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Mental illness and guns: the issue is suicide

Few murders will be prevented, but many lives will be saved

By Steven S. Sharfstein

8:00 AM EDT, March 17, 2013

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Some years ago, I was called by one of my patients who had just suffered severe rejection in a love relationship. She told me that she was on her way to buy a gun but thought she might call me first. I suggested that she come see me before she purchased a gun so we could talk it over.

In the intense debate on gun violence and mental illness, with a focus on the extremely rare event of mass murders such as in Newtown, Conn., or Aurora, Colo., what is lost in the conversation and debate is the serious suicide epidemic we experience in the United States every year due to gun violence.

Of 30,000 gun deaths in the U.S. every year, nearly 20,000 are suicides. If you try to kill yourself with a gun, you will be successful 80 percent of the time, as compared to suicide attempts by overdose, in which the success rate is less than 2 percent.

The lethality of guns and easy access to them are major contributors to this public health problem. The state with the highest suicide rate in the U.S. is Wyoming, where the prevalence of guns in the home is the highest. There is a direct correlation between the availability of guns, their presence in the home, and suicide. Seventy-five percent of guns used in youth suicides are accessible in the home or the home of a friend.

Creating barriers to the availability of lethal means has been shown to have a strong impact on the suicide rate. When physical barriers were erected at the Golden Gate Bridge in San Francisco, suicide from that readily accessible structure decreased drastically, and those individuals did not go to another bridge and try the same thing. Many people who commit suicide by gun are momentarily desperate and panicked rather than classically depressed. Approximately 40 percent who kill themselves with a gun are not in therapy at the time of death, and many families report that the first time they were aware of such extreme distress was after the event of a gun suicide. But depression is the most important risk factor for suicide, and restricting access to guns would be lifesaving.

In contrast, less than 4 percent of homicide gun deaths are attributable to individuals with mental illness. People suffering from mental illness are more likely to be victims of homicide than perpetrators. So, as the legislature and the governor consider restricting access to guns, we need to keep in mind this contrast between risk for suicide and homicide. Barriers to purchasing a gun for those with a history of treatment for mental illness will likely have a positive impact on the suicide rate but not much effect on the homicide rate.

My patient did come to see me before going to a gun shop, and her suicidal impulse subsided after her psychotherapeutic session. Creating time between a suicidal impulse and getting a loaded gun is clearly lifesaving.

Dr. Steven S. Sharfstein is president and chief executive officer of Sheppard Pratt Health System in Baltimore. His email is ssharfstein@sheppardpratt.org.

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