm access increases risk only for those with a prior attempt
- Living in a home with a firearm roughly doubles the risk of suicide
- Firearm access increases suicide risk by approximately 3 times (Correct answer)
- Firearm access has no independent effect after controlling for depression
Correct answer: Firearm access increases suicide risk by approximately 3 times
Research consistently shows that access to a firearm in the home increases the risk of suicide death by approximately 2 to 3 times compared to homes without firearms.
Question 3: Which of the following is an example of a 'structural' lethal means restriction approach?
- A psychiatrist counseling a patient to lock up their medications
- A state law limiting magazine capacity
- A bridge railing designed to prevent jumping (Correct answer)
- A counselor helping a family secure firearms
Correct answer: A bridge railing designed to prevent jumping
Structural approaches modify the physical environment — such as installing barriers on bridges — without requiring individual behavioral change.
Question 4: A patient reports that her husband keeps firearms and she is not ready to disclose her suicidal thoughts to him. What is the clinician's best next step regarding means safety?
- Breach confidentiality immediately and contact the husband
- Explore options for means safety that do not require disclosure to the husband, such as storage at a gun range (Correct answer)
- Defer the firearms discussion until she is more stable
- Advise her to remove herself from the home
Correct answer: Explore options for means safety that do not require disclosure to the husband, such as storage at a gun range
Clinicians can explore means safety options like third-party storage or gun range storage that don't require the patient to disclose her mental health situation to a partner.
Question 5: The term 'lethal means' in suicidology refers specifically to what?
- Any substance or object that can cause physical harm
- Methods or items with a high case fatality rate if used in a suicide attempt (Correct answer)
- Tools used in occupational settings that could cause injury
- Medications that cause dependency
Correct answer: Methods or items with a high case fatality rate if used in a suicide attempt
Lethal means refers to methods with high case fatality ratios — the proportion of attempts using that method that result in death — such as firearms.
Question 6: Dispensing medications in smaller quantities to at-risk patients is an example of means restriction applied to which category?
- Structural environmental change
- Pharmaceutical means restriction (Correct answer)
- Individual behavioral counseling
- Involuntary treatment
Correct answer: Pharmaceutical means restriction
Limiting medication supply (pill counts or refill frequency) reduces the stockpiling risk and is a pharmaceutical form of means restriction.
Question 7: Which outcome measure is most relevant when evaluating a community-level lethal means restriction program?
- Number of firearms collected from voluntary surrender programs
- Overall suicide rate in the community, not just firearm suicide rate (Correct answer)
- Patient satisfaction with clinician counseling
- Number of crisis calls received
Correct answer: Overall suicide rate in the community, not just firearm suicide rate
The ultimate measure of success is whether overall suicide rates decline, not just method-specific rates, to account for possible method substitution.
AAS Lethal Means Restriction 4
When discussing means restriction with a veteran who is reluctant to give up his firearms, which approach aligns with best practice?