Analysis: Local gun suicides and mental health linked

Sean F.’s July 2010 obituary in the American-Statesman said he had passed away “unexpectedly.” But the 39-year-old had already tried to kill himself twice before, his parents later told investigators — once, three years earlier, with a gun. He had bipolar disorder and possibly was schizophrenic, according to his autopsy report. The Austin Police Department had also identified him internally as an “EDP,” an emotionally disturbed person recognized by officers from previous contacts.

Yet, one week before he died, he was still able to purchase a gun. He then used the 9 mm handgun to shoot himself inside his North Austin apartment. (The Statesman isn’t using the full names of suicide victims because in some cases their families or friends couldn’t be reached.)

The recent nationwide discussion about gun violence has concentrated mainly on firearms used in homicides. Since December’s elementary school massacre in Newtown, Conn., lawmakers’ focus has been even more specifically on guns used in the sort of mass murders that fuel public outrage and prompt policy reforms.

In the meantime, they have largely ignored a huge subset of gun victims: mentally ill people who use firearms to kill themselves. The result is a system in which even those with severe, debilitating or long-standing psychiatric illnesses, including histories of suicide attempts and hospitalizations, often can still buy or possess guns without hindrance. A comprehensive American-Statesman review of every gun-related death in Travis County in 2010, 2011 and 2012 — more than 250 in all — shows that access to firearms has had deadly consequences.

For every gun-related homicide in Travis County over the past three years, three people committed suicide using a firearm. Autopsy, toxicology and investigative reports show that more than a third either had psychiatric medication in their blood, or it was found at the scene of their deaths. (Thirteen had Klonopin, a type of anti-seizure drug used for depression that studies have linked to an increase in suicidal thoughts.) A dozen had severe bipolar or schizophrenia diagnoses. More than two dozen had histories of treatment at local psychiatric hospitals; 50 had documented histories of suicide attempts or thoughts.

Records show some were impaired enough that they did not hold jobs. Yet, in one form or another, all had ready access to guns.

This spring, in the wake of the Newtown shooting, some in Congress tried unsuccessfully to tighten the so-called gun show loophole, which allows private sales of firearms between individuals to bypass the instant background check that federally registered dealers must perform before a sale. The check is designed to exclude those with felony convictions, protective orders and pending criminal trials from buying guns.

The current law also is supposed to prohibit those with severe mental illnesses from acquiring guns. Yet it is narrowly written; experts say only a small number of those it might help are identified.

Preferring to avoid the charged issue of gun control altogether, a handful of states also have begun embracing a voluntary program that trains health care providers to help separate suicidal patients from their guns and enlists the help of firearm dealers to spot customers who appear bent on self-harm. Texas has not adopted it in any organized way.

Following Donald I.’s failed attempt to kill himself by stepping in front of a truck in late 2009, Gaylan Ray Dubose said his 46-year-old friend was hospitalized at Seton Shoal Creek Hospital, an Austin psychiatric treatment facility. He was released on anti-psychotic medication. “It wasn’t like a one-time thing,” Dubose said. “He was obsessed with suicide for two years.”

In February, Donald, who’d been diagnosed as a bipolar and paranoid schizophrenic, shot himself with a newly acquired .38-caliber derringer. “How did somebody like that get a gun?” Dubose asks. “There was no way that boy should’ve had a gun.”

Homicide is focus

The vast majority of laws designed to keep guns from those who might misuse them are written to protect people from harming others, not themselves. Generally, serious criminals or people with a history of violence or threats against others are reported to the federal National Instant Criminal Background Check System, run by the FBI. Licensed firearms dealers must check the database prior to a gun sale. A match will scuttle or at least delay the sale.

“Adjudicated mental defectives” are also prohibited from gun purchases, according to federal law. The key word is “adjudicated”: Only those found by a court to be not guilty by reason of insanity, under guardianship, incompetent to stand trial or committed to an inpatient psychiatric facility go on the list of prohibited gun buyers.

Further limiting the law’s commitment provision is that a person must be admitted to a facility involuntarily — typically for 90 days — to be prevented from gun buying. Those who enter a psychiatric hospital voluntarily or undergo outpatient treatment, or who are merely held for observation, are excluded from making the no-buy list, no matter how incapacitated they are.

Gun rights supporters say that’s as it ought to be; the so-called no-fly list should be as small as possible. The government is not to be trusted with deciding who is mentally capable of owning a gun, said Mike Cox, an Austin firearms instructor and advocate for the Texas State Rifle Association. “The system is intrusive,” he said.

Travis County Probate Judge Guy Herman, who presides over local psychiatric commitment cases, said the reason for the narrow legal definition is to not discourage people from seeking treatment. “We want people to recognize they have a problem and solve it,” he said.

