Friday, December 5, 2014

Gun Shops, Public Health Officials Find Common Ground

A string of suicides prompted gun store owners in New Hampshire to adopt a voluntary self-regulation program.

In April 2009, a young man just a day shy of his 25th birthday bought a gun at Riley’s Sport Shop in Hooksett, New Hampshire, just northeast of Manchester. Within hours, Gregory Castillo died by his own hand. He was one of three people that week who bought a gun at Riley’s and soon after turned it on themselves.

When Ralph Demicco found out about the string of suicides, he was horrified. “I heard that and thought, ‘Oh my God,’” says Demicco, then-owner of Riley’s, the largest gun store in the state. With his sales staff, he went over the records of the three purchases, asking if there were any telltale signs of the customers’ deadly intent. “My clerks remembered the transactions somewhat, but said there was nothing strange,” he says.

Out of these tragedies was born, as a project of the New Hampshire Firearm Safety Coalition, an unlikely partnership of firearms owners, gun advocates and public health professionals. Their common ground was a desire to prevent gun suicides. “What was great about this committee was that the suicide prevention people were largely not gun owners. The gun owners on that committee didn’t have a background on mental health or suicide issues,” says Catherine Barber of the Harvard School of Public Health’s Injury Control Research Center and an author of a study on the committee’s work. “We learned so much from each other.”

A civil conversation about gun safety began, resulting in a voluntary self-regulation program. The result of its efforts, recently published in the journal "Suicide and Life-Threatening Behavior," shows that 48 percent of gun dealers in New Hampshire now display suicide prevention materials in their shops.

People with guns are not more likely to be suicidal. But a suicidal person who uses a gun is far more likely to die in a suicide attempt. Suicide is the 10th leading cause of death in the Unites States, and guns account for more suicide deaths—51 percent—than all other methods combined, according to theCenters for Disease Control and Prevention. When people try to end their lives with pills or knives, for example, the attempt ends in death in about 2 percent of cases. When people make the attempt with a gun, the result is death in 83 percent to 90 percent of cases. Gun suicides outnumber gun homicides: In 2010, there were 19,392 suicides by firearm compared to 11,078 gun homicides, according to the CDC.

Often, suicide victims are as impulsive as they are desperate. A small but significant percentage—8 percent—of gun suicides happen in less than a week, and often within hours, of purchasing guns, according to the recent study. In another study, 153 survivors of a nearly lethal suicide attempt were asked how much time had passed between their decision to commit suicide and their suicide attempt. Nine out of 10 deliberated for less than a day; one out of four deliberated for less than five minutes.

To help stop fatal, impulsive decisions, the coalition members talked about how to prevent sales to potentially suicidal customers. “We contacted NAMI (the National Alliance on Mental Illness, a mental health education, advocacy and support organization) and asked if there were warning signs that a customer might be suicidal. We looked at surveillance tapes of the three recent gun purchases that ended in suicide. We talked,” says Barber. The coalition’s gun advocates and gun control advocates were on the same side. “What struck me,” says Elaine Frank, co-chair with Demicco of the coalition and an author of the study, “was that the stuff that gun people were saying and the stuff that gun control people were saying about safe storage was the same.”

They came up with a tip sheet for retailers to help reduce the odds that a gun purchased in their store would soon be used in a suicide. Does the customer display no knowledge of guns, and no interest in learning? Is the customer vague when asked what the gun will be used for? Do they mention a crisis, like a divorce or a job loss? Do they appear distraught?

Gun store owners and managers are not mental health experts and can’t be expected to diagnose depression. But they’re adults with life experience, says John Yule, manager of Wildlife Taxidermy and Sports Center in Manchester, New Hampshire, and a member of the coalition. Most adults have seen what depression looks like. “I know people with depression. Some people come in the store generally disinterested in any of the uses of a gun. They have no sporting interest,” he says. “If we say, ‘What are you buying it for?’ and they say they just want a gun; or if we say, ‘Let me show you some cleaning accessories,’ and they say they won’t be needing to clean it, we’re not going to sell them a gun.”

