Means Matter

FAQs

 

  

1. Won’t a suicidal person just substitute another method if they can’t get a gun?

Often yes. But virtually every other method is less lethal than a firearm so there’s greater chance the person won’t die in their attempt. Also, other methods-particularly pills, sharp instruments, and car exhaust-allow time for the attempter to be rescued, or gives the ambivalent attempter some time to back out mid-attempt if they change their mind.

 

2. If a suicidal person substitutes another method and doesn’t die, won’t they eventually figure out a way to kill themselves later?

Acute suicidal feelings often pass over time or with changes in life circumstances, treatment, or other support. A review of 90 studies of longterm outcomes for people who survived a suicide attempt (Owens, British Journal of Psychiatry, 2002) found that 89-95% did not go on to die by suicide, even when followed over a period of 9 years or more and even when narrowing the field to studies of serious attempters, like those who jumped in front of a subway train. Some 20-25% did make another nonfatal attempt; roughly 70% made no further fatal or nonfatal attempts.

 

3. Gun ownership is higher in rural areas; maybe suicide rates are higher among households with guns not because of the gun but because it’s more likely the person lives in a rural area. Aren’t people more apt to be depressed and suicidal in rural areas? 

Most studies (not all, but most) have found that people in rural areas do not have higher rates of depression than those in urban areas. Also, data from the National Comorbidity Survey and the ICARIS study indicate that people living in homes with guns are no more likely than those living in homes without guns to suffer from depression, substance use problems, and suicidal thoughts and are no more likely to report having attempted suicide. It therefore looks likely that it is the lethality of the gun itself that makes suicide attempts in homes with guns more deadly than in homes without guns.

 

4. In my state, more people die by hanging than by gunshot wounds, so doesn’t that mean this isn’t my issue?

All US states in which suffocation suicides outnumber or equal firearm suicides (CT, HI, MA, NJ, NY, RI) have a low firearm ownership rate and a low suicide rate compared with the rest of the U.S. People might therefore think since firearms are not their leading method of suicide they don’t need to talk about it. But here’s the thing: a low suicide rate in a state with several million residents is still going to result in more deaths than a high suicide rate in a state with a very small population. It’s a matter of arithmetic. There are more gun owners in New York than Montana–not as a percentage but in raw numbers. Urging them to store those firearms elsewhere if a household member is at risk for suicide is important no matter which state they live in.

 

5. Gun ownership is very high in my state and feelings run hot. If our suicide prevention group started talking about firearms and suicide, won’t we be in for a lot of controversy?

It depends in part on how the issue is framed. Approaches focused on protecting people who are in the midst of a suicidal crisis are far less likely to be considered controversial, particularly if there is no “anti-gun” bias in your approach. For example, the suicide prevention coalition in New Hampshire sponsors CALM (“Counseling on Access to Lethal Means”) trainings for providers. The program has not drawn much controversy. They presented the program to the state Firearms Safety Coalition, which included representatives from gun manufacturers and Gun Owners of New Hampshire; all gave the program the thumbs-up with minor revisions to make the language and assumptions sensitive to gun owners’ perspectives. They worked with safety-oriented gun owners to help ensure that materials were not “anti-gun.” About half of all gun shops in New Hampshire have distributed suicide prevention materials that urge customers to be alert to signs of suicide in a loved one and to keep firearms from them until they are no longer in crisis.

 

6. Does means reduction apply to other methods too?

Yes. In Asia and the Pacific Islands, the most pressing means reduction issue is reducing the human lethality of pesticides, as these are the most commonly used method of suicide in that region, and suicide rates rise and fall with the lethality of the pesticides currently approved for agricultural use. The reduction of carbon monoxide in domestic gas in Europe is believed responsible for saving thousands of lives. Installation of bridge barriers has been found effective in preventing site-specific suicides here and in other countries, and most studies have found no evidence of displacement to other sites. Changes in medication packaging have also been associated with reductions in the severity of suicide attempts.

 

7. Does means reduction always work?

No. For a given individual reducing access may not be effective, particularly for those who are deliberative in planning their attempts. Also, reducing access to methods with very low lethality (such as certain medications) may not have a measurable impact.

See When Do Means Matter? for a worksheet on circumstances under which means reduction WOULD and WOULD NOT be expected to make a measurable difference.

 

8. Aren’t suicide rates higher in some countries with low firearm ownership?

Yes. Many factors influence suicide rates: religious and cultural attitudes regarding the acceptability of suicide, economic conditions, prevalence of mental health and substance abuse problems, etc. Easy access to highly lethal methods is only one factor among many. This is why means reduction is just one component of a comprehensive approach to suicide prevention.

 

9. Every house has a rope or a cord. Why would reducing access to guns matter when a person can always hang themselves?

Hangings are a major concern. The method is very available and can be relatively lethal. And yet, access to guns at home is still found to be a risk factor for suicide. Why? First, according to emergency department and death certificate data, the case fatality ratio (which means in a group of fatal and nonfatal cases the percent that are fatal) for suffocation suicides  is lower than for firearms (69% for suffocation vs. 85% for firearms according to the CDC). But that’s emergency department data. Emergency department data are likely to overstate the case fatality ratio for suffocations and to be pretty accurate for firearms. For firearms, once the trigger is pulled, the outcome is virtually always death or a trip to the hospital. For suffocations, once the ligature is tightened, the attempter often has a small window of opportunity within which to change their mind without injury (and therefore without a trip to the hospital). A study of coroner records in England (Bennewith et. al., British Journal of Psychiatry, 2005) found that half of all hanging deaths involved ligatures that could be removed by the person him or herself even after they initiated the attempt. Therefore, the true case fatality ratio for suffocation suicide attempts may be lower than that calculated using emergency department and death certificate data. It is the combination of the firearm’s high lethality and irreversibility that puts suicidal individuals living in homes with firearms at greater risk.