Colorado emergency departments take new steps to prevent youth suicide

A new study conducted in seven Front Range emergency departments demonstrated success in helping parents make their homes safer when a teen is distressed.

The study published in the Annals of Emergency Medicine showed that efforts by hospitals to counsel parents on safe storage of guns and medications were successful. For the study, investigators from the Program for Injury Prevention, Education and Research (PIPER) in the Colorado School of Public Health on the Anschutz Medical Campus collaborated with investigators from Northeastern and Harvard Universities.

The researchers worked with mental health providers at emergency departments to counsel parents of adolescents at risk of suicide. The counseling included advice on how to more safely store guns and medications, and parents received free locking devices.

Though conducted before the coronavirus crisis, the results are even more important now during this time of added stress when families are spending more time at home and gun sales are on the rise.

According to lead Colorado investigator, Carol Runyan, MDH, Ph.D., founding director of PIPER, "This is important because Colorado's teen suicide rate is the 8th highest in the nation and has increased nearly 70% over the last decade, with more than 1,135 Colorado youth dying from suicide between 2000 and 2018. Most of these happen at home. By storing medications and guns more safely, parents can save lives. That was the motivation behind the study."

Emmy Betz, MD, MDH, associate professor of emergency medicine at the University of Colorado School of Medicine, and study co-investigator, adds, "A visit to the emergency room is an important opportunity to reach parents to talk about in-home safety measures that can be effective. Until now, though, consistent counseling about firearm and medication safety has not always been routine."

Conducted over two years, the study demonstrated that a brief online training for counselors, coupled with free medication and firearm locking devices, helped parents make changes at home to improve safety. The research followed up with 575 parents who brought teens to the hospital with a mental health crisis. The results include:

• The percentages of parents reporting safer storage practices after the counseling more than doubled, indicating that counseling can help change in-home practices.
• The behavioral health counselors who participated in the study expressed enthusiasm for the changes, indicating that they found the online training very helpful and easy to deliver in a way acceptable to parents in a time of extreme stress.
• The study documented that the percentages of counselors reported to have talked to parents about these topics improved during the study period, with 57% counseling about safe firearm storage after the study was implemented (versus just 19% at the start).
• Counseling about medication storage also increased, to 80% from just 32%.

But, there is still room for improvement, noted Colorado School of Public Health investigator, Sara Brandspigel, MPH. "We are hopeful that these seven hospitals will continue to maintain their counseling efforts and that more hospitals will take advantage of the free training and increase their counseling on safe storage of firearms and medications." She also noted that when someone is at risk of suicide, the safest firearm storage location is outside the home. Working with Betz, as an outgrowth of the study Brandspigel initiated development of a web-based resource showing where in Colorado families can take their guns to store away from the home.

Sarah Brummett, Director of the Office of Suicide Prevention at the Colorado Department of Public Health and Environment, and a study consultant, notes that the training for hospital-based counselors is available for free online through Train.org/Colorado (ID 1076412 "Lethal Means Counseling: A Role for Colorado Emergency Departments to Reduce Youth Suicide") and urges all hospitals to build their capacity for collaborative safety counseling. She notes, in particular, that in this time of added stress during the COVID-19 response effort, that crisis hotlines such as the Colorado Crisis and Support line (1-844-493-8255) are providing support and resources to a greater number of clients and that safe storage of firearms and medications can protect not only young people, but all family members.