Guns & Suicide

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I think it saved my life.

Reduce Access to Means of Suicide
Statement for the American Association of Suicidology Regarding the Role of Firearms in Suicide and the Importance of Means of Safety in Preventing Suicide Deaths
Duration of Suicidal Crisis
The 3-Day Rule and Suicide
One Important Suicide Fact That Nobody Is Talking About
Don't know what to say?
One patient at a time, this Wash U program works to reduce gun suicides
More than 20,000 Americans a year kill themselves with a gun. Alarmed gun sellers are joining the suicide prevention fight
'Out of control': Why Montana has the highest suicide rate in the country
Guns & Suicide: The Hidden Toll - Harvard Public Health (17 page PDF)
Reduce Access to Means of Suicide
Why are suicide rates increasing so much in the U.S.?
Being Suicidal: What It Feels Like to Want to Kill Yourself - Scientific American
A Collection of Real Suicide Notes
Inside Tumblr’s teen suicide epidemic

Suicide Notes

Famous Suicide Notes That Could've Been Tweeted
One patient at a time, this Wash U program works to reduce gun suicides
Why Aren't We Talking About Suicide When We Talk About Gun Violence?


We need common sense steps to save lives. President Obama


Comparison of gun-related suicide rates to non-gun-related suicide rates in high-income OECD countries, 2010, countries in graph ordered by total suicides. Graph illustrates how the U.S. was the only high-income OECD country in which gun suicide rates exceeded non-gun suicide rates.[21]

A common suicide method is to use a firearm. Generally, the bullet will be aimed at point-blank range, often at the temple or, less commonly, into the mouth, under the chin or at the chest. Worldwide, firearm prevalence in suicides varies widely, depending on the acceptance and availability of firearms in a culture. The use of firearms in suicides ranges from less than 10% in Australia [22] to 50.5% in the U.S., where it is the most common method of suicide.[23]

Surviving a self-inflicted gunshot may result in severe chronic pain for the patient as well as reduced cognitive abilities and motor function, subdural hematoma, foreign bodies in the head, pneumocephalus and cerebrospinal fluid leaks. For temporal bone directed bullets, temporal lobe abscess, meningitis, aphasia, hemianopsia, and hemiplegia are common late intracranial complications. As many as 50% of people who survive gunshot wounds directed at the temporal bone suffer facial nerve damage, usually due to a severed nerve.[24]

A positive association exists between firearm availability and increased suicide risk.[25][26][27][28] This relationship is most strongly established in the United States.[29] This association is almost certainly not due to confounding, as any confounding risk factor that could account for this association would have to meet multiple implausible criteria.[30] Those who have access to firearms as part of their profession are more likely to commit suicide through the use of a firearm, 91.5% of suicides by police officers in America involved the use of a firearm.[citation needed] The United States has both the highest number of suicides and firearms in circulation in a developed country and when gun ownership rises so too does suicide involving the use of a firearm.[citation needed] More firearms are involved in suicide than are involved in homicides in the United States. Those who have recently purchased a firearm are found to be high risk for suicide within a week after their purchase.[31]

A 2004 report by the National Academy of Sciences found an association between estimated household firearm ownership and gun suicide rates,[32][33] though a study by two Harvard researchers did not find a statistically significant association between household firearms and gun suicide rates,[34] except in the suicides of children aged 5–14.[34] Another study found that gun prevalence rates were positively associated with suicide rates among people aged 15 to 24, and 65 to 84, but not among those aged 25 to 64.[35] Case-control studies conducted in the United States have consistently shown an association between guns in the home and increased suicide risk,[36] especially for loaded guns in the home.[37] Numerous ecological and time series studies have also shown a positive association between gun ownership rates and suicide rates.[38][39][40] This association tends to only exist for firearm-related and overall suicides, not for non-firearm suicides.[39][41][42][43] A 2013 review found that studies consistently found a relationship between gun ownership and gun-related suicides, with few exceptions.[44] A 2016 study found a positive association between gun ownership and both gun-related and overall suicides among men, but not among women; gun ownership was only strongly associated with gun-related suicides among women.[45] During the 1980s and early 1990s, there was a strong upward trend in adolescent suicides with a gun,[46] as well as a sharp overall increase in suicides among those age 75 and over.[47] A 2014 systematic review and meta-analysis found that access to firearms was associated with a higher risk of suicide.[48]

In the United States, states with stricter gun laws have lower overall suicide rates.[49][50] A 2006 study found a decline in firearm-related suicides in Australia accelerated after the National Firearms Agreement was enacted there. The same study found no evidence of substitution to other methods.[51] Multiple studies in Canada found that gun suicides declined after gun control, but methods like hanging rose leading to no change in the overall rates.[52][53][54] Similarly, a study conducted in New Zealand found that gun suicides declined after more legislation, but overall suicide rates did not change.[55] A case-control study in New Zealand found that household gun ownership was significantly associated with gun suicides, but not overall suicide.[56] A Canadian study found that gun ownership by province was not correlated to provincial overall suicide rates.[57]

Gun legislature

The laws regulating the use, purchase, and trading of firearms are varied by state in the US.[58] The Midwest and Southeast have the least legislature regulating firearm use and purchase where there is missing or unclear legislature on gun control and the open and concealed carrying or handguns and long guns are allowed with or without a permit depending on the state. These regions correlate with the states with the highest increases of suicide rates in the past 17 years.[59]

There are certain areas in the United States where firearms are illegal entirely.[60] In 1976, the District of Columbia banned the possession, sale, transfer, and purchase of handguns by civilians. Since the prohibition of handguns homicide by handguns decreased by 25% while suicides by handgun decreased by 23% in the District of Columbia. The rates of homicide and suicide in the surrounding areas where the restrictions were not applied and noted that there was no significant change in these rates. This study has been criticized.[61]

Research studies

A case control study was conducted by Kellermann, Rivara, Somes, Reay, Francisco, Banton, Prodzinski, Fligner, and Hackman[62] in the locations of two counties: Shelby County, Tennessee, and King County, Washington. The cases of suicide that took place in the person's home were recorded for both counties between 23 August 1987, and April 1990. The study used the cases that were deemed suicides by the medical examiners and cases with potential litigation over the cause of death were excluded from the study. Each case subject was found a proxy who was preferably a relative who lived in the same home as the case subject. The proxy was then given a matching control who lived in the same county. The variables of race, sex, and age range were controlled. Each proxy and control was interviewed on the presence of guns in their home along with questions about domestic violence, drug and alcohol consumption, and criminal records. The study showed that 73% and 83% of at home suicides were committed with a gun in Shelby and King County, respectively. This led the study to conclude that the increased availability of firearms in the home was likely to be associated with higher rates of at home suicides.

According to criminologist Gary Kleck, studies that try to link gun ownership to victimology often fail to account for the presence of guns owned by other people.[63] Research by economists John Lott of the U.S. and John Whitley of Australia indicates that safe-storage laws do not appear to affect juvenile accidental gun deaths or suicides.[64] In contrast, a 2004 study by Daniel Webster and his colleagues found that such laws were associated with a "modest" decline in suicide rates among youth between the ages of 14 and 17. Webster's study also noted that Lott and Whitley's study was suspect because "their use of Tobit regression to estimate the laws' effects is vulnerable to bias when data are highly skewed and heteroskedastic, as is the case for state-level data on youth suicides."[65]

See also: Multiple gunshot suicide


21 Grinshteyn, Erin; Hemenway, David (March 2016). "Violent Death Rates: The US Compared with Other High-income OECD Countries, 2010". The American Journal of Medicine. 129 (3): 266–273. doi:10.1016/j.amjmed.2015.10.025. PMID 26551975.

