Firearms and Suicide Risk: A Loaded Conversation

Several researchers and clinicians have expressed urgent and understandable concern about the connection between firearms and veteran suicide. Firearms are the primary go-to method of suicide deaths among members of the American military.[i] They are highly lethal: 85 percent of attempts with firearms lead to completed suicides, while just 2 percent of poisoning or overdose attempts lead to the same.[ii] And firearms are very dangerous in combination with the rapid onset of self-destructive urges.[iii]

To this point, a number of research studies suggest that periods of acute suicidal urges may be relatively short in duration. For instance, a study of more than twenty-six thousand college and graduate school students suggested that a typical period of acute suicidal thinking lasted less than a day for over half of those who were suicidal at any time.[iv]

Another study of eighty-two patients in a psychiatric university hospital showed an even shorter duration of acute suicidality; just under half of participants reported a span of ten minutes of less for their suicidal process.[v] Similarly, in another study, 40 percent of the sample considered self-harm for ten minutes or less before making an attempt.[vi]

In these critical moments, firearms initially intended for protection can suddenly become weapons of self-destruction for those who own them. Research suggests that 90 percent of those who die by suicide with a firearm had no prior suicide attempts by any method.[vii]

There is also compelling research to show that restricted access to firearms can have an immediate positive impact on suicide rates.[viii] In a study conducted in Israel, where weekend firearm suicides among military service members were noted as a troubling pattern, a small change in policy to require that IDF soldiers leave their weapons on base over weekends resulted in a 40 percent decline in the annual number of suicides.[ix]

Based on research like this, clinicians and peer supporters have been urged to boldly and frequently ask questions about firearm ownership and firearm-related storage practices.

Unfortunately, this approach can seriously backfire. To many veterans, asking questions about firearm ownership feels intrusive at best and possibly deeply disrespectful. Asking the question can immediately rupture the therapeutic relationship and may lead many veterans to drop out of treatment entirely.

How do I know? Because I expressed interest in learning what veterans really think about this topic, and a veteran colleague of mine who wanted to help me get to the truth asked a group of seventy fellow veterans.

Brian Vargas, a UC Berkeley social work Master’s level graduate, who has long been a leader in the Northern California veterans community, polled a group of seventy veterans, enrolled at three local colleges. When asked, “Are you likely to be open and truthful about whether you own firearms if asked by a provider you do not know well,” over half (53 percent) said “probably not” or “no.” However, the most critical finding in this poll, and the one that is most concerning, is that half of the veterans said that they would probably drop out of treatment if a clinician they did not know well asked them whether they own a firearm.

The way these seventy veterans responded should give us all serious pause for reflection. If trust is the strongest currency we can earn, we should ask ourselves about the cost of driving the therapeutic relationship towards potential dishonesty. The perception that a clinician may have the agenda or ability to remove a firearm (even if this perception is factually inaccurate)[x] can be a substantial barrier to care.

Compelling clinicians by standard policy and practice to have this discussion upfront, before developing trust, widens the trust gap at precisely the time when we need to connect and build trust with our patients. In fact, asking questions about firearm ownership may even increase suicide risk if this leads veterans to avoid seeking care in the first place. Firearms are closely tied to the identity of many of our nation's warfighters. The removal of a firearm is a power move made by someone who has rank over a service member. When a service member has a firearm removed, they tell me that this is often associated with feelings of shame or humiliation, as this signifies loss of a core function in their role as a warrior. When healers have such conversations about firearms in the clinical spaces where veterans receive care after their discharge from the military, all of the emotionally loaded meanings migrate into the conversation.