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Access to Lethal Means, Firearms, and Suicide

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Suicide Risk Assessment and Prevention

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Abstract

A clinical case scenario: a patient is being treated in the state of California. He is a retired army veteran who keeps a handgun on his nightstand for protection and a shotgun in his closet for hunting. His suicide risk is estimated to be moderate secondary to his endorsement of passive suicidal ideation without intent or plan. As part of the Veterans Affairs (VA) safety plan, the clinician works with the patient to have his friend take over ownership of the firearm in order to reduce the potential for the use of lethal means. What are the possible problems with this scenario? First, federal law bars certain individuals from possessing firearms (18 USC § 922(g) [1]) and prohibits anyone from furnishing a firearm to these prohibited persons (18 USC § 922(d) [1]). California law requires that a firearm transfer goes through appropriate agencies and procedures, including a background check and 10-day waiting period (Cal. Penal Code § 27,545). Depending on the county, further jurisdictional issues and differences arise. In attempting to protect the patient, the clinician likely encouraged them to commit multiple infractions of both state and federal law. Further, the clinician has opened themselves up to a potential for a claim of professional negligence and providing an inappropriate standard of care. The ethical dilemma at hand showcases several considerations for the mental health professional regarding access to lethal means but is by no means an exhaustive list of possible issues.

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References

  1. 18 U.S.C. § 922. 2016.

    Google Scholar 

  2. 48 Stat. 1236 (Pub. Law 73-474).

    Google Scholar 

  3. 554 US 570. 2008.

    Google Scholar 

  4. 561 US 742. 2010.

    Google Scholar 

  5. 82 Stat. 1213-2.

    Google Scholar 

  6. American Psychological Association. Ethical principles of psychologists and code of conduct. 2017. https://www.apa.org/ethics/code/

  7. Anestis MD, Houtsma C. The association between gun ownership and statewide overall suicide rates. Suicide Life Threat Behav. 2017;48(2):204–17.

    Article  PubMed  Google Scholar 

  8. Anestis MD, Anestis JC, Butterworth SE. Handgun legislation and changes in statewide overall suicide rates. Am J Public Health. 2017a;107(4):579.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Anestis MD, Selby EA, Butterworth SE. Rising longitudinal trajectories in suicide rates: the role of firearm suicide rates and firearm legislation. Prev Med. 2017b;100:159–66.

    Article  PubMed  Google Scholar 

  10. Barber CW, Miller MJ. Reducing a suicidal person’s access to lethal means of suicide: a research agenda. Am J Prev Med. 2014;47(3):S264–72.

    Article  PubMed  Google Scholar 

  11. Barnhorst A, Kagawa RMC. Access to firearms: when and how do mental health clients become prohibited from owning guns? Psychol Serv. 2018;15(4):379–85.

    Article  PubMed  Google Scholar 

  12. Bernert RA, Hom MA, Weiss Roberts L. A review of multidisciplinary clinical practice guidelines in suicide prevention: toward an emerging standard in suicide risk assessment and management, training and practice. Acad Psychiatry. 2014;38(5):585–92.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Betz ME, Kautzman M, Segal DL, Miller I, Camargo CA Jr, Boudreaux ED, Arias SA. Frequency of lethal means assessment among emergency department patients with a positive suicide risk screen. Psychiatry Res. 2018;260:30–5.

    Article  PubMed  Google Scholar 

  14. Bryan CJ, Stone SL, Rudd MD. A practical, evidence-based approach for means-restriction counseling with suicidal patients. Prof Psychol Res Pract. 2011;42(5):339.

    Article  Google Scholar 

  15. Caron J, Julien M, Huang JH. Changes in suicide methods in Quebec between 1987 and 2000: the possible impact of bill C-17 requiring safe storage of firearms. Suicide Life Threat Behav. 2008;38(2):195–208.

    Article  PubMed  Google Scholar 

  16. Chapman S, Alpers P, Agho K, Jones M. Australia’s 1996 gun law reforms: faster falls in firearm deaths, firearm suicides, and a decade without mass shootings. Inj Prev. 2006;12(6):365–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Drapeau CW, McIntosh JL. U.S.A. suicide: 2018 official final data. American Association of Suicidology; 2020. https://suicidology.org/wp-content/uploads/2020/02/2018datapgsv2_Final.pdf

    Google Scholar 

  18. Edwards SJ, Sachmann MD. No-suicide contracts, no-suicide agreements, and no-suicide assurances: a study of their nature, utilization, perceived effectiveness, and potential to cause harm. Crisis. 2010;31(6):290–302.

    Article  PubMed  Google Scholar 

  19. de Fatima Marinho de Souza M, Macinko J, Alencar AP, Malta DC, de Morais Neto OL. Reductions in firearm-related mortality and hospitalizations in Brazil after gun control. Health Aff. 2007;26(2):575–84.

    Article  Google Scholar 

  20. Fleegler EW, Lee LK, Monuteaux MC, Hemenway D, Mannix R. Firearm legislation and firearm-related fatalities in the United States. JAMA Intern Med. 2013;173(9):732–40.