22 "A review of suicide statistics in Australia". Government of Australia.

23 McIntosh, JL; Drapeau, CW (28 November 2012). "U.S.A. Suicide: 2010 Official Final Data" (PDF). American Association of Suicidology. Archived from the original (PDF) on 28 June 2014. Retrieved 25 February 2014.

24 Backous, Douglas (5 August 1993). "Temporal Bone Gunshot Wounds: Evaluation and Management". Baylor College of Medicine. Archived from the original on 17 May 2008.

25 Miller, M; Azrael, D; Barber, C (April 2012). "Suicide mortality in the United States: the importance of attending to method in understanding population-level disparities in the burden of suicide". Annual Review of Public Health. 33: 393–408. doi:10.1146/annurev-publhealth-031811-124636. PMID 22224886.

26 Council on Injury, Violence (1 November 2012). "Firearm-Related Injuries Affecting the Pediatric Population". Pediatrics. 130 (5): e1416–e1423. doi:10.1542/peds.2012-2481. PMID 23080412.

27 Westefeld, John S.; Gann, Lianne C.; Lustgarten, Samuel D.; Yeates, Kevin J. (2016). "Relationships between firearm availability and suicide: The role of psychology". Professional Psychology: Research and Practice. 47 (4): 271–277. doi:10.1037/pro0000089.

28 Anglemyer, Andrew; Horvath, Tara; Rutherford, George (21 January 2014). "The Accessibility of Firearms and Risk for Suicide and Homicide Victimization Among Household Members". Annals of Internal Medicine. 160 (2): 101–110. doi:10.7326/M13-1301. PMID 24592495.

29 Brent, David A. (25 January 2006). "Firearms and Suicide". Annals of the New York Academy of Sciences. 932 (1): 225–240. doi:10.1111/j.1749-6632.2001.tb05808.x. PMID 11411188.

30 Miller, M.; Swanson, S. A.; Azrael, D. (13 January 2016). "Are We Missing Something Pertinent? A Bias Analysis of Unmeasured Confounding in the Firearm-Suicide Literature". Epidemiologic Reviews. 38 (1): 62–9. doi:10.1093/epirev/mxv011. PMID 26769723.

31 Lewiecki, E. Michael; Miller, Sara A. (January 2013). "Suicide, Guns, and Public Policy". American Journal of Public Health. 103 (1): 27–31. doi:10.2105/AJPH.2012.300964. PMC 3518361. PMID 23153127.

32 Committee on Law and Justice (2004). "Executive Summary". Firearms and Violence: A Critical Review. National Academy of Science. doi:10.17226/10881. ISBN 978-0-309-09124-4.

33 Kellermann, A.L.; Rivara, F.P.; Somes, G.; Francisco, Jerry; et al. (1992). "Suicide in the home in relation to gun ownership". New England Journal of Medicine. 327 (7): 467–472. doi:10.1056/NEJM199208133270705. PMID 1308093.

34 Miller, Matthew; Hemenway, David (2001). Firearm Prevalence and the Risk of Suicide: A Review. Harvard Health Policy Review. p. 2. One study found a statistically significant relationship between estimated gun ownership levels and suicide rate across 14 developed nations (e.g. where survey data on gun ownership levels were available), but the association lost its statistical significance when additional countries were included.

35 Birckmayer, Johanna; Hemenway, David (September 2001). "Suicide and Firearm Prevalence: Are Youth Disproportionately Affected?". Suicide and Life-Threatening Behavior. 31 (3): 303–310. doi:10.1521/suli.31.3.303.24243.

36 Miller, Matthew; Hemenway, David (March 1999). "The relationship between firearms and suicide". Aggression and Violent Behavior. 4 (1): 59–75. doi:10.1016/S1359-1789(97)00057-8.

37 Brent, D. A.; Bridge, J. (1 May 2003). "Firearms Availability and Suicide: Evidence, Interventions, and Future Directions". American Behavioral Scientist. 46 (9): 1192–1210. doi:10.1177/0002764202250662.

38 Briggs, Justin Thomas; Tabarrok, Alexander (March 2014). "Firearms and suicides in US states". International Review of Law and Economics. 37: 180–188. CiteSeerX doi:10.1016/j.irle.2013.10.004.

39 Miller, Matthew; Warren, Molly; Hemenway, David; Azrael, Deborah (April 2015). "Firearms and suicide in US cities". Injury Prevention. 21 (e1): e116–e119. doi:10.1136/injuryprev-2013-040969. PMID 24302479.

40 Miller, M.; Barber, C.; White, R. A.; Azrael, D. (23 August 2013). "Firearms and Suicide in the United States: Is Risk Independent of Underlying Suicidal Behavior?". American Journal of Epidemiology. 178 (6): 946–955. doi:10.1093/aje/kwt197. PMID 23975641.

41 Miller, M (1 June 2006). "The association between changes in household firearm ownership and rates of suicide in the United States, 1981-2002". Injury Prevention. 12 (3): 178–182. doi:10.1136/ip.2005.010850. PMC 2563517. PMID 16751449.

42 Miller, Matthew; Lippmann, Steven J.; Azrael, Deborah; Hemenway, David (April 2007). "Household Firearm Ownership and Rates of Suicide Across the 50 United States". The Journal of Trauma: Injury, Infection, and Critical Care. 62 (4): 1029–1035. doi:10.1097/01.ta.0000198214.24056.40. PMID 17426563.

43 Anestis, MD; Houtsma, C (13 March 2017). "The Association Between Gun Ownership and Statewide Overall Suicide Rates". Suicide & Life-Threatening Behavior. 48 (2): 204–217. doi:10.1111/sltb.12346. PMID 28294383.

44 Stroebe, Wolfgang (November 2013). "Firearm possession and violent death: A critical review". Aggression and Violent Behavior. 18 (6): 709–721. doi:10.1016/j.avb.2013.07.025.

45 Siegel, Michael; Rothman, Emily F. (July 2016). "Firearm Ownership and Suicide Rates Among US Men and Women, 1981–2013". American Journal of Public Health. 106 (7): 1316–1322. doi:10.2105/AJPH.2016.303182. PMC 4984734. PMID 27196643.

46 Cook, Philip J.; Ludwig, Jens (2000). "Chapter 2". Gun Violence: The Real Costs. Oxford University Press. ISBN 978-0-19-513793-4.

47 Ikeda, Robin M.; Gorwitz, Rachel; James, Stephen P.; Powell, Kenneth E.; Mercy, James A. (1997). Fatal Firearm Injuries in the United States, 1962-1994: Violence Surveillance Summary Series, No. 3. National Center for Injury and Prevention Control.

48 Anglemyer, A; Horvath, T; Rutherford, G (21 January 2014). "The accessibility of firearms and risk for suicide and homicide victimization among household members: a systematic review and meta-analysis". Annals of Internal Medicine. 160 (2): 101–10. doi:10.7326/M13-1301. PM4ID 24592495.

49 Anestis, Michael D.; Khazem, Lauren R.; Law, Keyne C.; Houtsma, Claire; LeTard, Rachel; Moberg, Fallon; Martin, Rachel (October 2015). "The Association Between State Laws Regulating Handgun Ownership and Statewide Suicide Rates". American Journal of Public Health. 105 (10): 2059–2067. doi:10.2105/AJPH.2014.302465. PMC 4566551. PMID 25880944.

50 Conner, Kenneth R; Zhong, Yueying (November 2003). "State firearm laws and rates of suicide in men and women". American Journal of Preventive Medicine. 25 (4): 320–324. doi:10.1016/S0749-3797(03)00212-5.

