All in favor of curbing gun deaths, say “aye.”
Yep, that seems to be just about everyone, including all gun owners I know, which is not an insignificant number. Now we have to address the difficult task of how to do such a thing.
Outlining the framework
In my profession - that being mental healthcare - the first thing we do to help someone is to start by defining the problem. Without a clear definition of the patient’s struggles, we cannot move forward for a variety of reasons; more on that later.
After we define the problem, we usually collaborate to establish a goal, which usually entails solving the problem, or at least reducing its negative impact on the individual. Next we select objectives to that goal, and then, finally, we implement an intervention. Typically the objectives and goals would be time-limited, measurable, achievable, and In counseling we collectively call this a “treatment plan.” This formula is generally applicable to most of life’s quandaries.
Let’s apply this treatment planning framework to gun violence, but first let’s define that term properly. For our purposes I will include firearm suicides in the general term of “gun violence.” Although I believe in parsing suicide from homicides, negligence, and all other non-death injuries, that’s not what most researchers (or media outlets) usually do.
In truth, most of us in the mental health/crisis intervention/suicide prevention realm bristle a bit when we are told that suicide is lumped in with “violence” because the concept of “self violence” opens a Pandora’s Box of debate. However, that is probably a discussion better left in the halls of academia and not worth muddying the waters here.
So if we agree on that definition of gun violence, we now have to identify our problem. That problem is probably something like, “we have too many preventable firearm deaths and injuries.” I don’t think anyone would disagree with that without presenting a very bizarre argument, so we’ll move forward to the goal. This is where the therapeutic framework starts to get sticky.
Aligning expectations
Esteemed emergency physician and public health researcher Megan Ranney recently shared that “part of the public-health approach is also saying that we’re not going to get to zero.”
That point should not be overlooked, it is both important and sensible. Setting a goal of perfection is maddeningly frustrating and inevitably disappointing. It also invites the notion that someone can (or should) have complete control over other people, which is simply not possible. Or at least, not without some egregious human rights violations along the way.
Not to rabbit-trail it too much, but this is what we’ve seen play out with covid measures: the idea that policy interventions can get all human beings to think and act alike, and that zero infection (or transmission or hospitalization or whatever measure is in vogue today) will somehow be achieved. This biased attitude, however conscious or unconscious it may be, not only causes anxious distress in people who get upset when others don’t simply do what they’re told, it also engenders contempt between and among all of us. Thuse, the goal of “zero gun deaths” is off the table.
As Dr. Ranney mentions, if we rewind to just 10 years ago firearm deaths broadly were down 40 percent from their 1970s peak, and sounds like a significant accomplishment. Let’s examine that mark and let’s also examine a breakdown of the deaths and what comprises the various contributors to the pie chart. Data courtesy of CDC, EFSGV, and Everytown.
In 2017 in the United States the following gun deaths were tallied:
14,542 homicides
23,854 suicides
1,377 negligent/legal intervention/undetermined (486/553/338)
161 deaths in mass shootings
In 2018:
13,958 homicides
24,432 suicides
1,350 negligent/legal intervention/undetermined (458/539/353)
112 deaths in mass shootings
In 2019:
14,414 homicides
23,941 suicides
1,546 negligent/legal intervention/undetermined (486/520/346)
160 deaths in mass shootings
In 2020:
19,411 homicides
24,297 suicides
1,532 negligent/legal intervention/undetermined (breakdown unavailable)
79 deaths in mass shootings
Preliminary data for 2021 are all we have so I am not including them until they are verified and published. In broad terms for 2021, it looks like the homicides dropped and suicides increased.
Focusing on suicide
The overall takeaway here is that across the past four years, 60% of all firearm deaths are suicides, 38% are homicides, and 0.3% are mass shootings.
If we’re also talking about the type of gun used in mass shootings, on average since 2004, 14% (of that 0.3%) are by assault rifles, which renders the ongoing debate about weapon style restrictions virtually useless anyway. Besides, it only takes one round to end a life and no rifle ban or magazine capacity limit will solve that. That brings me to the point of this article:
The link between gun deaths and mental health is through suicide.
If we want to reduce gun violence broadly, we have to focus on suicide prevention specifically. From there, any reasonable person can draw a line to homicide prevention. In fact, credible people have hypothesized that mass murder is merely suicide turned outward, so it is not a point to be overlooked.
The problem is that suicide isn’t sexy and doesn’t sell clicks. The largest mass shooting in America occurred in Las Vegas on October 1, 2017 at the Route 91 concert, resulting in 59 innocent deaths plus the shooter. By comparison, each day in America we have almost 67 suicides daily just by firearm. That’s a mass shooting bigger than Route 91 every. single. day. But there’s no news coverage.
This column is not the place for debate about the root causes of violence, though I could certainly have a pretty deep philosophical conversation about that. I would assert that if we address overall individual wellbeing (which is a public health matter for sure) that we might strike two objectives with one metaphorical policy stone.
Suicide is just one among many options for desperate people to process their internal distress. Homicide is another. Substance abuse, depression, anxiety, psychosis, gambling, sexual escapades, mood fluctuations, self-harm, identity crises, and indeed, within the entire DSM and parts of the ICD are methods by which unwell people cope. Poorly, for sure, but it’s still coping nonetheless. Address the illness at its root - that being the individual - and all of society will heal. If we improve individual and family wellness, then societal wellness will also improve.
I mentioned earlier that we cannot move forward with treatment without a clear definition of the patient’s struggles. Metaphorically, this “patient” is society and the “struggle” is that gun violence, either toward self or toward others, is far too frequent. The goal seems to be a reduction in that violence. The objectives even seem to be aligned: quantifiable, time-limited reduction in homicides and suicides.
