A mental health awareness sign along 17th Street in Salem on Dec. 1 (Rachel Alexander/Salem Reporter)
Firearms instructor Brett Bass grew up in a gun-owning household. He joined the Marines, became an expert marksman, and found himself employed as a gun range manager in a Seattle suburb.
One day, his boss at the Bellevue Gun Club received an invitation for a forum on suicide prevention and gun violence. He suggested Bass go instead.
When Bass showed up, he was the only firearms expert on a daylong agenda put together by a gun-control group.
Efforts to reduce U.S. gun violence are largely framed around homicides and mass shootings, so gun owners and non-gun owners alike often are surprised to learn that most U.S. gun deaths are suicides.
About half of all suicides are completed with guns, even though firearms are used in only 1 percent of suicide attempts. People at highest risk of firearm suicide belong to gun-owning households, not because they are more likely to attempt suicide, but because those attempts are more likely to be fatal. In a home, the single biggest predictor of death by suicide is an unlocked and loaded gun, which increases suicide risk by 300 percent, multiple studies have shown.
In June, a 12-year study of 26 million California residents found men who owned handguns were three times as likely to die by suicide than those who did not own handguns, while women handgun owners had a seven times higher rate of suicide than those without handguns, researchers reported in the New England Journal of Medicine.
Finding effective ways to prevent firearm suicides could address up to three out of every five U.S. gun deaths — and even more in Washington, Oregon, and other western states, where suicide rates and gun ownership are higher than the national average and rising.
At the gun-control conference, Bass asked for a show of hands of gun owners. About one-third of Washington residents owns at least one firearm. But only two other hands went up in this audience of about 200 health professionals gathered to discuss strategies to prevent firearm suicide.
It was wildly apparent to Bass that almost no one there had any idea how to talk about basic concepts in gun safety with firearms owners — as he pointed out to them, like the staff sergeant he was — despite their professional mandate to learn about and respect the different world views, beliefs, values, and attitudes of the people they serve.
And how did several hundred health experts react to Bass telling them how to do their jobs? They gave him a standing ovation.
In the last few years, variations on this scene have been playing out across the country. Gun owners and health professionals are coming together to devise new solutions to the public health crisis of suicide.
“It’s not always easy,” says Jennifer Stuber, a professor of social welfare at University of Washington. Stuber co-founded Forefront Suicide Prevention two years after her husband, a lawyer, killed himself with a gun in 2011. “But having everyone at the table is exactly what needs to happen. The conversation has not been focused on firearm suicide.”
The newly influential voices of gun owners in public health are changing the conversation — and not only in the Pacific Northwest.
In recent years, similar state coalitions have sprung up across the country. New Hampshire is the home of the original Gun Shop Project, a mix of firearm retailers, range owners, and firearm rights advocates who helped develop materials and training to prevent firearm suicide.
The collaborative spirit has spread to Colorado, Utah, and beyond.
In Oregon, preliminary discussions are underway among nonprofit groups, local and state health officials, and military and veteran organizations about forming a firearms safety coalition with the explicit goal of involving gun owners, firearm-related business representatives, and gun rights advocates in suicide prevention.
“For so long, gun owners have been left out of the suicide conversation,” says gun rights lobbyist Clark Aposhian, chair of the Utah Shooting Sports Council, the state’s largest gun lobbying group.
Some gun owners are taking the initiative. Two years ago, Michael Sodini, president of his family’s military-style gun import business, founded Walk The Talk America. The Nevada nonprofit quickly became his main gig. He partnered with Mental Health America, sold his company, and has persuaded several gun makers to insert suicide prevention fliers into their new gun boxes.
“You can defend your rights and also offer solutions,” Sodini says.
Brett Bass conducts education and training to get the message about suicide prevention to gun owners and advocates.
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Her husband’s death was a brutal lesson for Stuber about the widespread misinformation and lack of firearm suicide prevention skills among health professionals, gun owners, and the public.
