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Why Lockboxes Could Become a Key in Zero Suicide Initiative

February 23, 2022

For some, talking about the Tide Pod Challenge may be a joke, but for others keeping dangerous items out of reach of young children or teens with suicidal ideation can be a matter of life or death.

Limiting access to certain items can help delay a dangerous situation — such as consuming a prescription medication or Tide Pods — and if people delay the action, they may have more time to manage the suicidal crisis safely, either independently or with the help of others.

Providing lockboxes for families is part of a pilot program, which the Zero Suicide initiative is involved in through the United Way and the Connecticut Suicide Advisory Board, to reduce access to lethal means.

“A lockbox is only as good as the conversation you are having with the family and the teen,” said Patricia Graham-Sullivan, clinical coordinator of the Child & Adolescent Advances Services for Adolescents with Psychosis Program at the Institute of Living. “We want to involve teens, so it is not seen as a punishment, but a way to take agency and have a safety conversation. They can take an active role in the planning and prevention.”

The lockboxes are made available in conjunction with Counseling on Access to Lethal Means (CALM), an evidence-based intervention for suicide prevention.

The Zero Suicide prevention initiative has been facilitated at Hartford HealthCare’s Behavioral Health Network for more than three years, with staff training, outreach, suicide-risk screenings and care for caregivers affected by suicide loss. Goals for 2022 include ensuring patient safety through various efforts, including lethal means counseling and collaborative safety planning, such as these conversations with families.

The lockbox conversations are a key part of the initial treatment at inpatient child and adolescent units, also at outpatient clinics and schools, where the lockbox is offered to store sharp items, such as needles or any syringes if in the home, razor blades, knives, or potentially dangerous items, such as medications, cough syrup or even detergent pods for dishwashers or washers.

“These conversations are meant to be collaborative,” said Marissa Sicley-Rogers, a staff psychologist at the Institute of Living, and a member of the executive steering committee for Zero Suicide. “We are building motivation of doing the right thing. It might not be their child who wants the medication, but even a friend or someone who comes over. More often than not, families are already trying to hide these items, so they understand the risks and are seeking guidance or help.”

Graham-Sullivan said they also discuss if there are firearms in the home and stress the importance of storing firearms and ammunition separately and appropriately locked.

“It is really is a family conversation about where medications are stored in your home,” she said. “It shouldn’t be sitting out and about, the lockbox itself should be hidden as well.”

She said they have a discussion with all the families in their programs, not just ones that may have suicidal ideation, and families can have more than one if they need multiple boxes.

“Overall families have been very receptive to it,” she said.

The program started in May 2020, and since then 510 boxes have been passed out, with 506 families having received the lethal means counseling. Some families have already gotten a box from an inpatient situation or previously received the counseling.