America’s Biggest Gun Problem Is Suicide

On June 17, after sitting quietly through a prayer service at Emanuel African Methodist Episcopal Church in Charleston, South Carolina, 21-year-old Dylann Roof allegedly opened fire on parishioners with a .45-caliber handgun, killing nine. It was another devastating rampage—one that would be followed by shootings in Chattanooga, Tennessee; Lafayette, Louisiana; and Moneta, Virginia—in what has begun to feel like a grievous and regular ritual.

These types of catastrophic events can warp our view of what gun violence in the U.S. really looks like. The five deadliest U.S. mass shootings of the 21st century—Virginia Tech, Sandy Hook, Fort Hood, Binghamton and the Washington Navy Yard—resulted in 101 deaths combined. In 2012 (the most recent year for which there is solid data), 32,288 people died from gunshot wounds in the United States. According to research published this year in theAnnual Review of Public Health, suicides accounted for 64 percent of those deaths. We may have cut down murders in this country over the past two decades, but gun violence has not abated so much as it has evolved into a more insidious form.

The media, however, miss the trend entirely. In 2013, Slate and Twitter user @GunDeathscollaborated on the Gun Deaths Project, an ambitious (though short-lived) attempt to track down every news report of fatal gun violence in America. Perhaps the project's most trenchant discovery came not from what they found, but what they didn't. By the end of the year, Slate realized it was capturing only one-third of all gun deaths; it had recorded around 11,400 deaths, while the U.S. Centers for Disease Control and Prevention reports roughly 32,000 every year. The missing 20,000 deaths? Almost all suicides.

There’s a culture of euphemism in obituaries involving gun suicide; “died suddenly,” “died at home” and "passed unexpectedly" are all used to cover an ugly fact. This systemic aversion to the topic has made it difficult for the general population to understand how suicide and gun ownership overlap, and enables firearm suicide to flourish in darkness.

For example, it’s rarely something people consider when contemplating why someone took his own life; we don’t say “he owned a gun” the way we cite things like clinical depression, financial woes and drug problems—but we probably should. Evidence suggests guns are not just a means of executing a hard and fast decision to kill oneself; they are a risk factor that should be considered alongside mental illness, substance abuse and family history.

David Hemenway, a professor of health policy and the director of the Harvard Injury Control Research Center (HICRC), has studied firearm violence and the relationship between guns and suicide in the U.S. for 15 years. In that time, he has amassed an abundance of statistical evidence indicating that access to guns increases the chances of suicide. “Why does Arizona have more suicides than Massachusetts?” he asks. "Is it mental health, is it diet, or is it alcohol or smoking, or is it depression?” It’s none of those. The one thing that explains different rates of suicide across regions, states and even cities is simple: guns.

In a study published in 2008 in the New England Journal of Medicine, Hemenway and his co-authors found that men were 3.7 times more likely to die by gun suicide in the 15 states with the highest rates of gun ownership compared to the six states with the lowest. Women in the states with the highest gun ownership were 7.9 times more likely to kill themselves with a firearm. And in a 2014 paper published in the International Review of Law and Economics, Justin Briggs and Alexander Tabarrok found that for every 1 percentage point increase in household gun ownership, suicide rates go up between 0.5 and 0.9 percent. The Briggs-Tabarrok effect, as it became known, starkly illustrates how in America having more guns leads to more suicides.

One of the great misconceptions about suicide attempters is that, after considerable deliberation, they have reached a point of no return. In fact, in many cases the complete opposite is true. In an oft-cited 2001 study published in Suicide & Life-Threatening Behavior, 153 survivors of suicide attempts were asked when they had made the decision to kill themselves. Seventy percent of the responders said they had decided to kill themselves within an hour of the actual attempt; 24 percent said within less than five minutes. This phenomenon is known as suicide impulsivity, and it seems to find its perfect match in firearms. Shooting yourself does not entail the preparation of overdosing on pills or the grisly persistence of slitting your wrists. It is immediate and requires zero protracted thought: the perfect mechanism for the instant fulfillment of what might otherwise be a fleeting inclination.

