Counseling on Access to Lethal Means (CALM): An Evaluation of a Suicide Prevention Means Restriction Training Program for Mental Health Providers

Overview

Journal Community Ment Health J

Specialty Health Services

Date 2017 Nov 30

PMID 29185154

Citations 27

Authors

Elizabeth Sale

Michelle Hendricks

Virginia Weil

Collin Miller

Scott Perkins

Suzanne McCudden

Affiliations

Soon will be listed here.

Abstract

This paper evaluates the effectiveness of the Counseling on Access to Lethal Means (CALM) suicide prevention program. CALM trains mental health providers how to counsel suicidal individuals and those who support them on mean restriction during times of crisis. Pre/post/3-month follow-up assessments measured knowledge of lethal means, confidence and comfort in discussing means restriction (self-efficacy), and future intentions to counsel clients on means restriction. Change in the number of clients receiving lethal means counseling was also assessed. All constructs increased significantly at posttest. Confidence and counseling intentions were sustained at follow-up and significantly more clients received means counseling in the 3 months following the CALM training. Knowledge and comfort levels decreased at follow-up but not to pre-training levels. CALM is effective at increasing mental health professionals' comfort, knowledge, and frequency of talking about means restriction with clients. an effective means restriction training program. A template to assess clients for suicidality and lethal means access and booster sessions are recommended to further sustain effects.

Citing Articles

Frequency of Black and American Indian/Alaskan Native US Residents Screened for Firearm Access.

Bond A, Rodriguez T, Goldman G, Moceri-Brooks J, Semenza D, Anestis M J Racial Ethn Health Disparities. 2025; .

PMID: 40063295 DOI: 10.1007/s40615-025-02334-8.

Engaging suicide prevention and firearm stakeholders in developing a workshop promoting secure firearm storage for suicide prevention.

Christian H, Crasta D, Lloyd-Lester G, True G, Goodman M, Bass B Inj Epidemiol. 2024; 11(1):26.

PMID: 38877541 PMC: 11179275. DOI: 10.1186/s40621-024-00511-7.

A call to action: informing research and practice in suicide prevention among individuals with psychosis.

Chalker S, Sicotte R, Bornheimer L, Parrish E, Wastler H, Ehret B Front Psychiatry. 2024; 15:1378600.

PMID: 38711871 PMC: 11073495. DOI: 10.3389/fpsyt.2024.1378600.

Management of youth with suicidal ideation: Challenges and best practices for emergency departments.

Santillanes G, Foster A, Ishimine P, Berg K, Cheng T, Deitrich A J Am Coll Emerg Physicians Open. 2024; 5(2):e13141.

PMID: 38571489 PMC: 10989674. DOI: 10.1002/emp2.13141.

Suicide Screening, Risk Assessment, and Lethal Means Counseling During Zero Suicide Implementation.

Boggs J, Richards J, Simon G, Aguirre-Miyamoto E, Barton L, Beck A Psychiatr Serv. 2024; 75(7):638-645.

PMID: 38566561 PMC: 11404670. DOI: 10.1176/appi.ps.20230211.

References

Vergouwen A, Bakker A, Katon W, Verheij T, Koerselman F . Improving adherence to antidepressants: a systematic review of interventions. J Clin Psychiatry. 2004; 64(12):1415-20. DOI: 10.4088/jcp.v64n1203. View

Crome P . The toxicity of drugs used for suicide. Acta Psychiatr Scand Suppl. 1993; 371:33-7. DOI: 10.1111/j.1600-0447.1993.tb05371.x. View

Turvill , Burroughs , Moore . Change in occurrence of paracetamol overdose in UK after introduction of blister packs. Lancet. 2000; 355(9220):2048-9. View

Luoma J, Martin C, Pearson J . Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry. 2002; 159(6):909-16. PMC: 5072576. DOI: 10.1176/appi.ajp.159.6.909. View

Mortensen P, Agerbo E, Erikson T, Qin P . Psychiatric illness and risk factors for suicide in Denmark. Lancet. 2000; 355(9197):9-12. DOI: 10.1016/s0140-6736(99)06376-x. View