    Article  PubMed  Google Scholar 

  21. Fowler KA, Dahlberg LL, Haileyesus T, Annest JL. Firearm injuries in the United States. Prev Med. 2015;79:5–14.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Granello DH. The process of suicide risk assessment: twelve core principles. J Couns Dev. 2010;88(3):363–71.

    Article  Google Scholar 

  23. Hedegaard H, Curtin SC, Warner M. Increase in suicide mortality in the United States, 1999–2018. Centers for Disease Control and Prevention; 2020. https://www.cdc.gov/nchs/products/databriefs/db362.htm#:~:text=Data%20from%20the%20National%20Vital,year%20from%202006%20through%202018

    Google Scholar 

  24. Jobes DA, Rudd MD, Overholser JC, Joiner TE Jr. Ethical and competent care of suicidal patients: contemporary challenges, new developments, and considerations for clinical practice. Prof Psychol Res Pract. 2008;39(4):405–13.

    Article  Google Scholar 

  25. Kahane LH, Sannicandro P. The impact of 1998 Massachusetts gun laws on suicide: a synthetic control approach. Econ Lett. 2019;174:104–8.

    Article  Google Scholar 

  26. Kapusta ND, Etzersdorfer E, Krall C, Sonneck G. Firearm legislation reform in the European Union: impact on firearm availability, firearm suicide and homicide rates in Austria. Br J Psychiatry. 2007;191(3):253–7.

    Article  PubMed  Google Scholar 

  27. Kayman DJ, Goldstein MF, Wilsnack J, Goodman M. Safety planning for suicide prevention. Curr Treat Options Psychiatry. 2016;3:411–20.

    Article  Google Scholar 

  28. Kegler SR, Dahlberg LL, Mercy JA. Firearm homicides and suicides in major metropolitan areas – United States, 2012–2013 and 2015–2016. MMWR Morb Mortal Wkly Rep. 2018;67(44):1233–7.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kleespies PM, Penk WE, Forsyth JP. The stress of patient suicidal behavior during clinical training: incidence, impact, and recovery. Prof Psychol Res Pract. 1993;24(3):293–303.

    Article  Google Scholar 

  30. Kochanek KD, Murphy SL, Xu J, Arias J. Deaths: final data for 2017. Centers for Disease Control and Prevention; 2019. https://stacks.cdc.gov/view/cdc/79486

    Google Scholar 

  31. Labouliere CD, Stanley B, Lake AM, Gould MS. Safety planning on crisis lines: feasibility, acceptability, and perceived helpfulness of a brief intervention to mitigate future suicide risk. Suicide Life Threat Behav. 2020;50(1):29–41.

    Article  PubMed  Google Scholar 

  32. Lee WS, Suardi S. The Australian firearms buyback and its effect on gun deaths. Contemp Econ Policy. 2010;28(1):65–79.

    Article  CAS  Google Scholar 

  33. Leenaars A, Cantor C, Connolly J, EchoHawk M, Gailiene D, He ZX, … Schlebusch L. Controlling the environment to prevent suicide: international perspectives. Can J Psychiatry. 2000;45(7):639–44.

    Google Scholar 

  34. Leenaars AA, Moksony F, Lester D, Wenckstern S. The impact of gun control (Bill C-51) on suicide in Canada. Death Stud. 2003;27(2):103–24.

    Article  PubMed  Google Scholar 

  35. Lubin G, Werbeloff N, Halperin D, Shmushkevitch M, Weiser M, Knobler HY. Decrease in suicide rates after a change of policy reducing access to firearms in adolescents: a naturalistic epidemiological study. Suicide Life Threat Behav. 2010;40(5):421–4.

    Article  PubMed  Google Scholar 

  36. Mackelprang JL, Karle J, Reihl KM, Cash RE. Suicide intervention skills: graduate training and exposure to suicide among psychology trainees. Train Educ Prof Psychol. 2014;8(2):136–42.

    PubMed  PubMed Central  Google Scholar 

  37. McPhedran S, Baker J. Suicide prevention and method restriction: evaluating the impact of limiting access to lethal means among young Australians. Arch Suicide Res. 2012;16(2):135–46.

    Article  PubMed  Google Scholar 

  38. Naghavi M, Marczak LB, Kutz M, Shackelford KA, Arora M, Miller-Petrie M, … Muray CJL. Global mortality from firearms, 1990–2016. J Am Med Assoc. 2018;320(8):792–814.

    Google Scholar 

  39. Pirelli G, Witt P. Firearms and cultural competence: considerations for mental health professionals. J Aggress Confl Peace Res. 2017;10(1):61–70.

    Article  Google Scholar 

  40. Public Law. 90-351.

    Google Scholar 

  41. Public Law. 103-159.

    Google Scholar 

  42. Roush JF, Brown SL, Jahn DR, Mitchell SM, Taylor NJ, Quinnett P, Ries R. Mental health professionals’ suicide risk assessment and management practices: the impact of fear of suicide-related outcomes and comfort working with suicidal individuals. Crisis: J Crisis Interv Suicide Prev. 2018;39(1):55–64.