A small memorial made of several bullets, stones and flowers, marks the spot where Army veteran Michael Ecker killed himself in front of his father, Matt, in the woods behind their Champion, Ohio home on April 19, 2012. Jason Cohn/Reuters

The problem is that firearms are frighteningly lethal. The most common method of attempting suicide, overdosing on drugs, has a completion rate of just 3 percent (in other words, 97 percent of attempters survive). Gun suicide, by comparison, has a completion rate of 85 percent. This is surely gun violence at its most virulent—Berettas and Glock 17s crystallizing passing impulses into something horrifically permanent—and yet it is rarely, if ever, acknowledged as a gun issue.

For years, the HICRC has been trying to change this through its “Means Matter” campaign, a suicide prevention initiative focused on what is called "means restriction.” The idea is that if we can restrict the availability of lethal means for individuals showing warning signs of suicide, we can stymie impulsive attempters until the desire passes, saving lives.

There are convincing precedents. One is what suicide prevention experts refer to as the "British coal-gas story." In the 1950s, domestic gas in the United Kingdom contained high levels of carbon monoxide, and self-administered gas inhalation poisoning was the leading means of suicide in the country. By the end of the decade, carbon monoxide poisoning accounted for roughly 2,500 suicides a year, slightly under half the nation’s total. In the 1960s, the British government undertook the detoxification of domestic gas, replacing the coal-derived gas high in carbon monoxide with nontoxic natural gas. By the early 1970s, the country's suicide rate had dropped by almost a third.

Even more directly relevant is the success of an Israeli Defense Forces policy change that went into effect in 2006. That year, in an effort to prevent suicides in the military—90 percent of which occurred with firearms, often when soldiers were on weekend leave—the military didn’t let soldiers take their firearms off base on weekends. The suicide rate fell by 40 percent.

Despite those impressive results, codifying some form of means restriction into law in the U.S. seems impossible. Here’s where politics enters the fray. Firearm suicide by its very nature is a confluence of two social issues—gun rights and suicide—that are most often discussed and understood in isolation, the former a polarizing political wedge calcified along party lines, and the latter typically interpreted in the context of mental health and psychiatric illness.

Truly substantive means restriction—imposing significantly more stringent background checks on handguns, for example—would require a level of political consensus that is just not possible in a U.S. where Second Amendment furor is as strong as ever. Even small compromises between gun owners and activists are fought over with vehemence. Take trigger locks, for example, the small metal devices that clamp around a gun’s trigger. Those fighting for means restriction argue that by legally requiring guns to be stored in a locked container or secured with a trigger lock, you could create enough of an impediment to gun access that it would significantly cut down on suicide rates—all without actually taking people’s guns away. But Massachusetts is the only state with such a legal requirement, and in 2008’s District of Columbia v. Heller, the Supreme Court struck down a portion of the Firearms Control Regulations Act that required all firearms in Washington, D.C.—the city with some of the strictest gun laws in the country—to be kept unloaded or trigger locked, deeming it a violation of the Second Amendment.

The fight over trigger locks might seem petty, but the reality is that even incremental limitations on gun access could have dramatic effects on suicide rates. That’s because people can and do usually overcome the desire to kill themselves.

Dese’Rae L. Stage, 32, a photographer and writer who lives in Philadelphia, is one such survivor. Trapped in an abusive relationship, one night in 2006, Stage says she “lost it.” After a desperate call to her girlfriend was coldly rebuffed, “I just decided that that was it.” She took enough wine and pills to end her life, but her girlfriend alerted the police, who barged into her apartment. They took her to the emergency room, where she was treated and released three hours later.

Today, Stage is an outspoken advocate for suicide attempters as founder of the Live Through This project, in which survivors tell their stories. After years working with survivors, she knows firsthand that if you can eliminate a suicidal person’s access to a gun, he or she will likely survive to tell the tale. “There’s this myth that someone who is suicidal, when impeded from an attempt, will just find another way,” she says. “Not true.” The data backs her up: Over 90 percent of all attempters never die by suicide. Limit access to bridges and guns, and that number will surely creep toward 100 in the U.S.