51 Chapman, S; Alpers, P; Agho, K; Jones, M (1 December 2006). "Australia's 1996 gun law reforms: faster falls in firearm deaths, firearm suicides, and a decade without mass shootings". Injury Prevention. 12 (6): 365–372. doi:10.1136/ip.2006.013714. PMC 2704353. PMID 17170183.

52 Caron, Jean (October 2004). "Gun Control and Suicide: Possible Impact of Canadian Legislation to Ensure Safe Storage of Firearms". Archives of Suicide Research. 8 (4): 361–374. doi:10.1080/13811110490476752. PMID 16081402.

53 Caron, Jean; Julien, Marie; Huang, Jean Hua (April 2008). "Changes in Suicide Methods in Quebec between 1987 and 2000: The Possible Impact of Bill C-17 Requiring Safe Storage of Firearms". Suicide and Life-Threatening Behavior. 38 (2): 195–208. doi:10.1521/suli.2008.38.2.195. PMID 18444777.

54 Cheung, AH; Dewa, CS (2005). "Current trends in youth suicide and firearms regulations". Canadian Journal of Public Health. 96 (2): 131–5. PMID 15850034.

55 Beautrais, A. L.; Fergusson, D. M.; Horwood, L. J. (26 June 2016). "Firearms Legislation and Reductions in Firearm-Related Suicide Deaths in New Zealand". Australian & New Zealand Journal of Psychiatry. 40 (3): 253–259. doi:10.1080/j.1440-1614.2006.01782.x. PMID 16476153.

56 Beautrais, Annette L.; Joyce, Peter R.; Mulder, Roger T. (26 June 2016). "Access to Firearms and the Risk of Suicide: A Case Control Study". Australian & New Zealand Journal of Psychiatry. 30 (6): 741–748. doi:10.3109/00048679609065040. PMID 9034462.

57 "Firearms, Accidental Deaths, Suicides and Violent Crime: An Updated Review of the Literature with Special Reference to the Canadian Situation". 10 March 1999.

58 Cage, Feilding; Dance, Gabriel (16 January 2013). "Gun laws in the US, state by state – interactive". the Guardian. Retrieved 24 February 2019.

59 Prasad, Ritu (11 June 2018). "Why US suicide rate is on the rise". Retrieved 24 February 2019.

60 Loftin, Colin; McDowall, David; Wiersema, Brian; Cottey, Talbert J. (5 December 1991). "Effects of Restrictive Licensing of Handguns on Homicide and Suicide in the District of Columbia". New England Journal of Medicine. 325 (23): 1615–1620. doi:10.1056/nejm199112053252305. PMID 1669841.

61 Britt, Chester L.; Kleck, Gary; Bordua, David J. (1996). "A Reassessment of the D.C. Gun Law: Some Cautionary Notes on the Use of Interrupted Time Series Designs for Policy Impact Assessment". Law & Society Review. 30 (2): 361–380. doi:10.2307/3053963. JSTOR 3053963.

62 Kellermann, A.L.; Rivara, F.P.; Somes, G.; Francisco, Jerry; et al. (1992). "Suicide in the home in relation to gun ownership". New England Journal of Medicine. 327 (7): 467–472. doi:10.1056/NEJM199208133270705. PMID 1308093.

63 Kleck, Gary (2004). "Measures of Gun Ownership Levels of Macro-Level Crime and Violence Research" (PDF). Journal of Research in Crime and Delinquency. 41 (1): 3–36. doi:10.1177/0022427803256229. NCJ 203876. Archived from the original (PDF) on 20 September 2006. Studies that attempt to link the gun ownership of individuals to their experiences as victims (e.g., Kellermann, et al. 1993) do not effectively determine how an individual's risk of victimization is affected by gun ownership by other people, especially those not living in the gun owner's own household.

64 Lott, John R.; Whitley, John E. (2001). "Safe-Storage Gun Laws: Accidental Deaths, Suicides, and Crime". Journal of Law and Economics. 44 (2): 659–689. CiteSeerX doi:10.1086/338346. It is frequently assumed that safe-storage laws reduce accidental gun deaths and total suicides. We find no support that safe-storage laws reduce either juvenile accidental gun deaths or suicides.

65 Webster, Daniel W. (4 August 2004). "Association Between Youth-Focused Firearm Laws and Youth Suicides". JAMA. 292 (5): 594–601. doi:10.1001/jama.292.5.594. PMID 15292085.


More than 20,000 Americans a year kill themselves with a gun. Alarmed gun sellers are joining the suicide prevention fight

“We want to work with the gun owners instead of against them,” said a suicide prevention coordinator in Utah.

Early one evening in February 2014, a man in his 40s walked into Rowdy’s Range & Shooter Supply in St. George, Utah, and asked to rent a gun for target practice. He was sociable and seemed calm as he handed over his driver’s license, went to his assigned lane and began shooting at the target, stopping every so often to chat with off-duty police officers in the lane next to his.

Just before his hour was up, an employee alerted him. The man thanked him, and the worker left. Then, still standing in the practice lane, the man turned the gun on himself and took his own life.

After paramedics took his body away and customers were escorted from the range, the company’s owner, Rowdy Reeve — who opened the range three months earlier with two partners in an industrial park at the edge of the Mojave Desert — began asking himself questions: Was there anything his staff should have noticed about the customer before handing him a gun? Could they have helped him?

“It was like a punch in the gut,” Reeve said.

That reckoning led Reeve and the two other co-owners to join a growing movement that aims to reduce gun suicides by spreading prevention techniques among firearm owners and sellers. It’s an effort that is slowly sweeping through gun country - states with high rates of firearm ownership, like Utah, that have shouldered a disproportionate weight of America’s rise in suicides. The endeavor has brought together longtime adversaries: the medical community, which typically sees guns as a public health threat, and the firearms industry, which distrusts most efforts to restrict access to guns.

Gun dealers, range owners and firearms instructors have found that suicide prevention fits into their mission to promote the safe use of guns. Hundreds of them around the country now share suicide-prevention literature, emphasize prevention techniques in their concealed-carry classes, teach workers to recognize distress among customers and welcome prevention advocates to firearm trade shows.

This seemingly unlikely partnership has unfolded quietly, in contrast to the public divisiveness that typically characterizes the debate over gun violence. It originated from mental health researchers and advocates, who see curbing firearm suicides - which make up more than half of all suicides in America, or nearly 23,000 in 2016 - as integral to reducing the number of firearm deaths.

“This is a new way to go about reducing suicidal persons’ access to guns - not by promoting an anti-gun agenda but by asking gun owners to be part of the solution,” said Catherine Barber, who directs the Means Matter Campaign to prevent suicide at the Harvard School of Public Health’s Injury Control Research Center. “Vilifying them isn’t going to work.”

"We want to work with the gun owners"

The new public-health emphasis on gun suicides is driven in part by statistics showing that they are far more prevalent than homicides committed with a firearm. That is particularly so in rural areas and the intermountain West. Utah, Colorado, Nevada, Idaho and New Mexico all rank in the top 10 for suicide rates, with more than 20 deaths per year per 100,000 people (the national rate is 13.5 deaths and rising).

Unlike “red flag” laws that allow police officers to temporarily confiscate guns from people deemed a danger to themselves or others, the partnership of the gun industry and the suicide-prevention community requires no new legislation. It is voluntary, focusing on public-education campaigns to make people more comfortable talking about guns and suicide, and encouraging gun owners who feel suicidal to hand their weapons over to someone they trust. While there are no studies yet measuring the campaigns’ effect on death rates, advocates gauge success by the growing interest in the gun industry.

“At first I was very skeptical, because we have been trained to think when people talk about suicide that it’s nothing more than a veiled attempt to take away our guns,” said Clark Aposhian, chairman of the Utah Shooting Sports Council, the state’s biggest gun-rights lobbying group. “Then I checked the data.”

