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How to incorporate means restriction into your
community suicide prevention efforts
Debbie RueberKenosha County Division of Health
Amy Schlotthauer Injury Research Center at the Medical College of WI
Means Restriction/Reduction
• Activities designed to reduce access or accessibility to the means and methods of deliberate self-harm in order to reduce the odds that an attempter will use a highly lethal means, thus lowering the case fatality ratio of suicides/suicide attempts
• Reducing the odds that an attempter will use highly lethal means
Examples of Means Restriction
2000-2010 Suicides in Kenosha County
Define the suicide problem in your area
2000-2010 Suicides in Kenosha 2000-2010 Suicides in Kenosha County by Method County by Method
When do people take their lives?
• Some take their lives after careful planning & deliberation but many act impulsively
• 1/3 of youths who died by suicide had faced a crisis within the past 24 hrs
• Among people who nearly died in a suicide attempt, 24% said less than 5 minutes elapsed between deciding on suicide and making the attempt
How do people most commonly complete suicide?
• Firearms are used more than every other method combined
• Most non-fatal attempts are overdoses followed by cutting
Why firearms?
They are quickThey are irreversibleThey are more lethal
85% of youth under 18 who died by firearm suicide used a family member’s gun, usually a parent’s
What did Kenosha County Do?
1.Education on firearm safety - What resources were out there?
Project ChildSafe
www.projectchildsafe.org
Harvard Means Matter
Anatomy of a Firearm
Muzzle
Barrel
Hammer
Butt
Frame
GripTrigger
Cylinder
CABLE GUN LOCK
What it is: A device that blocks the chamber to prevent a cartridge from being fired.How it works: Chamber locks are inserted in or through the magazine well or chamber, or are
inserted through the gun barrel and chamber to block a cartridge from moving into position. A combination lock or key opens the lock.
Features: Metal cylinders, vinyl covered wire cables, or other designs. Locks may be "universal" or may only fit certain revolver or pistol models. Some models have anti-tamper alarms.
Advantages:• Long cables may be threaded through several guns. • Inexpensive Disadvantages:• Thin cables could be cut
Message
Store guns• Locked• Unloaded • Ammunition locked and stored separately
*Most teens know where their parents keep their guns.
What did Kenosha County Do?
1. Education on firearm safety - What resources were out there?
2. Is there evidence-based practice for this initiative?
QPR
• SPRC Best Practice Registry• Added means restriction component• Offer cable gun locks at presentations
Evidence Based Practice C.A.L.M. Training
Sample CALM Training Agenda I. The Problem—Youth Suicide and Access to Lethal
Means A review of data on youth suicide focusing on
means usedII. Introduction to Firearms and Their Operation A basic introduction to the operation and safety
features of firearmsIII. Negotiation of Means Restriction-Video
Presentation A video demonstration of a family intervention wherein
means restriction is presented and negotiatedIV. Strategies for Securing and Removing Firearms and
Other Lethal Means A review and discussion of ways to secure or remove
lethal means as necessary to restrict access
Take A Few Minutes to C.A.L.M.Counsel on Access to Lethal MeansThree specific CALM steps:•Explain that you believe that they or a family member is at risk for suicide and why you have made this determination•Explain that they can reduce the risk by reducing access to lethal means, particularly firearms.•Discuss specific steps they can take to remove or at least reduce access to firearms and other lethal means A 90 minute workshop for Primary Care and ED Providers A one hour workshop for a general audienceFor more information contact Elaine Frank at [email protected] has been accepted into the SPRC/AFSP Best Practices Registry for Suicide Prevention
What did Kenosha County Do?
1. Education on firearm safety - What resources were out there?
2. Is there evidence-based practice for this initiative?
3. Who are the key partners?
Partners
• Medical Examiner• Law Enforcement• Medical Community• Gun Clubs• Duck Unlimited• Media
Age of patient
Gender of patient M F
Race White African American Asian American Indian Hawaiian Pac. Islander Other Unknown
Ethnicity Hispanic Non-Hispanic
Date handed out # of Cable Locks
Injury/Reason for being at ED
What’s next?
• Prevent Suicide Wisconsin• Funding – Charles E. Kubly Foundation• Continue to foster relationships
Medication Collection Day
• Events have been done in April/May & October
• Locations• Partnered with surrounding communities and
other agencies• Volunteers• Paid staff• Funding
Partners
• Pharmacist(s)• Law Enforcement• Emergency Management• Greener Kenosha• Concerned Citizens Coalition Drug Free
Communities• Businesses• Disposal Company
Prior to event• Contact Environmental Services - Veolia• Recruit volunteers • Order postcards• Press release • Ads in newspaper*• Post on business website• E-mail announcement to address book• Questionnaire• Confirmation phone call/e-mail to volunteers• Gather items needed for event
Volunteers
• Questionnaires• Runners• Sorters• Traffic Control• Pharmacist• Law Enforcement
Medicine Collection Day for Households a prescription for clean water & safe kids
NEVER FLUSH or pour unused medicine down the drain. Bring it to the FREE Medicine Collection Day.