That leads us to the interventions, where even the most reasonable, competent people depart from one another. One camp advocates for gun and ammunition restrictions. The other camp…mumble mumble…something else.
Inspiring hope!
Enter Walk the Talk America (WTTA), a 501(c)3 nonprofit founded by firearms industry professionals and upon whose board I sit. We offer several interventions.
The first solution is to invite gun owners to check on themselves via free and anonymous screenings, powered by Mental Health America. Gun owners have historically been suspicious of receiving clinical care of any kind, particularly mental health care. Reasons stem from judgmentalism from the counseling community about gun ownership (I’ve endured some of that myself), as well as the NRA infamously telling doctors to “stay in their lane.” The culture of avoidance is palpable, real, and inhibits care access. As such, “free and anonymous” really resonates.
The way we get this screening invitation to firearms owners is through gun, parts, and accessories manufacturers themselves. A flier with the screenings link is now included in firearms packaging across America from companies such as Hi-Point, Bersa, Armscor, and many others. A different version of the flier sits on the counters at retail stores and ranges such as Reno Guns and Range, inviting gun owners just to start thinking about screening and getting treatment. Before WTTA’s founding in 2018 this kind of outreach was outside the gun community’s Overton Window.
And prior to 2019, firearms cultural competence training for practitioners was outside the clinical community’s Overton Window. But that isn’t true anymore. With the creation of the three-part cultural competence course (good for CEUs with most licensing boards!), we are closing the cultural gap between clinicians and firearms owners. Across the country multiple federal, state, and local governmental entities have enlisted Walk the Talk America to train their staff on how to understand and navigate the stigma gun owners face from the medical and mental health communities.
Additionally, WTTA works with the firearms community to change its language around storage from “safe” to “responsible,” the latter of which is defined as “preventing unauthorized access.” That unauthorized person might be a burglar who smashes the car window, but it might also be the angsty teenager in the home or the kids’ friends over for a slumber party. It might even be the owner herself in a time of mental health crisis. Improving personal accountability and responsibility in firearm storage prevents a lot of harm.
We are also working to demystify the counseling process with training sessions for firearms instructors, staff at shooting ranges, and firearms manufacturers. We have similar outreach for law enforcement and veterans organizations. Through this endeavor more gun owners who were previously skeptical and/or suspicious of mental health services are warming to the idea that mental health professionals aren’t going to call the deputies to seize their property just because they’re experiencing anxiety or PTSD.
(author’s note: Yes, this reluctance to seek care is a problem and it afflicts many professions. Law enforcement, both active and retired military, and other demographics suffer significant job-induced mental stress and deserve treatment without stigma or fear of reprisal. The advent of so-called “Red Flag'' and “background check loophole” laws has had a chilling effect on firearms owners pursuing care because people don’t want to become felons for trying to do the right thing in a crisis, such as holding a friend’s guns. Judgmental language found in Nevada’s own laws intimates that criminality is synonymous with mental illness, which perpetuates stigma and misunderstanding. Another Nevada statute shows the barrier to rights restriction as low (reasonable suspicion) but the hurdle to rights restoration as being high (clear and convincing evidence). The meta message to gun owners is, “seek care at your own risk because you might lose your rights and never get them back.”)
Finally, Walk the Talk America also has a podcast, appropriately entitled Guns and Mental Health, where we foster conversations never before had in either realm. The chasm was so bad, in fact, that when I first met WTTA founder Mike Sodini, I had him as a guest on my own podcast and I told him that we could talk about his organization but we couldn’t discuss me being a gun-owning therapist. I was too afraid to come out of the closet to my own peer colleagues. That situation is both sad and telling.
We’ve done a lot of work and come a long way since then. Notably, we benefitted from a wonderful documentary by the venerable Connie Wray, who lost her own Marine veteran daughter to suicide by firearm and who was literally afraid of guns…until she did the documentary. We also owe a debt to Crisis Support Services of Nevada for connecting us with Connie because it has created a lot of healing throughout the community.
Doing something
Our next endeavor is to create a national directory of self-identified gun-friendly clinicians to whom firearm owners can turn when they need care. This has proven to be a heavy lift though. As it turns out, far too many of us in my field still fear the stigma of their peer colleagues judging us for walking in both realms. Even Psychology Today seemingly blew off our request to have “Firearm Friendly” listed as a specialty treatment area on clinician profiles. But 40% of American adults own firearms (including our military service members and police) which means that when kids are counted, more than half of our patients will either own guns or live with them. We cannot afford to ignore this demographic.
“Someone should DO something!” they demand on social media. Well, we are that something. Root cause mitigation is not politically expedient. It will not generate donations for the next political campaign cycle. Counseling does not trigger the limbic system with fear or deliver instant gratification. It will probably take an entire generation to change the way firearms owners view treatment and the way clinicians view firearms owners.
But we believe that by addressing firearm suicide we will move the needle on gun violence overall, perhaps even by 40% in the next 10 years. That is a boon to everyone.
And most importantly, we will do it without restricting anyone’s rights
If one considers the enormity of 100,000 suicides in just four years, he has to see the logic of this article as sound thinking. Humans have tried to control everyone in their spheres of influence since there have been humans, but all such attempts have been temporary at best and have come with losses of other freedoms for most in those spheres (as in dictatorships).
Unlike mass shooting deaths, those 25,000 suicides per year don't grab headlines unless the individual has fame. Pundits and politicians call for one-size-fits-all action that work no better than Prohibition did at stopping alcohol use or restrictions on illegal drug use did in preventing fentanyl deaths. Suicides are iindividual tragedies that exceed those mass shooting deaths. (For 2018 data shown, suicides made up 61% of all gun deaths--no insignificant percentage!--and mass shooting deaths for 2018, though horribly tragic and possibly preventable, amounted to 0.0028 percent of the year's total)