Aposhian was drawn into the issue in 2013, when Steve Eliason, a Republican member of the Utah House of Representatives, asked for his support on a campaign to curb suicides. The pitch included some alarming statistics: Utah had one of the country’s highest suicide rates, and half of them were by firearm. Of all of the state’s firearm-related deaths, 86 percent were suicides.

Aposhian joined the Utah Suicide Prevention Coalition, which has developed literature to distribute at gun shops, produced videos and created a suicide-prevention training module for concealed-carry training courses.

“We’re to the point now where we felt it would be a disservice and inappropriate to our membership to not let them know what’s going on in Utah and across the nation,” Aposhian said.

The Utah partnership has trickled down to communities all over the state, including Washington County, where Rowdy Reeve’s range is and where nearly half of all households own at least one firearm and many children grow up handling them. The suicide rate there is twice the national rate.

“We want to work with the gun owners instead of against them,” said Teresa Willie, the county’s suicide prevention coordinator. She oversees a campaign that includes public-education efforts at churches, schools and law enforcement agencies and running before films at the local theater. “We don’t want to polarize the community at all," she said.

Reeve sought Willie out after the suicide at his range in early 2014. She visited the range, and taught his workers how to identify warning signs from customers who could be suicidal — and how to help them.

As Reeve listened, he felt a deepening sense of responsibility.

“If we are going to be selling these things, then we should also offer people help if they have any problems,” he said.

How the movement spread

The affiliation between the gun industry and public health advocates has its roots in New Hampshire, where in April 2009 a gun shop owner named Ralph Demicco found out that three people in one week had killed themselves using guns bought at his store. The news shook him; he considered himself a socially responsible business owner, and was cautious about selling firearms to people who seemed risky - drunk, on drugs, agitated, inexperienced. He was already a member of the New Hampshire Firearms Safety Coalition, which pressed gun-safety issues. “I was bewildered. I didn’t know what to do,” Demicco recalled.

One of his colleagues from the coalition asked if he would help in a new suicide prevention effort, driven by research that identified guns as a major risk factor - not because gun owners were more suicidal than anyone else, but because suicide is often impulsive, and guns are an effective means of death. Suicide prevention advocates needed Demicco because they knew gun owners would trust him more than they would public health officials. Demicco agreed, and together they created The Gun Shop Project, distributing posters to retailers with tips on how to spot and help people who appear suicidal.

The Gun Shop Project has since spread to 10 more states, including Utah, and there are similar partnerships in about 10 others, according to the Harvard Injury Control Research Center. Some are homegrown. Others are the result of a joint venture by the American Foundation for Suicide Prevention and the National Shooting Sports Foundation, an industry trade group that distributes suicide prevention “toolkits” to retailers and ranges.

“It’s a chance to overturn myths about suicide in the gun-owning community,” said Bill Brassard Jr., a National Shooting Sports Foundation spokesman.

‘Difficult conversations, but you've got to have them’

Among those myths, according to researchers, is that if someone wants to end his or her life but doesn’t have access to a gun, the person will find another way. Researchers say that making it more difficult for someone who is suicidal to access a planned means of death can buy time until the suicidal thoughts subside.

That is particularly important in the case of guns, which, they say, are present in about a third of American homes and are the most lethal method of suicide. About 85 percent of suicide attempts with a firearm end in death, while drug overdoses — the most common method of suicide attempts — are fatal in less than 3 percent of cases, according to researchers at the Harvard Injury Research Control Center.

“The importance of education in talking to gun owners is not saying they shouldn’t own guns, and it has nothing to do with the Second Amendment,” said Marian Betz, an associate professor of emergency medicine at the University of Colorado School of Medicine and co-founder of the Colorado Firearm Safety Coalition, which has adopted the Gun Shop Project and National Shooting Sports Foundation programs. “It’s saying, ‘Sometimes we get so sad we can’t think straight, so how can we make things safer for you?’”

Jacquelyn Clark, owner of the Bristlecone Shooting, Training and Retail Center in Denver and a member of Colorado’s firearm safety coalition, redoubled her efforts after a first-time customer shot himself at her range two years ago.

Clark revamped her staff training and offered more customer-education literature, from suicide hotlines to gun-storage tips. She sought advice from other gun shops, adopting some of their rules, including a prohibition against new customers using the range alone without a recommendation from a family member, colleague or friend. The staff now looks more closely at new customers — and regulars — by examining eye contact, attention to safety briefings, and whether they seem in a rush.

Clark’s staff turns away more people now. Employees once asked a regular customer, upset because his wife had left him, to come back another day. They once asked a new customer, who was alone and seemed to want to rush through a handgun purchase, for a personal reference; instead, he left.

Some of these people leave angry. Some may not be dangerous to themselves or anyone else. But the cost of lost business is a price Clark said she’s willing to pay.

“These can be difficult conversations, but you’ve got to have them,” Clark said.

A gun instructor's mission

In the city of Loretto, in rural central-south Tennessee, firearms instructor Matt Holt sees those uncomfortable conversations as a personal crusade.

Four years ago, Holt learned that one of his closest friends had taken his own life with a gun. That motivated Holt to work with the Tennessee Suicide Prevention Network to persuade the state to require a suicide module in the state curriculum for handgun carry-permit training. The change went into effect July 1.

When Holt teaches the 10-hour course, he starts the suicide section by telling his students about his friend — and other friends and family members, including his mother, who have tried to kill themselves. “I try to engage them, to get them talking about it. Really talking,” Holt said.

He tells them about the signs of suicide, what to say to someone who exhibits them, and how to find a safe place for their guns.

He knows his openness makes him an exception in the gun community. He wants the curriculum to include videos on suicide prevention, he says, because “a lot of instructors still don’t feel comfortable with suicide, either.”

‘It's got to help'’

Last year, a man in his 40s walked into Rowdy’s Range & Shooter Supply and asked to speak with someone in charge. Reeve and his two co-owners came to the desk and began chatting with him. “I’m suicidal,” the man said. He wanted help in keeping himself away from guns. He asked them to take his picture, share it with their staff and tell them that if he returned and inquired about renting a gun, to refuse.

By then, Reeve had become trained to teach a suicide prevention course and was no longer unnerved by such conversations. He and his partners quickly agreed to the man’s request.

They kept chatting for about 45 minutes before the man shook their hands and thanked them. He said he hoped he wouldn’t see them again.

He hasn’t. Last Reeve heard, the man was doing fine.

“We tell our staff not to see our customers as customers but as a person. Spend time to talk to them, what brings them in today, get to know them,” Reeve said. “I’m a firm believer that if we can get out there and teach these classes and spread the firearms safety word, it’s got to help.”

If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 800-273-8255, text SOS to 741741 or visit for additional resources.

Statement for the American Association of Suicidology Regarding the Role of Firearms in Suicide and the Importance of Means of Safety in Preventing Suicide Deaths

Approximately half of all suicide deaths in the United States result from self-inflicted gunshot wounds. In 2015, over 22,000 Americans died by suicide using a firearm, a number that exceeded homicide deaths by all methods combined (18,000). An estimated 85%-95% of all suicide attempts involving firearms result in death. This stands in stark contrast to the most commonly used method, intentional overdose, in which 2-3% of attempts result in death. In other words, nearly all individuals who attempt suicide using overdose survive, and nearly all individuals who attempt using firearms die." Further highlighting the prominence of this issue, firearms are present in at least one-third of all American households, meaning that highly lethal suicide attempt methods are widely accessible across the country.