Demicco has put the brakes on sales when he suspected the buyer might be suicidal. “I remember one well-dressed woman who came in, and it was clear she knew nothing about guns,” says Demicco. “She just randomly pointed and said, ‘Let me see that one.’ I asked her if she was sure she wanted to buy a gun, and she started crying.” He didn’t sell her a gun. He took her in a back room and talked to her. She had just been released from a state institution, and was talking about ending her life. Demicco called her psychiatrist. “I really feel that at least that time, I possibly saved her life. That’s what we gun dealers can do,” he says.

Both Demicco and Yule emphasize that gun shops are under no obligation to sell a gun to anyone. And stopping sales of guns to suicidal customers is an important, but relatively small, part of the guns-and-suicide problem. Of the people who use a gun to kill themselves, most of them -- 92 percent -- already have access to a gun.

That’s where friends and family come in, and the coalition also distributes suicide-prevention materials aimed at distribution to customers in gun stores. The posters challenge customers to think about people they know who might have talked about being better off dead or who seem otherwise depressed. If somebody is at risk of suicide—going through a horrible divorce, struggling with depression, experiencing a financial setback—friends can offer to temporarily hold onto their guns, the posters and handouts advise. Or the person’s family can lock up the guns and put the key in a safe deposit box until the crisis passes. “It’s not fail safe, but it’s the low hanging fruit to make things a little safer,” says Barber.

The cooperation between gun store owners and public health suicide experts represents only a tiny dent in the broad national debate about firearms. When Mary Vriniotis, a researcher for the study, began approaching gun store owners in New Hampshire to survey their feelings about displaying the coalition’s anti-suicide messages, she made a conscious effort to appear neutral on gun control. “I was definitely concerned about not coming off as anti-gun,” she says. It was important to have the conversation without anyone’s biases getting in the way. “And after all,” she says, “not many people are pro-suicide.”

They seem to have pulled it off. The effort to include suicide prevention messages in gun literature is spreading, with efforts under way in Tennessee, Nevada, and Shasta County, California. “There’s a guy in Wyoming who, totally on his own, started giving out free gun locks from his shop,” says Barber. “That was in response to a high-profile suicide in the state.” Most gun owners know about what is called the 10 Commandments of gun safety, including getting proper instruction and being sure of the target. The coalition has added an 11th commandment: Consider temporary off-site storage if a family member may be suicidal.
Gun locks, which can help prevent a gun from firing, are a significant step toward preventing impulsive, unsafe use

No one is particularly optimistic that a similar collaborative effort would reach common ground on other gun issues, such as background checks or bans on certain types of firearms. Still, the suicide prevention project is the most successful coalition between the two groups that anyone involved can remember. “I trust Elaine,” Demicco said, referring to coalition co-chair Elaine Frank. “I thought, if I don’t get involved, who will. My input will help steer this thing in a neutral direction.”

And with Demicco’s participation, other gun shop owners grew less suspicious. “When I saw Ralph Demicco’s involvement, I knew it wasn’t a liberal cover group to disarm everybody,” says Yule. “It’s been very refreshing in this world of left and right to find common ground.”

The study could only measure the number of gun stores willing to display information about gun suicide in their shops; it doesn’t gauge how many suicides the effort may have stopped. And that may be something no one will ever know. Even the most empathic and compassionate gun dealer can’t always predict who might be buying a gun for suicide. After the three suicides by recent gun buyers who bought their guns at Riley’s, Demicco studied the store’s security video of each of the buyers. He remembers one in particular, a man who showed none of the signs of an impulsive gun purchase. “One of the suicide victims spent 53 minutes talking to clerks, going from one gun to another. There was no indication that he’d take his life,” Demicco says. “But an hour and a half later, he was dead.”