Implementation of Alternate Care Facilities During Public Health Emergencies: A Qualitative Study.

Suicide is the second leading cause of death among adolescents (high school students in grades 9-12, typically aged 14-18 years) in the US. In 2020, firearms became the leading method of youth suicide, surpassing all other means. Firearm suicide attempts are highly lethal, and access to firearms in the home is associated with substantially elevated risk of suicide among youth. The transition from suicidal ideation to attempt occurs in less than 1 hour for most individuals, and many youths who attempt suicide have no prior mental health diagnosis. This impulsivity underscores the importance of means restriction: whereas suicide attempts by drug ingestion result in death less than 3% of the time, attempts with firearms are fatal more than 90% of the time. Ideation-to-action frameworks suggest that the transition from suicidal thoughts to attempts requires not only a desire for death but also acquired capability, including habituation to fear and fearlessness about death. Among adolescents, carrying a firearm may represent both increased access to lethal means during acute crises and heightened capability for suicide, accelerating the transition from ideation to attempts. Recent trends highlight concerning racial and ethnic disparities in firearm suicide among US adolescents. Since 2014, firearm suicide rates have increased by 245% among Black youths and 98% among Latinx youths, compared with a 6% decrease among White youths. These shifts signal a departure from prior decades when firearm suicide rates were highest among White youths and underscore the need to examine the intersection of firearm access, state firearm policies, and racial disparities in adolescent suicide risk.