In 2020, the most recent year for which data are available, over half of all completed suicides in America involved a firearm–that is more than 24,000 Americans dying by firearm suicide in one year alone. However, suicide attempts involving a firearm account for fewer than 5 percent of all suicide attempts. September is Suicide Prevention Awareness Month and for this episode, we are re-issuing a recorded Twitter Spaces conversation hosted by Jaclyn Schildkraut, interim executive director of the Regional Gun Violence Research Consortium at the Rockefeller Institute and Michael Anestis, the executive director of the New Jersey Gun Violence Research Center at Rutgers University. The discussion focuses on the risk factors associated with firearm suicide as well as what policies and tools exist to help to mitigate firearm suicides.
Guests:
Jaclyn Schildkraut, interim executive director of the Regional Gun Violence Research Consortium
Michael Anestis, executive director of the New Jersey Gun Violence Research Center
Go in-depth:
Transcript was generated using AI software and may contain errors.
SPEAKERS
Alexander Morse, Jaclyn Schildkraut, Michael Anestis
Alexander Morse
Welcome to Policy Outsider presented by the Rockefeller Institute of Government. I’m Alex Morse. In 2020, the most recent year for which data are available, over half of all completed suicides in America involved a firearm. That is more than 24,000 Americans dying by firearm suicide in one year alone. However, suicide attempts involving a firearm accounted for fewer than 5% of all suicide attempts. Firearms are uniquely deadly relative to other methods of suicide. For example, intentional overdose is the most common method for attempting suicide in the United States, but only two to 3% of attempts result in death. Second Chances matter. According to one study published in the British Journal of Psychiatry, 70% of those who attempt suicide and survive, never attempt again. But more often than not, many who attempt suicide with a firearm. Do not get that second chance. September is Suicide Prevention Awareness Month. And for this episode, we are reissuing a recorded quitter spaces conversation, edited for length and clarity. With Jaclyn Schildkraut, interim executive director of the Regional Gun Violence Research Consortium at the Rockefeller Institute, and Michael Anestis, the executive director of the New Jersey Gun Violence Research Center at Rutgers University. The discussion will focus on the risk factors associated with firearm suicide, as well as what policies, tools and effort exists to help mitigate firearm suicides coming up next.
Jaclyn Schildkraut
Hi, everybody, thank you so much for joining us today. My name is Jaclyn Schildkraut. And I am the Interim Executive Director of the Regional Gun Violence Research Consortium at the Rockefeller Institute of Government, and I am joined today by Michael Anestis. Mike, do you want to do your intro?
Michael Anestis
Sure. Hi, everybody. Thanks for joining us. I’m Mike Anestis. I am a clinical psychologist and the executive director of the New Jersey Gun Violence Research Center and an associate professor in the School of Public Health at Rutgers,
Jaclyn Schildkraut
Not to mention that you’re also a member of the Regional Gun Violence Research Consortium, which is, which is what paired us together. So really excited to be able to have this conversation today, which will focus on firearm suicide and how we can protect the vulnerable. And for those of you who may not be aware, on September is National Suicide Prevention Month, and tomorrow, September 10, is actually national suicide awareness day. And so given Mike’s research focus on firearm related suicide, we thought that this would be a really important and timely topic in honor of those who may need our assistance or who may have felt that this was a way that they needed to address a situation. So I think that there’s a lot we can learn from this conversation. So Mike, I think a really important starting place is, you know, why do we need to have this conversation?
Michael Anestis
Sure, I think that one of the things that, as a suicide researcher has sort of frustrated me over time is it, it’s been a real struggle for us to communicate effectively and broadly about the scope of this issue. And so because of that, I think it’s not on people’s radar a lot of the time. And so it doesn’t get spoken about as much as it should, and often as accurately as it should. And so in this case, we’re talking specifically about firearm suicide in this conversation, because firearms account for more than half of the suicide deaths in the United States every single year, and suicides accounted for somewhere between half and two thirds of all the firearm deaths in the United States every year. So this is a big deal. We’re talking 10s of 1000s of deaths. It’s worth having a conversation.
Jaclyn Schildkraut
Why do you think it is that we don’t talk about this enough in our country? You know, obviously, you know, there’s other forms of firearm violence that sort of dominate the narrative. Why do you think that we’re not talking about this more?
Michael Anestis
So you know, obviously, I’m just kind of guessing on this to be fair, but I think about this a pretty good bit, and I think it’s a couple of things. One is just that for a lot of folks, suicide feels like something that is about other people. It isn’t about us, or it is about us, but we don’t realize it’s also about other people. And so we don’t want to share quit feels intensely private and personal. And folks don’t realize quite as how relatable it really is. And so I think there’s a sense of people not understanding how relevant it is to them or how relevant it is. As to others as well. On the firearm side of things, I think that we portray and talk about other forms of gun violence more often. And it feels like that’s something that’s around the corner from us a little bit more. And so things like mass shootings or homicide will take up most of the conversation on gun violence because it feels I think, for some folks more immediate
Jaclyn Schildkraut
in the course of your work, you know, even just talking with people out within the communities, what are some of the misconceptions that you’re hearing about firearm suicide,
Michael Anestis
there are a few pretty common myths or misconceptions that come up a lot. And the thing about them, the reason they’re so sticky is that they are genuinely intuitively appealing. And the biggest one is that this isn’t a conversation worth having. Because it doesn’t matter how someone dies by suicide, it matters why and that we should focus on that. Because if you stop someone from using a firearm, they’ll just find another way. And that’s problematic for a few reasons. One is it creates the sense that there’s a false choice, we’re either going to talk about firearms, or we’re going to talk about depression, but you can’t talk about both. But of course we can. We’re just talking about one of them right now. It doesn’t mean we’re dispensing with the other. But perhaps the most important and common pushback is this idea that people will switch methods. And the data is don’t necessarily back that up. Certainly some people will write. But I think people don’t realize that suicide is hard. And people often have a conception in their mind of what it’s going to look like. And when you stop them from using a specific method, they typically don’t switch to another method. But even if they did, firearms result in death, 85 to 95% of the time under using the suicide attempt, all other methods combined result in death less than 5% of the time. So even if folks did switch methods, they’d almost certainly survive. And that’s a big deal.
