It doesn't mean gun control. We can come up with other ways — we don't need legislative policies, we can use family and individual polices to look out for one another to make sure a gun isn't misused in a suicide. —Cathy Barber, Means Matter campaign
It wasn't just about a background check.
"A woman came into the shop asking about buying a gun because of some emotional problems. I told her she didn't need a gun, she needed spiritual help. So I took her to my pastor. She never did come back for a gun," wrote one New Hampshire gun shop owner, explaining the impact of a set of suicide awareness materials delivered to the shop.
"There was a guy I wouldn't sell a gun to because he just didn't seem right. I later got a letter from his attorney thanking me for saving his life," another gun shop reported.
Most people who die by guns in the U.S. do so by their own hand. According to the National Center for Health Statistics, suicides made up three out of every five gun deaths in the U.S. in 2010, and firearm suicides made up more than half of all completed suicides.
The New Hampshire Firearm Safety Coalition, the group that distributed materials to gun shops across that state, is one of several initiatives around the country bringing together mental health professionals and the firearms community in an unlikely alliance. As Americans brace for a polarizing debate in Washington about gun control legislation, these partnerships are sidestepping the legal fight and looking for practical ways to work together to prevent some of the most tragic firearm casualties.
“We're all just wishing we could be doing it sooner,” says Regina Schneider, a National Alliance on Mental Illness volunteer and certified Mental Health First Aid instructor who is forming a coalition in Maryland. “The vast majority of firearms owners and dealers want nothing more than to prevent tragedies from happening.”
Firearms top the list of lethal means of suicide in the U.S., with 85 percent of attempts ending in death. According to meansmatter.org, more suicides are committed with guns each year than every other method combined — and in numerous studies, gun ownership has been correlated with higher suicide rates.
Statistically, gun owners are not more depressed than their gun-free counterparts, nor do they attempt suicide any more often than the general population. But when it comes to suicide prevention, access to lethal means makes a big difference in whether the attempt will be completed.
To illustrate this difference: According to data from the American Foundation for Suicide Prevention, girls and women attempt suicide at a rate that triples their male counterparts. Yet there are four male suicides for every female suicide because boys and men tend to use more lethal means than females — primarily hanging and firearms.
"Most suicide methods also allow you to interrupt the method once you've started it; if you think better of it, you have a chance to stop ... and call 911,” says Cathy Barber, the director of the Means Matter campaign at the Harvard School of Public Health. “That's not an option with a gun."
“Suicidal crises for some people are very short-lived,” Barber says. “People might be suicidal for a long or short period, but that moment when you're actually ready to pull the trigger, that period is often pretty brief.”
Extremely brief, in fact. In a Center for Disease Control survey of those who made a near-lethal suicide attempt, survivors were asked how long it had been from suicidal impulse to attempt. For half, it had been an hour or less. For 24 percent, it was less than five minutes.
Barber says before she started studying suicide, she wouldn't have even thought to put five minutes or less as an option.
“The picture people have of suicidal people is that once you're suicidal you remain suicidal, but for a lot of people it's not” the case, says Barber. “There's a short-term spike, and you really want to get the person through that vulnerable period safely and hopefully figure out a way to bring the misery down.”
Crucial to bringing individuals through the vulnerable period is reducing access to lethal means of committing suicide. "There's a tremendous variety in methods of suicide," says Barber. "Most methods aren't going to kill you." And, she said, 90 percent of people who survive an attempted suicide do not die by suicide later.
Barber points to Sri Lanka as an example of the importance of means reduction. When the country took a particular pesticide off the import list, suicide rates dropped by half — not because fewer people attempted, but because the attempts were less successful.
"It's not at all an anti-gun message, but rather a suicide prevention step and hopefully a very temporary one," says Barber. "It doesn't mean gun control. We can come up with other ways — we don't need legislative policies, we can use family and individual polices to look out for one another to make sure a gun isn't misused in a suicide."
A collaborative effort
That's precisely the approach Dr. Elaine Frank and Ralph Demicco took in New Hampshire, with gun owners, researchers, firearms dealers and health professionals working together to prevent suicide and reduce deaths.
Drawing on the Means Matters data and taking a collaborative approach, Frank and Demicco developed a packet of suicide prevention materials and mailed them to 65 to 70 gun shops around the state.
“We did one mailing and then a follow-up visit; on the follow-up visit, 48 percent were using at least one of the materials, which we thought was pretty (dang) good,” says Frank, who is the former program director of the Injury Prevention Center out of Dartmouth college.
The packet included materials for both staff reference and display, including posters, tip sheets, lifeline cards and sale checklists. The NHFSC also compiled brochure, adding an 11th commandment about suicide prevention to the traditional “10 Commandments of Gun Safety.”
“Most of the gun shop folks had really never thought about firearm suicide in a systematic way. Almost everybody had a pretty direct experience with suicide by firearms, but they didn't realize how widespread and they didn't know that guns were the leading method,” says Frank.
The NHFSC is now working with volunteers in four different states to implement similar suicide prevention programs through those who are most at risk: the gun community.
“We just want to make sure that when somebody else adopts the program they have that same balance of pro-gun groups and anti-suicide groups,” says Frank. “We don't want either side to predominate — it needs to be both.”
The Schneiders embody that balance. Regina Schneider is a firearm owner in Maryland, and her husband, Stephen, owns several firearm shops and is the president of the Maryland Licensed Firearm Dealer Association.
The Schneiders, among others, are working on revising the New Hampshire materials for Maryland and will send them to “every licensed firearms dealer and every (firing) range in the state.”
Means reduction training and gun shop owner materials are just one part of comprehensive suicide prevention, and it's too early to tell if such projects will be effective in suicide reduction. Most firearm suicides occur with already owned guns — not purchased specifically for that purpose. Plus, trends in suicide may change. According to the CDC, rates of suicide by suffocation, not firearms, are increasing among young people.
"Whether it's going to save lives or not, I don't know," says Barber. "Hopefully in 10 years, every gun safety class and website will have a section on suicide awareness."
It's also crucial that families and individuals work to prevent suicide. Offering to hold guns for friends or extended family who are struggling is a means of prevention. And if someone in the household is struggling, be sure to lock up firearms and other lethal means. According to Means Matter, of firearm suicides among youth teens, 85 percent are committed with the family gun.
“Be supportive and nonjudgmental in talking to that family member; be actually a part of them getting help,” says Regina Schneider. “And if the family does have firearms, they really need to know that they can't just hide the key someplace — the guns have to be locked securely. They need to either have a combination safe or a key-type safe where the key is not kept anywhere where the (person at risk) could possibly access those firearms.”
Regina Schneider says that even if parents think the key is hidden, teens often know where it is. She recommends storing ammunition separate from firearms or giving firearms to a trusted neighbor or relative to store out of the house completely during the time of crisis.
“Safe storage is not hard to do,” Schneider says. “People just have to do it.”
To view the materials created by the New Hampshire Firearms Safety Coalition, visit www.theconnectprogram.org.
If you or someone you know is suicidal, contact the National Suicide Prevention Lifeline at 1-800-273-8255.