There is one question Carol Runyan considers vitally important to ask the parents of suicidal teens: Is there a gun in the house?

Runyan, the director of Program for Injury Prevention, Education, and Research at the Colorado School of Public Health, knows the presence of a firearm in a home increases the odds that someone who lives there will take his or her own life. Guns are reliably lethal — research indicates that suicide attempts involving a firearm result in death 85 percent of the time, compared to less than three percent when the means is a drug overdose.

Runyan’s advice to clinicians counseling a parent who owns firearms and has a suicidal child is to tell them to get the weapons out of the home as quickly as possible. Colorado is one of 18 states that require background checks on at least some private gun sales and transfers, so this directive can be complicated to carry out. There are exceptions to the Colorado law for transfers to immediate family members, such as grandparents. There is also a waiver for temporary transfers to friends — but the latter is good for just 72 hours, which may not be sufficient time for a suicidal episode to pass.

Some other states with universal background check laws, including Massachusetts, Connecticut, and Rhode Island, don’t have any allowances at all for emergency transfers. These are the findings of a new paper, published in The Journal of the American Medical Association, which examines the legal obstacles to temporarily transferring a firearm away from a suicidal person. The authors conclude that universal background checks may have “unintended consequences” that might adversely affect suicide prevention efforts.

“When we’re making gun policy we’re thinking of the high profile incidents: Orlando, Sandy Hook, what’s happening in Chicago every weekend,” explains Runyan, one of the paper’s co-authors. “And that’s really important, too, but we don’t talk about suicides.”

Oregon is one of the few states with a universal background check statute that specifically allows for emergency transfers “for the purpose of preventing imminent death or serious physical injury.”

According to the most recent federal data, more than 21,000 people ended their own lives with a firearm in 2014 — guns account for more than half of all deaths by suicide in the United States.

Despite popular belief, most people who attempt suicide and live do not go on to make a second attempt. Which is why, Runyan says, “it’s particularly important to remove access. People who attempt with a firearm rarely get a second chance.”

On November 8, the state of Nevada approved a ballot initiative that requires a criminal background check for all gun sales, “with reasonable exceptions for family, hunting, and self-defense.” But, according to a spokesperson for Safe Nevada, the group that sponsored the initiative, the language does not carve out specific exceptions for gun transfers involving suicidal people.

The paper’s authors are quick to point out that they are not suggesting universal background check laws be scrapped. “They are critically important,” explains co-author Jon Vernick, a professor at the Johns Hopkins School of Public Health. “There is already a very persuasive body of research that tells us these laws reduce homicide and suicide.”

But statutes need to be crafted with suicide risk in mind, they say. They suggest adding specific statutory language to universal background check laws that allows for temporary firearm storage with federally licensed dealers, law enforcement personnel, family members, and friends. They also recommend extending current provisions that allow for temporary transfers to 14 days, or longer if recommended by a mental health professional.

The penalty for transferring a gun without a background check in states with a universal background check law varies. It’s a misdemeanor in some states and a felony in others.

“Whether a prosecutor would even find out about, much less prosecute, a temporary transfer to prevent a suicide is unknown,” says Vernick. “But our concern was that the very presence of the law — without a suitable exception — could deter some clinicians and gun owners.”

Paul Nestadt, a psychiatrist at Johns Hopkins University in Baltimore, is one such clinician. Typically, Nestadt says he will tell a suicidal patient that it’s not entirely clear what the law says about who they can transfer a firearm to and for how long. He says that he highly recommends his patients remove the weapon from their home as quickly as possible.

Maryland has a universal background check law, but it is silent on whether temporary transfers are allowed.

In 2006, Maryland’s high court held that citizens could transfer a regulated firearm “temporarily” to another adult. But the exception was not written into law, and Nestadt, who routinely advises suicidal patients, told The Trace he hadn’t heard of the provision until he read the new research.

Nestadt says he hopes the paper will spur legislative action that will make it easier for him and his colleagues to advise their at-risk patients.

“At the end of the day you do what’s best for the patient before worrying about liability,” he says. “But having it spelled out helps a lot.”