"Say what you have to say, and not what you ought."
~ Henry David Thoreau

Sunday, January 13, 2013

Suicide and Guns

Although I try not to get too political on this blog, today is an exception. There have been many things I've wanted to write and share since the tragic school shooting in Newton, Connecticut and the ensuing national argument about gun control. I have very strong opinions on the subject, and personally feel our government leaders need to take immediate, strong action to strengthen gun control laws. My reasons for thinking this way are perhaps different than many others, and are very personal. I work to prevent suicide. Guns are overwhelmingly the weapon of choice in a large number of suicides, including suicides-by-cop and murder-suicides. In an email received the other day from the QPR Institute for Suicide Prevention, its President and CEO, Dr. Paul Quintett, said this: 

"We at the QPR Institute are concerned that the national debate following the Sandy Hook tragedy is veering off course.

Almost no one has noticed that most mass murderers take their own lives or are killed by police gunfire (suicide-by-cop).

So long as America remains uninformed about the role suicidal self-directed violence plays in these tragedies, and in domestic violence murder-suicides as well, our debate will not lead to new possible solutions."

Last week, The QPR Institute was asked by the American Psychological Association for recommendations to reduce gun violence in America. The APA will share these recommendations with federal officials as they discuss new gun violence prevention strategies.  The recommendations, which I fully endorse, are below. My hope is that by sharing them, others will read them and perhaps change their perspective on gun control and the need to reduce gun violence in this country. Gun violence is a serious national health issue, as is suicide. I believe both can be reduced by following the common sense, evidence based recommendations outlined below. 

Prevention Strategies to Deter Mass Shootings and Reduce Gun Violence: Recommendations and Resources

© 2013, Paul Quinnett, Ph.D., President and CEO, QPR Institute, Inc.
(This document may be widely shared, reprinted and distributed without permission.)

To prevent the next gun violence tragedy we believe America needs science-based, constitutionally-appropriate, community-based interventions which are available now for immediate implementation. For each recommendation below, web sites or links to best practice programs are included.

Following the tragedy at Newtown, the premise for these recommendations is the observation that most mass murderers either take their own lives or expect to be killed by police (“suicide-by-cop”) after committing multiple homicides, e.g., Lanza, Cho, Harris, Klebold, and others.  In addition, among the far more common “simple” suicides (those not involving a homicide—approximately 39,000 deaths a year), over half are by firearm.

These evidence-based recommendations target several sectors of our society: the general public, health professionals, gun dealers, gun owners and law enforcement professionals.

For the General Public, Health Professionals, Gun Dealers and Citizen Gun Owners:

1.     Train the general public to recognize suicide/homicide warning signs among their family members, friends, students, co-workers and throughout their social networks.

Then teach them to intervene as follows:
-Clarify the meaning of the warning sign(s) with the person
-If in distress, intervene to get the person immediate help
-Restrict access to firearms, e.g., immediate removal, off-site storage, key gun part removal, locks
-Train all gun owners in the“11th Commandment” of responsible firearm ownership: Keep firearms from distressed persons

2.     Train firearm dealers to recognize distressed persons attempting to purchase guns, how to delay or deny the sale and how to make a referral for assistance or secure a mental health evaluation when warning signs are present.

3.     Educate mental health and health professionals on the overlap of suicidal/homicidal desire and intent, and legally mandate training in how to detect, assess, and manage suicide/homicide risk. This training deficit accounts for many missed opportunities to reduce gun violence and deter mass shootings (http://www.sprc.org/bpr/section-II/preventing-suicide-through-improved-training-suicide-risk-assessment-and-care). In recognition of this potential public health hazard, in 2012 Washington State passed a law “requiring certain mental health professionals to complete education in suicide risk assessment, treatment and management.” http://apps.leg.wa.gov/documents/billdocs/2011-12/Pdf/Bills/House%20Passed%20Legislature/2366-S.PL.pdf