Although firearms are involved in a disproportionate amount of American suicide deaths, it is vital to note that evidence consistently indicates firearm ownership is not associated with suicidal thoughts. In other words, owning a firearm does not prompt an otherwise non-suicidal individual to suddenly develop thoughts of suicide. Instead, firearms increase the risk of death by suicide. Only a small minority of individuals who think about suicide go on to make a suicide attempt and emerging evidence indicates that, in order for an individual to make that relatively rare transition, he or she must be capable of suicide. Such capability involves, in part, access to and aptitude with lethal means for suicide. Along these lines, it appears that firearms increase the risk for death by suicide among suicidal individuals by facilitating their transition from thought to action, with that action almost universally resulting in death (whereas access to less deadly methods could facilitate a non-lethal suicide attempt). This unique role – a facilitator of action within the context of already existing suicidal thoughts – is highlighted by decades of research demonstrating that firearm access is associated with death by suicide even when accounting for who an individual is (male/female, young/old), how that individual is feeling (depression symptoms, substance use, social isolation), whether that individual has access to proper care (population density, socioeconomic status), and whether that individual has been suicidal in the past (prior suicidal thoughts, prior suicide attempts). Firearm access increases suicide risk among all members of a home where a firearm is present, and risk is greatest when household firearms are stored unlocked and loaded.

  • Approximately 50% of all American suicide deaths result from firearms
  • 85%-95% of all suicide attempts involving a firearm result in death
  • Firearm access is not associated with developing suicidal thoughts
  • Firearm access is associated with death by suicide
  • Firearms may facilitate the rare transition from suicidal thoughts to death by suicide

Fortunately, lessons learned from other public health struggles, as well as emerging evidence specific to firearms and suicide, present a blueprint for success in addressing this problem. Means safety – defined as actions that render a specific method for suicide less deadly or less accessible during a suicide attempt – represents a promising path towards reducing firearm suicides and, consequently towards lowering the overall suicide rate. This approach is often referred to as “means restriction;” however, research has demonstrated that use of the word “restriction” decreases the willingness of firearm owners to engage with the intervention.

Means safety has been applied to a range of suicide methods. For instance, the detoxification of domestic gas resulted in substantial reductions in the overall suicide rate in the UK in the mid-20th century. Reducing access to the most highly human-toxic pesticides in Sri Lanka led to a 50% drop in the overall suicide rate, driven by a drop in poisoning suicides.. When means safety is effective, it reduces the overall suicide rate by reducing the method-specific suicide rate, while suicide rates by other methods either remain flat or only marginally increase. The goal is to prevent individuals from dying, not to simply change the method by which they die. Reductions in overall suicide rates highlight the fact that, when an individual is prevented from using a specific method to die by suicide, they do not simply find another way. The effect of means safety, however, hinges upon the lethality, popularity, and accessibility of the targeted method. As such, means safety efforts in the United States must focus specifically on firearms in order to have optimal effects because firearms are the leading method, the most lethal, and easy to access.

Means safety specific to firearms can take several forms, each of which has varying levels of evidence supporting its efficacy as well as varying degrees of plausibility depending in part upon geographic location. In recent years, suicide prevention experts have collaborated with the firearm owning community to develop “gun friendly” materials, messaging, and curriculum aimed at gun-owning families. These interventions do not vilify firearms or firearm owners; they capitalize on the existing culture of gun safety and the shared goal of preventing suicide death. The primary focus of these programs is to encourage voluntarily storing firearms away from the home when a household member is at risk for suicide or otherwise making them inaccessible to the at-risk person. These programs also encourage routinely storing guns locked, not only during times of crisis. Such approaches are akin to successful efforts to curb drunk driving and to reduce the overall motor vehicle fatality rate (e.g. “friends don’t let friends drive drunk”). They are non-coercive and focus on preventing an unwanted outcome rather than demonizing firearms and risking a lack of buy-in from the firearm owning community. The collaborative approach has yielded partnerships with high profile firearm organizations (e.g. National Shooting Sports Foundation), which in turn lends credibility to such projects and increases the plausibility of large scale dissemination and implementation.

Research considering the suicide prevention potential of legislation (e.g. universal background checks, mandatory waiting periods; extreme risk protection orders) indicates that states with certain laws in place tend to exhibit lower overall suicide rates and a less severe suicide rate trajectory across time. Given the magnitude of the effect sizes reported in this research, such legislation may represent one useful tool in efforts to prevent suicide. That being said, in areas of the country in which firearm ownership is substantially more common, the political feasibility of such legislation is lower, rendering the potential reach of at least certain forms of the intervention limited.

  • Means safety – rendering suicide methods less deadly or less accessible during a suicide attempt
  • Important to avoid alienating terms such as “restriction”
  • Means safety has demonstrated effectiveness across many suicide methods
  • Legislation regulating handgun ownership (e.g. background checks) may be effective but less palatable
  • Collaboration with firearm community is paramount to success
  • Encourage safe storage – store firearms locked, unloaded, separate from ammunition, in secure location
  • Encourage storing firearms away from home when a household member is at increased risk of suicide

Research examining the effectiveness of non-legislative means safety approaches is currently lacking and such data should be a focus of suicide research in the coming years. As research is conducted in this area, other potentially fruitful avenues for increasing effectiveness and reach include promoting the use of lethal means counseling; improving locking technologies; and increasing access to and knowledge about safe and legal options to temporarily store firearms during times of crisis. An important consideration is the target population for such interventions. One possible route is to focus on high risk individuals such as those seeking mental health care and/or endorsing suicidal thoughts. Such approaches would focus on ensuring that individuals we have identified as being at high risk for suicide take steps to reduce their access to specific methods for suicide.

Although these are certainly valuable groups to consider, an argument could be made that a better approach is to aim for population level implementation regardless of known risk. Recent research indicates that we have not improved in our ability to prospectively predict suicide risk since the 1950s. This failure has many explanations, but one component is likely that the individuals most likely to die by suicide, particularly those who would die using a firearm (e.g. men in general, middle aged or older white men, military personnel) tend to avoid mental health care altogether and to underreport thoughts of suicide. Because of this, we are typically ill equipped to identify individuals at risk for suicide until they are dead. By implementing means safety at the population level, we can diminish our reliance upon correctly identifying individual risk levels and instead ensure our communities as a whole are at lower risk of suicide death regardless of current suicidal thoughts. As such, although we do not oppose approaches that target high risk individuals, we would see such efforts as needing to be one component of a multifaceted approach that also includes population level prevention initiatives.

Duration of Suicidal Crisis

While some suicides are deliberative and involve careful planning, many appear to have been hastily decided-upon and to involve little or no planning. Chronic, underlying risk factors such as substance abuse and depression are also often present, but the acute period of heightened risk for suicidal behavior is often only minutes or hours long (Hawton 2007).

The Houston study interviewed 153 survivors of nearly-lethal suicide attempts, ages 13-34. Survivors of these attempts were thought to be more like suicide completers due to the medical severity of their injuries or the lethality of the methods used. They were asked: “How much time passed between the time you decided to complete suicide and when you actually attempted suicide?” One in four deliberated for less than 5 minutes! (Simon 2005).

Duration of Suicidal Deliberation:

24% said less than 5 minutes
24% said 5-19 minutes
23% said 20 minutes to 1 hour
16% said 2-8 hours
13% said 1 or more days

A study from Deisenhammer asked people who were seen in a hospital following a suicide attempt how long before their suicidal act they first started thinking about attempting it. 48% said within 10 minutes of making the attempt. The full distribution is as follows:

Less than 5% between 11-2=-30, 31-60, 1-6 hours, 6-24 hours, then 10% for 1-7 days, 1-4 weeks and 1-12 months.

