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.

www.qprinstitute.com

(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.

(http://www.cdc.gov/injury/wisqars/index.html).

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“11^th 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 “11^th 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:

1.     http://www.sprc.org/bpr/section-III/question-persuade-refer-qpr-law-enforcement

2.     http://www.sprc.org/bpr/section-III/calm-counseling-access-lethal-means and http://www.consensusproject.org/learningsites

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

Lightning Can Strike Twice in the Same Place

This week I had every intention of writing about my recent motorcycle trip to Jackson Hole and Yellowstone.  That all changed when my sister called me late in the day on Tuesday.  As she soon as I heard her voice I knew something was wrong.  I'd only heard that particular tone in her voice once before.  And, just like when I'd heard it before, my body immediately knew something was wrong, almost before she uttered the words "Have you read Jason's email?" my insides were already turning to liquid, my heart started racing and I wanted to vomit.  I logged into my email as she told me the news.  "Jason's sister is dead.  She killed herself."  For the second time in my 42 years, the world seemed to stop spinning, and I felt like I was watching myself from a distance as my mind tried to wrap itself around something that it desperately wanted to keep from knowing.

Jason's email told me everything I didn't want to know.  He even included a news clip about the tragic way his sister had chosen to end her life.  There I sat at work, staring at my computer, dumfounded, without words.  How could this be happening?  Again?  To Jason?  It just isn't fair.  That's when my tears started, thinking of him and all that he'd already endured.  Not even two weeks before, my mom and I had been talking about Julie, as we often do.  I mentioned that one of the few things I hadn't yet forgiven Julie for was how her suicide affected Jason.  I'm just not okay with it.  He, among everyone in her life, was there for her no matter what.  He loved her, despite her maddening ways. From my perspective, she took advantage of his love, dismissing it, not understanding how rare such loyalty is. His love and loyalty never wavered, even in death.  It was Jason who spared Amy from having to find her sister dead.  Instead, he went, knowing full well what he'd find.  He stayed with her until the very end, waiting until the coroner took her away.  And now this.  Again.  

Still in shock, I called Jason. Actually, I called, got his voice mail, left a message, then he called back and left me a voice mail, which I listened to, and then called him back.  Even in the midst of such sadness and shock, Jason didn't miss the significance of me listening to his voice mail and returning his call.  "Well, I guess I know how to get you to listen to one of my voice mails now" was how he answered.  We laughed at the morbid irony. Julie's last phone call was to me, and she got my voice mail.  She left me a message.  As per my habit, and keeping with my instructions to send me a text if it's urgent and important, I deleted her message without ever listening to it.  To this day I don't know what she said. 

At least laughing about what it takes to get me to listen to a voice message broke the ice. But then I had to actually talk about what why I was calling. I'd like to say that I had all the right words and knew exactly how to respond to such a tragedy.  After all, I know exactly how it feels to lose your sister to suicide.  Instead, I swore.  Really, what else is there to do?  We both agreed my profane word was really the only thing to say in response to suicide.  

I've spent the last 48 hours thinking, wondering, remembering and reliving.  It's the emotional, physiological memory of such trauma that's the worst.  It's like when you have a burn and the thin top layer of skin has just started to heal, covering the burn.  You nurse the wound, being very tender with yourself, protecting your injured part, knowing how fragile it is.  Then, out of nowhere, the wound gets bumped and the thin, new skin gets torn off.  The pain is there all over again, not as bad as the original burn, but close.  

Today I watched Robin Roberts say goodbye on Good Morning America.  She'll be gone for an indeterminate amount of time recovering from a bone marrow transplant.  As she talked about her experience with cancer, and subsequently finding out that her cancer treatment had given her a rare disease requiring a bone marrow transplant she said, "Life provides losses and heartbreak for all of us.  But the greatest tragedy is to have the experience and miss the meaning." 'I am determined not to miss that meaning."  I stopped what I was doing when I heard her, amazed at her simple, yet profound wisdom and amazing optimism and courage. I'm not even close yet to knowing what sort of meaning any of us will gain from this latest tragedy. It's still too raw, too soon, but her words shifted my focus and gave me hope, which right now is enough.  

Grieving In Front of the World

I haven’t watched the video of Junior Seau’s mother crying, lamenting the loss of her son shortly after learning of his suicide.  I don’t need to.  Just seeing the still image of her face in a news story was too much for me to bear.  It hits too close to home.  Simply glancing at her picture stirred up memories for me that I try not to think about.  It obviously unsettled my mind, because last night I dreamt of his mother crying, wailing, and grieving for her son.  In my dream I tried to comfort her.  Somehow I wanted her to know I understand what she’s feeling. 

I know that kind of psychic, gut-wrenching pain, the animalistic wailing that doesn’t seem like it’s coming from your own body, the feeling  of having a piece of your very soul forcefully ripped from your body.  There weren’t cameras around to document the moment the bottom dropped out of my world.  Not that there needed to be, because I can replay that moment in my mind like it’s a movie, as if I’m watching someone other than me experience it.  It really did feel like an out-of-body experience.  I know what it feels like to temporarily lose your mind with grief. 

It was a beautiful, sunny Saturday in May.  I was walking out of the grocery store where I’d just stocked up on essentials for the Memorial Day weekend.  I was sitting alone inside my car when Jason found my sister and confirmed to me what I most feared.  I’m sure my screaming and wailing could be heard outside my car.  I’ve always wondered why nobody stopped to make sure I was okay. Certainly I looked and sounded like a crazed, raving lunatic.  I remember hanging up the phone and numbly watching people walk into the grocery store, amazed that life’s mundane tasks continued for others, when my world as I knew it was collapsing. 

Then I called my dad.  I didn’t even try to break the news gently.  I blurted the words out.  Even though he was clear across the country in Minnesota, his screams sounded like he was right next to me.  I felt his pain through the phone.  Having to tell my dad that his daughter was dead isn’t something I’ll ever get over.  It’s why I don’t need to hear Junior Seau’s mom to know exactly what her grief sounds and feels like.  George Schroeder, a writer for the Register-Guard captured the feeling well in this thoughtful column published today, as he talked about Luisa Seau crying out “I don’t understand.  I don’t know anything.”  Sadly,  she now joins the legions of other suicide survivors in this country left wondering, trying to understand, seeking an answer to the unanswerable question of why.