Help protect Lake Michigan Prevent childhood poisonings Reduce substance abuse
Ointments, sprays, inhalers, creams, vials and pet medications are acceptable. Keep all medication in original bottles Cross out your name but leave the name of the medication visible Put all medication in a sealed bag
Do NOT Bring: Illegal Drugs, Biohazardous Material, Needles/Sharps, Personal Care Products (shampoo, soaps, lotions, sunscreens, etc.)
You Can Bring: Prescription Medication & Over the Counter Medication.
Saturday, April 16th, 2011
9:00 a.m. to 1:00 p.m.
For more information contact: Kenosha County Division of Health (262) 605-6700
Location 8600 Sheridan Rd, Entrance D (Kenosha County Job Center)
Kenosha County Medication Collection Day Kenosha County Job Center
April 16, 2011 Municipality: KENOSHA BRIGH BRIS PARIS RAND SAL SOM WHEAT GEN CY PAD LK PL PR SLV LK TW LK Other How many bottles/medications are you dropping off? 1-2 3-5 6-8 9-12 13+ How did you hear of this drug collection? NEWSPAPER AD POSTCARD TV FLYER
Without this collection site, how would you get rid of your medications?
Flush in a toilet Put in trash Future collection Other
Items needed for event• Reflective vests• Clipboards• Pens• Markers• Gloves• Goggles• Hand sanitizer• Bleach wipes• Cones• Signs• Tables (2-4) chairs
• Resources to dispose of sharps
All Aurora Pharmacies will accept sharps and needles. They must be in sharps containers. The pharmacies sell the containers. If you are an Aurora customer, you may turn in your filled container and receive a new one at no charge. Other pharmacies also sell the sharps containers and exchange full ones for empty containers if you purchased the container at their store.
The following facilities are current for the collection of sharps containers in Kenosha/Racine Counties as of January 1, 2011.
Facility Address Phone Hours
Aurora ($5 charge if not a customer)
7540 22nd Avenue Kenosha
262-605-3674 M-Th 8:30am-5pm Fri 8:30am-4:30pm
No weekends
10400 75th Street
Kenosha 262-948-7040
M-Th 8:30am-5pm Fri 8:30am-4:30pm
No weekends
7014 Green Bay Road
Kenosha 262-697-4011
M-Th 8:30am-5pm Fri 8:30am-4:30pm
No weekends
25320 75th Street
Paddock Lake 262-843-2373
M-Th 8:30am-5pm Fri 8:30am-4:30pm
No weekends
700 N. Lake Avenue
Twin Lakes 262-877-2234
M-Th 8:30am-5pm Fri 8:30am-4:30pm
No weekends Other (Kenosha)
Good Value Pharmacy ($5 charge if not a customer)
3401 80th Street Kenosha
262-697-5744 M-F 9am-9pm Sat 9am-6pm Sun 9am-5pm
Good Value Pharmacy ($5 charge if not a customer)
9916 75th Street Kenosha
262-925-0201 M-F 9am-6pm Sat 9am-3pm
RACINE Aurora
($5 charge if not a customer) 3900 Erie Street
Racine 262-639-1611
M-F 9am-7pm Sat 9am-3pm Sun 9am-1pm
8348 Washington Avenue
Racine 262-884-4030
M-F 9am-7pm Sat 9am-3pm Sun 9am-1pm
4310 67th Drive
Union Grove 262-878-1171
M-F 8am-8pm Sat 8am-5pm Sun 9am-1pm
210 S. Pine Street
Burlington 262-763-7177
M-F 8:30am-7pm Sat 8:30am-5pm
Sun 9am-1pm Other (Racine)
Walgreens Hwy 11 & Green Bay Road 262-554-6116 M-F 8am-10pm
Sat & Sun 9am-6pm Hedata/Medicine Collection/Sharps II rev. 01/17/11 nlr
Day of Event
• Set up cones and signs• Set up tables• Set up food/beverage station• Greet volunteers• Fill in for volunteers needing a break• Be available to answer question by
participants and volunteers
After the event
• Calls from those who missed the event• Report • Thank you notes
Other Resources
• University of Wisconsin Extension– Melissa Boehm
414-227-3344
• Drug Enforcement Agency (DEA)• Walgreens
Funding
• Dept of Agriculture, Trade & Consumer Protections (DATCP) grant $3,700
• HWPP grant• Permanent Site
Lessons Learned• Be prepared for opposition• Definitions are important• Examples aren’t necessary• Dump out medications – DON’T REACH IN
BAGS• No company/business drop offs
Medication Lockbox
Resources • Harvard Injury Control Research Center Means Matter Campaign
– Means Matter Booklets– www.meansmatter.org
• ASK campaign– http://www.paxusa.org/ask/index.html
• Suicide Prevention Resource Center– www.sprc.org
• Project Childsafe– www.projectchildsafe.org
• Washington State Department of Health– www.lokitup.org
• MedReturn Drug Collection Unit– www.medreturn.com
• Lock Med– www.lockmed.com
Questions?
Debbie Rueber, B.S. , C.H.E.SKenosha County Division of [email protected]
Amy Schlotthauer, MPHInjury Research Center at the Medical College [email protected]
