"It's Just So Important to Make Them Feel Seen": Teen and Caregiver Perspectives of Lethal Means Safety Planning for the Emergency Department.

Abstract

Lethal means safety counseling involves limiting access to lethal means of suicide in times of crisis. The National Institute of Mental Health Emergency Department (ED) Suicide Risk Screening Pathway recommends lethal means safety counseling for patients with suicidal thoughts being discharged from the ED. We sought to understand ideal characteristics of a lethal means safety counseling tool for the ED from the perspective of teens and caregivers with lived experience. This qualitative study was conducted at a tertiary care children's hospital ED from September 2024 to June 2025. Patients ≥10 years are screened for suicide risk using the Ask Suicide-Screening Questions; those with a nonacute positive Ask Suicide-Screening Questions screen and reported firearm access were eligible. We conducted semistructured interviews with teens (13 to17 years) and/or their caregiver participants spoke English. Teens and caregivers were interviewed separately. Interviews were recorded and transcribed. Inductive coding was performed by 2 team members. Themes were identified using content analysis. We completed 33 interviews (19 caregivers, 14 teens, 14 dyads). Participants were mostly women, heterosexual, White, and non-Hispanic. Themes included the following: (1) lethal means safety counseling is beneficial and helps families feel cared for; (2) specific lethal means safety counseling tool elements should utilize technology, consider equity, and include straightforward language and supportive messaging, as well as an actionable plan; and 3) differing family dynamics and balancing teen autonomy and safety remain barriers to lethal means safety counseling. Lethal means safety counseling is an essential, high-yield component of suicide prevention. Our findings will directly inform the development of a brief family-centered lethal means safety counseling intervention for the ED.