Jaclyn Schildkraut
Yeah, that’s a super interesting point you raise there for those individuals who are listening or may listen in the future, since this is also being recorded. Why do we see such a disparity in the outcome between firearms and other methods of suicide,
Michael Anestis
it really is just a matter of the sort of violent nature of the method itself, and the immediacy of the injury, right. So with intentional overdose, for instance, that’s by far the most common suicide attempt meth in the United States. That’s more than half of the attempts in any given year. But it only accounts for about 16% of the deaths most years. And that’s because only two to 3% of intentional overdose suicide attempts result death. And that’s because it’s difficult to have sort of a lethal reaction in overdoses, there are all sorts of other non death related problematic outcomes that can come from a non fatal intentional overdose. But folks, oftentimes will either the effect doesn’t happen long enough, or quickly enough or someone walks in while they’re trying, or because it’s not an immediate death, they can call and ask for help themselves. You can’t get that with a firearm. I think a compelling example of this is you hear the story of folks who are survivors of jumping off the Golden Gate Bridge, Kevin Hines talks about this a lot that folks jump off the bridge, and their immediate reaction is, oh, I’ve made a horrible mistake. And most of those folks also can’t survive. But the ones who have tell us, Oh, man, I wish I hadn’t done that. But I couldn’t do anything once I jumped, you can’t do anything once you’ve pulled the trigger. And so very few people survive, that you end up with this discrepancy in death rates in firearms versus other methods.
Jaclyn Schildkraut
So one of the things we obviously hear about in the conversation, you know, towards prevention is things like safe storage, how does the presence of a firearm or maybe more open access to a firearm increase the risks or affect the risks for suicide?
Michael Anestis
Sure, so regardless of how a firearm is stored, when you bring a firearm into the home, the risk for death by suicide is at least tripled for everybody in that home who might access the firearm, not just the firearm owner themselves. But when the firearm is stored on safely that risk goes up further, exactly how much further it’s sort of depends on the study you’re looking at. But But meaningfully so and when I say stored safely, when I’m talking about safe storage, from the suicide prevention perspective, I’m talking about storing a firearm unloaded separately from ammunition in a lock location, like a gun safe or a lockbox, or at least with a locking device, like a cable lock or a trigger lock or a clamshell case on. And what that does this secure storage is it certainly does not fundamentally prevent someone from attempting and dying by suicide with a firearm, right? They could unlock it, they could load it. But it slows that process down and it makes it more difficult. And the reality is, because I’ve said this a little bit earlier, suicide is hard. And anytime you approach something that’s hard and scary, that you might have some ambivalence about when you make it a little bit harder. You’re less likely to pursue that decision. And the reality is that a suicidal crisis can pass quickly. If you can get through that moment by making it a little bit more difficult to do this thing that’s so likely to kill you. There’s a very good chance he won’t try.
Jaclyn Schildkraut
Well, that’s right really, really interesting. What have you found in your research? What are some of the avenues related to firearm suicide that you’ve explored?
Michael Anestis
So I think a lot about how to reach firearm owners and convince folks to be a little bit safer. So I come at this from a risk mitigation perspective, the idea is that even before firearm sales surged over the last couple of years, we already had hundreds of millions of firearms in circulation, right, so they’re already there. So the solutions don’t involve banning firearms or getting rid of firearms, because it’s largely fundamentally impossible at this point. And it’s, you know, according to the Heller decision codified in our Constitution, that folks have the right to have a firearm. So I come at this from a perspective of Okay, folks have this right. And that right, comes with some risks. So how can I get folks to shift the risks around so that they still feel like they’ve maintained their, their identity and their culture, but they’ve made it less likely that they’re going to die by suicide. And so I come at this through a couple of different styles of intervention. One of them is lethal means counselling. And we can talk a little bit more later about some of the randomized trials that I’ve done or in doing on this particular intervention, that is sort of a one-time conversation aimed at getting people to store their firearm more safely. And the other approach that my team has really leaned into really hard is thinking about public health messaging. So think a lot about the messages, we heard about getting us to sneeze into our elbows instead of our hands or to let people hold our keys if we’ve had too much to drink the simple little behavior changes that had this massive downstream effect to preventing horrible outcomes, but they don’t require us to change who we are to really do much of anything different take really small steps to get really big outcomes. Those are the kinds of interventions that my research takes a look at, in my efforts to sort of help prevent this outcome.
Jaclyn Schildkraut
You know, one of the things that really jumps out to me about your discussion there is the point about public health messaging. And you know, certainly researchers definitely tried to amplify those messages through the media, how do you think that the media are helping or hurting this conversation?
Michael Anestis
I’m yet to meet a journalist who isn’t genuinely interested in helping so I don’t have any sort of negative views. And I don’t think anybody’s out there intentionally causing trouble. In fact, I think folks like me, academics have done such a poor job of getting information out on this, that I don’t blame folks for often taking steps that aren’t very helpful. I think the biggest problem is simply that folks don’t talk about this very much, just like you mentioned in the introduction to this conversation. And so if you ask most folks around the country, what causes the most gun deaths in this country suicides probably going to be ranked near the bottom, even though again, it counts for more gun deaths than all other forms of gun violence combined. And so I think the media has struggled to get that information out. And again, academics, like myself have given a huge assist to that sort of lack of effort, because we just typically don’t engage.
Jaclyn Schildkraut
How do you think we can sort of break down those barriers between the public health researchers in the media to perhaps team up for a better messaging approach?
Michael Anestis
Part of it, I think, is a culture change among academics to just get them to realize the value in getting the work beyond academic journals and paywalls and conferences to speak to the folks that in theory their work is supposed to serve? Part of it’s about creating an incentive system through the academic landscape. So tenure and promotion right now. It’s based on journal articles and grant dollars, those are good things. But if that’s all you prioritize, that’s all people are going to chase, right? Like anything else in a capitalist society where there’s incentives, there’s pursuit of that outcome that yields that incentive. So we need to incentivize academics and train them so that they’re more effective at it to talk about things and then we need to figure out through that training, how can we sort of breakdown I think the current impression of science and scientific studies and researchers and, and their role in society and their the degree to which they are sort of political actors, because without any trust in what we’re saying, and this relates to all of our public health messaging conversation, if you don’t trust the messenger, you’re not gonna buy the message.
Jaclyn Schildkraut
Absolutely. That is such a great point. And one of the things that really stands out to me kind of creates an additional roadblock, if you will, when we’re talking about raising funding dollars is that we know that gun violence has not historically been very well funded. How do you think that that has impacted the research into firearm suicide?