Suicide is the tenth leading cause of U.S. death, she learned, but it doesn’t have to be. Most people with suicidal thoughts show some warning signs that friends, family and well-placed strangers can learn to recognize and take recommended steps to intervene. Research shows “for every one person who dies by suicide each year, there are 280 people who seriously consider suicide but find a way forward and go on to live their lives,” says Donna Harrell, spokesperson for Lines for Life, a Portland-based nonprofit that runs crisis help lines for adults, teens and veterans.
“It’s a myth that, when someone wants to die, there’s nothing you can do to prevent it,” Stuber says. “My husband died because no one knew what to do. If he had had a different set of interventions, he would be very much alive.”
She identified another problem. Suicide prevention is not a standard part of firearms purchasing or gun safety training. Stuber cold-called the National Rifle Association to ask why. It was a surprisingly productive call on a potentially touchy topic.
That call led to others. She looped in her state’s NRA lobbyist and recruited a divergent group of people and organizations in Washington state to craft the first round of legislation.
“It’s in the interest of gun owners to sit down at the table,” says Alan Gottlieb, founder of the Second Amendment Foundation, a national organization based in Bellevue, and co-chair with Stuber of the Safer Homes coalition. “It’s all about preventing suicide, and not about other issues. We have to talk about the problem in a way that doesn’t threaten gun owners. We have to talk about safe storage when people are a threat to themselves or others.”
With overwhelming bipartisan support, the Washington state legislature passed the nation’s first law in 2012 to require continuing education in suicide risk assessment and treatment for certain licensed health professionals. The training mandate later expanded to school-based counselors.
Since then, after a ballot initiative passed to make firearm transfers illegal, the Safer Homes task force pushed for an explicit exemption for people at risk of harming themselves or others.
After Stuber heard Bass at the firearms suicide forum, she recruited him to the task force and hired him two years later. Bass now leads the Safer Homes firearms community outreach programs. One project pairs suicide prevention and gun safety education with free storage devices and medication disposal kits distributed at gun shows and community events.
In September, the team took their message national, thanks to task force co-chair Alan Gottlieb, who booked them for the annual Gun Rights Policy Conference. The meeting moved online, like so many pandemic events, and found an even larger audience.
Dr. Jeff Sung, a Seattle psychiatrist and task force member, briefed the audience on what it’s like to go into and come out of a suicidal thought process to show how safely stored guns can protect people in the home.
“A suicidal crisis is not fatal in and of itself,” Sung says. “The vast majority of people get through it. Research shows that when people don’t have immediate access to a lethal method, they find a way to get through suicidal crisis, and find a way to reconnect with life, reconnect with a new sense of purpose.”
Stuber’s husband purchased a gun four hours before he killed himself, but that happens less than 10 percent of the cases. Most firearm suicides happen with legal, longstanding firearm ownership, Sung says.
The demographics of U.S. firearm suicide lean heavily toward men (86%), white (91%) and adult (86%), also known as “men in the middle.” Guns are used in 70% of veteran suicides.
Women attempt more often, usually with less lethal means, but women veterans are more than 300 percent likely than their civilian counterparts to die by gun suicide.
Most people find their way out. “The world is filled with suffering,” Sung says. “It’s also filled with overcoming suffering.”
Since the pandemic, the Safer Homes team has followed the surge in gun sales with concern. Gun shops were open, but shooting ranges for training and safety classes were not.
Meanwhile, a national survey in June found that about twice as many adults reported serious consideration of suicide in the past month than did U.S. adults in 2018 in the past 12 months (10.7% compared to 4.3%), according to the U.S. Centers for Disease Control and Prevention.
Going virtual, the Safer Homes team put together a two-hour online firearms safety course. It explains the four universal rules of gun safety and demonstrates how suicide prevention can be part of a standard gun safety class.
Firearms are the most common and lethal means of suicide in Oregon.
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Four years ago in Utah, when gun lobbyist Clark Aposhian was approached to join the state’s suicide prevention coalition, he was skeptical. At first it sounded like another avenue to try to ban guns.
But Aposhian is a data guy. And the shocking data made a new kind of sense to him.
