Missouri’s suicide rate ranks 13th in the nation.
In 2016, there were roughly 10 suicides per 100,000 residents, and more than half were gun-related. Yet despite the statistics, only about half of emergency-room doctors in the U.S. ask patients at risk of suicide if they have access to guns at home.
A new Washington University program aims to tackle this issue directly by working with patients at risk of suicide before they’re discharged from the hospital. The Counseling on Access to Lethal Means (C.A.L.M.) program helps patients temporarily store dangerous items they may have at home, including guns and prescription medication.
"It’s a distinctly proactive approach," said Kristen Mueller, a Barnes-Jewish Hospital emergency-room doctor and C.A.L.M. program coordinator.
“As a physician, I got into the game to help save lives,” said Mueller. “There’s only so many patients I could take care of in the emergency department before we started to say, 'Enough is enough.' What can we do to start preventing this from happening in the first place?”
The program, which is funded through grants from the Washington University Institute for Public Health and the Barnes-Jewish Hospital Foundation, trains research coordinators using online materials from the Suicide Prevention Resource Center.
As part of the program, research coordinators work one-on-one with patients to help identify if they have access to guns at home.
“You do your best to get an assessment of what’s immediately available,” said registered nurse and C.A.L.M. research coordinator Chris Kriedt. “I’ll ask, ‘Do you have a firearm readily available? Is it loaded? If you were in a crisis moment, would you be able to reach over and just pick it up?’”
During the initial assessment, Kriedt helps patients who have access to guns come up with a plan for storing them. Patients may opt to store their guns temporarily at a local gun range, for instance, or in the home of a friend.
Research coordinators have worked with 15 patients through the C.A.L.M. program since its inception in December. Kriedt said a key component of the program is following up with patients two to three days after they have left the hospital.
“I believe that some kind of support after the fact, after the hospital, after the emergency room, is important. Because people, I think, feel like they’re left high and dry,” said Kriedt. “They’re told to follow up, but they don’t have anybody to help them along the way.”
Suicide prevention initiatives often face a number of challenges, including the stigma associated with mental health issues.
Mueller hopes the C.A.L.M. program will help normalize the idea that it’s not a weakness to have mental health issues or signs of depression.
“Many people are perfectly comfortable talking about child safety seats in their cars, talking about whether or not they wear their seatbelt, talking about whether they’re smoking or not smoking,” said Mueller. “This is just another aspect of personal and public health.”
There are also deep-seated misconceptions about suicide risk. The rate of gun-related suicide varies substantially based on demographics, with white males over the age of 55 at the highest risk in Missouri.
Men are also seven times more likely to die by gun suicide than women in Missouri, according to the Centers for Disease Control and Prevention.
The C.A.L.M. program at Barnes-Jewish Hospital will continue through December, after which organizers will conduct an assessment and determine whether to continue the program long term.
“The benefit would be even if one person from this entire study stores their firearm safely and doesn’t commit suicide, to me, that makes it worth it,” Mueller said.