  • An Australian study of emergency department visits found 40% of attempters took action within 5 minutes of deciding to attempt (Williams 1980). The authors summarized seven earlier studies that found one-third to four-fifths of attempts were impulsive.
  • In an Australian study of survivors of self-inflicted gunshot wounds, 21 of 33 subjects (64%) stated that their attempt was due to an interpersonal conflict with a partner or family member (deMoore 1994). Most survivors were young men who did not suffer from major depression or psychosis, and the act was almost always described as impulsive. A similar study in Texas with 30 firearm attempters found 60% had experienced an interpersonal conflict during the 24 hours preceding their attempt (Peterson 1985).
  • At least one-third of suicide decedents under age 18 experienced a crisis within 24 hours of taking their life, according to NVISS data drawn from police and coroner/medical examiner reports. The proportion with a crisis declined with age. In some cases the crises were not just same-day but virtually same-moment (as when decedents shot themselves in the midst of an argument).
  • Interviews with 268 patients hospitalized for a poisoning suicide attempts in Sri Lanka found that just over half took the poison after less than 30 minutes of thought, often directly following an argument (Eddelston 2006). While most of the patients survived their attempts, 13 died. Like the nonfatal attempters, over half of those who died deliberated less than 30 minutes.


The 3-Day Rule and Suicide

Many people who attempt suicide do so impulsively. Extremely impulsively.

One study of people who attempted suicide found that 48% thought of suicide for fewer than 10 minutes before making the suicide attempt.

The haste with which many people die by suicide is staggering. Had they waited a little longer, then the intense impulse to act on suicidal thoughts might have passed.

This brings me to the 3-day rule. I’ve heard about this rule anecdotally and read about it here and there on blogs and other websites. One site in particular sums it up quite well:

“For me I have a 3 day rule. With most big decisions that will affect my life, I give myself 3 days. If I still think it is the best choice for me after 3 days, then I go with it. Yes even with suicide…

“If even for one moment you feel a smidge of joy or like life is actually worth living, you have to start the 3 days again. Again time many times brings clarity.”

The author, Ali McCollum, also states, “Spoiler… death by my own hand has yet to feel like the right choice for 3 straight days.”

Keep On Keeping On

The old adage “one day at a time” holds true here. With suicidal thoughts, however, the mantra may be “one hour at a time,” or “one minute at a time.”

Even “one moment at a time” can be difficult.

If you hold off for three days, chances are you will not feel 100% intent on dying that entire time. And maybe you will even feel hope, or pleasure, or some other reason to live.

If your suicidal thoughts are so intense that even waiting 3 days seems impossible, please get help immediately. Call 911 (or, if you are outside the U.S., whatever the emergency number is in your country). Or go to an emergency room. Or call someone who will help you stay safe.

Really? Suicidal Thoughts Stop After 3 Days?

Keep in mind that I’m not talking about all suicidal thoughts. It would be foolish to say that suicidal thoughts tend to pass in 3 days. Some people think of suicide for weeks and months, even years.

What I m referring to is the profound intent to act on suicidal thoughts. If someone is on the verge of suicide, those 3 days can mean the difference between life and death.

Suicidal thoughts might persist, but the impulse to act on them can change many times over three days.

To quote the late psychologist Edwin Shneidman, one of the pioneers in suicidology:

“The acute suicidal crisis (or period of high and dangerous lethality) is an interval of relatively short duration – to be counted, typically, in hours or days, not usually in months or years. An individual is at a peak of self-destructiveness for a brief time and is either helped, cools off, or is dead.”

Naturally, my hope is that you are helped or cool off.

What If 3 Days Go By and Suicide Still Beckons?

Time does not heal all wounds, especially not quickly. The 3-day rule aside, I do not mean to imply that you should end your life if you still feel acutely suicidal after three days.

In some ways, 3 days is a long time. A lot can happen. Feelings can change. Perspective can change.

Getting a good night’s sleep during those 3 days, or talking with a friend or suicide hotline, or simply surfing the waves of moods, can weaken the suicidal impulse.

In other ways, 3 days is hardly a blip on the radar screen of an entire life. If after 3 days you still are intent on dying, please get help.

Reach out to others, whether someone you know or a stranger at hotline or online. For a list of places where you can get help anonymously, you can start here.

What Next?

Even if you follow the 3-day rule and no longer feel adamantly that suicide is your only option, the suicidal thoughts might still persist or revisit.

Ultimately, to survive suicide’s assault, more is needed than waiting.

You might need to uncover reasons for living. Tapping into hope and rediscovering pleasure can also help.

More than anything, talking back to suicidal thoughts and learning to cope with them can fortify you in your fight against suicidal forces.

A Good Starting Place

The 3-day rule is a good place to start. Not only can it save your life, it can also show you with amazing clarity that suicidal thoughts can waver in their intensity.

Those 3 days can demonstrate that at least the strength of suicidal thoughts, if not suicidal thoughts themselves, can be temporary.

Suicidal thoughts can change, as can you, your mood, and your life.

One Important Suicide Fact That Nobody Is Talking About

Most suicide attempts are unsuccessful—except when it comes to guns.

We hear about gun violence in blips: The latest mass shooting or grisly homicide brings national attention and calls to action, and then the issue falls under the radar. It's easy to forget that two-thirds of gun deaths aren't high-profile homicides, but suicides—happening quietly, at a rate of one every 25 minutes.

A new report by the Brady Center to Prevent Gun Violence, a gun safety advocacy group, delivers sobering stats based on data from the Centers for Disease Control and Prevention and academic journal articles—perhaps the most eye-opening being that keeping a firearm at home increases the risk of suicide by three times. A whopping 82 percent of teens who commit suicide with a gun are using a family member's firearm.

Guns are a particularly effective means of suicide precisely because they are so lethal: Of those who attempt suicide by firearm, nine in 10 succeed. By contrast, only one in 50 overdose attempts result in death. The lethality is compounded by impulsivity: The majority of suicide attempts occur less than an hour after the decision is made to commit suicide.

One common argument of the gun lobby is that suicidal individuals will find a way to take their lives—if they don't die by gun, they'll do it by some other means. But the reality is that 90 percent of those who fail in a suicide attempt do not end up dying by suicide. With guns, though, not many get a second chance.

Don't know what to say?

Try one of these opening lines to get the conversation rolling:

"I've noticed you've been down lately. What's going on?"
"Hey, we haven't talked for a while. How are you?"
"Are you OK? You don't seem like yourself lately."
"I know you're going through some stuff: I'm here for you."
"No matter what you're going through, I've got you're back."
"This is awkward, but I'd like to know if you're really all right."
"I haven't heard you laugh in a while. Is everything OK?"
"I'm worried about you and would like to know what's up so I can help."
"Is there anything you want to talk about?"
"Hey, you seemed frustrated today. I'm here for you. Want a hug? Or a chat?"
"Hey, where have you been? Missed you at practice."
"You ok? I noticed you've missed school a few times."
"I feel like something's up. Can you share with me?"
"Your face is telling me you could use a good talk."
"You know you can tell me anything. I won't judge."
"Seems like something's up. Do you wanna talk about what's going on?"
"Listen, you're my friend, and I just want to know how you're feeling."
"Whenever you're ready to talk, I'm ready to listen."
"I know life can be overwhelming sometimes. So, if you want to talk, I'm here."
"Is there anything you want to get off your chest?"
"Maybe it's me but I was wondering if you were all right."

No need to be an expert. Just be a friend. These tips should make starting a conversation about mental health a lot less awkward:

Keep it casual. Relax: think of it as a chill chat, not a therapy session.

You seized the awkward. What now? Keep checking in, and if you want to do more, there's a bunch of other ways to help your friend: Don't give up. Maybe the first attempt didn't go so well or maybe they just weren't ready to talk. Show your friend that you're there for them. Stay available and keep checking in.