Nearly nine out of 10 Utah gun deaths are suicides, he learned. And nearly nine out of 10 people who attempt suicide with a gun will not survive. Yet nearly nine out of 10 people who survive a suicide attempt never go on to die by suicide by any means.
“This was something so huge, and no one was talking about it,” says Aposhian, who also owns FairWarning Training and hosts the weekly Gun Radio Utah radio show and podcast.
“If you want to drop the numbers, the biggest bang for your buck is addressing suicide,” he says. “But you don’t fix suicide the same way you fix a drive-by shooting. If we don’t do something to address it in our own culture, it will be done for us, and it won’t be pretty — a new mandate, a new law — and it won’t be as effective as the peer-to-peer relationship.”
Little is known about the effectiveness of most existing firearm suicide prevention strategies.
The research itself has been controversial. A 1992 CDC-funded study concluded “the ready availability of guns increases the risk of suicide in the home.”
In response to that and similar findings, an outraged gun lobby convinced Congress to prohibit federal funding for what they viewed as gun control research. (In this year’s fiscal budget, funding returned.)
In Utah, Washington, and elsewhere, the state firearms safety coalitions are using what evidence exists and pushing to learn more as they go. In fact, a new armistice seems to be emerging around the science itself.
“It’s a demilitarized conversation,” says Catherine Barber, director of the Means Matter program at the Harvard T.H. Chan School of Public Health in Boston, who consults on suicide prevention. “We’re all jointly looking for data to understand the problem and come up with strategies. We need to take a scientific approach. We need to evaluate what works and toss what doesn’t work.”
A key strategy in Utah, Washington, New Hampshire, Colorado, and elsewhere looks at the how, and not the why, of suicide. Studies around the world have shown dramatic drops in suicide rates by 30% to 50% when the most lethal means are made less lethal or less available.
For example, a British study traced a drop in suicide deaths there in the 1960s back to a gradual change in the source of domestic gas, from coal-based to natural gas. The resulting lower carbon monoxide made it nearly impossible to die by sticking one’s head in an oven.
A past suicide attempt is a risk factor for attempting again. But most will not try again. Even for the small subset of people with many repeated attempts, one study in Austria reported, three-quarters of the survivors went on to live lives that did not end by suicide.
The acute phase of a suicidal crisis can be brief and is often unplanned, Barber says. It can flare up once during a divorce and never come again, for example, or there can be spikes over time, such as if someone is struggling with substance abuse or mental health issues and then has a relationship breakup, a job layoff or an arrest.
“Suicide doesn’t come out of the blue, but the escalation from misery to ideation to attempt can sometimes be very rapid,” Barber says. If a gun or other chosen means is unavailable, they are more likely to survive. “A life saved in the short term is often a life saved, period,” she says.
The take-home lesson for modern day firearm suicide prevention seems straightforward: Put time and distance between a person at risk and their guns through voluntary safe storage in the home using locking devices or dismantling guns or, if necessary, getting them out of the home for a while.
This is where the technical and cultural expertise of gun owners becomes such a game changer.
Gun owners in firearm safety coalitions often compare their messaging to “friends don’t let friends drive drunk.” In their communities, they want to spread a powerful new social norm, in which friends and families of gun owners help keep loved ones safe.
That could mean friends or family holding guns, gun owners storing their weapons with the local gun dealer or police or pawning them temporarily, or having friends and families change the gun-safe combination or hold the keys.
Advocates hope the voluntary approach will help save more lives from suicide than legal interventions, such as the “red flag” laws in Oregon and Washington. More formally known as extreme risk protection orders, they allow judges to require someone at extreme risk of harm to themselves or others to turn over guns for safekeeping. A red flag order can be requested by law enforcement, family or household members.
A single catchphrase for the gun-owner-driven suicide prevention message hasn’t caught on widely, as with “designated driver.” Some slogans of different programs and campaigns include: “Means matter,” “Cause the pause,” “Hold my guns,” “End family fire,” “Be somebody’s second chance,” and “Is your safety on?”
