Intermountain Healthcare has adopted a four-part strategy to establishing time and distance between people in crisis and firearms.
Intermountain Healthcare is tackling a daunting suicide prevention challenge—limiting access to guns for people in crisis.
In 2017, suicide was the 10th leading cause of death in the United States, with more than 47,000 lives claimed, according to the Centers for Disease Control and Prevention (CDC). In that year, there were more than twice as many suicides than homicides, the CDC found.
Visits to healthcare providers are a significant suicide prevention opportunity. One study found that 38% of people who attempted suicide made some type of healthcare visit in the week before the attempt.
To rise to the challenge and seize opportunity, Intermountain adopted the Zero Suicide initiative in June 2018.
"The Zero Suicide program is both a commitment to suicide prevention—acknowledging that these deaths are preventable—and a recognition that all of us in healthcare have a role to play, whether we are clinicians, administrators, or facility staff," says Morissa Henn, DPH, MPH, community health program director at the Salt Lake City, Utah-based health system.
Intermountain has made gun safety the centerpiece of the health system's approach to the Zero Suicide initiative, she says. "At Intermountain, we are proud to be developing our own version of Zero Suicide. Here in Utah, the strategy we developed recognizes some of the unique risks and protective factors in our communities. One of the key elements is understanding how important access to firearms is as a driver of Utah's high suicide rate."
Utah is an outlier for suicides involving firearms, Henn says, noting that 85% of all gun-related deaths are suicides. In the United States as a whole, about two-thirds of gun deaths are suicides.
"Firearms are widely accessible in Utah. Half of homes here have at least one firearm. Gun ownership ranges from 35% of homes in Salt Lake City to about 70% of homes in more rural areas," Henn says.
There are four primary components of Intermountain's approach to promoting gun safety: partnering with gun owners, holding structured conversations with patients, waging a social norms campaign, and offering gun-locking devices to patients.
1. Working with gun owners
"We focus explicitly on issues related to firearms access, and we are doing so in deep collaboration with Utah gun owners and gun advocates. We know that if we are going to move the dial on this problem here in Utah, the issues of access to firearms and suicide are inseparable," Henn says.
For example, Intermountain has developed public service announcements targeted at gun owners, she says. "These announcements make it clear that we are not trying to ban guns, which are part of our cultural heritage and recreational identity in Utah."
2. Structured patient conversations
In coordination with the Harvard School of Public Health, Intermountain has developed a course for healthcare professionals called Counseling on Access to Lethal Means (CALM). The one-hour course trains medical staff to have effective, sensitive, evidence-based conversations with patients about reducing access to lethal means for high-risk people.
The key elements of CALM include training about how to raise the topic of suicide prevention with patients, holding conversations about gun safety, and follow-up efforts, Henn says.
"CALM helps healthcare professionals to understand the rationale for having these conversations, provides some specific language to practice using, and makes these conversations part of a regular dialogue between healthcare providers and patients in a way that is prevention-oriented. We don't want to wait until people are in crisis. CALM develops plans to help patients and healthcare professionals navigate the dark times safely," she says.
3. Social norms campaign
Intermountain is developing a social norms campaign focused on social media and traditional media such as radio and billboards. The campaign will include encouraging help-seeking behaviors for people in crisis and promoting positive messages of hope and recovery.
"In consultation with many community stakeholders, we are in the process of developing what we hope will be a first-of-its-kind major, comprehensive, and evidence-based social norms campaign modeled on a successful underage drinking prevention campaign in Utah called Parents Empowered. … We also want to encourage a means-reduction approach—ensuring that there is always time and distance between someone in crisis and a lethal method such as firearms," Henn says.
4. Providing gun locks
To improve gun safety in people's homes, Intermountain plans to offer gun locks to patients who may be a high-risk for suicide imminently or in the future.
"As the largest provider of health services in Utah, we are looking at how Intermountain can distribute gun locks in our clinics and our hospitals. Oftentimes, gun locks are an important way to open the conversation and to encourage safe-storage behavior," she says.
Intermountain has set four goals to help gauge the impact of the health system's gun safety efforts and other suicide prevention initiatives:
- In conjunction with state-based efforts, Intermountain wants to achieve a 10% reduction in suicide rates among patients and in the health system's overall geographic region by the end of 2021.
- Intermountain wants to get 5% of key caregivers—healthcare providers who interact with high-risk patients—to get CALM training by the end of this year.
- After at-risk patients receive care at an Intermountain facility, the health system wants at least 40% of them to schedule and attend a behavioral health appointment within seven days.
- The last goal is process-oriented such as identifying patient resources and triggers for suicidal thoughts, Henn says. "We want to develop brief, evidence-based interventions for safety planning—a collaboratively developed plan for someone who is identified as high-risk."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
In 2017, suicide was the 10th leading cause of death in the United States.
In Utah, 85% of all gun-related deaths are suicides.
Intermountain Healthcare wants to achieve a 10% reduction in suicide rates among patients and in the health system's overall geographic region by the end of 2021.