Michael Anestis
Just enormously and I don’t, I think it’s, you know, not unique to firearm suicide relative to other forms of gun violence. I’m sure you’ve encountered this in the exact same way as me, but we don’t have funding available to study a particular topic. That means researchers not only aren’t going to pursue it themselves, but they’re not going to train the next generation to do it. And so what you lose is not just a study that I would have done or you would have done, but you’ve lost an entire series of minds that we would have worked with to train and all the folks they would have Train, and all the ideas they would have come up with and all the studies they would have done. They didn’t happen, because there was no incentive to pursue it. And because academic jobs and tenure hinge upon funding and publications, the absence of that funding completely cut off the pursuit for a lot of folks. And there’s some of us out here doing it for one reason or another. I think that folks like Gary Wintermute, funding his research himself for like decades, and that’s astoundingly awesome. But that’s rare, you know, you get the occasional unicorn, you can pull that off. But a lot of folks needed to pursue different topics. And so we lost all value that day, and the folks that would have trained would have contributed to this issue.
Jaclyn Schildkraut
Do you see that like rebounding at all? Obviously, we know in probably the last three to five years, there’s been a little bit more of an emphasis on creating funding streams for firearms research.
Michael Anestis
I do I feel optimistic about it. And maybe that’s just me, you know, being a generally sort of optimistic person and trying to keep myself feeling upbeat. And maybe it’s just because I’m involved in training students, so I see it. I don’t know how representative that is. But I feel like I encounter more and more folks who are pursuing this topic with or without funding. And I see more and more opportunities for funding coming up, whether that’s through NIH or CDC, or whether that’s through sort of private groups like Arnold ventures, so the choice foundation. So I do think that the tide is turned a little bit, it’s still massively underfunded as an issue, whether we’re talking about firearm suicide, in particular gun violence prevention research in general, but, but I think it’s important to acknowledge progress when it happens.
Jaclyn Schildkraut
Yeah, absolutely. You know, one of the things that kind of, I guess is a question on my mind, is, are there any risk factors or groups that are potentially more vulnerable to firearm suicide that researchers and the public could focus more on helping to protect it?
Michael Anestis
Absolutely. And so you know, a firearm in the home is as dangerous for anyone as for anyone else. So it’s not that some folks are more vulnerable when the firearms present, but the issue is that the firearm is more likely to be present for some groups. And those groups are more familiar with uncomfortable with firearms. And so one way to think about this, I know is a little bit of a roundabout answer to your question. My promise I’m getting directly to it, is people tend to attempt suicide with methods that they are comfortable with, that’s shaped the way they think about suicide and what they might do in that situation. So what’s the most common attempt method, intentional overdose? What have we all done? Without taking medicine over the counter method? We know how to do this. We know what that looks like we can picture right? Well, some folks spend a lot more time with firearms and use firearms have grown up around firearms or work with them professionally, it becomes a part of who they are becomes a tool that they are eminently comfortable with. So when they think about suicide, not only do they have access to it, but their thoughts are going to be shifted in me that says great research showing in fact, if you have a sample of firearm owners and non firearm owners, all of whom have suicidal thoughts, currently, the folks most likely to develop a suicide plan that is about using a firearm, are the firearm owners and you’d be like, well, no kidding. I’d be like, Well, yeah, right. So their experiences shaped their thoughts. And so who are those groups, most likely to have their thoughts shaped that way and dusty, have firearms and use them well, is starting broadly, men more often than women, white men in particular, often folks in rural environments. Professionally speaking, you can talk about military service members and veterans, you can talk about law enforcement. It’s groups who have, again, greater familiarity and comfort with firearms. It is important to note though, that the demographics of firearm ownership have changed dramatically over the last couple of years, Matt Miller’s group and Casper fossies Group have shown really compellingly that the folks have been purchasing for the last couple of years, they’re more likely than firearm owners in the past to identify as female to identify as black to identify as Hispanic or Latinx. The demographics are changing. And I think that’s important to note, because there’s some information just came out from a report that trace put out showing an estimated 8% increase in firearm suicides from 2020 to 2021, the greatest single year increase that they’ve seen, ever, and that corresponds quite well with this purchasing surge. And so the groups that are most vulnerable, also could be changing. And so we’re going to need to track that carefully and not get too stuck in who historically has been most vulnerable and make sure that we are keeping track of some folks who might otherwise get lost in the shuffle.
Jaclyn Schildkraut
And you know, what’s interesting, like when you mentioned the purchasing surge, obviously, we know that there’s been COVID, and a lot of that led to increased surges in firearm purchasing. How do you think that the pandemic has impacted this issue?
Michael Anestis
I think it’s impacted in a couple of ways. A lot of the research that that I’ve done recently and particularly research led by my good friend Craig Bryan, has shown that folks who are purchasing lately are thinking about purchasing during the surge, tend to have endorsed this sort of not just an intolerance of uncertainty overall but a sense of threat sensitivity. The world is dangerous people can’t be trusted. And when we ask folks why they’ve purchased on The last couple of years some folks sort of say broadly speaking, COVID. And I’m not exactly sure what that means they’re not buying a firearm to shoot a pathogen, right? I think the general stress or uncertainty that comes from the pandemic, and how it’s all the upheaval that comes from that. But also a good number of folks have endorsed things like supply chain concerns. So I think that folks who are motivated to sell that a good job of noting, Hey, these are flying off the shelves, get it now before you can. And also a good number of folks endorsed this sense of, I need to be able to keep the peace myself, I don’t know if I can trust law enforcement to be able to hold the line on this. And so I need to protect myself from my family. So you see a lot of folks who wouldn’t have otherwise purchase a firearm made a different decision over the last couple of years. In some of the data we have in New Jersey, I found that that 60% of the folks who purchased the firearm between March 2020, and Mark in sort of mid 2022, in New Jersey, that was the first firearm they ever bought, whereas in other states somewhere more like 20 30%. And so there are some states where you have this surge of new firearm owners responding to the chaos of the last couple of years. And I worry about how familiar are those folks with safe storage? And how distressed were they when they made that purchase? One
Jaclyn Schildkraut
thing that stands out, I know that you guys in New Jersey have this tool and we in New York habit as well as like safe storage maps. Can you talk a little bit about how you guys put yours together? I know you guys are getting ready, I think you said to kind of revamp or rehab it right?