In an emergency. If you or your friend needs urgent help, call 911 right away. Or even take your friend to the emergency room for assistance. If you feel it's safe, stay with your friend or find someone to stay with them until help arrive.

One patient at a time, this Wash U program works to reduce gun suicides

Missouri’s suicide rate ranks 13th in the nation.

In 2016, there were roughly 10 suicides per 100,000 residents, and more than half were gun-related. Yet despite the statistics, only about half of emergency-room doctors in the U.S. ask patients at risk of suicide if they have access to guns at home.

A new Washington University program aims to tackle this issue directly by working with patients at risk of suicide before they’re discharged from the hospital. The Counseling on Access to Lethal Means (C.A.L.M.) program helps patients temporarily store dangerous items they may have at home, including guns and prescription medication.

"It’s a distinctly proactive approach," said Kristen Mueller, a Barnes-Jewish Hospital emergency-room doctor and C.A.L.M. program coordinator.

“As a physician, I got into the game to help save lives,” said Mueller. “There’s only so many patients I could take care of in the emergency department before we started to say, 'Enough is enough.' What can we do to start preventing this from happening in the first place?”

The program, which is funded through grants from the Washington University Institute for Public Health and the Barnes-Jewish Hospital Foundation, trains research coordinators using online materials from the Suicide Prevention Resource Center.

As part of the program, research coordinators work one-on-one with patients to help identify if they have access to guns at home.

“You do your best to get an assessment of what’s immediately available,” said registered nurse and C.A.L.M. research coordinator Chris Kriedt. “I’ll ask, ‘Do you have a firearm readily available? Is it loaded? If you were in a crisis moment, would you be able to reach over and just pick it up?’”

During the initial assessment, Kriedt helps patients who have access to guns come up with a plan for storing them. Patients may opt to store their guns temporarily at a local gun range, for instance, or in the home of a friend.

Research coordinators have worked with 15 patients through the C.A.L.M. program since its inception in December. Kriedt said a key component of the program is following up with patients two to three days after they have left the hospital.

“I believe that some kind of support after the fact, after the hospital, after the emergency room, is important. Because people, I think, feel like they’re left high and dry,” said Kriedt. “They’re told to follow up, but they don’t have anybody to help them along the way.”

Suicide prevention initiatives often face a number of challenges, including the stigma associated with mental health issues.

Mueller hopes the C.A.L.M. program will help normalize the idea that it’s not a weakness to have mental health issues or signs of depression.

“Many people are perfectly comfortable talking about child safety seats in their cars, talking about whether or not they wear their seatbelt, talking about whether they’re smoking or not smoking,” said Mueller. “This is just another aspect of personal and public health.”

There are also deep-seated misconceptions about suicide risk. The rate of gun-related suicide varies substantially based on demographics, with white males over the age of 55 at the highest risk in Missouri.

Men are also seven times more likely to die by gun suicide than women in Missouri, according to the Centers for Disease Control and Prevention.

The C.A.L.M. program at Barnes-Jewish Hospital will continue through December, after which organizers will conduct an assessment and determine whether to continue the program long term.

“The benefit would be even if one person from this entire study stores their firearm safely and doesn’t commit suicide, to me, that makes it worth it,” Mueller said.

(Editor's note: C.A.L.M. is SPRC`s free self-paced online course to improve your knowledge and skills in suicide prevention. It is especially for clinicians and other service providers, educators, health professionals, public officials, and members of community-based coalitions who are responsible for developing and implementing effective suicide prevention programs and policies.)

(Editor's note two: People ask why physicians are treating psychosocial issues and social workers are seemingly not involved. Possibly because it is NOT a requirement for psychologists and mental health professionals (therapists, social workers, etc) to have suicide prevention training as part of their license or as continuing education. Of course some may take it as an 'option', but it is NOT required. Oregon tried to change that to make is mandatory in this 2017 legislative session with SB 48 but there was too much resistance from CO and some of the legislators that it was changed to a suggestion and passed. Our thought: if you suffer from anxiety, depression, suicide thoughts and want help from a mental health professional, don't assume that just because they have an professional looking license to practice, that they have the necessary training in suicidality to help keep you from killing yourself. It is too big of a risk.)

Common Ground: Reducing Gun Access
“Let’s not get on the anti-gun or pro-gun bandwagon,
let’s get on the anti-suicide bandwagon.” Ralph Demicco

Limiting access to guns can help save the lives of people who are at risk of suicide. And who better to take on this suicide prevention effort than the gun community, asserts Cathy Barber of Harvard’s Means Matter Campaign. Ralph Demicco, a former gun shop owner agrees, “I’ve experienced an awful lot of incidents where friends, customers, and acquaintances have taken their lives with firearms, so it’s a very striking issue to me.” Barber and Demicco joined together with gun owners and public health professionals to form the Gun Shop Project, forging an unlikely but highly successful partnership with the mission of reducing a suicidal person’s access to guns.

Reduce Access to Means of Suicide

Reducing access to lethal means of self-harm for a person at risk of suicide is an important part of a comprehensive approach to suicide prevention. Firearms are the most lethal among suicide methods. Also of concern are medications that are lethal at high doses.

Why It's Important

Here are some of the reasons why reducing access to lethal means is important:1

  • Many suicide attempts take place during a short-term crisis, so it is important to consider a person's access to lethal means during these periods of increased risk.
  • Access to lethal means is a risk factor for suicide.
  • Reducing access to lethal means saves lives.

What You Can Do

Families, organizations, health care providers, and policymakers can take many actions to reduce access to lethal means of self-harm. Some of these are general household health and safety precautions that should be used regardless of suicide risk. Examples include limiting access to medications and storing firearms safely when not in use.

Other actions may be more appropriate when a person is at risk for suicide. If someone in the home is feeling suicidal, has recently attempted suicide, or is experiencing a crisis, it is safest to remove lethal means from the household entirely until the situation improves. For example:

  • Store firearms with law enforcement (if allowed), or lock up firearms and put the key in a safe deposit box or give the key to a friend until the crisis has passed.
  • Ask a family member to store medications safely and dispense safe quantities as necessary.

Some communities also focus means restriction efforts on local suicide “hotspots,” such as bridges. As part of strategic planning, states, tribes, and communities should examine their data to identify what suicide means they should address.

Families, organizations, health care providers, and policymakers can take make many actions to reduce access to lethal means of self-harm.

Take Action

Obtain and share knowledge about the issue and how others can help.

  • Learn more about this topic by visiting the Means Matter website, maintained by the Harvard T. H. Chan School of Public Health.
  • Educate family members and others about ways to limit access to lethal means during a suicidal crisis.
  • Train nontraditional providers in lethal means counseling, for example, divorce and defense attorneys, probation/parole officers, and first responders.
  • Educate the community about options for temporary storage of a firearm outside of the home during a suicidal crisis.

Collaborate with others in your community to increase safety.

  • Institute lethal means counseling policies in health and behavioral health care settings and train health care providers in these settings.
  • Pass policies that exempt at-risk patients from mandatory 90-day refill policies.
  • Work collaboratively with gun retailers and gun owner groups on suicide prevention efforts. (See Gun Shop Project for examples of materials developed with and for firearms retailers and range owners.)
  • Distribute free or low-cost gun locks or gun safes.
  • Ensure that bridges and high buildings have protective barriers.


Harvard T. H. Chan School of Public Health. (n.d.). Means matter website. Retrieved from

One patient at a time, this Wash U program works to reduce gun suicides

The firearm suicide rate (6.3 per 100,000 people) is higher than the firearm homicide rate and has come down less sharply. The number of gun suicide deaths (19,392 in 2010) outnumbered gun homicides, as has been true since at least 1981.

