One approach to addressing suicide risk in these younger patients is to counsel their families on ways to reduce access to lethal means of self-harm. For a small study published in the Western Journal of Emergency Medicine, Carol W. Runyan, MPH, PhD, and colleagues evaluated a protocol that aimed to improve the quality of lethal means counseling for parents of pediatric patients being seen for suicidality.

Piloting an Intervention

In the analysis, lethal means counseling was delivered by trained ED behavioral health specialists. The intervention was designed to educate parents about common risks for suicide, urge them to lock all medications in lock boxes or other secure locations, and encourage them to store firearms away from home or lock them securely during mental health crises.

According to the results, it was feasible to incorporate lethal means counseling for parents of suicidal youth into emergency care in a way that was acceptable to them and that led to positive behavioral changes. “Parents had favorable impressions of the counseling and good recall of the main messages,” says Dr. Runyan. “The majority of families described their discussions as being clear and respectful of their needs. Importantly, these discussions did not appear to slow down ED processes and procedures.”

The study also showed that rates of parents reporting all medications in the home being locked away from their teens increased from 10% at the time of the ED visit to 75% when assessed at follow-up after the intervention was implemented. In addition, about two-thirds of parents reported that all guns were locked away at the initial visit, but this rate reached 100% at follow-up after the intervention was administered.

More Research Needed

Although the findings are encouraging, Dr. Runyan says more data are needed to determine if the intervention can work on a larger scale. “It’s possible that our lethal means counseling intervention may need to be expanded,” she says. The protocol was delivered only to adults accompanying patients who were being discharged from the ED after they were evaluated. Dr. Runyan says future research should seek to better understand how counseling is given and to determine if any particular approaches are more effective than others.

Greater efforts may also help clinicians find out if modifications to training protocols are needed. The study suggests that staff meetings can be used to reinforce the importance of specific recommendations for storage of guns and medications and for sharing ideas on how best to deliver those recommendations. “In the meantime,” says Dr. Runyan, “our data suggest that lethal means counseling appears to be feasible, effective, and should be considered as a part of routine emergency care.”

Carol W. Runyan, MPH, PhD, has indicated to Physician’s Weekly that the O’Shaunessy Foundation supported the pilot study referenced in this article and Children’s Hospital Colorado provided evaluation support.


Runyan CW, Becker A, Brandspigel S, Barber C, Trudeau A, Novins D. Lethal means counseling for parents of youth seeking emergency care for suicidality. Western J Emerg Med. 2016;17:8-14. Available at:

Counseling on Access to Lethal Means (CALM) online training. Suicide Prevention Resource Center. Available at:

Betz ME, Miller M, Barber C, et al. Lethal means restriction for suicide prevention: beliefs and behaviors of emergency department providers. Depress Anxiety. 2013;30:1013-1020.

Betz ME, Wintemute GJ. Physician counseling on firearm safety: a new kind of cultural competence. JAMA. 2015;314:449-450.

Barber CW, Miller MJ. Reducing a suicidal person’s access to lethal means of suicide: a research agenda. Am J Prevent Med. 2014;47:S264-S272.