Michael Anestis
Yeah, so my team has put together a couple of maps. So one, I can speak about more in detail than the other but let me start with New Jersey to New Jersey, we were sort of really lucky and beneficial. Another team of Ruckers researchers or former Rutgers researchers, so Bernadette Hall and Mike Osterman, and their team collected data, they contacted firearm retailers across New Jersey, and then we’re sort of generous enough to share the results of that with us. And we created the New Jersey firearm storage mat that has I want to say 13 or 14 retailers on it, largely in North Jersey. And now we have are finalizing a contract with the New Jersey Department of Human Services Division of mental health and substance abuse to expand the map, do a sort of follow up round, try and disseminated further get more participation, make sure that New Jerseyans know about it as a resource, we did a similar thing in Mississippi and you see these like you said, new New York’s and your guys’s map is amazing. I actually, I feel a little bit intimidated by it, to be honest with you. But then Colorado and Washington and Maryland, Wisconsin just put out a really good good one. And I spoken to folks in other states doing it too. And the underlying idea is we spend a lot of time, particularly in suicide prevention, talking about hey, in a time of stress, it might be a good idea to store your firearm outside the home, just like you let someone hold your keys. And in some states like Mississippi where I used to live, that’s easy, there aren’t a lot of restrictions on temporary transfers. So however you want to move it out of the home, you pretty much can in places like I live down in New Jersey, it’s a little bit harder to do a temporary transfer. And so if I’m going to give some of the advice of hey, maybe you should store this outside their home, I need to pretty readily and clearly provide a resource that says Oh, and by the way, here’s some legal ways to do that. And some locations that are willing to on a case by case basis, consider storing your firearm for you temporarily. And that’s the whole idea is if we want to make a life saving behavior happen more often, we have to make it easy. I mean, that’s this is a lot make it universal, make it easy, the maps can make it easy.
Jaclyn Schildkraut
So if you’re somebody who maybe doesn’t know about one of these maps, who could be listening down the road or even with us today, you know, what kind of information do the maps provide? And what are the people at the other end of the map? Meaning where you’re directing them to what’s sort of their role in the process? Yeah, it’s
Michael Anestis
gonna vary a little bit state by state. But the basic principle is if you go to one of these maps, and for New Jersey’s, for instance, it’s on the New Jersey Gun Violence Research Center’s website. So Gun Violence Research center.ruckers.edu. And Jackie, I don’t know if you know that URL put in New York sight off the top of your head.
Jaclyn Schildkraut
I don’t but while you’re explaining this, I will look it up.
Michael Anestis
But so while she’s looking at it, but the idea that the mass they leverage Google Maps so easily easy to navigate, and you’ll see little stars or some icon that denote each of the places that have agreed to be listed on that map, whether that’s a firearm retailer or a law enforcement agency, and their agreement to be on the map is not an agreement that they are going to store your firearm. It’s that they are open to taking calls and deciding on a case by case basis whether or not they will store a firearm temporarily based on capacity or reason or just whatever they feel is it need this is their their business and their situation they so you need to have some say so on this, right. So, from the suicide prevention perspective, there’s a lot to like about that. One is that again, we’re creating an easy tool that involves collaborating with the community to help keep people safe. But what I also like about it is that there are lots of reasons you might need to store your firearm safely outside of though maybe your grandkids are coming to visit me or going out into And maybe you’re having some work done in or around the house and you’ve got strangers coming in, you don’t want them to potentially stumble upon and perhaps steal your firearm or misuse it right. So there’s all sorts of reasons, which means if someone’s not comfortable talking about their suicidal thoughts, and for folks who die by firearm suicide, that is often the case, maybe you have another path to storing it outside of your home without having to disclose something that feels intensely personal. But I also know that a lot of these sites don’t want to know the reason. Because if you go in and say, I’m feeling suicidal, please store my firearm, they don’t know necessarily when they give it back. And and they’re worried that giving it back too early could result in them being liable for bad outcomes. And so I like that this, these maps provide a path that doesn’t require disclosure for so many reasons.
Jaclyn Schildkraut
And I think one thing that that you pointed out, which I think is a really good, I mean, I hate to use the term selling point of these maps is that you know, safe storage sites can be used for so many different reasons. And so being able to message this as a broader issue of just firearm safety might help with the stigmatization that somebody who is struggling could feel for those of you who are interested in the New York map, it is rock inst, rock i n s t.org, Ford slash blog, forward slash new dash York dash firearm dash storage dash map. When we post this as a podcast, we will make sure to link both the New Jersey and New York maps in there for our listeners, but you can also go to the Rockefeller Institute website, under the research areas choose gun violence, and it’s right in the blog, The New York firearm storage map. You know, one thing I actually was going to ask a little earlier and then our conversation took a little bit of a different turn is when we were talking about demographics, you know, and you were mentioning different groups and have different familiarities with firearms, or maybe you know, different cultural differences. I’m somebody that actually grew up in the south where of course, we know firearms are incredibly prevalent. And we know that firearms aren’t normally distributed throughout our country. Do you see any sort of regional patterns or like any sort of patterns by location of how firearm suicide occurs?
Michael Anestis
Yes, absolutely. And quite frankly, that’s largely what got me into this field. My whole professional career was based in South Mississippi and Phil a couple of years ago, where firearm ownership is much much higher, and we’re almost 70% of suicide deaths come from this single method. And so what you see are in, in states for firearm ownership is higher, not just the firearm suicide rate, but the overall suicide rate is higher. And so you see that a lot in states in the deep south and states in the Mountain West like Wyoming, you see this in states that have sort of more ready access to firearms, which then facilitates more ownership of firearms. And one of my former students now Dr. Claire Houseman and I published a paper a couple years back where we basically were building off of folks have been doing by for decades, and we showed that this state firearm ownership rate was associated with state overall suicide rate evenly accounted for just about everything you could possibly think of from demographics to how saturated your population is, with veterans to even previous years suicidal thoughts based on SAMSA data mean elevation above sea level, which has a shockingly high correlation with the suicide rate. Even when you factor all those things in many, which are very important. The firearm ownership rate at the state level matters. And obviously, there’s variations within a state. But the take home always is where the geographic region is more inundated with firearms, the suicide rate is higher.
