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Health care professionals have an opportunity to engage collaboratively with at-risk patients to help prevent firearm-related injuries and deaths. Lethal means safety counseling is a patient-centered, evidence-informed health care intervention that can be used to help prevent suicides, homicides, unintentional gun deaths, and nonfatal firearm injuries. 

Lethal means safety counseling gives health care clinicians the tools they need to: 

1. Determine if a person at risk for injury or death has access to lethal means, including firearms, sharp instruments, and medications.
2. Work collaboratively with the person and their family or friends to reduce access to lethal means until the risk decreases. 

With regard to firearms, health care clinicians can use lethal means safety counseling to work alongside their patients and patients’ families to find patient-centered, mutually agreeable solutions that temporarily reduce access to guns and in turn, reduce their risk of gun-related injury or death.

What Is Lethal Means Safety Counseling?

Lethal means safety counseling is a voluntary, patient-centered health care intervention that prevents injury and death by helping patients and their families reduce access to lethal means for those at risk. Lethal means are objects (e.g., firearms, sharp instruments, medications) that can be used to inflict self-harm or violence. Reducing access to lethal means, such as firearms, is an important part of a comprehensive approach to suicide prevention.¹

Safe storage reduces risk:

• When not in use, firearms should be stored locked and unloaded, ammunition should be stored separately (preferably locked up), and key or lock combinations should be inaccessible to children, adolescents, and those at elevated risk of harm to themselves or others.

• Ask a family member to store medications safely and dispense safe quantities as necessary.¹

Every patient at an elevated risk of firearm injury (or their parent or guardian, as appropriate) should receive lethal means safety counseling, even if they do not have access to lethal means, such as firearms, at the time of the counseling. Family or friends should be included in the counseling if possible. All patients, regardless of risk level, should be asked about firearm access and provided with information on safe firearm storage.

Why Is Lethal Means Safety Counseling Important?

Gun violence claimed 46,728 lives in 2023, marking the third-highest number of gun-related deaths ever recorded in the United States. 27,300 people died by suicide using a firearm, reaching a record high in 2023. This trend is not new—since 2019, there has been a 12% increase in the gun suicide death rate.² Firearms are the most lethal method of suicide attempt.³ Clinicians have a critical opportunity to engage at-risk patients and support them in temporarily limiting access to firearms during periods of elevated risk—an intervention that can ultimately save lives. 

Easy access to firearms turns risky situations deadly:

• While only 8% of suicide attempts are fatal, when a gun is available, 9 out of 10 suicide attempts result in death.³
• An estimated 82% of adolescent firearm suicides involve a gun belonging to a family member.⁴
• 80% of school shooters under 18 access a firearm from their own home or that of a relative or friend.⁵
• A woman is 5x more likely to be murdered when her abuser has access to a gun.⁶

Mitigating access to firearms with safe storage practices prevents gun violence. One way to reduce access to guns for people at risk or during high-risk time periods is through lethal means safety counseling.

The 5 Ls

The 5 Ls is a mnemonic to help guide health care clinicians in asking key questions and engaging in lethal means safety conversations about firearms storage in cases where their patient (or the patient’s parent/guardian) indicates that a firearm is in the home. The 5 Ls mnemonic was proposed in: Pinholt EM, Mitchell JD, Butler JH, & Kumar H. (2014).  Journal of the American Geriatrics Society.

When Should Lethal Means Safety Counseling Be Used?

Chart adapted from: Wintemute GJ, Betz ME, & Ranney M.L. (2016). . Annals of Internal Medicine.

Is Lethal Means Safety Counseling Effective?

Lethal means safety counseling prevents firearm injuries and deaths by improving firearm storage practices. Studies show that interventions by health care clinicians can influence patients’ gun storage practices, which in turn can substantially lower risk of suicide or other firearm-related injury.⁸

For Example:

• Among patients who owned or lived with someone who owned a gun, researchers found that patients who received a family physician’s verbal or combined verbal and written safe storage recommendation were three times more likely to make safe changes in firearm storage practices than patients who did not receive counseling.⁹
• In another study, researchers found that for every five gun-owning parents whose child’s pediatrician gave them lethal means safety counseling and free cable locks, two parents reported using the cable locks six months later.¹⁰

Patients Want Clinicians to Ask About Guns.

Studies have shown that patients want their health care clinicians to ask about guns and offer guidance on how to protect their families from firearm-related harm.¹¹ Clinicians should routinely assess their patients for risk of harm from firearms and counsel patients and their families on the importance of safe gun storage practices.