Russell remembers his father as a sensitive, caring man. But when his parents got divorced, Russell recalls a change in his father’s behavior. He was more impulsive and reckless. He started drinking too much and misusing drugs, including opioids, that he prescribed to his patients. One morning when Russell was 15, his mother pulled him out of his freshman English class. She told him his father was in the hospital for a self-inflicted gunshot wound. When Russell arrived, his father was on life support. He ultimately didn’t survive. For decades, Russell didn’t speak about his father’s suicide. Oftentimes it was by choice; other times it was because the subject made other people feel uncomfortable. But the entire time, Russell couldn’t stop asking himself the question, “Why?" Suicide is often a split-second decision, the culmination of a temporary crisis that may last just minutes. According to one study of about 150 suicide attempt survivors, 1 in 4 said they had thought about their decision for less than five minutes. Roughly another quarter thought about it for up to 20 minutes, and another quarter up to an hour. “Because there’s an element of the unknown. There’s the constant question of ‘why’ that is never satisfactorily answered,” he says. “If someone dies of cancer or a car crash, there’s an explanation for why they died. But with suicide there isn’t.” Russell eventually found solace in support groups and by sharing his story with others who have lost a loved one to suicide — a growing cohort in this country. Today, he is a volunteer for Moms Demand Action and a fellow with the Everytown Survivor Network, both organizations that advocate against gun violence.
Suicide Is on the Rise in the United States
That Russell’s father died by suicide was no anomoly. Suicide deaths in the United States have increased by 35 percent in the last 20 years, according to the American Psychiatric Association (APA). That accounts for over 830,000 deaths, with more than 45,000 in 2020 alone, according to the Centers for Disease Control and Prevention (CDC). It was also the second-leading cause of death that year for people ages 1 to 44. Additional data from the CDC (PDF) shows that firearms have long been the most common method for suicide among males in the nation, like in Russell’s father’s case. In 2020, it became the most common method among females as well. Gunshots are also the most deadly means of suicide attempts, with more than 8 in 10 attempts leading to a fatal injury, per the Harvard T.H. Chan School of Public Health in Boston. The CDC also reports that fatal firearm injuries account for more than half of all suicide deaths in the United States. The percentage of suicide deaths by firearm is even higher among veterans, a group that already has much higher suicide rates than the civilian population. In 2018, for every 100,000 veterans ages 18 to 34, over 45 died by suicide — the highest rate of suicide among any veteran age group, and nearly 3 times the rate of civilians of the same age, according to the nonprofit RAND Corporation. Of all veteran suicides that year, 70 percent were the result of a firearm injury, according to the Department of Veterans Affairs.
Guns Turn Momentary Crises Into Deadly Ones
According to Matthew Miller, MD, co-director of the Harvard Injury Control Research Center in Boston, past research has found that while gun owners are more likely to die by suicide, they are not more likely to attempt suicide compared with non-gun-owners. The difference is that gun owners at risk of suicide have access to a highly lethal method than non-gun-owners do not. “Eliminating firearm access would give these people in crisis a second chance,” says Lauren Khazem, PhD, a research assistant professor in the department of psychiatry and behavioral health at Ohio State University in Columbus, who also works with the university’s Suicide and Trauma Reduction Initiative for Veterans (STRIVE). Dr. Khazem stresses that the point of gun safety and suicide prevention is not to eliminate firearm access altogether, or for an indefinite period of time. “It’s a temporary solution until a crisis passes. Firearms are a lot of peoples’ identities, a lot of peoples’ cultural backgrounds, and we don’t want to take that away from anyone,” she says. “But we want to balance that with safety in times of crisis.” Dr. Miller adds that in an ideal intervention, a person’s firearms are temporarily removed during a crisis period and returned at a time mutually agreed upon by both the gun owner and the person temporarily storing the firearm. “If you can prevent someone’s suicide today by making it harder to reach for a gun, you not only saved their lives today, but likely in the long run. We know people who have attempted suicide are more likely to attempt it again in the future,” Miller said.