Jaclyn Schildkraut
One of the things that stands out to me to kind of shift directions a little bit, thinking back about the public health messaging and just conversations that you and I had in preparation for today’s spaces chat, is how we talk about firearm suicide. And I don’t know if any of our listeners picked up on this. But you’ve mentioned a number of times, you know, the term died by suicide? And how does that vernacular compound this issue or, you know, maybe contribute to the difficulty in talking about it?
Michael Anestis
Sure. So I think the most common phrase people say all the time, and if this is something, if you’re listening in on this, some of you say I’m not trying to make you feel bad about it. The common phrase is committed suicide. And it’s just something we’re used to saying. And the problem with that, is that it perpetuates a stigma intentionally or not, because commit has this sort of negative tone to it, right? Like you commit a crime. I don’t commit breakfasts, hopefully Jackie and I are not committing this talk, right? Hopefully those things have good value to them. And so we don’t attach a verb like commit to it. But we do that with suicide often and I think that that compounds the shame and the privacy concerns and the secrecy and the lack of desire to seek help and so I use died by suicide because it’s factual. It’s not placing a value judgment doesn’t mean I’m celebrating suicide doesn’t mean I’m saying suicides a good thing. Right. But it means that I don’t evaluate people, I don’t put my values or judgments on their behaviors, I just want people to be okay. And the fact is, someone died by suicide, they didn’t commit it. So I do think, you know, I certainly think there are probably situations where maybe we do place too much of emphasis on a word here or there. I don’t know if that’s true or not, I know in this case is definitely not true. In this case, this, this really matters, I think, as you speak, to survive loss survivors or attempt survivors. And what they feel when folks are speaking about suicide, intending to help them use that term is shame, and distress. And so we just kind of want to avoid that.
Jaclyn Schildkraut
I think that’s such a great point. And obviously, the goal would be to create less stigmatization to encourage more people to talk about it. And obviously, the end goal with more people reaching out for help. What are some other ways do you think that in the firearm context or beyond the firearm context, that we can maybe kind of help to break down that barrier, that stigmatization?
Michael Anestis
That’s a tough one, to be honest with you. And I believe we can make progress on that I do. But I also think it’s, it’s hard to, to move on that so much that is baked into some of the cultural norms around things like gender, and it’s hard to suddenly make shifts on that. And so I think it’s important for us to pound away at trying to get people to not feel stigmatized, try and get people to speak openly about their thoughts, and certainly to try and get people to seek and obtain evidence based care. But I come at this more from the perspective, I don’t think I’m going to know who’s at risk, I don’t think I’m going to know who’s feeling the most distress. And so rather than try to find the needle in the haystack, I tried to take approaches that help the needle and the hay at the same time. And so I think about making the environment safer. And I think about in the context of firearms and firearm owners who are less likely to reach out for help. I think about leveraging trusted voices within those communities. And our research is showing law enforcement in particular being a voice that is seen as very compelling on this issue across demographic groups or regional groups, getting those voices to take the lead and talk about firearm safety, secure storage as being important for suicide prevention and other reasons, that sort of overt messaging. But I also think that we we bend the curve on this through what I call covert messaging, having it be modeled, so I would love to see TV and movies where folks are without putting a big PSA and stopping and shining the light on it just always putting their hand gun and a gun safe when they get home and always taking it out. Right, I noticed that my wife and I watched a law and order episode yesterday, I saw someone open the gun safe, and I freaked out and totally ruined the rest of the episode for both of us. But it’s like, look what they did, right? Like, I think we need that you need to normalize behavior. So people just see this as a thing people do people I relate to instead of feeling like this is something that that other person’s telling me I have to do.
Jaclyn Schildkraut
It’s really interesting that you you raise that point, because one of the things that I’ve looked at in my research at mass shootings is the contagion effect, which I think that, you know, we do know from the research that suicides, especially when it’s a high profile suicide, correct me if I’m wrong, can that also be a similarly contagious behavior?
Michael Anestis
So I take a stance, there’s, that’s it’s a divisive debate on this. So I unquestionably without a doubt, there are suicide clusters. So you will see situations where suicides occur in a unexpectedly large amount within a geographic space. And I do think there can be some influence of suicide events on other people’s suicides. I don’t know if I think about it as contagion that both the clearest example I’ve heard came from David Klonsky, who so often says things much more intelligently than I can even aspire to. And I was debating this because there is data showing that after high profile suicides, you do see an increase in suicides, particularly amongst folks who are sort of might relate to that individual. So there’s something there. And what Klonsky said, is that he thinks what this has is that is a very temporary effect on someone’s capability for suicide. Suicide isn’t contagious, and that someone you’re previously fine suddenly becomes suicidal and dies, because they heard that story. That’s not how suicides a slow group, but what might happen is that someone who’s already at risk already struggling, see someone that is sort of relatable to them sees a story about them dying by suicide, here’s about a method for how they did it, and thinks maybe I could do that, too. And so you get a temporary boost in their capacity for suicide. And so it’s different than contagion. It’s more facilitation, I think.
Jaclyn Schildkraut
Yeah. So that’s, I’m really glad that you clear that because I’m not gonna lie, you know, and maybe that’s my ignorance. So I’m glad that I’m learning something today, too. I had actually seen a study was in plus one, or plus one, I actually don’t say that. But it looked at suicides in the United States after Robin Williams died by suicide, and it found an a 10% increase in suicide, but a 32% increase in suicides by the means that he had used to die. And so I thought that that was particularly interesting. But all of that was to kind of to come back to something that I think is really interesting when we talk about messaging with regards to the role of them. ADEA. And, you know, we know that groups like the World Health Organization and the Society for professional journalists have some best practice guidance about how to responsibly report about suicide. So things like not talking about the means not putting certain surgery. And they’re just sort of these different kind of don’ts. But it sounds like with what you’re saying about the law and order episode, maybe we need to focus more on the things that we should do not only the things that we should don’t, what are your thoughts about that?
