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Abstract
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I recognize, of course, that our country is a national battleground with respect to the second amendment, with volatile, polarized opinions throughout the country about gun control. Hard as it is to have a calm, reasoned discussion on the topic, we must do so. Let's start by using the term "gun safety," since in our role as mental health professionals, that's what counts. Volumes have been written on all sides of the issue, but a few facts stand out. In a recent New York Times opinion piece entitled "Why are we still going great guns?" Gail Collins1 noted that "in 2020 more than 19,000 Americans died from gun violence--not including the 24,000 who committed suicide with a gun." Her lament, echoed by many, is that even with numbers like these, steps that do not conflict with the second amendment such as universal background checks and a ban on automatic rifles--steps that would strengthen gun safety--nonetheless get stifled by lobbying and politics. And she cites the recent notorious developments in my home state of Texas, where it is now legal to openly carry a gun, without a permit, and to purchase a gun without being required to learn how to use it. Collins cites many tragic deaths, often of children, from loaded guns in the home, carelessly left in plain sight.
OK, I realize these are one journalist's opinions, and there are loud choruses of opinions on many sides. But it is our duty, even if ducking for cover, to keep the focus on gun safety. In doing so, how do we appropriately intervene in our work with patients and families? In recent issues of the Journal in the Law and Psychiatry Column, Hal Wortzel has gathered a group of colleagues to provide expert advice on therapeutic risk management for violence. In this current issue of the Journal, we present the latest report in this series, by Simonetti, Wortzel, and Matarazzo, entitled "Therapeutic Risk Management and Firearm-related Lethal Means Safety." They cite evidence that firearms are a leading cause of death by suicide, particularly among men, military veterans, and the elderly, and, alarmingly, that firearms account for 41% of suicides among children 18 years of age or younger. The authors point out that firearm access is an independent predictor of suicide, and they present recommendations for education about Lethal Means Safety strategies, to proactively introduce to patients and families. As well, they discuss ways to ask about firearm access, and they suggest practical steps to recommend to families, such as out-of-home firearm storage and in-home storage options. Again, the emphasis here is not anti-gun, but an appeal for collaborative, open discussions with patients and families about ways to increase gun safety.
Also, in this issue of the Journal, Berardelli and colleagues present a study in an inpatient psychiatric setting looking at high-lethality suicide attempts. In this study of patients who made nonfatal suicide attempts, high-risk methods did not include firearms, probably because suicidal use of firearms is almost always fatal. Many of the principles of Lethal Means Safety education, however, are quite applicable when discussing suicide risk with patients and families. Identification of those more likely to use methods with higher lethality (including but not limited to firearms) can be life-saving...
Language: en |