Vitamodo School · Bundle 2: Suicide Recognition & Prevention · Brochure 7 of 10 · Version 1.0
Andris Saulitis, MD
If you are yourself currently considering suicide, this brochure is not the right place to start. Please reach out to a crisis line or emergency service now.
Latvia: 116123
European Union: 112
United States: 988 (Suicide & Crisis Lifeline)
United Kingdom: 116 123 (Samaritans)
For other countries: findahelpline.com
For those who: live with, or are close to, someone at elevated risk of suicide, and want to understand what means restriction is, why it works, and how to do it in your specific home.
Not for those who: are themselves at risk — see the crisis lines above and reach out before reading further.
What this is — the clinical reality
This brochure is for the family member, partner, or close friend of someone at elevated risk of suicide, who wants to know what to do about access to means in the immediate environment. Means restriction — the deliberate removal or securing of methods a person could use to end their life — is one of the most evidence-based suicide-prevention interventions known. It is also one of the most underused, because it is counter-intuitive. This brochure is about why it works and how to do it.
Three things you need to know.
The first is that most suicide is, in clinical terms, more impulsive than the lay imagination assumes. The lay picture is of a long-planned act after sustained deliberation. The clinical picture is more often a constricted state in which the act follows a triggering event by hours, sometimes minutes. In studies of survivors of nearly lethal attempts, a substantial proportion describe the time between decision and act as less than an hour; for many, less than fifteen minutes. This narrow window is the window in which means matter most. A means that is not at hand cannot be reached in fifteen minutes.
The second is that the substitution myth is wrong. "If they want to do it, they will find a way." This statement, treated as common sense, is empirically false at the population level. When access to a specific method is restricted — barriers on bridges, safer pharmaceutical packaging, stricter firearm storage — the rate of suicide by that method drops, and the rate by other methods does not rise to compensate. The deaths the restriction prevents are not transferred to other methods. They are prevented. The data on this is among the most robust in suicidology.
The third is that means restriction is a thing the family can do, not only a thing public policy can do. The clinician treats the underlying state. The hospital provides containment in acute crisis. The crisis line interrupts the constriction. The family is the one with access to the home, the medication cabinet, the workshop, the garage, the bathroom. The means in the immediate environment are the means most likely to be used. Restricting their availability — temporarily, transparently, in collaboration where possible — is one of the highest-impact interventions a non-clinician can perform.