Background: The Firearm Suicide Crisis

Firearms are used in approximately 54% of all U.S. suicide deaths — the numerically dominant method of suicide mortality. The case fatality rate for firearm suicide attempts is approximately 85%, compared to roughly 5% for the most common non-firearm methods. This lethality difference means that firearm access during a suicidal crisis is a critical variable — not because suicidal crises always lead to death, but because they so often do when a firearm is immediately accessible.

Veterans face disproportionate risk: approximately 70% of veteran suicides involve firearms, and veterans are about 1.5× more likely than age-matched civilians to die by suicide. In Wisconsin, firearm suicide accounts for a significant share of total suicide mortality, with rural populations, agricultural communities, and veterans at elevated risk.

The Science of Lethal Means Restriction

The most empirically supported suicide prevention strategy is reducing access to lethal means during periods of crisis. Suicidal crises are typically time-limited and impulsive — most people who survive do not attempt again. A landmark study of Israeli military policy found that requiring soldiers to store firearms off-base during weekend leave reduced firearm suicide rates by approximately 40%, with no compensatory increase in other methods. (Lubin et al., 2010) Individual-level lethal means counseling (LMC) — specifically the CALM curriculum — has demonstrated that brief, non-judgmental conversations about storage significantly increase safer storage practices following clinical encounters. (Runyan et al., 2016)

Theoretical Frameworks

Social-Ecological Model

FLAME is grounded in the social-ecological model of suicide prevention, which addresses risk and protective factors across individual, relationship, community, and societal levels. FLAME operates primarily at the individual and relationship levels — the most amenable to rapid intervention.

Integrated Motivational-Volitional (IMV) Model

The IMV model distinguishes between defeat/entrapment states that motivate suicidal ideation and the volitional factors that enable action. Critically, the IMV model identifies access to means as a primary volitional enabler — the bridge between suicidal intent and completed action. FLAME's multiplier-based scoring architecture directly operationalizes this: firearm accessibility is the mechanism through which all other risk factors gain or lose their lethality.

Transtheoretical Model (Stages of Change)

Individuals exist at different stages of readiness for behavior change. FLAME's readiness and openness questions explicitly assess motivational stage, and the feedback layer is calibrated to the respondent's stated readiness — not assuming uniform motivation across all users. (Miller & Rollnick, 2013)

FLAME v5 Scoring: The Accessibility-Multiplier Model with Configuration Rules

FLAME v5 builds on the multiplier model introduced in v4, adding six mandatory floor and cap rules that enforce clinically meaningful score ranges based on storage configuration, ammunition accessibility, and load status. These rules override the base formula when the physical configuration of firearms in the home represents a defined risk level regardless of other factors.

How the Score Is Calculated

Step 1 — Combined Risk Score (0-65): Three domains are summed additively. These scores represent stable household risk independent of storage configuration.

Step 2 — Accessibility Multiplier (M, 0.0-1.0)

The multiplier represents how accessible firearms are right now, from completely inaccessible (off-site, M=0.0) to maximally accessible (loaded within arm's reach, M=1.0). The multiplier is derived from primary storage method, adjusted by the behavioral anchor (what the respondent actually did last time) and ammunition separation practices. For households with firearms in vehicles or outbuildings, the highest multiplier across all locations is used.

Step 3 — FLAME Score with Configuration Floor/Cap Rules

FLAME Score = (Combined Risk ÷ 65) × 100 × M². This formula produces the base score. Six configuration-specific rules then apply mandatory floors and caps that override the formula when the storage/ammo/loaded state represents a clinically defined risk level regardless of what the formula produces.

Risk Tier Classification

Validated Score Scenarios (5-Point Increments)

The following calibrated scenarios confirm that the algorithm produces clinically meaningful scores across its full range. Each scenario represents a complete household profile; scores within ±3 of the target confirm correct behavior.

The Structural Gap: Scores 46-64 Are Not Reachable

A key property of the FLAME v5 algorithm is that scores between 46 and 64 are structurally unreachable. This is intentional — it is a direct consequence of the floor/cap architecture.

The gap arises from the interaction of two rules:

• The highest score achievable with locked ammunition and unlocked storage is 45 — produced when a hidden, unlocked firearm has load status unconfirmed, ammunition is locked, and every other risk domain is at maximum (C=65, M=0.67, formula=44.9).
• The lowest score when ammunition is accessible and the firearm is unlocked is 65 — Rule 1 fires on any household risk factor, regardless of how low the formula would otherwise produce.

