In 2011, there were around 20,000 suicides using guns, almost twice the number of people killed in gun homicides.In a recent Fountain House blog, Summer Berman addressed the renewed stigmatization of those living with mental illness, which has become so common in recent discussions of gun violence. It is now a popular reaction, particularly from those who want to promote the widespread possession of guns, to say that mental health treatment should be expanded in order to “control” people with mental disorders. Enhancing the availability of mental health care is, of course, an important goal, but as Summer pointed out, such efforts would have little impact on the overall rate of violence, because people with serious mental illnesses actually commit only a very small percentage of violent crimes. Most violent crimes are committed by people without major mental illness.
There is, however, a more prevalent issue that involves guns and those with mental illness, and that is the issue of suicide. Many people do not realize that the number of gun homicides in this country has been decreasing significantly over the past twenty years. While there were 17,000 homicides in the US using guns in 1993, there were only about 11,000 such deaths in 2011. During the same period, the number of gun suicides has not decreased but has actually increased slightly. In 2011 there were around 20,000 suicides using guns, almost twice the number of people killed in gun homicides.
Guns provide the most reliably fatal way of committing suicide. Whereas suicide attempts by overdosing on pills are not usually fatal (probably less than 15 % of the time) suicide with guns is almost always fatal (probably 85% of the time or more.) Many suicides are not planned in advance; often, suicide is an impulsive act. Having a gun readily available makes an impulsive suicide attempt much more likely to be fatal. Comparing the suicide rates in different states seems to bear this out: states with the highest suicide rates (e.g. Alaska, Montana, Wyoming) have almost three times as many suicides per 100,000 people, compared to low-suicide states like New York and New Jersey. In the high suicide states, as many as 60% of people keep guns at home, whereas in New York and New Jersey, relatively fewer people do (perhaps 12-18%).
The factors that determine the suicide rate are very complex. They certainly include the prevalence of mental illness, including PTSD; the prevalence of substance abuse; the degree of stigma toward mental illness, which can deter people from acknowledging that they need help; as well as the availability of mental health care for those who do seek it. But one hypothesis generated by considering the data quoted above would be this: that the lower availability of guns kept in the home tends to protect people in New York and New Jersey from the risk of death by impulsive suicide.
If we take the issue of suicide prevention seriously, it is abundantly clear that much of the heated debate about guns in the media and in Congress is irrelevant to suicide. Laws restricting the sale of semi-automatic rifles and large magazines would have no impact on the problem of suicide, since most gun suicides require only a single bullet. Some regulations might be helpful, for example, requirements for trigger locks or storage of weapons in locked cases. Even these measures, however, do not protect the person who has the key. And while many gun owners reassure themselves that they don’t have to worry about suicide, the fact is that no one knows whether they might be seriously depressed five years from now.
Changing our gun culture – for example, moderating the idea that guns are necessary everywhere for home defense – will continue to be a very long-term process. (One piece of good news is reflected in another, front page Sunday Times article this week: the rate at which people keep guns in their homes has in fact been decreasing gradually all across the country in recent decades.) In a way the problem is similar to the overall problem of stigma, because attitudes about the risks of guns in the home, like attitudes about the risks and dangers of mental illness, tend to change slowly in response to public education. For this reason, our continuing efforts at addressing these issues realistically and without stigmatizing those with mental illness are that much more important.
Howard Owens, MD
Board of Directors, Fountain House