Tuesday, November 20, 2018

Reducing Firearm Deaths Requires Greater Attention to Suicide Prevention

Mental health advocates must work to ensure that suicide is front and center of conversations about gun violence, Jeffrey Swanson, Ph.D., a professor of psychiatry at Duke University, wrote in a commentary in Psychiatric Services. Swanson is an expert in the epidemiology of gun violence.

“The national conversation about gun violence tends to focus on senseless rampages by troubled young men while public officials pay lip service to an oversimplified, gun-ignoring solution: ‘fix mental health’,” Swanson noted. However, “suicide is a public health problem that is twice the size of the homicide problem—13.4 versus 6.1 deaths per 100,000 people in 2016, and the number of suicide decedents dwarfs the number of mass shooting victims.”

Swanson noted that the suicide crisis “sits squarely at the intersection of inadequate (or poorly implemented) gun laws and a failing mental health care system.” Mental illness is most often the reason that people try to end their own lives, and access to a firearm used to die by suicide is most often the reason they do not survive, he wrote. “Although there is lingering social stigma and moral approbation associated with suicide, there is also a growing public understanding that most suicides (unlike most homicides) result from a serious mental illness for which the person bears no blame.”

Swanson pointed to the enactment of risk-based, time-limited gun removal laws as a good example of an intervention that would reduce gun violence and suicide deaths. A number of states have laws that use a civil court process to give police officers clear legal authority to search for and remove firearms from people who pose a significant risk of harming themselves or others. The law can be used to prevent acts of gun violence toward others, but the most common use is to separate guns from someone in a suicidal crisis, Swanson wrote.

“We have known for decades that people with serious mental illnesses carry a risk of suicide many times greater than that of people who do not have these illnesses. We have also known that guns are an extremely lethal means of intentional self-injury; nearly 90% of suicide attempts involving firearms result in death, compared with less than 10% of suicide attempts using most other methods,” he wrote.

“Better identification and more effective treatment delivered to people with severe mood disorders, alcohol problems, and other psychiatric maladies would surely prevent many from trying to hurt themselves. And keeping guns out of the hands of suicidal individuals could prevent many more from dying. We should use the levers of public policy to do much more on both fronts.”

For related information, see the Psychiatric News article “Resource Document Offers Clinicians Guidance on Risk-Based Gun Removal Laws.”

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