Still, mental health advocates wrestle with how to not stigmatize their patients’ psychiatric disorders — most of which never veer into violence — while acknowledging that some people clearly should not have access to guns. “The number of deaths by guns is shocking,” said Jim Van Norman, chief medical officer at Austin Travis County Integral Care. But, he added, “I don’t know what the answer is.”

A bill awaiting Gov. Rick Perry’s signature allowing Texas police to more easily take and hold firearms from people in a mental health crisis received broad support. But earlier this year, when New York state passed a comprehensive law designed to keep more guns from psychiatric patients who might hurt themselves, it was opposed by many heath care workers.

The New York law requires treatment professionals to report anyone they think is a danger to themselves or others to the agency that licenses gun ownership (unlike Texas, which requires a license only for carrying concealed handguns, New York requires all handgun owners to be licensed). Local police can then take away the person’s guns. Counselors feared patients might not seek treatment if they knew they could lose their firearms.

Some suicides come without an obvious warning, so would not be prevented by any early warning. Other people are so determined no law would help: Earlier this year, a man used a homemade gun constructed from plumbing pipe to kill himself, Travis County medical examiner’s office records show.

Yet there is also a growing group of people convinced that the simple act of physically separating a suicidal person from a gun can have a profound effect, and so have sought out tactics besides changing the law. “We estimate it could save 2,000 lives a year,” said Catherine Barber, researcher manager for the Harvard Injury Control Research Center.

Suicides impulsive

In the past, suicide has been treated as a symptom of an underlying psychological problem, so prevention efforts have focused on controlling the person’s disease. “Traditionally, suicide has focused on the ‘why,’” Barber said. “But now we’re looking at the ‘how.’”

That’s because a growing body of information suggests that, in some cases, prevention can be much less complicated. Interviews with survivors, for example, show suicide is often impulsive; one study found the majority of subjects deliberated less than a day before attempting to kill themselves. Other research has punctured a long-held belief that a person who fails to kill himself once will eventually succeed later; 70 percent never try again, according to one study.

How a person tries to kill himself also matters tremendously. Statistics from the federal Centers for Disease Control and Prevention show 98 percent of the people who attempt suicide by drug overdose or cutting themselves survive. Guns occupy the opposite end of the odds; more than 85 percent of suicide attempts with firearms end in death.

“During that short period (people contemplate suicide), it’s going to matter what you’re grabbing for,” Barber said.

Initiatives in other countries indicate removing the deadliest tools can have dramatic results. In 2006, the Israeli Defense Force began prohibiting soldiers from bringing their guns home on weekends. Weekend suicides dropped by 40 percent, even as the weekday rate stayed constant.

Researchers in Sri Lanka, where pesticide poisoning is a common suicide method, found that rates were higher in areas where toxic pesticides were more commonly used and readily available — and that suicides plunged when access to the chemicals was limited, even when suicides by other methods remained unchanged. Australia lowered the carbon monoxide content of car emissions for environmental reasons. But carbon monoxide was also a common means of suicide, and the change caused an unexpected drop in that country’s suicides, according to a 2010 study.

Several studies exploring the link between gun access and suicide in this country have suggested a similar connection. “Household firearm ownership levels are strongly associated with higher rates of suicide,” suggesting “the availability of lethal means increases the rate of completed suicide,” one 2007 paper concluded. Other research indicates a waiting period for gun purchases can lower suicide rates.

Any discussion of limiting firearm ownership is muddied by politics, and pro-gun groups have resisted efforts to legally restrict ownership. Yet trying to keep guns from people in danger of using them to kill themselves “is not a political strategy; it’s anti-suicide,” said Elaine Frank, a Dartmouth College researcher and co-chair of the New Hampshire Firearm Safety Coalition.

The organization recently began training hospital workers and others in contact with people contemplating self-harm, urging them to always ask if patients have ready access to guns, and, if so, where they can be locked away for safekeeping until the crisis passes.

The coalition also started its Gun Shop Project two years ago in response to a 2009 coincidence in which three unrelated people in one week purchased a gun from the same dealer and then used it to kill themselves within hours. The group later determined that about 1 in 10 firearm suicides were committed with a gun purchased a week or less before, a number researchers suspect is low because police often don’t ask.

The project alerts gun dealers to recognize potential purchasers who might be suicidal. Ralph Demicco, owner of the New Hampshire store where the three suicide guns were purchased in 2009, embraced the program, training his clerks to look for untrained buyers or obvious warning signs — “Somebody who says they just need something cheap, the smallest box of ammo possible, no cleaning supplies,” he said. He posts suicide hot line signs in his store and reminds his clerks they don’t have to sell to anyone they have suspicions about.

“We’re not in the business of being psychologists,” Demicco said. “However, over the years I was absolutely convinced that a number of people were here to buy a gun to take their life. I tell my people to trust their gut.”

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