Many suicidal individuals seek care in emergency departments (EDs), providing a unique opportunity for prevention. Reducing access to the most lethal means (i.e., guns) of committing suicide (referred to as means restriction) has shown effectiveness in reducing suicides and is recommended by several professional organizations. However, EDs have not uniformly adopted counseling about means restriction as part of ED discharge planning for suicidal patients. The obstacles to incorporating discharge protocols that include means restriction counseling are unknown but may include organizational barriers, concerns of key decision makers, as well as realistic and suitable options for patients to store their guns outside the home. Drawing on the Diffusion of Innovation Theory and published research on adoption of innovations in clinical care, we will document current ED discharge practices for suicidal patients, examine barriers and facilitators to adopting new ED protocols generally and means restriction counseling specifically. We will also examine the potential of law enforcement agencies, gun retailers or shooting ranges partnering with hospitals to provide temporary safe storage options for families with a suicidal member. Focusing on the eight state region of the Mountain West (AZ, CO, ID, MT, NV, NM, UT, WY) that experiences higher suicide rates than the US overall (18.2 vs. 12.1 per 100,000 respectively) and a strong culture of gun ownership, our innovative study will utilize a two-phase mixed qualitative-quantitative methods approach. First, we will conduct in-depth qualitative interviews with a sample of hospital decision makers as well as leaders of law enforcement organizations gun retailers, and shooting ranges. This information will enable us to learn about potential barriers and facilitators to promoting means restriction counseling and out-of-home storage of guns and the language used to discuss the issue. Using the information from the qualitative interviews, we will refine our data collection instruments and conduct computer assisted telephone surveys with medical directors of all 392 hospital EDs throughout the Mountain West as well as with others they designate as influential in making decisions about mental health-related protocols in EDs. Using the same two-phase qualitative-quantitative process, we also will collect data from leaders in all 1242 law enforcement agencies, 1234 gun retailers and 104 shooting ranges in the region. As the first study of its kind, this research is responsive to the new NIMH suicide research agenda and will enable us to design future investigations testing approaches to promoting adoption of means restriction counseling as part of ED discharge protocols that are sensitive to hospital concerns and reflective of the community options for temporary safe storage of guns. Our approach and findings will inform firearm suicide prevention research and practice in both the Mountain West and nationwide.

R21MH105827

2014-12-01

2017-11-30