Evaluating the Effect of Routine Lethal Means Counseling in the Emergency Department on Suicide Mortality Among Mental Health Patients.

INTRODUCTION

Each year in the U.S. there are more than 2 million emergency department visits for mental health disorders; approximately 500,000 of those are for self-harm. Although not widely implemented in emergency departments, lethal means counseling, which advises patients how to safely store firearms and other lethal means, has been found to improve the safe storage of firearms and medications, which are responsible for two thirds of suicide deaths.

METHODS

An observational cohort study of 1,148,546 emergency department patients with mental health disorders was conducted to determine the association between routine emergency department lethal means counseling and suicide death (ICD-10-CM: X60-X84, Y87.0, U03) within the 30- and 180-day periods post-discharge. The sample included patients seen during 2016-2018 at one of the 438 hospitals identified in national Medicaid claims data who responded to an emergency department management of self-harm survey. Hospitals were dichotomized into whether or not they routinely provided lethal means counseling (on a routine basis versus usually but not routinely, sometimes, or never or rarely).

RESULTS

Slightly more than one third (39.7%) of visits occurred in emergency departments that routinely provided lethal means counseling. Individuals with mental health disorders treated at emergency departments with routine lethal means counseling had significantly lower adjusted odds ratios of death by suicide within the 30-day (4.8, 7.9 deaths by suicide per 100,000 population, Adjusted Odds Ratio (AOR)=0.62, =0.020) and 180-day (38.9, 50.4 per 100,000, AOR=0.77, =0.049) periods following the emergency department episode. Of the 438 included hospitals, 37.0% routinely conducted lethal means counseling.

CONCLUSIONS

Where implemented routinely, lethal means emergency department counseling appears to reduce the risk of suicide during the critical 30- and 180-day periods following an emergency department visit among patients with mental health disorders.