General
NPHW guest post: Addressing suicide by firearm
It’s National Public Health Week! We’re spotlighting the daily themes of the week with a series of guest blogs from APHA members. Today’s NPHW theme is injury violence and prevention. Guest bloggers from APHA’s Injury Control and Emergency Health Services Section — Section Policy Committee co-Chairs David Swedler, PhD, MPH, and Carol Thornton, MPA — discuss strategies for reducing suicide death by firearm.
After the mass shooting at Marjory Stoneman Douglas High School in Florida in February, the national mood on gun safety has shifted to strongly favor policy changes. Sadly, this popular enthusiasm appears to have produced almost no legislative action in the current Congress. In APHA’s Injury Control and Emergency Health Services Section, we have been developing the steps needed to address the specific issue of firearm suicides in the United States. The action steps we propose have proven efficacy and are collaborative in nature, not requiring sweeping legislative action. By targeting a specific gun violence threat and not pinning our hopes on obstinate legislators, we believe that our recommendations can serve as a guide for other public health practitioners looking to end other forms of firearm violence.
In the U.S. in 2016, 22,938 people died due to firearm suicide; over half of all suicide fatalities that year. This proportion of firearm suicide fatalities is unique to developed nations. Because firearms are such a disproportionate means for fatal suicide, we can use public health principles and proven injury prevention practices to reduce firearms suicide via means restriction. Means restriction is a process by which the lethal means commonly used in suicides are made less available or less deadly.
Other nations have successfully reduced suicide fatalities by targeting common means. The most famous example is public gas in the United Kingdom, but other examples include medication, pesticides and even firearms. The latter cases were natural experiments due to firearm policy changes by the Israeli and Swiss armed forces. Many suicide attempts occur with little planning during a short-term crisis, so means restriction would be targeted to these windows of increased risk. The results of means restriction programs are not that potentially suicidal individuals will complete suicide via a different means — the commonly stated, insensitive refrain of “they’ll just find some other way to kill themselves” — but that completed suicides are reduced. So means restriction can work; the question then becomes how do we do it?
We argue that four evidenced-based strategies are needed to prevent suicide by firearm: (1) relocating household firearms away from home when a family member is at risk for suicide; (2) safely storing firearms at home if relocation is not possible; (3) working with leaders in the gun community to develop and implement messaging about the above strategies that will be favorable to most gun owners; and (4) increasing screening for access to firearms by health professionals and other gatekeepers. We want to specifically highlight strategy No. 3 in this blog post. Contrary to expectations in this hyper-polarized political atmosphere, there are ongoing collaborations between public health suicide prevention experts and gun rights advocates. We propose collaborations with firearms retailers, range owners and instructors, among others. These key stakeholders already serve as resources for firearms safety and storage and we believe that they can normalize inclusion of suicide prevention in gun safety education.
We also encourage collaborating with other professionals involved in suicide prevention, researching the impact of policies, such as gun violence restraining orders, and working with states and localities to adopt broad firearm safety laws and initiatives. None of our evidence-based strategies or recommendations call for passing federal legislation as a path for reducing suicides by firearm.
We believe that a collaborative approach is one that will resonate within and outside the traditional medico-public health community. The Injury Control and Emergency Health Services section, led by our policy committee and in concert with APHA, always considers the best science available to direct our strategies to reduce suicides by firearms. We will continue to follow the peer-reviewed literature and will work with our partners to reduce the burden of firearm morbidity and mortality in the U.S.
Today is NPHW Student Day! Join APHA and public health student members and partners for a webcast today from 1-3 p.m. EDT to learn more about the future of public health and join the conversation. To learn more about National Public Health Week and how to get involved, visit www.nphw.org.