    Article  Google Scholar 

  43. Rudd MD, Mandrusiak M, Joiner TE Jr. The case against no-suicide contracts: the commitment to treatment statement as a practice alternative. J Clin Psychol In Session. 2006;62(2):243–51.

    Article  PubMed  Google Scholar 

  44. Santaella-Tenorio J, Cerdá M, Villaveces A, Galea S. What do we know about the association between firearm legislation and firearm-related injuries? Epidemiol Rev. 2016;38(1):140–57.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Schmitz Jr. WM, Allen MH, Feldman BN, Gutin NJ, Jahn DR, Kleespies PM, … Simpson S. Preventing suicide through improved training in suicide risk assessment and care: an American association of suicidology task force report addressing serious gaps in U.S. Mental health training. Suicide Life Threat Behav. 2012;43(2):292–304.

    Google Scholar 

  46. Simon RI. Suicide risk assessment: what is the standard of care? J Am Acad Psychiatry Law. 2002;30:340–4.

    PubMed  Google Scholar 

  47. Small Arms Survey. Estimating civilian owned firearms. 2011. http://www.smallarmssurvey.org/about-us/highlights/highlight-research-note-9-estimating-civilian-owned-firearms.html

  48. Small Arms Survey. Annual Report 2018. 2018. http://www.smallarmssurvey.org/fileadmin/docs/M-files/SAS-Annual-Report-2018.pdf

  49. Stanley B, Brown GK. Safety planning intervention: a brief intervention to mitigate suicide risk. Cogn Behav Pract. 2012;19(2):256–64.

    Article  Google Scholar 

  50. Stanley B, Brown GK, Currier GW, Lyons C, Chesin M, Knox KL. Brief intervention and follow-up for suicidal patients with repeat emergency department visits enhances treatment engagement. Am J Public Health. 2015;105(8):1570–2.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Stanley B, Chaudhury SR, Chesin M, Pontoski K, Mahler Bush A, Knox KL, Brown GK. An emergency department intervention and follow-up to reduce suicide risk in the VA: acceptability and effectiveness. Psychiatr Serv. 2016;67(6):680–3.

    Article  PubMed  Google Scholar 

  52. Stanley B, Brown GK, Brenner LA, Galfalvy HC, Currier GW, Knox KL, … Green KL. Comparison of the safety planning intervention with follow-up vs usual care of suicidal patients treated in the emergency department. JAMA Psychiat. 2018;75(9):894–900.

    Google Scholar 

  53. Stanley IH, Simpson S, Wortzel HS, Joiner TE. Documenting suicide risk assessments and proportionate clinical actions to improve patient safety and mitigate legal risk. Behav Sci Law. 2019;37:304–12.

    Article  PubMed  Google Scholar 

  54. Stone DM, Simon TR, Fowler KA, Kegler SR, Yuan K, Holland KM, … Crosby AE. Vital signs: trends in state suicide rates – United States, 1999–2016 and circumstances contributing to suicide – 27 states, 2015. MMWR Morb Mortal Wkly Rep. 2018;67(22):617–24.

    Google Scholar 

  55. Takahashi Y. Suicide in Japan. In: Suicide prevention. Boston: Springer; 2002. p. 121–30.

    Chapter  Google Scholar 

  56. Traylor A, Price JH, Telljohann SK, King K, Thompson A. Clinical psychologists’ firearm risk management perceptions and practices. J Community Health. 2010;35:60–7.

    Article  PubMed  PubMed Central  Google Scholar 

  57. U.S. Const.. Amend. II.

    Google Scholar 

  58. World Health Organization (WHO). Suicide in the world: Global health estimates. 2019. https://apps.who.int/iris/bitstream/handle/10665/326948/WHO-MSD-MER-19.3-eng.pdf.

  59. Zonana J, Simberlund J, Christos P. The impact of safety plans in an outpatient clinic. Crisis. 2018;39(4):304–9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Palo Alto University, Palo Alto, CA, USA

    Anna Feinman, Dana Lockwood, Tina Thach & Bruce Bongar

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  1. Anna Feinman
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  2. Dana Lockwood
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  4. Bruce Bongar
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Correspondence to Dana Lockwood .

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Editors and Affiliations

  1. Department of Neurosciences, Sapienza University of Rome, ROMA, Roma, Italy

    Maurizio Pompili

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Feinman, A., Lockwood, D., Thach, T., Bongar, B. (2021). Access to Lethal Means, Firearms, and Suicide. In: Pompili, M. (eds) Suicide Risk Assessment and Prevention. Springer, Cham. https://doi.org/10.1007/978-3-030-41319-4_78-1

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  • DOI: https://doi.org/10.1007/978-3-030-41319-4_78-1

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  • Print ISBN: 978-3-030-41319-4

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