For each of the above recommendations, the following best practice and evidence-based programs are now available:
1.     General public training in suicide prevention
-       http://www.sprc.org/bpr, e.g., QPR, CALM, and others
2.     Firearm dealers, gun safety instructors, gun and hunter club training
-       http://www.sprc.org/bpr, CALM
3.     Health professional training
-       http://www.sprc.org/bpr, Section II “Adherence to Standards” programs

For Law Enforcement Professionals:

1.     Using best practice registered programs, train law enforcement officers in how to:
-       Recognize the warning signs of suicide/homicide and how to conduct a simple 3-step CPR-equivalent emergency intervention
-       Conduct a suicide risk assessment interview using the same methodology used by thousands of mental health professionals, and of particular value to officers responding to domestic violence calls, jumpers and others
2.     Enhance the mental health/suicide/violence prevention literacy and skills of law enforcement officers by providing training about:
-       Their key role in the National Suicide Prevention Strategy 2012
-       Successful violence prevention interventions, e.g., the US Air Force project and means restriction strategies (www.meansmatter.org)
-       The link between mental illness/substance abuse and violence
-       Evidence-based risk mitigation/intervention strategies
-       How to prevent suicide inside the law enforcement community itself
-       How to develop community partnerships with firearm dealers, gun owners, gun safety instructors, hunting clubs and others to enhance gun safety and restriction of access to firearms though teaching the “11th Commandment” of responsible firearm ownership: Keep firearms from distressed persons

To enact these recommendations, the following best practice and evidence-based programs are available now:

Key References:

Barber C, Azrael D, et al., Suicides and suicide attempts following homicide: Victim–suspect    relationship, weapon type, and presence of antidepressants. Homicide Studies, August         2008 vol. 12 no. 3 285-297

Feldman, B. N., & Freedenthal, S. (2006). Social work education in suicide intervention and prevention: An unmet need? Suicide and Life-Threatening Behavior, 36, 467-480. doi: 10.1521/suli.2006.36.4.467

Institute of Medicine. (2002). Reducing suicide: A national imperative. Washington, DC: The National Academies Press.

Knox. K.L., Litts, D.A, Talcott, G.W., Feig, J.C., Caine, E.D., (2003). Risk of suicide and related adverse outcomes after exposure to a suicide prevention programme in the U.S. Air Force: cohort study. British Medical Journal. 13, 327 (7428)

Luoma, J. B., Martin, C. E., & Pearson, J. L. (2002). Contact with mental health and primary care providers before suicide: A review of the evidence. American Journal of Psychiatry, 159, 909-916. doi: 10.1176/appi.ajp.159.6.909

Slovak, K., & Brewer, T. W. (2010). Suicide and firearms means restriction: Can training make a difference? Suicide and Life-Threatening Behavior, 40, 63-73. doi: 10.1521/suli.2010.40.1.63


  1. This issue with guns is on a lot of minds. I have a couple of conservative cousins whose Facebook posts for the last two weeks have been on guns alone, and our right to have them.

    I heard in a discussion the other day, from a mental health professional in attendance, that the antidepressant Prozac is known to have suicidal thoughts as a side effect. She said that every one of the recent mass shooting perpetrators had been on it. I don't know whether that's entirely true. But I believe guns are not the issue. People are the issue. And as long as they are suffering from depression or another mental health issue, there will be risks. I wish the money and attention could be directed to the people.

  2. Much to chew on here. I've also thought much about those who are involved in the mass shootings also taking their own lives in the process. Some do not, but it seems most do. As Linda said, I also wonder about the side effects of some antidepressants.

    There is much that needs to be done in educating the public about suicide and suicidal tendencies. Gun control is just one issue in this matter, but it is one that must be addressed. Ironically, Vice President Biden said, "There is no silver bullet for gun control issues." (Interesting choice of words, don't you think?) True, but as a civilized society, we must begin to look seriously at these evidence based recommendation.

  3. Thanks for publishing this. There's much to ponder. There are a lot of guns in my house. The spouse hunts and is a trap shooter. The guns are kept in a gun safe. It's not having access to guns that is the problem. It's a mental health issue. And even if alert family members identify a problem, there is frequently no treatment option available. We're a rich country with many resources. We can do better.


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