Lethal Means Counseling

Lethal means counseling is an evidence-informed intervention designed to reduce the risk of injury among people at risk of suicide.^1,2 It gives healthcare providers tools to:

1. Determine if a patient is at risk for imminent injury or death and has access to lethal means, like firearms​
2. Work with the patient and their support system (e.g., family or friends) to reduce access to those lethal means until the risk decreases.

​Healthcare providers can use lethal means safety counseling to work alongside their patients and patients’ families to find mutually agreeable solutions that temporarily reduce access to firearms and, in turn, reduce their risk of firearm-related injury or death.³
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The first step in lethal means counseling is to identify patients at risk for injury or death by a lethal means, including firearms. This typically involves the use of mental health diagnostic tools to assess conditions such as depression and suicidality, which are beyond the scope of this tool.
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Patients receiving lethal means counseling are usually those who are at acute risk of violence to themselves, or to others, such as patients with:

• Suicidal or homicidal ideation or intent
• History of violent behavior or violent victimization​
• Substance use disorders​
• Serious mental illness
• Temporarily impaired cognition or judgment

For more information on screening and identifying patients at risk of injury, see the Firearm Injury Risk Screening section with example tools and resources.​
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Once a patient is identified as at acute risk for firearm injury or death, lethal means counseling often involves motivational interviewing techniques to explore the patient’s perceived benefits and barriers to reducing firearms access. Clinicians should avoid language that may be perceived as threatening (such as ‘confiscate’) and emphasize the temporary nature of the change. Healthcare providers may include this topic as part of a broader discussion around other potential lethal means (e.g., medications), which may help reduce patients’ concerns about firearm safety discussions.​

When the patient has access to a firearm, the focus of lethal means counseling is to collaboratively identify more secure storage options and alternatives with the patient and their family members to temporarily reduce access to firearms and therefore reduce the risk of firearm-related injury or death. One helpful tool that supports the safety planning process is the online resource Lock to Live.

In some states, clinicians, in partnership with patients and families, may request Extreme Risk Protection Orders (ERPOs) from a civil court as another tool to temporarily restrict firearm access to individuals who present a risk to themselves or others.⁴

Safety Planning​

Lethal means counseling may also be part of Safety Planning— a collaborative process in which the provider and patient identify steps to take during a mental health crisis or if experiencing suicidal ideation. Safety planning involves identifying:

• Warning signs or triggers
• Internal coping strategies
• People and social settings that provide distraction when experiencing suicidal ideation
• Supportive contacts (e.g., family or friends) who can help
• Professionals and emergency resources who can be contacted for support
• Actions to create a safer environment to reduce access to lethal means

Lethal means counseling plays a critical role in this final step​.
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Clinicians may receive training on strategies such as lethal means counseling and safety planning as part of injury or suicide prevention training programs.⁵