b'|Suicide Prevention Workplan - Los Angleles|57|58There are four basic ways to restrict or reduce access to lethal means by persons at imminent risk of suicide: Safety planning is a collaborative effort between patient/client and treatment provider that is used to provide people who are experiencing suicidal ideation with a specific set of concretePlace the person in a safer environmentstrategies to use in order to decrease the risk of suicidal behavior. Including steps to reducePut a barrier between the person and the means access to lethal means is an important part of safety planning. Create time between the person and the means3.Poisoning/Overdose Make the means (and an attempt) less lethalWhile overdose (or poisoning) accounted for only 11% of suicide deaths in Los Angeles (2016), There are some common elements among any means safety efforts: a public awareness component,they accounted for 49% of Treated and Released Emergency Department Visits (2014) and 65% of where information and resources are available that help people understand the importance of meansNon-Fatal Hospitalizations (2014) for suicide attempts. This accounts for 4,170 people utilizing safety and how they can use the information; trainings for key gatekeepers that offer specificpoisoning for suicide deaths and attempts (as opposed to 293 firearms suicide relatedincidents). information about their role in promoting and supporting means safety; and lethal means counselingSafe disposal initiatives encourage individuals, providers, and pharmacies to work together to ensure from providers and others that are in an important position to intervene with those at highest risk.that potentially dangerous medications that are no longer in use are properly disposed. Strategies Some of the details of means safety approaches vary depending on the means in question, itsinclude at-home disposal, or disposal at a facility that accepts them. Another strategy is to work with availability in the environment, legal issues, and individual level factors. pharmacies to train pharmacists as gatekeepers for suicide prevention and to disseminate There are various areas of means safety to consider including in comprehensive approaches tomedications in bags that include information on crisis support and suicide prevention resources. suicide prevention. Approaches to implement means safety can be targeted by age group as lethality4.Site and Location Specific Effortsof means increases with age.For example in 2016, 51% of suicide deaths of people in Los Angeles County aged 65 and older were by firearm, while 48% of suicide deaths among those younger thanWhile suicides at a specific location may represent a small number of overall suicides, 29 years old were by hanging/suffocation.general guidelines indicate that if on average more than one suicide occurs in a specific location per year, these locations represent a hot spot for suicide deaths and means safety measures should be considered. Numerous studies have examined site specific means 1.Firearm Suicide Prevention Efforts safety measures and identified that physical barriers that completely block access to the site can reduce up to 100% of suicides at that location. The majority of means safety programs focus on firearm suicide prevention. This is partly due to the high lethality of the method and its prevalence in suicide deaths, but also becauseParking structures often have open sides for ventilation, allow customers to enter with little strategies to promote firearm safety are more straightforward to implement than some otheror no security checkpoints, and generally have few people walking around. Parking garages means. near health centers are more frequently hotspots for suicide deaths than other parking structures. A survey from the International Parking & Mobility Institute found that 51% of Suicide deaths by firearm represented 36% of all suicide deaths in Los Angeles County inparking organizations have experienced a suicide or an attempt at one or more of their 2016, similar to the statewide average of 38% of suicide by firearms. While only 5% of suicidestructures. There are several types of physical barriers that can be installed to support attempts are made using a firearm, 85-95% of those attempts are lethal leading to the highmeans safety in parking structures, from fencing or screening to landscaping, that deters percentage suicide deaths by firearm.easy access to heights.2.Counseling on Lethal Means and Safety Planning 5.Addressing Means Safety for Hanging/Suffocation Lethal means safety counseling is the process that healthcare providers undertake to determineLike firearms, men are more likely to die by hanging/suffocation than females. Individuals younger if an individual at risk for suicide has access to lethal means, and to work with the individual andthan 30 years old are more likely to utilize this means. Means Safety measures around hanging and their family or friends to reduce access until the risk of suicide decreases. Health care and othersuffocation are difficult to implement because of the challenges with restricting access to means. provider professionals are often unsure how to provide such counseling. Training and educationPrevention and early intervention strategies such as identifying risk/suicidal ideation, connecting about the effectiveness of means safety and how to have this conversation can increase thepeople to help, and developing a safety plan are still available.likelihood that providers will use this strategy when working with high risk patients/clients.Draft 3.3.2020 Not For Distribution Draft 3.3.2020 Not For Distribution'