Saturday, April 25, 2015

How to prevent suicide and other gun deaths

With suicides making up two-thirds of all firearm deaths in the United States, the American Psychological Association takes on the issue of gun violence.

How to prevent suicide and other gun deaths

The American Psychological Association addresses the issue from multiple angles in a new report.
The American Psychological Association addresses the issue from multiple angles in a new report.

Editor’s note: Diane R. Girardot, a writer and psychotherapist in private practice in Chadds Ford, filed this dispatch from the American Psychological Association conference in Washington, D.C. Aug. 7-10.


At age 18 and severely depressed, Jordan F. Burnham jumped from his ninth-floor apartment in King of Prussia on Sept. 28, 2007. The Upper Merion High School student survived because of his fortitude, his family, the medical care he received -- and because there wasn’t a loaded gun in his home. 

“I didn’t just get a second chance at life, I got a chance to say yes to a lot of life opportunities,” says Burnham, now 25 and a mental health advocate who has spoken at more than 200 high schools, the White House, and next week will tell his story at the United Nations.  “I’m glad to be alive and I’m glad there wasn’t a gun around.”

That second chance is what an American Psychological Association report titled Gun Violence: Prediction, Prevention, and Policy hopes to provide to protect people from the lethal effects of firearms. 

In a presentation about the report at the APA conference in Washington, on Aug. 7, Dr. Susan Sorenson, a professor at the University of Pennsylvania School of Social Policy, said the most pressing issue in gun violence prevention is addressing suicide, not gang-related crime or mass shootings. When you add statistics about domestic violence intimidation, coercion and often unintentional death as a result of firearms, she said, a very real national crisis becomes evident. 

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Statistics show the number of people who kill themselves, domestic partners or family members using a handgun is greater than all other firearm-related deaths combined. An estimated two-thirds of the 30,000 gun related deaths reported in the United States last year were suicides--even more in suburban and rural areas,with the opposite pattern in some big cities like Philadelphia.  

“You usually don’t get a second chance with a gun,” said Sorenson, who co-authored a chapter on public policy in the new report. She said she is confident the basic tenet of public policy - protection of human life - is the intervention that can successfully “cross the aisle” in the political divide plaguing the gun violence issue.

University of Arizona professor Joel A. Dvoskin, also a co-author who spoke in the conference session about the report, agreed that creating ways to keep guns out of the hands of people in crisis would reduce gun related violence drastically.  “The enemy is despair and the cure is help and hope,” he said. “If we restore their ability to respond differently we can prevent a tragedy.”

And Arthur C. Evans Jr., another co-author and commissioner of the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, speaking at separate session at the convention on diminishing access to psychiatric treatment, said “people can and do recover” -- drawing applause from the mental health professionals in attendance.  

Traditionally, Evans said, treating the mentally ill has been “crisis oriented -- where someone is in crisis before they get help.”  In the report, he proposed a recovery-oriented system with early intervention and community engagement to draw more people into treatment, an approach that that his department has been trying for several years. 

W. Douglas Tynan, a pediatrics professor at Jefferson Medical College, co-authored a section of the report as part of a collaboration by a panel of 10 experts.  The report outlines a science-based, public health strategy to reduce firearm-related homicide, suicide and unintentional shootings. 

Tynan, who wrote about community and health care provider involvement, was not available for the panel presentation. In a phone interview, he said the APA policy presents a scientific solution to a public health problem.

 “The role of the policy is to study and look objectively at ways to help reduce the death toll,” Tynan said. “It’s tone is rational in a debate that is often irrational.” 

The report upholds the value of background checks, waiting periods, mandatory reporting of who sells and who buys, firearm design changes, ammunition limits, and assault weapons bans, maintaining that they successfully thwart gun access and use and save lives.  Of course, they also kindle an incendiary debate over “gun rights” vs. “gun control.” 

Sorenson and her colleagues stress that policy can circumvent the “guns are good, guns are bad” conversations that erupt by bringing science and psychology to the table.

Studies to date show that these measures reduce homicides, injury, and suicide without disturbing an individual’s right to own a gun - the same way life-saving measures within the tobacco industry didn’t deny smokers from buying cigarettes, Sorenson said. 

“If we view firearms as a consumer product and use a public health approach we can reduce gun deaths,” Sorenson said. “Things are not that futile that we shouldn’t do anything.”

Sorenson said public policy was instrumental in reducing death and injury through the design of safer cars, instituting graduated teen drivers’ licenses, raising the drinking age to 21, and creating anti-smoking campaigns to reduce lung and mouth cancer rates. 

Research findings on design, manufacture, distribution, advertising, and sale of firearms and ammunition has been underused, she said.  “Smart guns” that can be fired only by an authorized user is a promising idea that would reduce school shootings and teen suicides.  Several patents for fingerprint-activated triggers already exist; a German-designed and -produced model has been approved for importation to the United States. 

Increasing reporting to the National Instant Check System (NICS), which restricts sales to convicted felons, persons dishonorably discharged or under restraining orders, or people adjudicated as “mentally defective” or committed to any mental institution -- as well as enforcing firearms-sale and -purchase procedures -- are ways to keep guns out of the hands of the wrong people. They are not always mentally ill. 

“Mental disorders are not the root cause of violent behavior,” Dvoskin said. “Profiles and stereotypes blind us to the real risks and actually scare people away from treatment.”

Sorenson pointed out that 1 in 10 Americans have some form of diagnosable depression or anxiety and that “most people, including the severely mentally ill, don’t go out and shoot people.” 

Fortunately, said Sorenson, more states -- including Pennsylvania, which was lax in previous years -- are reporting “no buy” persons. As of Jan. 31, 2014, there were more than 3 million mental health records in NICS, at least one-third of them added in 2013 alone, according to the federal website.

The increase follows mass shootings in Virginia, Arizona, Colorado, and Connecticut where mental health history was missing from the background check, or the gun was purchased by someone else and used by the shooter. 

States are federally authorized, but not obligated, to release mental health records of adjudicated persons to NICS, as well as the tracking information collected about gun licensing, transfers, sales, and purchases. The American Psychological Association policy urges universal access to this data for better risk management. 

“Science and psychology work together through the development of policy to give the folks on the other side of big business an equal voice,” Sorenson said. She cited as successful examples having the drinking age raised to 21 -- a coup over the alcohol and beverage industry -- by attaching federal highway dollars to compliance, and intense anti-smoking campaigns that targeted advertisers and levied heavy taxes on cigarettes, helping to reduce the number of smokers and related cancers. 

She hopes that public policy will prevail to curb gun violence and death and provide a lot more second chances.

“Short term doesn’t look good but in the long run, the United States will be a better place if we make the science relevant,” she added. “Our citizens value health.  Our gun violence policy is the beginning of building bridges in that direction.”


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Check Up covers regional health news and a wide array of healthcare topics from pharmaceutical happenings to patient safety. Read about some of our bloggers here.

Portions of this blog may also be found in the Inquirer's Sunday Health Section.

Michael R. Cohen, R.Ph. President, Institute for Safe Medication Practices
Daniel R. Hoffman, Ph.D. President, Pharmaceutical Business Research Associates
Hooman Noorchashm, M.D., Ph.D. Cardiothoracic surgeon in the Philadelphia area
Amy J. Reed, M.D., Ph.D. Anesthesiologist and Surgical Intensivist in the Philadelphia Area
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