This commentary is by Paul Manganiello, M.D., emeritus professor of obstetrics and gynecology at Geisel School of Medicine at Dartmouth, co-medical director of the Good Neighbor Health Clinic in White River Junction, and president of the GunSenseVT Education Fund. He lives in Norwich.
Welcome to 2022, and the final legislative session of the Vermont biennium! There are a lot of issues from last year that need to be addressed by the Legislature. And as Yogi Berra famously said in 1973, “It ain’t over until it’s over.”
One of those issues that need to be addressed relates to public safety and public health: the need to reduce access to lethal means.
The Vermont Department of Health has posted its 2021 Intentional Self-harm and Suicide Report. Sadly, over the past decade, the rate of deaths by suicide has stubbornly ranged from 15.3 to 18.3 Vermonters per 100,000, while non-fatal self-inflicted harm has ranged from 176 to 251 Vermonters per 100,000.
Suicide rates are highest among 25- to 44-year-olds (25.5 per 100,000), followed by 45- to 64-year-olds (23.7 per 100,000) and then people 65 years and older (21.1 per 100,000).
Among suicides, because of their inherent lethality, firearms account for approximately 50% to 60% of deaths. Males are more likely than females to die by suicide using a firearm. There are several risk factors for suicide: individuals with a family history of suicide; personal history of suicide attempts; a mental health diagnosis; feelings of hopelessness, isolation; history of alcohol and substance use; having experienced maltreatment as a child; and easy access to lethal means.
It is this last risk factor that I wish to focus on. Unless there is criminal liability (a felony) for an owner not securing a firearm while the firearm is not in their possession, we will never reduce the incidence of suicide by firearm as well as unintentional firearm injuries.
The reality is that death by suicide affects not only the individual who dies, but their families, friends and the communities where they live. This is especially sad since most attempts are impulsive, and 90% of those who attempt death by suicide, and who survive, do not go on to die by suicide.
Fortunately, death by suicide and intentional self-harm can be reduced. They are both priorities set forth in the Vermont State Health Improvement Plan for 2019-2023.
We need to take a public health approach and adopt universal screening for suicidal ideation and target whole communities that are at risk: veterans, schools, health centers, the workplace and, yes, even gun shops and gun ranges. There are clinical tools that can be adapted to various at-risk populations.
But screening for at-risk individuals will not be helpful without resources to assist those identified as being in need. Currently there are multiple evidence-based suicide prevention programs to help increase public awareness, train providers, develop treatment networks within schools and communities, and increase prevention outreach.
In addition to these interventions, we need to address access to lethal means. It would be wonderful if everyone acted responsibly, but we know that individuals will oftentimes be noncompliant to public health directives (as we have seen with this current pandemic), and that is why public health measures may need to be legislated, similar to, seat belts, helmets, (vaccine mandates).
From the work of David Hemenway, professor of health policy at Harvard T.H. Chan School of Public Health, and Cassandra Crifasi, the deputy director of the Johns Hopkins Center for Gun Policy and Research, we know that having a gun in the home increases the chance for accidental injury, homicide and suicide, and these risks outweigh the potential protective benefits of having firearms in the home.
That is why it is so important to do a better job educating gun owners in effective, safe storage. Dr. Rebecca Bell at the University of Vermont has developed a curriculum for physicians to educate patients about safe storage in order to protect their loved ones from intentional or accidental tragedies.
Federally licensed firearm dealers need to be part of the solution. The Department of Justice has set a new rule requiring such dealers to certify that they have safe storage options that are compatible with the firearms they are selling, and that those options are available to customers. Those dealers are in a position to help identify at-risk individuals, but they need to be given the proper tools to do so.
Researchers at the New Jersey Gun Violence Research Center at Rutgers collaborated with that state’s Department of Human Services Division of Mental Health and Addiction Services in creating the NJ Firearm Storage Map, a free resource that helps residents find legal, temporary storage for their firearms outside their homes. Four additional states — Colorado, Mississippi, Maryland and Washington — have also developed these safe firearm storage maps, which will connect individuals to federally licensed firearm dealers and law enforcement agencies willing to consider offering temporary storage.
No “right” is absolute. That’s why it is not acceptable to yell “Fire!” in a crowded movie theater. If individuals want to enjoy their constitutional right to own a gun, justice requires that we as a society need to respect a non-gun owner’s “right to life, liberty, and the pursuit of happiness,” so they need not be fearful of going out into public spaces to be injured or, worse, killed because of this ongoing firearm violence. We need to keep guns out of the hands of an individual who is a threat to the safety of either themselves or to others.
For years, American researchers have been hampered in creating a public health model to address firearm violence in the U.S. Until recently, they have not been able to perform research to determine risk factors to determine, and then implement, strategies to reduce gun violence.
This resulted from the actions of a Republican Congress at the behest of the National Rifle Association, which in 1996 passed the Dickey amendment, mandating that no funds be made available to the Centers for Disease Control and Prevention that would be used to advocate and promote “gun control.” This was reversed during the Obama administration.
The RAND Corporation’s Gun Policy in America Project was initiated to create resources for policymakers and the general public, supplying unbiased information that would help to inform the establishment of effective firearm safety legislation. The most recent update was November 2021, and in that report, the studies that were analyzed indicated that child access prevention laws were effective in reducing intentional and unintentional self-harm in children and young adults in those states that have encouraged safe storage inducements, along with child access prevention laws. They concluded that, from available research, child access prevention laws reduce total suicides among youths aged 14-20.
As citizens, we need to do our part. Our legislators need to hear from us, their constituents, that firearm safety is a public health issue and that public safety is a priority.
One way to reduce firearm violence is to support policies and initiatives that will encourage safe storage and hold individuals responsible for their actions with a strong child access protection provision. If you have had a loved one, or know of a family member or an individual in your community who has died by suicide with a firearm, contact your representatives and your senator to facilitate safe storage practices and implement a strong child access protection law for Vermont residents.