Michael Anestis
Yes, I think that’s a really good reframe on it, there are lots of things that are worth doing. So for instance, include aspects of hopefulness include health resources for people who are reading it and feel distressed, the don’ts, I’m less convinced by I think some of the don’ts are important from a sense of like, don’t make people feel distressed by talking about something in a sensational, holistic way. And that’s, that’s a very reasonable and laudable goal, I’m less worried that story suddenly make people suicidal, in terms of some of the smaller things, I think that these are, the guidelines are not often based off of data. And so what I will say is a bunch of us at this point, and more years ago than I’m comfortable admitting it’s more recent than that, but we did it. Basically a randomized controlled trial, we took a study about about my mentor, Thomas joiner, and he talked about the death of his father by suicide, which she often does in a really compelling way. But the story itself, which was in Newsweek, I think, violated a lot of the reporting guidelines. And I read the story, and I thought, oh, my gosh, what a heartfelt, wonderful, broadly disseminated story about suicide, but some other folks said, Oh, my gosh, this is gonna make people die. And I just didn’t believe that. And now that some of my colleagues, so we did a randomized control trial, we expose people to that article, we expose them to that article minus the violations, or we exposed them to an article about a death by cancer that violate all those same norms. And what we found actually said, the one that violated norms didn’t cause any increases in distress. And in fact, the people who had been suicidal, felt better in response to the one that was a violation than anything else. And the one that caused the most distress was the one that described in detail died by cancer. And so my point isn’t that there’s nothing we can do that can be harmful. But that sometimes our most well intentioned guidelines, I think, can actually be a little bit counterproductive, because that might demotivate talking about suicide in the media, because they’re so worried about what they’re gonna say, in a way that makes them not say anything. And so I certainly think people need to speak artfully I think people need to speak sensitively, I think people need to speak with hope and with provision of resources. But I’m less convinced that by talking about things, we’re going to cause someone to die. I think that yes, high profile celebrity suicides could weaponize already existing distress. And so we need to be cautious. And what’s our goal and talking about this, but I don’t think stories about firearm suicide or suicide by any particular method in general, that don’t go into just one long narrative about one person’s agony and death are going to be harmful.
Jaclyn Schildkraut
I really like what you’re saying, because it sounds almost, and this is something that I’ve tried to do in my own work, we have to give people permission to feel that way. Not that they need our permission, but we have to make it more acceptable to talk about it, right, because the the sort of ostrich syndrome of stick your head in the sand and pretend it’s not happening, it’s not working. And so maybe by us being more willing to have conversations, and not only do the speaking but also more importantly, the listening, it might give people who otherwise would come forward and seek help or be willing to talk about their experiences and where they’re at, it might give them more hope and opportunity to do that.
Michael Anestis
Yeah, we don’t solve complicated issues by ignoring them or refusing to talk about them. We do it through collective thoughtful efforts. And that’s what this is, it’s again, it’s not I’m not being dismissive of caution in how and where and when we speak about suicide. But I am saying, Man, we need to do a lot more of it. And it’s probably not as dangerous as some people fear. Given that you do a lot of the do’s and aren’t so heavily focused on the don’ts.
Jaclyn Schildkraut
For sure. Obviously, what brought us here today, for those of you who are just joining us September, or just recently joined us, September is National Suicide Prevention Month. And so obviously, our goal and what brought us here, even just in the title of our speakers is how can we protect the vulnerable? And so I want to kind of loop back to something you referenced a little bit earlier, because I thought it sounded really interesting. I’d love to hear more about it is that lethal means counseling that you mentioned. Can you tell us a little bit about that?
Michael Anestis
Sure. Lethal means counseling is not a new intervention by any means. And it comes in in a bunch of different forms. But the basic gist is it’s a conversation about securing firearms, storing firearms securely in an effort to prevent suicide, although certainly you can talk about and many of us are trying to do this now in terms of preventing all sorts of outcomes. So it’s just safe storage for safety more broadly. And so The most common example this is an approach called calm or counseling on access to lethal means. And there’s some trials out there showing that when medical professionals are trained in calm, they feel much more capable and willing to speak about this issue. We my team took a different approach we used a form of lethal means counseling based on the principles of motivational interviewing, and we call it our project safeguarded. My collaborators were Craig Bryan and Annabelle Bryan at Ohio State, and Dan K Brown and University of Southern Mississippi. And what we did is we enrolled 232, firearm only members of the Mississippi National Guard, and they didn’t have to be suicidal at the time. And that’s a really important thing to lead with, which, which is that certainly they were welcome in if they were. But again, if the folks are most vulnerable to die by firearm suicide, are less likely to seek out behavioral health care and less likely to disclose their suicidal thoughts. I can’t test this tool only in people seeking healthcare and telling me about their suicidal thoughts, right, that’s the opposite. I need to make sure I can get people to change their firearm storage behavior, even if I don’t know if they have ever been or ever will be suicidal. So they came in, and we did a one time conversation. And I can’t go into motivational interviewing great depth interviewing in great depth. But the basic principle is that you don’t argue you weren’t coming in as the expert from above, prescribing a set of behaviors someone has to do, because you’re telling them to do so motivational interviewing says people come in ambivalent about making important changes in their life. And the only way they’re going to make sustainable change is that they’re intrinsically motivated to do so. So you accept ambivalence, you roll with resistance, and you help leverage that person’s own sort of internalized drive to change to move. So we had very friendly conversations with folks about their firearms and what practices they might be willing to adopt, at least under certain circumstances, in terms of storing their firearms and, and what we found is a couple of things. First of all, the intervention worked. And to be clear, we randomized people to some just some of them just got lethal means counselling. Some of them just got to control intervention, some people got cable locks, some people didn’t. With a lethal means counseling portion, if you received that intervention, you were more likely to folks who didn’t to store your firearms subsequently in gun safes, or to use cable locks or trigger locks. And we tested that at both a three and a six month follow up appointments, we had 10-15 minute conversation with folks who didn’t come in looking to talk to us about their firearms, and who didn’t necessarily buy it at the onset still resulted in meaningful changes, which I think is important. The other important thing is that people liked it 100% The people who received the intervention said they’d recommend it to appear. So all these concerns, if I’m going to alienate someone, no, if you come up with some cultural humility, and you don’t tell someone what they have to do, but you work within their value system and their home circumstances, you can get a good amount of movement pretty quickly. And I like to tell people, just one quick anecdote about this, which is that we have one guy who came in early in the trial. And I feel bad for the poor clinician who thought she did a terrible job when she did actually a wonderful job. But the guy came in and said, I don’t buy any of this is a bunch of BS, I’m not going to do any of this. It’s a waste of my time. And she very skillfully in the spirit of them, I sort of appreciated his his willingness to speak honestly and roll but that resistance and we figured out what and see the guy again, came back to this three month appointment, he said, I told you, it wasn’t gonna do this. And guess what? I didn’t, because it’s a bunch of BS. And I’m talking to this. And again, the clinician very skillfully said, Look, I appreciate your honesty. We don’t want people to come and tell us things that we want to hear. We want to know what’s happening. But that guy then came back with a six month appointment, he said, Look, since our last conversation, I broke up with my fiancé and I thought about the conversation we had. And I gave all my firearms to my brother to hold for me, and I’m pretty sure I’d be dead if I hadn’t done that. And so the thing about lethal means counseling is that a, you need to go upstream, you need to be able to talk to people before the house is on fire. So they come up with a plan B, you need to think about it as planting seeds, not picking flowers. This is about getting people to think about changes they might make when they need to. And you might not immediately see the payoff of them doing it. But if you do it skillfully, you do it calmly with some humility, you just very well may see exactly what you’re hoping for when it matters.
