How to talk to your patients about firearm safety

Less than 9% of suicidal acts result in death, but that percentage jumps to 90% when firearms are involved, according to a 2019 study in Annals of Internal Medicine. “With firearms, there’s usually no chance to regret what you’ve done or to call 911,” says Emmy Betz, MD, an associate professor of emergency medicine at the University of Colorado School of Medicine. And that’s why discussing safe firearm storage with patients at risk of suicide is so important. “We really don’t want someone who is going through a rough time to be able to reach for a firearm,” Betz says.

To lessen the chances of suicide, it’s important to put time and space between suicidal people and access to lethal means. For patients who have firearms in their homes, this could mean locking an unloaded firearm in a safe and storing ammunition separately; asking another household member to keep the firing pin or change the combination on a gun safe; or handing firearms over to a hunting buddy or friend from the shooting range. When discussing firearm safety with patients, experts recommend these steps:

According to a Gallup poll, 43% of Americans live in households with guns and 30% identify as gun owners themselves. That means it is highly likely you will have to discuss firearm safety with at least some of your patients. Recognizing your own biases and becoming culturally competent in this area are key, says Michael Anestis, PhD, executive director of the New Jersey Gun Violence Research Center at Rutgers University. “If you come across as an outsider who doesn’t know about the topic, you lose credibility,” he says. Learn about different types of firearms; watch YouTube videos about how firearm safety mechanisms like trigger locks and cable locks work; and find out how much gun safes, biometric gun boxes and other storage options cost. Some psychologists even visit shooting ranges.

Designed specifically for mental health professionals, CALM (Counseling on Access to Lethal Means) is a free online training developed by the Suicide Prevention Resource Center. The Department of Veterans Affairs offers a free webinar on lethal means safety training as well as a free Suicide Risk Management Consultation Program for providers working with veterans. Betz and her colleagues have developed a website called Lock to Live to help patients and clinicians think through storage options.

Asking about gun ownership at the outset of therapy could prompt your patient to distrust you, says Megan McCarthy, PhD, vice president of Project 2025, the American Foundation for Suicide Prevention’s initiative to cut the U.S. suicide rate by 20% by 2025. But if you’re seeing clients who report suicidal ideation, changes in behavior or activity level or warning signs like depression, agitation or insomnia, she says, “it’s time to start the conversation if you haven’t before.”

When starting the conversation, make it clear you’re not trying to take a patient’s guns away from them, says Craig Bryan, PsyD, ABPP, the stress, trauma and resilience professor of psychiatry and behavioral health at the Ohio State University’s Wexner Medical Center. “One of the most useful opening moves is just to ask a gun owner what types of guns they have—not in a way that makes it seem you’re judging or looking down on them but in a way that conveys interest,” says Bryan. Continue with open-ended questions as you explore how many firearms the person has, where they are stored and how you might move them along the spectrum of safe storage options.

Use the word “firearms” instead of “guns” since it covers more types of weapons and sounds more clinical and less polarizing, says Betz. Avoid words like “restrict” and focus on the voluntary and temporary nature of safer storage options. While you should appeal to patients’ desire to protect themselves and their families, recognize that “safety” may mean something different for your patient. For patients whose gun ownership is tied to protecting their families from intruders, Anestis points out, “safe storage means being able to access the firearm quickly in the night.”

With your patient’s permission, recruit peers or family members to attend sessions where you brainstorm ideas for safe firearm storage, suggests Russell Lemle, PhD, a senior policy analyst at the Veterans Healthcare Policy Institute. It’s always a good idea to involve family and friends in discussions of suicide, he says, but even more important when it comes to firearms. “They may have more credibility,” he says.

Getting a firearm out of a client’s home sometimes isn’t as easy as handing it off to a family member or friend. In some states, that’s actually illegal unless the person undergoes a background check and fills out the required paperwork. Gun shops, shooting ranges, and police stations may offer firearm storage. Betz is pushing states to create gun storage maps like the one the organization she helped found—Colorado Firearm Safety Coalition—has created for Colorado.

Above all, says Betz, don’t be afraid to bring up the topic of safe storage. “It can feel awkward the first couple of times you do it,” she says. “But just starting the conversation goes a long way: You don’t need to tell the person what to do with their guns; you just need to start the conversation and help them find an answer.”