Creating Time and Space Between People and Guns Can Save Lives
According to the research from the Harvard University T.H. Chan School of Public Health, how lethal a method of suicide is relies on five factors — but only one is the inherent deadliness of a particular method. The other four are:
How acceptable the method is perceived by the person in crisisThe ability to stop mid-attemptAccessibilityEase of use
Crucially, accessibility and ease of use can both be mitigated if proper gun safety precautions are followed, says Janel Cubbage, MPH, a licensed clinical professional counselor in Pikesville, Maryland. Cubbage also works as a suicidologist, studying suicide prevention at a public health level, and serves as a program manager at the Center for Gun Violence Solutions at the Johns Hopkins Bloomberg School of Public Health in Baltimore. According to Cubbage, creating time and space between a person in crisis and lethal means like firearms plays a huge role in preventing suicide deaths. Even just a few minutes can make a difference. “The crisis period for a suicidal crisis can be very brief but powerful,” Cubbage says, noting that research has found that a suicidal crisis often lasts for as little as five minutes to an hour. According to the U.S. Department of Veterans Affairs, people who are planning to die by suicide also don’t typically seek other methods if the one they’d planned to use is not available, nor will people attempt suicide if safeguards that are in place make the method more difficult. Cubbage says that setting up barriers to gun access, then, can buy lifesaving time. Some examples are:
Storing guns in a locked safeUsing a gun lockStoring ammunition separatelyStoring firearms outside the home, such as at a gun range or store, or even a law enforcement agency
If a loved one is not willing to let someone else temporarily store their firearms during a mental health crisis, implementing these types of safety measures could be a potential compromise that still creates time and space.
Gun Regulation Can Prevent Suicide Deaths — to a Point
Laws that create time between a person’s intent to purchase a gun and acquiring a gun can save lives, too. In a study published in 2015 in The American Journal of Public Health, researchers reviewed the impact on suicide rates of three types of state gun regulations: permit to purchase a handgun, registration of handguns, and license to own a handgun. The results showed that states with any of these laws had fewer suicide deaths by firearm compared with states without such regulations. In addition, some states, such as New York, have so-called red flag laws, also called extreme risk laws, which allow a loved one to express concern through a civil court process and temporarily remove a loved one’s firearm or prevent them from buying one if they believe their loved one is at risk for suicide. However, Miller notes that while it can help, legislation alone cannot make a significant difference in suicide deaths. “You will have a much larger effect on the population if you change the way people think about guns, and legislation isn’t going to do that,” he says. Instead, Miller says, big change can happen “through education, getting people to talk about these issues, and getting people to understand that when people live in places with fewer guns, thousands less die of suicide every year even though they don’t attempt it less.”
Mental Health Care and Access Both Play a Role
According to Miller, mental health care plays an important role in preventing suicide attempts, but preventing access to the most lethal means of suicide is key to preventing suicide deaths. Mental health care can only do so much if a person is in crisis, and because every person is unique, the same approach doesn’t work for everyone. “We don’t know what effect ‘ideal’ mental health therapies would have on suicide because we don’t have them. We do know that we can prevent people from taking their own lives, even if you don’t do anything to alter their underlying psychiatric problems, by making it harder for them to access guns,” Miller says. “Guns play a causal role. Access matters,” Miller adds.
Talking to a Loved One About Suicide and Gun Safety
Although there are known risk factors, such as anxiety, depression, and substance use disorder, suicidal behavior is very unpredictable, says Miller. On top of that, a study published in May 2022 in JAMA Network Open found that people who are suicidal and who own guns are less likely to be detected by screening questions that asks about suicidal thoughts. “You can’t wait until suicidal signs are showing to reduce access to firearms,” Miller says. “If someone is going through a hard time, they are at risk.” According to Khazem, collaboration is crucial if you plan to approach a loved one about their suicide risk and temporarily reducing their access to firearm. “It’s important to have these conversations in a collaborative manner, so everyone has input on where the gun storage can take place and when they can get it back if that’s something that someone in crisis wants,” she says. Cubbage adds that it’s also important to ask direct questions. “Ask, ‘Are you thinking about suicide?’” Cubbage advises. “If we use euphemisms, we run the risk of not being on the same page. We want to be direct in our asking and show compassion.” Some additional questions she suggests asking:
How or where are your guns and ammunition stored? Are they locked?Are you willing to put your guns in someone else’s care until you’re in a safer place?Can I help connect you with someone to talk to? Are you comfortable talking to me about what you’re feeling?
Cubbage recognizes that these conversations are tough and sometimes anxiety-provoking, but that initiating them is often the hardest part. “If you focus on being present with the other person, things can start to flow. It doesn’t mean you won’t feel anxious or uncomfortable during the conversation, but you — and the person you reached out to express care and concern for — will probably be glad you did,” she says.
