Interventions Promoting Safe Storage of Firearms: Time and Space

The Second Amendment – The Right to Bear Arms – just reading those words can elicit a myriad of thoughts and feelings; some logical, some less so, and all nuanced. The fact remains, however, that the right to own firearms is an important part of American culture and, for many, critical to individual identity. Here in Maine, the nation’s most rural state, gun ownership is highly personal to individuals concerned with safety, sports, hunting, and collecting. Regardless of current debates, firearms are here to stay.

Mental health needs are also not going away but, rather, increasing almost exponentially. More than 1 in 5 people nationwide are experiencing mental health issues, with Maine’s population landing in the higher-than-average category at 25% of our population having a mental health condition¹. The suicide rate here is also higher than average: 18.1% vs the national average of 14%^2,3. It is the second leading cause of death for young people. Suicide is indeed a public health crisis.

Now, putting together firearms and mental health, one no doubt sees a strong connection. Research does, in fact, demonstrate that access to firearms is associated with increased suicide risk and that handguns especially elevate that risk⁴, as does keeping handguns loaded when not in use and the use of alcohol in coping⁵. Firearms availability indeed contributes significantly to suicide deaths; there is a positive correlation between ease of access and suicide attempts.

Nationally, firearms are used in more than half of suicide deaths³, and in more than three-quarters of suicide deaths in Maine⁶. Unfortunately, the stigma attached to suicide, and the politics surrounding guns, makes it difficult for many to discuss the issue, even when it pertains to healthy living. Indeed, mental and medical health can talk about smoking, mindfulness, exercise and other beneficial decisions. As mental health professionals, we likely have talked with someone about self-harm and suicidal ideation. We may make safety plans. We are mandated to report. We may have talked about locking up medications or knives, read about bridge barriers, given helpline information…but many hesitate to screen for or specifically discuss suicide and firearms. One reason for this is that many practitioners lack knowledge about how to have such polarizing conversations without putting rapport at risk.

Nevertheless, research demonstrates that having those conversations about suicide and firearms safety can cause actions that directly intervene between the time one decides to act, and the attempt. This is important because we know that this interval can be as short as 5 or 10 minutes⁷. We also know that the method by which one decides to act typically doesn’t change, even when that means is restricted⁸. Finally, studies demonstrate a significant reduction in attempts and deaths when practitioners discuss access to firearms⁹. Thus, practitioners may hold crucial, lifesaving roles when properly educated and informed about safe storage. I wish I had known this myself a few years ago when my own practice was affected by a firearms-related suicide loss.

In the February 2024 APA Council of Representatives meeting, a resolution was adopted entitled, “RESOLUTION ON THE SECURE STORAGE OF FIREARMS AND LETHAL MEANS SAFETY STRATEGIES TO PREVENT SUICIDES.” This resolution calls upon psychologists to seek training in and to promote safe storage of firearms. Note that this is a resolution to encourage, not mandate (as was a concern during debate.) It is, nonetheless, an important consideration in suicide prevention. You can read the entire resolution here:

APA Resolution on the Secure Storage of Firearms and Lethal Means Safety Strategies to Prevent Suicides

Training is affordable, and practitioners are not required to own or advocate for ownership of guns. We need only to know if guns are available to the at-risk client and how we might become more comfortable in discussing safe storage. This can lead to an increase in time between planning and acting. It can save a life.

There are several programs wherein psychologists can find training. For example, the Veterans Affairs office has both written and video trainings available, as well as an online toolkit for use in the community. Additionally, CALMAmerica is an organization based out of New Hampshire, offering both online and in-person training to mental health providers. It addresses how to work collaboratively with at-risk clients and their families on methods for reducing access to firearms and other lethal means. These trainings can take between 1 and 3 hours, and include familiarization with gun safes or lock boxes, biometric storage, and trigger and barrel locks. They discuss reasoning for storing ammunition separately from the firearm as well as how to address off-site storage. Specific aspects of safety plans may also be discussed. In short, it might take very little to make a considerable difference.

To recap, Maine has high firearms ownership and high mental illness rates. Access to firearms increases the risk of suicide deaths. The more time elapsing between suicide plans and suicide actions, the greater chance of an intervention (time, interruption, impulsivity quelled, re-thinking, and reaching out for help, for example) that can save a life. Psychologists have a distinctive opportunity to contribute to that time and space. Training in that area is available and readily accessible.

References

1. Mental Health in Maine – NAMI Maine Stats and Facts
2. Amid national increase in suicide deaths, Maine sees decline | Maine Public
3. Suicide Data and Statistics | Suicide Prevention | CDC
4. Studdert DM, Zhang Y, Swanson SA, et al. Handgun ownership and suicide in California. N Engl J Med2020;382:2220-2229
5. Army Suicide Prevention Activities Focus on Reducing Lethal Means | Article | The United States Army
6. Report: Maine’s proportion of firearm deaths by suicide is significantly higher than the nation | Maine Public
7. Paashaus L, Forkmann T, Glaesmer H, Juckel G, Rath D, Schönfelder A, Teismann T. From decision to action: Suicidal history and time between decision to die and actual suicide attempt. Clin Psychol Psychother. 2021 Nov;28(6):1427-1434. doi: 10.1002/cpp.2580. Epub 2021 Mar 16. PMID: 33687121.
8. Yip PS, Caine E, Yousuf S, Chang SS, Wu KC, Chen YY. Means Restriction for Suicide Prevention. Lancet. 2012;379(9834):2393-2399.
9. Boggs, J. M., Beck, A., Ritzwoller, D. P., Battaglia, C., Anderson, H. D., & Lindrooth, R. C. (2020). A 62 Quasi-Experimental Analysis of Lethal Means Assessment and Risk for Subsequent 63 Suicide Attempts and Deaths. Journal of general internal medicine, 35(6), 1709–1714. 64 https://doi.org/10.1007/s11606-020-05641-4
10. Sale E, Hendricks M, Weil V, Miller C, Perkins S, McCudden S. Counseling on Access to Lethal Means (CALM): An Evaluation of a Suicide Prevention Means Restriction Training Program for Mental Health Providers. Community Ment Health J. 2018;54(3):293-301.