Shannon Murano is a planner.
When Murano, the aftercare coordinator for New Hampshire Hospital, visits families after children are discharged following suicide attempts, she looks for anything that could help them in a crisis.
Research suggests two methods can be used to keep individuals at risk for suicide safe in the short-term: Remove anything from the home that a child could use to harm themselves, and create a safety plan.
Experts say many suicide attempts are impulsive decisions made during temporary crises. If an individual has the safety net of these protections in place, they are less likely to make an extreme decision when feeling vulnerable.
Safety planningWhen a person is in a crisis, it can be difficult to think clearly enough to identify ways to calm down or seek help.
A safety plan, or a comprehensive list of warning signs, coping strategies and resources, can point a person in the right direction.
“It’s all about, ‘If I’m not feeling so hot, what can I do in the moment to get me through?’ ” Murano said.
Safety plans typically include emergency contacts and suggestions for activities that could calm an individual and make them feel safe, like exercise or watching a movie. It lists the potential warning signs that an individual might be a danger to themselves – such as isolation, feelings of depression and increased, severe panic attacks.
A safety plan can be a physical document, or something kept digitally. There are also several apps for safety planning – such as “MY3” safety planning – that you can keep on your phone and email to anyone you want to have it.
“We always talk about putting the safety plan in a place that’s readily accessible,” Murano said. “I know sometimes I’ll go to the doctor’s and I get paperwork and put it in a drawer. It’s really important to have that when you need it.”
Lethal means safetyNinety percent of people who attempt suicide and survive do not go on to die by suicide later. Removing an individual’s access to medication, firearms and sharp objects is a proven method to reduce a person’s risk during a sensitive time.
“Oftentimes, the decision to make an attempt comes on very quickly,” said Elaine Frank of the Injury Prevention Center at Children’s Hospital at Dartmouth. “Especially for those who have attempted before – whether it’s a break up with a girlfriend, or they failed an important test at school, it can bring up those feelings of hopelessness.”
“The common phrase is that putting time and distance between a suicidal person and lethal means can save their lives,” Frank said.
Clinicians are not always trained to ask about lethal means – so it’s important to be proactive about removing them when possible, Frank said.
Remove expired or unused medications, keep small quantities of those medications the family needs on hand and lock up the rest.
For firearms, the safest option is temporarily removing the gun from the home, and storing it either with a friend or relative. Other places where a person can bring firearms is the police station, or a gun shop or shooting range.
If removing the gun is not possible, buying a lock or changing the lock’s combination are also possibilities. A person could also disassemble the gun, and store a critical part like the slide or firing pin locked or away from home.
In New Hampshire, firearms are of particular risk because they are very lethal and accessible. People tend to use methods that are familiar when they decide to take their lives.
“You don’t have an opportunity to change your mind once you pull the trigger – there’s very little opportunity for rescue,” Frank said.
Frank said that as uncomfortable as it can be to go through the process of lethal means removal, it can be a life-saving step.
“Parents will say to me, ‘I don’t want to give them the idea that we don’t trust them.’ It isn’t that you don’t trust them, it’s that you care about them enough to take some protective steps to keep them safe.”
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If you or someone you know might be at risk for suicide, contact The National Suicide Prevention Lifeline 24/7 at 1-800-273-8255.
For additional resources, visit NAMI New Hampshire's Connect Program at www.theconnectprogram.org.