Your spouse is despondent, says life isn’t worth living – and has a gun. What do you do?
It’s a common scenario – suicide rates among young adults increased more than 200 percent over the past 50 years and suicide is the 10th leading cause of death in the United States, according to federal statistics.
This weekend’s apparent suicide of singer Mindy McCready highlights one other statistic about suicide – people who use guns are far more likely to actually kill themselves than people who attempt suicide using pills, car exhaust or some other method.
“More than 50 percent of suicides in this country are committed using firearms,” says Dr. Liza Gold, a professor of psychiatry at Georgetown University Medical Center. “If you limit the means, you can save people’s lives.”
But getting a gun away from anyone can be difficult, as the recent debate over changes to gun laws can demonstrate. Gold and her colleague Dr. Alan Newman have some pointers for friends, relatives and caregivers of people who might be at risk of suicide and who have access to guns.
“If you have a family member with chronic mental illness, guns should not be accessible to that person,” Gold said in a telephone interview. “People are often ambivalent about committing suicide. They go back and forth, and they are scared, especially if it’s in a moment of crisis. If you can get them through that crisis period, often they can get better.”
With a gun, "there is no second chance," says Gold.
Rule number one – don’t fight over the gun. “Never try to disarm anyone,” she says. “You definitely don’t want to get into a shoving match over a weapon with someone who in distress…and potentially might not be thinking clearly or rationally,” she added.
“If you know the person has access to a weapon, is suicidal, and is not willing to give up the weapon or becomes agitated if you ask for it, back off and call the police immediately. The people most likely to be shot and killed by family members -- with or without mental illness -- are other family members.”
It’s also important not to make the person defensive. Gold recommends using “I” language. “You say, ‘Look, I am worried about you. I love you and I am concerned,’” Gold advises. “You say, ’I would feel better if you would let me take the gun out of the house. I would feel better, would it be okay if I made the gun safe?’”
It is much less threatening, Gold says, than accusations. “If you say, ‘You’re crazy -- give me that gun right now’, people don’t respond well to that kind of approach. Let them know you are worried. Let them know it’s temporary and you are not taking it away from them forever.”
It’s also all right and downright desirable to contact a loved one’s doctor, says Newman. It’s not a violation of doctor-patient confidentiality if the doctor doesn’t reveal anything about the patient.
“A lot of clinicians make a mistake – they have somebody they are giving psychotherapy to or giving medications to and the relationship is all doctor-patient. They don’t communicate with the family,” Newman says.
“In that case, the doctor is pretty much limited to what the patient tells them.” A psychiatrist needs to know if someone who is depressed and potentially suicidal has a way to get hold of a gun.
“If the family wants to give you information, in that case you are not violating confidentiality. You are listening,” Newman says.
Doctors need to be careful in reaching out to family members. “I have seen everything you can imagine, from family members who don’t want the person to get better to family members who are afraid that if they tell you about firearms, the gun may be confiscated,” Newman says.
He advises giving patient and family members alike a plan for keeping the patient safe. “The worst thing is to say to the family right before they leave is to make sure you get rid of the guns. It shouldn’t be an offhand comment,” he said.
And then a doctor needs to check back and make sure the gun has been removed or locked up.
In the worst case, the police are trained to deal with people who are armed and possibly suicidal, and it may be necessary to call them, Newman and Gold both said. “At the end of the process, if you really feel like someone is imminently dangerous – that is the criteria for involuntary detainment in pretty much every state,” Gold says.
“Certainly they will at the very least send a mental health crisis team or a police officer to see what is going on.”
Newman recommends the American Association of Suicidology’s website for more advice.