The last one headlined a 30-second public service announcement for gun owners in Utah. In it, a man shoots twice, takes off his ear protectors, and turns to the camera.
“Last year I was at my lowest, going through some pretty serious depression,” he says. “A couple of friends stopped by the house and said they were worried about me. They said they would feel a lot better if they could hold onto my firearms until things turned around. I think they saved my life.” The voice over reinforces: “Things get better.”
“It is a tremendously optimistic message that you can get through this,” Barber says. “It took such a good approach. It started from a perspective of resilience and recovery. Non-gun people never think to frame it in a way welcoming to the gun owner.”
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For health professionals, it’s been a journey to understand the fierce gun safety culture, especially among firearm instructors, gun ranges, and sports shooting clubs. They are learning the various reasons why people own guns and what that means for safe storage.
For their part, gun owners are learning about moments of intolerable psychological distress that makes a loaded, unlocked gun risky to themselves and their family. They are strategizing on culturally acceptable ways to put time and distance between a person at risk and their guns.
“I don’t think we’re changing fundamental political views or views on ownership,” says Dr. Emmy Betz, an emergency room physician in Denver. She co-directs the Colorado Firearm Coalition with Dr. Michael Victoroff, a family physician and firearms instructor.
Firearm-informed suicide prevention leans into the beliefs and values of gun owners. “We start from the perspective that we don’t care what kind of gun you bought or why you bought it,” says Bass in Washington state. “We want you to apply the same values that led you to purchase it to the issue of how to store it or what you might do with it if you or someone in your home is in a crisis.”
People own guns for personal safety, sports shooting, collecting, professional reasons, family tradition, and hunting. Each group has its different norms and practices, but they share some common values. Protection and freedom are the top two, identified by a Pew Research Center survey.
“Their main thoughts are protecting the family from an outside risk, not protecting them from themselves,” Kyleanne Hunter told the online audience at the April 2020 meeting of the American Association for Suicidology. A Marine veteran, Hunter shared data from gun owners in focus groups designed to develop more credible suicide prevention messages for Brady’s End Family Fire campaign.
“There’s a perception gap that an intruder is the riskiest thing,” said Hunter, an instructor at the U.S. Air Force Academy. Yet, for each U.S. home invasion where defensive use of a gun is considered, even if not used, there are 30 deaths by suicide, she said.
Hunter and her colleagues asked about the single most important consideration in storing guns at home. The top answer was being able to grab a loaded firearm quickly and easily in the event of an intruder.
Most owners believe it’s essential or very important to keep most or all guns in a locked place, but just over half actually do so. The campaign landed on “Be someone’s second chance” as a safe-storage slogan to reinforce the core values of gun owners across the country.
Two other workshops at the April suicidology meeting shared similar gun-friendly cross-cultural lessons for health care providers in Washington and Oregon. In one, Bass and Sung presented gun-culture basics to help health workers become more trusted partners in firearm suicide prevention.
“People who own firearms do not view clinicians, especially physicians, as credible messengers around firearm safety,” Sung says. But a culturally competent conversation could save a life. In one multi-state study that included Oregon, nearly half of people who died by suicide had contact with their primary care provider a month before killing themselves.
But they probably did not talk with their doctors about guns.
In another workshop, Oregon State University-Cascades researchers in Bend told how they documented a culture gap between rural firearm owners and primary care providers and developed a way to bridge it.
That led to training for health care providers in how to hold effective conversations, as well as a brochure, emblazoned with the flag, eagle, and the U.S. constitution, which teaches when it’s time for trusted friends and family to hold guns temporarily.
The catchphrase on the cover is simple: “People who love guns love you.”
This story was funded by a journalism grant from the nonprofit National Institute for Health Care Management Research and Educational Foundation (NIHCM).
Carol Cruzan Morton is reporting on how existing and innovative data is helping to understanding and prevent suicides as a Health Care Performance Fellow of the Association of Health Care Journalists. The program is supported by The Commonwealth Fund.
This story is published with the permission of The Oregonian as part of a collaborative of news organizations in Oregon sharing news content. Salem Reporter is part of the arrangement.
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