Lethal Means & Suicide Risk: How to Continue the Conversation at Home

​​By: Rachel Cafferty, MD, FAAP and Brian Pitts, MD, FAAP

When your child’s pediatrician brings up suicide risk and lethal means safety, it can feel a little surprising at first. Many parents aren’t used to this topic being discussed during a medical visit, and it’s normal to wonder why the doctor raised it.

These conversations are meant to support you, not alarm you. Understanding what the doctor is trying to do and how you can continue the conversation at home can make the experience feel more comfortable. Keep reading to learn more.

What does "lethal means" mean?

Lethal means are things like firearms, medications or other household items that can be fatal in a suicide attempt. In a moment of crisis, limiting access to these items can increase the likelihood of survival.

Why is lethal means safety counseling needed?

A suicidal crisis can happen very quickly. Research has found that many people who attempt suicide move from suicidal thoughts to action in a matter of minutes, not days.

Creating some time and space between a crisis and access to lethal means can provide an opportunity for a child or teen to reach out for help, use their safety plan or connect with a trusted adult.

Any time a child or teenager screens positive​ for suicide risk during a healthcare visit, it’s important to talk about access to lethal means. The goal is to think about ways you can make your environment safer before a moment of crisis. Decreasing access to lethal means can delay a suicide attempt and increase survival.

How can I talk to my child about firearm safety?

Discussing firearm safety with your child is important. Firearms can be especially dangerous during suicidal crises as 90% of suicide attempts with a gun are fatal. Simple steps like temporarily removing firearms from the home or storing guns unloaded and locked can make a difference.

When talking with your child about lethal means like firearms:

• Let them know they aren’t alone and that you’re there to support them.

• Remind them that this is temporary. It isn’t about taking away their independence or controlling them; instead, it's about ensuring they’re safe and won’t make a decision they can’t take back.
  

• Try to involve them in the conversation about lethal means and safety planning as much as you can. See if you can figure out together how you can best protect and support them.
  

Although medication overdoses are less lethal than firearms, overdose is the most frequent method used in suicide attempts. Both prescription and over-the-counter medications, including acetaminophen (Tylenol), aspirin and diphenhydramine (Benadryl) can be fatal during a suicidal crisis. It’s important to have a plan to keep only the medications that your family needs in the home.

Consider where medications are stored in your home, and use these tips to prevent access:

• Lock up medications in a lockbox that your child can't access.
  

• Limit the quantity of medications stored in the home, to reduce the chance of an overdose.
  

• Safely dispose of medications that are expired or no longer needed.
  

• Purchase over-the-counter medications in blister-packs (pre-formed packages with individual pockets for pills) instead of bottles. Blister packs can slow down access to large quantities of medication in a crisis.
  

How do we make a suicide safety plan?

A suicide safety plan is a personalized, evidence-based tool that a young person can use to keep themself safe when they are experiencing suicidal thoughts and behaviors.

The safety plan outlines warning signs and triggers they may experience, lists healthy coping strategies for handling serious emotions that can come up during a crisis, and describes ways to limit access to lethal means.

A safety plan should also include activities that a young person can use to distract themself during a mental health crisis. It should list trusted adults, family members, friends and crisis resources your child can contact if they are thinking about suicide or need immediate support.

Here are a few tips:

• Choose a format that works best for your child. Safety plans are available as paper worksheets, digital documents and smartphone apps. The American Academy of Pediatrics (AAP) does not recommend one plan over another. If the safety plan is in a printed format, save a copy of it on your mobile phones. If they use an app, keep printed copies available in case they cannot access their device.

• Explore safety plan resources. Examples include:
  
  

• Stanley Brown Safety Plan

• My Safety Plan from the Child Mind Institute

• Substance Abuse and Mental Health Services Administration Safety Plan

• Share the plan with trusted adults. Give a copy to those listed in your child's plan and their school health team.
  

• Review the plan regularly. Talk with your child about when they would use their safety plan and how it can help during a crisis. Remind them that it is a personal tool they can turn to whenever they feel overwhelmed, hopeless or desperate. Check in regularly to see if they safety plan needs to be updated.

How do I start the conversation?

You might begin with simple, supportive language such as:

• "I want to keep our home as safe as possible for you while you’re feeling this way."

• "We can come up with a plan now, and you can keep it with you. That way, if you start having thoughts of suicide, you’ll know what to do to get you through the situation safely."

You can also compare a safety plan to something familiar:

• "Just like schools practice fire drills, a safety plan helps you know what to do in an emergency."
  

Keep the conversation going.

Talking with your child about safety, stress and other emotions doesn’t have to be scary or awkward. After your pediatrician starts the conversation, you can build on it by checking in with your child in a calm, open way.

Start by listening.

Let your child know:

• You care about their well-being

• They can come to you anytime

• You’re there to help—not judge
  

These small, frequent check-ins and open conversations help your child feel supported and understood. Over time, they also support trust and make your home a safer place for everyone.

More information

• Prevent Youth Suicide: Remove or Lock Up Lethal Items at Home

• How a Suicide Prevention Safety Plan Can Save Your Child’s Life

• Quiz: Suicide Prevention, Risks & Treatment
  

• How to Create a Suicide Prevention Safety Plan ​(video)