The number of firearms available for sale to or possessed by U.S. civilians (about 310 million in 2009, according to the Congressional Research Service) has grown in recent years, and the 2009 per capita rate of one person per gun had roughly doubled since 1968. It is not clear, though, how many U.S. households own guns or whether that share has changed over time.

Data on homicides and other deaths are from the Centers for Disease Control and Prevention, based on information from death certificates filed in state vital statistics offices, which includes causes of death reported by attending physicians, medical examiners and coroners. Data also include demographic information about decedents reported by funeral directors, who obtain that information from family members and other informants. Population data, used in constructing rates, come from the Census Bureau. Most statistics were obtained via the National Center for Injury Prevention and Control’s Web-based Injury Statistics Query and Reporting System (WISQARS), available from URL: Data are available beginning in 1981; suitable population data do not exist for prior years. For more details, see Appendix 4.

Appendices 1-3 consist of detailed tables with annual data for firearm deaths, homicides and suicides, as well as non-fatal firearm and overall non-fatal violent crime victimization, for all groups and by subgroup.Appendices 1-3 consist of detailed tables with annual data for firearm deaths, homicides and suicides, as well as non-fatal firearm and overall non-fatal violent crime victimization, for all groups and by subgroup

In 2010, there were 31,672 deaths in the U.S. from firearm injuries, mainly through suicide (19,392) and homicide (11,078), according to CDC compilation of data from death certificates.6

Still, due in part to recent increases in the number of suicides, firearm homicide accounted for 35% of firearm deaths in 2010, the lowest share since 1981, the first year for which the CDC published data.

The gun suicide rate has declined far less than the gun homicide rate since the mid-1990s; the gun suicide rate began rising in recent years, and the number of victims is slightly higher than two decades ago. See the textbox at the end of this section for more detail.

Suicide by Firearm

Based on death certificates, 19,392 people killed themselves with firearms in 2010, according to data from the Centers for Disease Control and Prevention. That is the highest annual total since the CDC began publishing data in 1981, when the suicide toll was 16,139. Firearm suicide was the fourth leading cause of violent-injury death in 2010, following motor vehicle accidents, unintentional poison (including drug overdose) and falls. Firearms accounted for 51% of suicides in 2010.

The firearm suicide rate peaked in 1990, at 7.6 per 100,000 people, before declining or leveling off for most years since then. However, in recent years, the rate has risen somewhat: From 2007 to 2010, it went up 9%. The firearm suicide rate in 2010 (6.3 per 100,000 people) was the same as it was in 1998. Preliminary 2011 data show 19,766 deaths, and no change in rates from 2010.

The number of firearm suicides has been greater than the number of firearm homicides since at least 1981. But as firearm homicides have declined sharply, suicides have become a greater share of firearm deaths. In 2010, 61% of gun deaths were due to suicide, compared with about half in the mid-1990s. (The remaining firearm deaths, in addition to suicide and homicide, are accidental, of undetermined intent or the result of what the CDC terms “legal intervention,” generally a police shooting.)

Males are the vast majority of gun suicides (87% in 2010), and the suicide rate for males (11.2 deaths per 100,000 people) is more than seven times the female rate (1.5 deaths). The highest firearm suicide rate by age is among those ages 65 and older (10.6 per 100,000 people). The rate for older adults has been relatively steady in recent years; the rate is rising, though, among those ages 41-64, according to CDC data. Among the three largest racial and ethnic groups, whites have the highest suicide rate at 8.5 per 100,000, followed by blacks (2.7) and Hispanics (1.9).

Comparing homicide and suicide rates, suicide rates are higher than homicide rates for men; they are about equal for women. By age group, suicide rates are higher than homicide rates only for adults ages 41-64 and those ages 65 and older. Homicide rates are higher than suicide rates for blacks and Hispanics; for whites, the suicide rate is higher than the homicide rate. Detailed tables on gun suicide can be found in Appendix 1.

Gun Ownership

The number of firearms available for sale to or possessed by U.S. civilians has grown in recent years, according to the Congressional Research Service and other research. A 2012 CRS report estimated that about 310 million firearms were available to or owned by civilians in the U.S. in 2009—114 million handguns, 110 million rifles and 86 million shotguns (Congressional Research Service, 2012). The figure was derived from manufacturing, export and import data published by the Bureau of Alcohol, Tobacco, Firearms and Explosives. The 2009 per capita rate of one person per gun in the U.S. had roughly doubled since 1968, the report said.

The 2007 Small Arms Survey, conducted by the Graduate Institute of International and Development Studies in Geneva (Completing the Count, 2007), estimated that 270 million firearms were owned by private citizens in the U.S. that year,13 or about 90 firearms per 100 people. The Small Arms Survey relied on ATF data and independent surveys.

It is not clear, however, how many U.S. households owned guns or whether the share of gun-owning U.S. households has changed over time.

According to a recent Pew Research Center survey (Pew Research Center, March 2013) 37% of adults say they or someone else in their household owns a Gun Ownership

The number of firearms available for sale to or possessed by U.S. civilians has grown in recent years, according to the Congressional Research Service and other research. A 2012 CRS report estimated that about 310 million firearms were available to or owned by civilians in the U.S. in 2009—114 million handguns, 110 million rifles and 86 million shotguns (Congressional Research Service, 2012). The figure was derived from manufacturing, export and import data published by the Bureau of Alcohol, Tobacco, Firearms and Explosives. The 2009 per capita rate of one person per gun in the U.S. had roughly doubled since 1968, the report said.

The 2007 Small Arms Survey, conducted by the Graduate Institute of International and Development Studies in Geneva (Completing the Count, 2007), estimated that 270 million firearms were owned by private citizens in the U.S. that year,13 or about 90 firearms per 100 people. The Small Arms Survey relied on ATF data and independent surveys.

It is not clear, however, how many U.S. households owned guns or whether the share of gun-owning U.S. households has changed over time.

According to a recent Pew Research Center survey (Pew Research Center, March 2013) 37% of adults say they or someone else in their household owns a firearm of some kind. The 2012 General Social Survey (GSS) reports 34% do. However, a Gallup survey in 2012 found that 43% of respondents said there was at least one gun in their household.

Gallup survey data indicates that the share of households with guns is the same now as in 1972 (43%),

Respondent error or misstatement in surveys about gun ownership is a widely acknowledged concern of researchers. People may be reluctant to disclose ownership, especially if they are concerned that there may be future restrictions on gun possession or if they acquired their firearms illegally. For whatever reason, husbands are more likely than wives to say there is a firearm in their households (Wright et al., 2012). Household surveys do not cover all gun ownership; they include only firearms owned by people in households.

most research agrees that civilians in the United States own more firearms both total and per capita than those in any other nation. The Small Arms Survey in 2007 found not only that U.S. civilians had more total firearms than any other nation (270 million) but also that the rate of ownership (about 90 firearms for every 100 people) was higher than in other countries. “With less than 5 percent of the world’s population, the United States is home to 35-50 per cent of the world’s civilian-owned guns,” according to the survey, which included estimates for 178 countries.

“Mexico, the USA and Northern Ireland stand out with the highest percentages gun-related attacks (16%, 6% and 6% respectively).” The U.S. had the highest share of sexual assault involving guns.

Teen Suicide, Struggling Teen

You can't unfire
a fire arm


It’s not the bullet that kills you, it’s the hole. Call 911.


“Place your hand over your heart, can you feel it? That is called purpose. You’re alive for a reason so don’t ever give up.”

“The person who completes suicide, dies once. Those left behind die a thousand deaths, trying to relive those terrible moments and understand … Why?” – Clark (2001)

“Suicide is a permanent solution to a temporary problem.”

“Never never never give up.” – Winston Churchill