Gunnell D, Eddleston M . Suicide by intentional ingestion of pesticides: a continuing tragedy in developing countries. Int J Epidemiol. 2003; 32(6):902-9. PMC: 2001280. DOI: 10.1093/ije/dyg307. View

Mott J, Wolfe M, Alverson C, Macdonald S, Bailey C, Ball L . National vehicle emissions policies and practices and declining US carbon monoxide-related mortality. JAMA. 2002; 288(8):988-95. DOI: 10.1001/jama.288.8.988. View

Barber C, Miller M . Reducing a suicidal person's access to lethal means of suicide: a research agenda. Am J Prev Med. 2014; 47(3 Suppl 2):S264-72. DOI: 10.1016/j.amepre.2014.05.028. View

Brent D, Baugher M, Birmaher B, Kolko D, Bridge J . Compliance with recommendations to remove firearms in families participating in a clinical trial for adolescent depression. J Am Acad Child Adolesc Psychiatry. 2000; 39(10):1220-6. DOI: 10.1097/00004583-200010000-00007. View

10.

Feldman B, Freedenthal S . Social work education in suicide intervention and prevention: an unmet need?. Suicide Life Threat Behav. 2006; 36(4):467-80. DOI: 10.1521/suli.2006.36.4.467. View

11.

Nielsen A, Nielsen B . [Pattern of choice in preparation of attempted suicide by poisoning--with particular reference to changes in the pattern of prescriptions]. Ugeskr Laeger. 1992; 154(28):1972-6. View

12.

Dolgin E . The ultimate endpoint. Nat Med. 2012; 18(2):190-3. DOI: 10.1038/nm0212-190. View

13.

Pirkis J, Spittal M, Cox G, Robinson J, Cheung Y, Studdert D . The effectiveness of structural interventions at suicide hotspots: a meta-analysis. Int J Epidemiol. 2013; 42(2):541-8. DOI: 10.1093/ije/dyt021. View

14.

Litteken C, Sale E . Long-Term Effectiveness of the Question, Persuade, Refer (QPR) Suicide Prevention Gatekeeper Training Program: Lessons from Missouri. Community Ment Health J. 2017; 54(3):282-292. DOI: 10.1007/s10597-017-0158-z. View

15.

Lester D . The effects of detoxification of domestic gas on suicide in the United States. Am J Public Health. 1990; 80(1):80-1. PMC: 1404527. DOI: 10.2105/ajph.80.1.80. View

16.

Gregory R, DeLucia-Deranja E, Mogle J . Dynamic deconstructive psychotherapy versus optimized community care for borderline personality disorder co-occurring with alcohol use disorders: a 30-month follow-up. J Nerv Ment Dis. 2010; 198(4):292-8. DOI: 10.1097/NMD.0b013e3181d6172d. View

17.

Johnson R, Frank E, Ciocca M, Barber C . Training mental healthcare providers to reduce at-risk patients' access to lethal means of suicide: evaluation of the CALM Project. Arch Suicide Res. 2011; 15(3):259-64. DOI: 10.1080/13811118.2011.589727. View

18.

Price J, Kinnison A, Dake J, Thompson A, Price J . Psychiatrists' practices and perceptions regarding anticipatory guidance on firearms. Am J Prev Med. 2007; 33(5):370-3. DOI: 10.1016/j.amepre.2007.07.021. View

19.

Slovak K, Brewer T . Suicide and firearm means restriction: can training make a difference?. Suicide Life Threat Behav. 2010; 40(1):63-73. DOI: 10.1521/suli.2010.40.1.63. View

20.

Hawton K, Bergen H, Simkin S, Dodd S, Pocock P, Bernal W . Long term effect of reduced pack sizes of paracetamol on poisoning deaths and liver transplant activity in England and Wales: interrupted time series analyses. BMJ. 2013; 346:f403. PMC: 3567205. DOI: 10.1136/bmj.f403. View