Jaclyn Schildkraut
That’s incredible. I think our audience thinks so as well. So I’m seeing a lot of like really cool reactions, I’d never heard about that. So I really appreciate you sharing that with us. Our goal is always going to be to protect the vulnerable. And I think you’ve given us you know, some really great suggestions between the lethal means counseling that’s available and also, you know, safer or secure storage. Are there any other ways that we can think about, you know, as we move forward from this conversation today, how we can help to protect individuals who may be susceptible to firearm suicide? Yeah.
Michael Anestis
So I mean, the approaches we’ve talked about here account for a lot of the sort of firearm specific approaches unless we start talking about things like policy changes at the state level, whether we’re talking about licensing laws or if you live in a state with extreme risk protection orders being aware of those as a tool. The other option remains, you can help prevent firearm suicide by using some of the evidence based tools Don’t focus specifically on them. Whether that’s crisis response planning, brief cognitive behavioral therapy, or dialectical behavior therapy, there are treatments out there that work specifically to help people feel less suicidal. And so if you can get someone you know, with suicidal to not feel that way, obviously, you can prevent firearm suicide, I just come at it from the other angle, which is said, I assume, I don’t know. And so I want to prevent anybody from possibly being in an environment that’s going to facilitate suicide, which is really the nature of the treatments you and I have been talking about today.
Jaclyn Schildkraut
It seems like and I’m glad that we’re having this conversation. But you know, as we started off with, it’s a difficult conversation to have. And I think, you know, as you’ve touched upon, so many people are really reluctant to have it, even though it’s a necessary conversation to help save people’s lives every single day. How do you think? Or do you have any tips for our listeners? You know, again, either now or in the future, that we could help to continue this dialogue beyond our spaces today?
Michael Anestis
Yeah, sure. So I have two thoughts on that. One of them is that for you, yourself as a listener, if you’re just thinking, how am I navigate this space, you know, there are all sorts of ways to get training on it. But just think about a few general principles, one of which is, don’t come in and tell someone what they have to do. Autonomy matters here. And so it’s about listening, understanding that someone might feel very differently about this and creating a space where they might be willing to think about making some changes, we don’t actually know which storage practices are the most protective. So there’s no sense of prescribing anything, it’s providing options that, you know, this person needs to have a firearm ready to go in case of home invasion, they’re convinced that’s necessary, well, maybe that person needs to hear about biometric lock boxes that they can program by their fingerprints to access quickly, is that the ideal option? From my perspective, no, as I won’t be the first meaningful step they can take. So just be willing to sort of give with that. So that would be, again, I think, one important perspective to take the other thing that occurs to me in response to your question, lines up with some of the work that me Betts and Craig, Brian and Annabel Brian and Kai Hunter and I are doing which is we’re trying to take lethal means counseling, beyond healthcare providers, so training folks all around the community who are community members who are talking to firearm owners all the time, whether that’s faith leaders, or unit leaders in the military, or what if my dream projects, which would be to train bartenders on how to have effective conversations, because you know, people who people talk to about sensitive issues, maybe if they feel comfortable having this conversation, and maybe if the conversation comes up often enough, we can normalize it, we can routine eyes it, so it becomes less of a shock. And something we’re more we’re all a little bit more comfortable chatting about, which I think then facilitates behavior change, like getting people to say, Yeah, I’m just going to keep my firearm in the safe when I’m at home.
Jaclyn Schildkraut
I love that. And I think it’s so interesting that you brought up bartenders as well, because obviously we know that haul, like firearms can make situations riskier. So I think, you know, having somebody in that capacity, you know, to be able to have that conversation is so interesting. When you talked about having somebody kind of out in our lives that we talked to about sensitive stuff, I’m not gonna lie, I totally thought about my hairdresser. I don’t know if anybody else went there. But, but I think that that’s so important to recognize that it doesn’t always fall to, you know, to the researchers or to clinicians, or even to law enforcement. It looks like we do you have a little bit more time. And I think one thing that’s really important is, of course, we never know who’s going to be listening to this. I’m not sure I’ve seen I can from the actually the New York New Jersey Gun Violence Research Center. I don’t know if Patrice is jumping in for us.
Michael Anestis
Yeah, I think there’s one.
Jaclyn Schildkraut
We actually have somebody who had a question. Oh, yes, absolutely.
Guest Question
So I just had a quick question about impulsivity and the increase that we’re seeing and actual attempts and following through with suicides with certain populations. We know that individuals dealing with behavioral health and addictions are kind of on the higher end of impulsivity, depending on you know, what their experiences are. But is there any new research or resources for some of these, these more vulnerable populations to actually draw some connections between impulsivity or the rise is that we’re seeing certain demographics?
Michael Anestis
Sure, I think there are two things I’d say in response to that. The first one and here again, much like the contagion stuff, I think I take an almost contrarian position to what the common belief is, but I’ve published some work on impulsivity and suicide. And my general sense is that impulsive folks are more likely to die by suicide. But the data supporting the idea that suicide happens impulsively is less compelling, someone’s risk can surge quickly. But folks don’t tend to sort of die on a whim it’s it’s been building for a while. It’s not their very first thought, but that that decision, that final decision, like the final decision to do anything can come at the last second. But the overall ideas as you said, impulsive folks are vulnerable to suicide and the treat it with data behind it that I think most directly addresses impulsivity is dialectical behavior therapy, which can be, you know, pretty complex treatment. But it has been shown through trial after trial after trial to be extremely effective at reducing suicide attempts, hospitalization, non suicidal self injury, people have used it outside of suicidality. Within the context of things like substance use and other impulsive behaviors. That would be the direction I would go, particularly if you’re thinking about populations who struggle with impulsivity and struggle with a sort of a host of behaviors, particularly when they’re upset that are dangerous or harmful, either in the short or long term.
