As mental health care providers, our ability to intervene before a firearm suicide death is often limited to those who seek treatment. However, countless individuals at high risk for firearm suicide remain beyond our reach, with only 26 percent of those who die by firearm suicide interacting with mental health services in their lifetime. This is especially concerning given that firearms account for over 50 percent of all suicide deaths and are the most lethal method with an 85-95 percent fatality rate; this means that when someone attempts suicide with a firearm, they rarely survive. This reality highlights the urgent need to expand suicide prevention efforts beyond mental healthcare and reach those at risk for firearm suicide before a crisis emerges. Physicians’ involvement, in particular, may help effectively reduce the rates of firearm suicide. Physicians are uniquely positioned to engage with those who might never seek or be able to access mental healthcare. There are immense demands on the time and energy of physicians, as they tirelessly care for patients in an already overburdened healthcare system, but screening for firearm access and promoting lethal means safety is essential—and there are resources available to support physicians in this effort.
The presence of a firearm in a home increases the risk for suicide—and other forms of firearm injury and death such as fatal domestic violence and unintentional shootings—for every person living in that home. But there are also known ways to reduce that risk such as secure firearm storage—keeping firearms locked, unloaded, and separate from ammunition—which creates critical time and space between a person in crisis and access to the most lethal method for suicide. While broadly helpful, this approach has been specifically highlighted as a way to decrease risks for populations disproportionately impacted by firearm suicide, including youth and veterans. All healthcare providers bear the responsibility to reduce suicide risk where possible; which can include discussing secure firearm storage and engaging in safety discussions with our patients. In this piece, we suggest three steps providers can take, based on research and practice in the field of firearm suicide prevention, to help reduce firearm suicide risk among their patients: (1) screening for firearm access, (2) discussing lethal means safety, and (3) providing resources and referrals to support safe storage practices.
Screening for Firearm Access
The first step in increasing secure firearm storage is determining who has access to a firearm. While professional organizations like The American Academy of Pediatrics emphasize the importance of routinely screening for firearm access, screening within healthcare settings is not commonplace. Additionally, when providers do screen, they may be selectively deciding who to ask about firearms based on age, race, and gender. However, it’s difficult to identify who should be screened based solely on appearance or background, especially given the increase in firearm purchasing and changing demographics of firearm owners. To mitigate the subjectivity of screening, physicians should screen all patients for firearm access.
Screening for firearm access does not need to be a lengthy or complicated process. It can be approached similarly to how physicians screen for other health behaviors, such as alcohol use or smoking. For example, a yes/no question about the presence of a firearm in the home, included on intake paperwork, check-in forms, or asked by support staff or the provider, may lead to more patients being asked about firearm access. This approach can be integrated seamlessly into existing screening procedures, making it a practical addition to routine assessment without placing an excess burden on providers.
Screening for firearm access does not need to be a lengthy or complicated process. It can be approached similarly to how physicians screen for other health behaviors, such as alcohol use or smoking.
It is important to note, that screening practices and firearm safety discussions may vary by state based on existing laws and regulations. For example, in New York, there are protective laws in place that address firearm access in cases where there is potential for harm. New York’s red flag law, for instance, establishes an extreme risk protection order that allows concerned family members, healthcare practitioners (including physicians), and certain other individuals to obtain orders to prevent those at risk of harming themselves or others from purchasing or possessing a firearm. Given such policies, physicians in New York may feel more comfortable broaching the topic of firearms and have more options for intervening to ensure patient safety.
Discussing Lethal Means Safety
Screening patients can help physicians decide who could benefit from discussions about how to reduce suicide risk by limiting access to firearms (i.e., lethal means safety). Similarly, to follow up with someone who reports drinking alcohol or smoking, physicians can have a collaborative and nonjudgmental conversation about firearms with patients. The Bullet Points Project offers a useful framework, called the “The 3 As,” for starting this discussion. The first “A” is to approach firearm discussions in a respectful, individualized way. It can be easy to slip into the mindset that healthcare providers should direct patients on how to stay safe. However, firearm owners have a wealth of knowledge on ways to store firearms, so hearing their perspectives and ideas is important. Second, assess the patient’s risks, firearm accessibility, and willingness to collaborate is paramount. Every firearm owner has different reasons for ownership, ownership habits, and needs, so it’s important to assess each patient individually and think of safety on a continuum. The goal with each patient is to create time and distance between individuals and a firearm; for some that may be storing a firearm outside of the home, while for others it may be moving it to a secured gun cabinet in the garage. And third, staying open-minded and brainstorming safety steps with the patient will help physicians determine how to act. Coming up with a specific step-by-step plan that patients can employ when they leave your office may lead to much more patient buy-in and greater adherence to secure storage.
Every firearm owner has different reasons for ownership, ownership habits, and needs, so it’s important to assess each patient individually and think of safety on a continuum.
There are several sources that offer training on how to have these conversations. Calm America offers an online lethal means counseling course. Walk the Talk America, while geared toward mental healthcare providers, offers a course for increasing cultural competencies for working with firearm owners. Project SafeGuard teaches individuals how to use motivational interviewing strategies to work collaboratively with firearm owners to increase secure storage.
Resources and Referrals to Support Safe Storage
While it is not necessary to be an expert on firearms or lethal means counseling to support safe storage, healthcare providers can offer valuable resources and referrals to help patients make informed decisions. Tools like Lock2Live can assist patients in exploring ways to temporarily reduce access to lethal means. For those open to storing their firearm outside the home, physicians can provide information on temporary storage options. There are several states with maps of locations that offer temporary storage, including New York and New Jersey. It is important to determine options within one’s own state and to be aware of state regulations related to the temporary transfer of firearms. Additional resources that can be shared with patients include Project Safe Child, which offers tips on safe storage and firearm safety discussions with kids. It’s also important to send patients home with the resources discussed and options for further firearm safety education. For example, Pause to Protect provides guidance on secure firearm storage for owners.
Conclusion
Physicians have a key role in preventing firearm suicides, and there are practical steps that can be taken to make a real difference, including asking straightforward questions about firearm ownership, discussing secure storage options, and providing essential resources. Each conversation about safe storage and every referral to helpful resources is not just a step towards preventing an individual tragedy but a contribution more broadly to reducing firearm suicides as well as other firearm-related deaths and injuries.
ABOUT THE AUTHORS
Alison E. Bond and Taylor R. Rodriguez are clinical psychology PhD candidates in the New Jersey Gun Violence Research Center whose research focuses on firearm suicide prevention and are members of the Regional Gun Violence Research Consortium.