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Methods Restriction

By Annette Beautrais, Ph.D.

A large body of research evidence shows that restricting access to means and sites of suicide is an effective approach to suicide prevention. This evidence ensures that means restriction is included as a component of all suicide prevention strategies. In addition, the clinical implications of this evidence are: 1. Suicide risk assessment should always include inquiry about plans and methods for suicide, as well as access to means of suicide;  2. clinicians should advise or arrange for removal of potentially dangerous means of suicide from the households of vulnerable individuals.

The rationale for restricting access to means of suicide as an approach to suicide prevention is that research evidence has shown that, under some circumstances, controlling access to means of suicide may reduce risks of suicidal behavior. For example, in the United Kingdom, detoxifying domestic gas significantly reduced suicides by that method; in New Zealand the introduction of regulations for licensing firearm owners and for safe and separate storage of firearms and ammunition was associated with a dramatic reduction in firearm-related suicides; In the US, UK, Europe, Australia and New Zealand installing barriers at iconic jumping sites for suicide reduced or eliminated suicides from those sites; in Canada and other countries suicides have been reduced in metro-rail systems where doors  open directly onto the platform only when the train has stopped, and by restricting public access to tracks; the use of catalytic converters to reduce toxic vehicle emissions, mandated in many countries for clean air purposes, has resulted in reductions in suicide by vehicle exhaust gas; restricting access to drugs commonly used for self-poisoning (including barbiturates, tricyclic antidepressants, and weak analgesics such as paracetamol) has reduced morbidity, rates of hospital admission and associated costs, as well as mortality.

Further rationale for a means restriction approach to suicide prevention is provided by the fact that suicidal behavior is often ambivalent and impulsive and may not be pursued if access to a favored method of suicide is thwarted. In addition, studies that have explored subsequent suicidal behavior among people who have survived near-fatal suicide attempts have found that most of those who survive do not go on to make further attempts by the same– or some alternative– method.  

Media reports or portrayals of methods of suicide may influence vulnerable  individuals to adopt particular methods, leading to both increases in overall numbers of suicides and increases in the use of particular methods of suicide.  For this reason media-reporting guidelines for suicide advise against reporting methods and sites of suicide. However, these cautions tend to be disregarded by news media if a method is deemed unusual, novel, dramatic, or otherwise newsworthy. 

While restricting access to a particular method of suicide may reduce suicides by that method, the extent to which reductions in rates of suicide by one method that is restricted are paralleled by reductions in overall suicide rates is less clear, and has led to debates about the extent to which restriction of one method may lead to substitution of an equally lethal method. While the risk of substitution has often been used as an argument against restricting access to specific methods of suicide, method restriction may still be justified even in cases in which substitution may occur.

Future efforts to promote suicide prevention by restricting access to means of suicide include, but are not limited to: 1. monitoring trends in method use, including emergence of new methods and prompt action to reduce their dissemination and use; 2. reducing access to lethal pesticides and promoting ready access to effective treatment for pesticide ingestion; 3. promoting adoption and compliance of firearms control regulations; 4. exploring ways to reduce the toxicity of motor vehicle emissions; 5. promoting safer prescribing and dispensing of medications and other lethal chemicals, especially those with high case-fatality that are commonly used in suicide attempts; 6. Fostering safe urban design for new structures, and installation of barriers at existing sites that emerge as suicide hotspots; 7. encouraging prudent  design for institutions that house people with a high risk of suicide, including psychiatric inpatient and correctional  facilities; 8. promoting compliance with media guidelines advising muted reporting of methods and sites of suicide.

Resources

Further information about means restriction and suicide prevention is available at Harvard University's Means Matter website:   

http://www.hsph.harvard.edu/means-matter/

The journal Crisis published a 70-page supplement on means restriction in 2007:

 http://psycontent.metapress.com/content/p4mu4l43836r/?p=32f7178067ff410e86d69700aad0ed14&pi=21

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