This commentary is by Paul Manganiello, M.D., president of the GunsenseVT Education Fund and a member of the Vermont Medical Society, which supports S.31.
The risk factors associated with individuals who attempt intentional self-harm and suicide are well known: depression and other mental health disorders; substance abuse disorder, often in conjunction with a mental health disorder; a prior suicide attempt; a family history of suicide; family violence; and firearms in the home.
One of the public health priorities for Healthy Vermonters 2020 is reducing hospitalization and emergency department visits for self-harm injuries.
According to the most recent data from the Vermont Department of Health, in 2018 there were a total of 1,091 hospitalizations or emergency department visits at Vermont hospitals for intentional self-harm, and in 2019 there had been 109 self-inflicted deaths.
Over the past decade, death by suicide, of which 50% to 60% are firearm-related, has not changed statistically. Unless we address this public health issue, lives will continue to be lost each and every year going forward.
Overall, in 2018 there were 18.8 deaths by suicide per 100,000 people in Vermont (approximately 600,000 residents); this compares with 14.2 per 100,000 for the United States overall. The death rate for those under the age of 21 was 2.9 per 100,000, the age that an individual can legally purchase a firearm, but for those between the ages of 25 and 44, the death rate was 25.5 per 100,000; for those 45-64, it was 23.7; and for those over 65 it was 21.1.
One of the myths associated with death by suicide is that a person who survives an attempted suicide is bound to attempt it again in the future. Despite the fact there were over 1,000 hospitalizations or emergency department visits for self-harm, only 27% of those who died by suicide had a made a previous attempt. Roughly 60% of hospital visits for self-harm were women, 55% were males. Males were more likely to die, as a result of choosing a firearm, due to the lethality of the choice of that method.
We do not know how many Vermonters have died by suicide within 72 hours of purchasing a firearm, but we do know that attempts at self-harm and death by suicide are often impulsive. A study from California found that a person who purchased a handgun was 60 times more likely to die by suicide with a gun in the first week of the purchase as compared to an average state resident.
A waiting or “cooling-off” period occurs between the time when an individual decides to purchase a firearm and when that individual actually takes possession of the firearm. This could offer protection against the impulsivity of a individual experiencing a mental health crisis
We need to take a public health approach in attempting to reduce the incidence of death by suicide. Suicide occurs throughout the spectrum of life. Comprehensive legislative measures will be necessary to reduce access to lethal means and hopefully result in a significant reduction in death by suicide with a firearm.
We know that one measure alone will be inadequate. We need to address the context each specific individual may find themselves in. A child under the age of 21 will not be able to legally purchase a firearm; likewise, an individual who already owns a firearm will not benefit from legislation that requires a waiting period. We need to implement a comprehensive approach if we hope to be successful.
Currently there are legislative initiatives before the Vermont House and Senate that have the potential to reduce access to lethal means and have an impact on the incidence of death by suicide. It is our responsibility to implement sensible protections that can save lives while not infringing on an individual’s constitutional rights.
Crucially, in order to prevent unintentional injury and self-harm in minors, we need to do a significantly better job educating gun owners about the need for safe storage of their firearms. There are an assortment of options (gun locks, trigger locks, safes, biometric gun locks). Individual gun owners also need to be held accountable, making sure that their firearms are safely stored to protect the lives of minors, as well as preventing firearms from being stolen or diverted for criminal activity.
Safe storage needs to be required of all gun owners. If someone is injured or commits self-harm, the gun-owner needs to be held legally accountable. Child access protection laws do just that, and have been shown to be effective in states that have enacted these statutes.
We need to support waiting period legislation, which would reduce the risk of an individual in a mental health crisis accessing a lethal method to carry out a suicide. Historically, if forced to consider a less lethal option, they would have a greater chance of surviving and receiving medical treatment.
Finally, for those individuals who already possess a firearm, Extreme risk protection orders allow public safety officers to take temporary possession of a firearm from an individual who is a danger to either themselves or others. Vermont does have this type of legislation, but it should be strengthened by allowing health care professionals to request forfeiture of a firearm by an at-risk individual.
There is important work to be done to protect vulnerable Vermonters. We need to contact our senators, asking them to support S.31 as introduced by Sens. Clarkson and Hardy. This legislation would require safe storage of all firearms, as well as a child access protection provision. It would institute a sensible 72-hour waiting period on the transfer of all firearms, as well as expanding our current extreme risk protection order to allow a health care provider to notify police if a person in possession of a firearm is a potential danger to themselves or others.
These three provisions would protect those vulnerable to accidental firearm injury and suicide and together have the potential to cumulatively reduce death by suicide with a firearm, which should be a Vermont priority.
