Suicide accounts for more than two-thirds of the 32,000 firearms deaths the United States averages every year. Or, to come at the issue a different way: Suicide is the second-leading cause of death for Americans aged 15 to 34, and more than 50 percent of cases involve guns. A big reason for the prevalence of firearms in suicides is the deadliness of guns themselves: When a firearm is used in a suicide attempt, there’s an 85 percent chance of it being successful. Whatever numbers you look at, they point to a significant public health problem. But because of a host of misconceptions and a lingering social stigma, suicides by firearm receive little popular attention.
According to Liza Gold, a clinical professor of psychiatry at the Georgetown University School of Medicine and editor of the forthcoming Gun Violence and Mental Illness, a lack of information about gun suicides makes preventing them increasingly difficult for mental health professionals. In a conversation with The Trace, Gold spoke about the biggest myths about firearm suicides, and why there’s no such thing as safe gun storage when a family member is in crisis.
The Trace: Why don’t we hear as much about gun suicide as we do about homicides and unintentional shootings?
Liza Gold: Culturally and historically, suicide has always come with a high level of shame and embarrassment. People don’t talk about it because they don’t know how to talk about it and they’re not given permission to talk about it. It’s also true that in most suicides, there is some connection to mental illness, which is highly stigmatized. People don’t want that associated with their families, so when suicides do occur, they don’t list the cause of death or they don’t count suicide as the cause of death.
The negative stereotyping also makes it difficult for people to ask for help, because they aren’t educated about the warning signs and they don’t necessarily know how to intervene.
As a society, though, I think we have to move towards a new social norm where we assume that people who are in a crisis of any kind — social, mental, addiction-related, or whatever — that those people might have access to a firearm. And we have to ask them, “Do you have access to a gun? Do you mind if I hold it for you until we find you some help?” That can be a friendly conversation that comes from a place of caring and concern. It’s sort of like when people are drunk and their friends take their car keys. Their friends aren’t stealing from them. They can have their car back the next day. But their friends are preventing them from becoming a fatality and maybe killing themselves or others, which they probably don’t want to do.
Does that mean access to a firearm is really only a risk factor for people showing clear signs of mental illness?
No, because suicides are often impulsive, meaning that there’s a very short time between the decision and the action. Seventy-five percent of suicides occur in the home, and many are also fueled by alcohol, which decreases inhibitions and increases impulsivity. With or without mental illness, someone could be sitting at home, going through a crisis. For kids, that tends to be an emotional or a relationship crisis, for adults it’s often a financial or marital crisis, and for older adults, it happens to be medical problems, especially dementia.
So, you have a person sitting at home, who may have some alcohol in their system, and they may impulsively decide that they’re going to kill themselves. Well, to do that, they’re going to use what’s at hand. And there are guns in over a third of the households in the United States, making them both lethal and easily accessible. If you know you have people going through those kinds of problems in your home, there is no such thing as safe gun storage. And there might not be any indication that someone is even considering suicide.
What would you say to people who argue that there’s no point to locking up a home’s firearms because people in crisis or with suicidal impulses will find some way to get a gun, or will just find another way to kill themselves?
That’s called means substitution, and studies show that there’s not a lot of evidence for it. First of all, research demonstrates that for every step you put between somebody and a firearm, you also decrease suicide and injury and homicide rates. For example, the suicide rate decreases about 10 percent if you keep a gun in your house unloaded. And then it decreases another 10 percent if you keep it locked and unloaded, and then another 10 percent if you keep it locked, unloaded, and keep the ammunition locked somewhere else. If you prolong the time that it takes someone to kill themselves, there’s more time for them to change their minds.
But let’s say that there was 100 percent means substitution, and someone found another way to attempt suicide. There’s not a lot of evidence that people will do that, but there’s also just no other method of committing suicide that’s as lethal as using a firearm. Even if someone then tried to overdose on pills or hang themselves, which is the second most common way to attempt suicide, it’s more likely that their method would fail or someone would intervene in time. And a lot of times, those people go into treatment and they don’t go on to kill themselves. In fact, of those people who attempt suicide and survive, only about 10 percent end up dying from suicide. So if you save someone’s life from a suicide attempt, there’s a very good chance that you really are permanently saving their life.
What do you say to those people that say gun suicides shouldn’t be counted with the total number of firearms deaths?
No, no, no. Firearm violence is firearm violence. Let’s say you work in a hospital and you have 100 people with lung cancer, and 50 percent of them have it because they were smokers. Are you going to say to the smokers, “Your cancer is not as important because you were smoking and you should have known better?” I don’t think so. You treat them exactly the same. So, firearm violence is firearm violence, whether it’s committed against oneself or committed against others. It’s all bad. And everyone who dies from a firearm injury has died prematurely from a preventable cause. They’ve died too young. Whether it’s a two-year-old shot by their 10-year-old brother, or a mass shooting, or someone who committed suicide.
There are also a lot of arguments about intervention methods and whether they should even be implemented. About 20,000 people die every year by committing suicide with a firearm. Let’s say we only save five percent of people by having everybody be required to use a gun safe to store a gun. Well, that’s still 1,000 people a year. Suicides are devastating to families and communities — they rip people’s lives apart. So, even if we “only” saved 1,000 people a year, that’s more than the number of kids who are unintentionally shot and killed every year, and we’re also protecting the many people who are impacted other than the victim.
There seems to be this standard that a gun measure has to be 100 percent effective for us to consider using it. I mean, we use speed limits and we don’t expect those to be 100 percent effective in preventing car accidents. We use traffic lights, we don’t expect those to be 100 percent. We still use seat belts. We don’t expect any other kind of public safety intervention to be 100 percent effective, so why is that the standard to which gun violence interventions are held?
The data shows that the gun homicide rate dropped significantly in the late 1990s and have more or less held constant since then. But the gun suicide rate never dropped as much, and recently it’s actually increased slightly. How do you account for that?
I can’t really tell you because the data only goes back so many years. What is interesting is that firearm suicide used to be primarily a phenomenon limited to men, but the incidences of women shooting themselves have been increasing.
There used to be the very sexist explanation that women didn’t commit suicide with guns because they didn’t want to disfigure themselves. They took overdoses so they didn’t look bad when they died. There’s no scientific evidence that supports that. The reason is that people kill themselves with what they have handy, and more men had guns than women, by far. Well, that’s starting to change.
[Photo: Flickr user Ashley Rose]