Counseling on Access to Lethal Means (CALM): An Evaluation of a Suicide Prevention Means Restriction Training Program for Mental Health Providers

Community Ment Health J. 2018 Apr;54(3):293-301. doi: 10.1007/s10597-017-0190-z. Epub 2017 Nov 28.


This paper evaluates the effectiveness of the Counseling on Access to Lethal Means (CALM) suicide prevention program. CALM trains mental health providers how to counsel suicidal individuals and those who support them on mean restriction during times of crisis. Pre/post/3-month follow-up assessments measured knowledge of lethal means, confidence and comfort in discussing means restriction (self-efficacy), and future intentions to counsel clients on means restriction. Change in the number of clients receiving lethal means counseling was also assessed. All constructs increased significantly at posttest. Confidence and counseling intentions were sustained at follow-up and significantly more clients received means counseling in the 3 months following the CALM training. Knowledge and comfort levels decreased at follow-up but not to pre-training levels. CALM is effective at increasing mental health professionals' comfort, knowledge, and frequency of talking about means restriction with clients. an effective means restriction training program. A template to assess clients for suicidality and lethal means access and booster sessions are recommended to further sustain effects.

Keywords: Firearms; Gatekeeper training; Lethal means restriction; Mental health counseling; Suicide prevention.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Adult
  • Counseling / education*
  • Female
  • Firearms
  • Follow-Up Studies
  • Health Knowledge, Attitudes, Practice*
  • Health Personnel / education*
  • Humans
  • Male
  • Mental Health / education*
  • Middle Aged
  • Missouri
  • Program Evaluation
  • Self Efficacy
  • Suicidal Ideation
  • Suicide Prevention*
  • Surveys and Questionnaires