What is Means Restrictions?
Means restriction is a technique for preventing suicide that involves restricting or preventing access to the tools used to attempt suicide. This can be things like pills (for overdosing), firearms (for shooting), or railways (for jumping.)
Some suicide methods have much higher lethality or chance of causing death than others. For instance, while 85% of firearm suicides results in death, only about 2% of overdoses do. Hangings are approximately 70% (Vyrostek, Annest, & Ryan, 2004).
There is a myth that if we limit one suicide method (like removing firearms from the home), that someone will simply use another suicide method. While it’s true that not all suicide methods exist in all countries and suicides still occur, suicide method restriction does not generally lead to method substitution during that time-limited suicidal crisis.
Support for Means Restrictions
The idea of means restriction (and its connection to means substitution) was first explored in the 1970s and 80s with the change from toxic coal gas to far less toxic natural gas in Great Britain. It was noted at that time that there was no displacement or substitution of suicide method. This was summarized by Clarke (1989).
Daigle (2005) reviewed a number of studies on means restriction and suggested two primary reasons for the reduction in suicide risk associated with restricting means:
- Individuals plan their suicide carefully, including becoming attached to specific methods. By restricting access to those methods people are less attached to the idea of dying by suicide at all
- Suicidal crises are often short lived periods of intense acute risk. By limiting the most lethal methods people are forced to either delay their suicide plan or switch to a less lethal method, which will either provide time for the suicidal crisis to pass or (in the event of a suicide attempt carried out) time to be rescued
The literature supporting means restriction and it’s relationship to means substitution is reviewed below based on common suicide methods, which are considered high-lethality methods and therefore most affected by means restriction.
Anestis & Anestis (2015) examined the impact of four firearm-related laws: waiting periods to receive one, universal background checks, gun locks, and open carrying regulations on their impact of the suicide rate. Their research found that firearm suicides were reduced when each was implemented and background checks, gun locks and open carrying regulations also reduced the overall suicide rate.
This pattern, stricter firearm laws leading to lower suicide rates was observed in both England (Gunnell, Middleton, & Frankel, 2000) and Austria. (Kapusta, Etzersdorfer, Krall, & Sonneck, 2007)
Additionally, Wintemute et. al. (1999) found that the rate of suicide among handgun owners is 57x higher than the general population in the first week of ownership (because of people who buy a gun for the specific purpose of suiciding) and 7x higher at the end of the first year. It is likely that a person’s risk of dying by suicide remains elevated as long as someone owns a firearm.
Lukaschek, Baumert, Erazo, & Ladwig (2014) examined railway suicides in Germany over 2 separate periods and found that railway suicides were most common on Mondays and Tuesdays. They note that blue lights in Japan and physical barriers have been helpful in reducing railway suicides, in addition to comprehensive changes introduced by the German Railway Suicide Prevention Project.
The changes implemented included “an awareness programme, media approaches, hotspot analysis….and the introduction of a rule regarding announcements to passengers waiting in station or trains, which requires avoidance of the term ‘suicide’, and an indication that the delay is due to a ‘medical rescue operation underway.'”
Law, Sveticic, & DeLeo (2014) examined the impact on the suicide rate in Australia after the installation of a suicide barrier on the Gateway Bridge in Brisbane. The barrier reduced the suicide rate 53%, while there was no shifting of means onto the nearby Stony Bridge.
Meanwhile in Auckland, New Zealand, a bridge barrier was removed on the Grafton Bridge and then reinstated; a 500% spike in the suicide rate occurred while the bridge barrier was absent. (Beautrais, 2009)
Counseling on Access to Lethal Means (CALM)
The Counseling on Access to Lethal Means (CALM) course provides a thorough exploration of means restriction to enable a worker to understand the theoretical basis for restricting access, but also the practical tools surrounding how, when and why to have the conversation about restricting means. It is particularly focused on youth but can be helpful for all populations.
Anestis, M.D., Anestis, J.C. (2015) Suicide Rates and State Laws Regulating Access and Exposure to Handguns. American Journal of Public Health. 105(10):2049-58. doi: 10.2105/AJPH.2015.302753
Beautrais, A.L., Gibb, S.J., Ferguson, D.M., Horwood, L.J., Larkin, G.L. (2009) Removing bridge barriers stimulates suicides: an unfortunate natural experiment. The Royal Australian and New Zealand College of Psychiatrists.
Clarke, R.V. Crime as OPportunity: A Note on Domestic Gas Suicide in Britain and the Netherlands. British Journal of Criminology, Delinquency and Deviant Social Behaviour, 29:1. 35
Daigle, M.S. (2005) Suicide prevention through means restriction: assessing the risk of substitution. A critical review and synthesis. Journal of Accident Analysis and Prevention. 37(4)625-32.
Gunnell, D., Middleton, N. & Frankel, S. (2000) Method availability and the prevention of suicide—A re-analysis of secular trends in England and Wales 1950–1975. Social Psychiatry and Psychiatric Epidemiology. 35:437–443
Kapusta, N.D., Etzersdorfer, E., Krall, C. & Sonneck, G. (2007) Firearm legislation reform in the European Union: Impact on firearm availability, firearm suicide and homicide rates in Austria. British Journal of Psychiatry. 191:253–257
Law, C.K., Sveticic, J., DeLeo, D. (2014) Restricting access to a suicide hotspot does not shift the problem to another location. An experiment of two river bridges in Brisbane, Australia. Australian and New Zealand Journal of Public Health. 38(2):134-8. doi: 10.1111/1753-6405.12157
Vyrostek, S.B., Annest, J.L & Ryan, G.W. (2004) Surveillance for fatal and nonfatal injuries–United States, 2001. Morbidity and Mortality Weekly Report (MMWR). 53(SS07);1-57. Accessed electronically from http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5307a1.htm on Jan 23 2016.
Wintemute, G.J., Parham, C.A., Beaumont, J.J., Wright, M., & Drake, C. (1999) Mortality among recent purchasers of handguns. New England Journal of Medicine. 341(21):1583-9