1) The evidence indicates that times of risk/crisis can be identified. For example, women are often killed by firearms in the context of domestic violence. Right now, individuals under a permanent, but not temporary domestic violence restraining order are prohibited from having firearms, which has been effective in decreasing the homicide rates in these situations. However, the time of highest risk of harm for women is when they attempt to leave a relationship. When they first apply for the restraining order, they get a temporary order (the permanent order comes later). Why not extend firearm prohibition to temporary as well as permanent restraining orders?
Another example is the case of felons who are categorically prohibited to own firearms, even though not all of them have committed violent crimes. It is the history of violence, not the conviction, that is highly associated with risk of future firearm violence. Why not tailor firearm prohibitions to anyone convicted of a violent felony or misdemeanor—particularly if it involves use of a firearm.
2) Public education programs and legal interventions to separate individuals from firearms at times of crisis are needed, along the lines of “friends don’t let friends drive drunk.” Family members and friends are often aware when someone they care about is going into a crisis. We need to educate people to ask and offer to hold firearms for their loved ones until the crisis passes (as we do when an individual may be suicidal).
3) Legislation based on the model of domestic violence would allow family members to petition the courts for a firearm restraining order at times of crisis, when law enforcement can be authorized to temporarily separate an individual from firearms. Such a law went into effect for the first time in California on January 1, 2016.
Dr. Forman: What are the top facts you think every psychiatrist should know about the connection between mental illness and gun violence?
Dr. Gold: These are my recommendations:
1) Always ask patients whether there are firearms in the home, not just whether they are firearm owners. Evidence shows increased risk of suicide and homicide in homes where there are firearms, regardless of who owns them.
2) If there are firearms in the home and children/teenagers, it is mandatory that guns are safely stored. Guns should be kept unloaded and locked, separately from ammunition, which should also be locked.
3) There is no such thing as safe storage of a firearm in a home where someone is in crisis with, for example, depression, psychosis, or substance abuse; is distraught over the loss of a relationship or job; has a recent diagnosis of serious medical illness; or has dementia. People with family members who fall into these categories, especially if one of them is a teenager or young adult, should not keep guns in the home.
Dr. Forman: Do you think suicide is a below-the-radar gun-related tragedy? Do you believe there are any policy changes that would reduce suicide rates?
Dr. Gold: Why does suicide go below the radar? Many people feel it shouldn’t count because it is self- inflicted. Also, it is highly stigmatized; many people are ashamed to acknowledge or admit that there might be an issue in the family. We need to recognize that there are many different types of gun violence, and suicide is one of those types. Interventions to decrease the morbidity and mortality of gun violence must include evidence-based policy that addresses suicide risk as well as homicide.