The 20-point discontinuity is the algorithm's expression of a clinical boundary: if a firearm is unsecured and ammunition is accessible, the household is in a categorically different risk zone than one where ammunition is locked. No configuration lands between 46 and 64. Scores either stay at or below 45 (ammunition controlled) or jump to at least 65 (ammunition accessible, firearm unlocked).

Staff training implication: A household scoring 45 — hidden gun, ammo locked, maximum risk factors — sits at the edge of the gap. A single change (switching from locked to accessible ammunition) causes the score to jump 20 points to 65. This transition is an explicit counseling target.

Validated Scenarios: 5-Point Increments

Each row is a complete, computationally verified household profile. All 18 reachable score points from 0 to 100 are covered. All scores verified against the live v5 algorithm to within ±2 points. M = Accessibility Multiplier · C = Combined Risk Score (max 65).

Key Design Innovations

Accessibility as Primary Score Driver

Placing accessibility as a multiplier — rather than an additive term — ensures the score reflects the causal mechanism: risk factors do not cause harm in isolation; they cause harm through access to lethal means. This architecture also produces more clinically meaningful score-impact estimates, because changing storage configuration changes the score dramatically and nonlinearly, mirroring the empirical evidence on means restriction effectiveness.

Behavioral Anchor Questions

Rather than asking respondents to characterize their general practices, FLAME asks about specific recent behaviors: "The last time you put a firearm away, what did you actually do?" Behavioral recall is more accurate and less subject to motivated distortion than self-characterization. Last-stored behavior adjusts the multiplier because it reflects what actually happened, not intent.

Vehicle and Outbuilding Storage

FLAME v5 explicitly captures firearm storage in vehicles and separate buildings. Firearms stored in vehicles present a distinct risk profile: they bypass household access barriers, are susceptible to theft, and may be accessible to individuals outside the home. The multiplier for unlocked vehicle storage (0.95) slightly exceeds that for home-accessible storage (1.0 maximum) to reflect this elevated unauthorized-access risk.

Suicide Bereavement as a Distinct Risk Factor

Previous versions of FLAME collapsed general bereavement and suicide bereavement into a single item. FLAME v5 separates these. General bereavement carries a weight of 3 points; suicide bereavement within the past 12 months carries a weight of 8 points — nearly as high as active suicidal ideation (12 points). This reflects the contagion literature, which identifies suicide bereavement — particularly within the first 12 months — as one of the strongest predictors of subsequent suicidal behavior in exposed individuals. (Jordan & McIntosh, 2011)

Projected Score Improvement

Each recommendation in FLAME v5 displays a projected FLAME score after that action is taken — not an abstract point reduction, but a specific new score. A summary box at the end of all recommendations shows the projected score if all recommended actions are followed. This approach leverages implementation intention research: concrete, quantified goals increase follow-through more than general behavioral intentions.

References

• Barber, C.W. & Miller, M.J. (2014). Reducing a suicidal person's access to lethal means. Am J Prev Med, 47(3S2), S264-S272.
• Crifasi, C.K. et al. (2018). Storage practices of US gun owners in 2016. Am J Public Health, 108(4), 532-537.
• Jordan, J.R. & McIntosh, J.L. (Eds.). (2011). Grief After Suicide: Understanding the Consequences and Caring for the Survivors. Routledge.
• Lubin, G. et al. (2010). Decrease in suicide rates after a change of policy reducing access to firearms in adolescents. Suicide Life Threat Behav, 40(5), 421-424.
• Miller, W.R. & Rollnick, S. (2013). Motivational Interviewing (3rd ed.). Guilford Press.
• Runyan, C.W. et al. (2016). Lethal means counseling for parents of youth seeking emergency care for suicidality. West J Emerg Med, 17(1), 8-14.
• Stanley, I.H. et al. (2017). Discussing firearm ownership and access as part of suicide risk assessment. Prof Psychol Res Pr, 48(4), 209-218.
• U.S. Department of Veterans Affairs (2024). VA National Veteran Suicide Prevention Annual Report. Office of Mental Health and Suicide Prevention.
• Wisconsin DHS (2023). Wisconsin Suicide Prevention Strategy 2023-2027. Madison, WI.