Jaclyn Schildkraut
Thank you for that great question. I’m sorry, I actually couldn’t see that because I’m, I’m listed as a speaker, not co host. So thank you, Patrice, also, for jumping in and making us aware of that. You know, Mike, I think, you know, our goal here is to leave people with some actionable information and resources. And so I want to kind of pitch this to you, if anybody, whether it’s somebody that’s listening to this at any point, or we know somebody who is struggling, what are some resources beyond safe storage, that they can reach out for assistance or to somebody to talk to.
Michael Anestis
Broadly speaking, if you’re not just talking about firearm suicide prevention, where they were the big thing really is about security, the firearm in the home or temporarily removing it from that home until things are less stressful? At that point, you’re thinking, what are the resources I can get to help this person who’s in agony feel less agony and suicide prevention can take a lot of forms, the most obvious is, is just talking to someone specifically about suicide risk. So that can involve telling people about 988. So the new number for the National Suicide Prevention Lifeline, you know, there’s veterans specific numbers, there are folks like the Trevor Project who are specific to helping suicidal folks who identify in the LGBTQ community, I think that there’s the Crisis Text Line, people can consider if they are less comfortable talking directly, sort of through a voice call, because they’re not old like me, and they only want to text to that is available. So I think that the key for me is always I want people to seek out help. But my hope is that they will seek out evidence based help I trust all those tools I listed, but but look in your local community for providers of cognitive behavioral therapy, dialectical behavior, therapy, crisis response planning, there are there are tools available that have been tested over and over again, and shown that when folks are in agony, these tools are quite good at getting people to feel better. And first and foremost, preventing them from attempting and dying by suicide.
Jaclyn Schildkraut
And of course, correct me if I’m wrong, but finding those within your local community also might help with some of the more cultural competency issues that we’ve talked about, right? So people that know the landscape of where this individual resides, or works, you know, might be helpful too.
Michael Anestis
100%. And realize that you also within all of that need to find the clinician you relate to, it’s a lot of it is about using the right treatment that’s been shown to work. But some of it is also about having a good rapport and finding someone who can see the world through your lens, and sort of see you for who you are in thinking about how to help you navigate such an intensely difficult moment.
Jaclyn Schildkraut
Wow, you have Mike, you have given us so much good information today. And I think you’ve really shed light on something that I did not know a ton about coming in, I’ve learned a lot. I guess I want to ask you this, you know, it sounds like this is something you’re definitely passionate about. I know you and I share a passion for our own respective areas. What’s next for you in terms of continuing to help people understand how we can protect the vulnerable?
Michael Anestis
You I really am leaning hard into these two interventions that I’ve been harping on quite a bit today, which is trying to figure out how can we make lethal means counselling adapted to very, very different set settings and communities that might benefit from it, and thinking about how can we develop, test, and then disseminate public health messaging on this topic in a way that shifts social norms on firearm storage, if they always come back to for me, I want this to go the direction of sneezing in your elbow. And I can recall, during my residency year, walking around the hospital in Jackson, and seen all these posters that say don’t sneeze into your hands, knees in your elbow, and I remember feeling kind of aggravated by them. So I was like, I always was told them being good when he covered my mouth and everything, you know, everybody’s, but eventually, at some point, I must have internalized and it realized that, you know, spinning germs over my hands and then rubbing it on the world is probably stupid. And so I don’t do that anymore. And I judge other people when they do it, which is, you know, a little hypocritical, but it’s the reality. And so my hope is that I can find a way that doesn’t come down to shaking people by the shoulders and saying don’t do this, but find a way to get the message out there as such that it’s permeating the communities that most benefit from it. And they those folks see their friends and neighbors and loved ones storing their firearm safely and it just becomes this thing that we do because yeah, of course that makes sense. Why not store it safely so that we don’t have this risk? At least that risk isn’t as high as it otherwise was. That’s my goal. And so that what I’m trying to find is ways I can do that through traditional academic channels and well beyond those channels to try and legitimately move the needle on an outcome that again, I think just doesn’t get as much airtime as it should.
Jaclyn Schildkraut
Yeah, absolutely. And I think that that’s one thing that we can all help with is creating that airtime you know, and holding people accountable when they’re not having the conversations that we know that need to be had. So thank you for giving us all the starting points to be able to help sort of move that dialogue forward.
Alexander Morse
Thank you to Jaclyn Schildkraut, Interim Executive Director of the Regional Gun Violence Research Consortium at the Rockefeller Institute, and Michael Anestis, Executive Director of the New Jersey Gun Violence Research Center at Rutgers University, we’re taking the time to discuss suicide, a sometimes difficult subject for money. But as Jacqueline and Michael noted, part of the effort to mitigate suicide is to talk about it in real terms, and provide a space for people to feel safe, honest and secure. If you are a loved one, or having trouble or experiencing suicidal thoughts, please call 988 The national suicide prevention hotline, or text HOME to 741-741 for the Crisis Text Line.
For additional research and resources, please visit the Regional Gun Violence Research Consortium’s website by visiting www.rockinst.org/gun-violence. Also follow the consortium social media on Twitter at RockGunResearch for the latest in gun violence policy and research. I hope you enjoyed today’s conversation. If you liked this episode, please rate subscribe and share. It will help others find the podcast and help us deliver the latest in public policy research. All of our episodes are available for free wherever you stream your podcasts. Transcripts are also available on our website. Special thanks to the Rockefeller Institute staff Joel Tirado, Heather Trela and Laura Schultz for their contributions to this episode. Thanks for listening. I’m Alex Morse. Until next time.
Policy Outsider is presented by the Rockefeller Institute of Government, the public policy research arm of the State University of New York. The Institute conducts cutting edge, nonpartisan public policy research and analysis to inform lasting solutions to the challenges facing New York state and the nation. Learn more at www.rockinst.org or by following at Rockefellerinst. That’s Rockefeller i n s t on social media. Have a question comment or idea? Email us at [email protected].
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