Mikey, a 13-year-old boy from Upstate New York, was friendly and engaged. One day in January, he shot and killed himself with one of his father’s guns. Mikey’s suicide came as a shock. “He may have gotten angry for some reason. At that age you’re not thinking how final a gun is.”–Alexandria Bodden, Mikey’s older sister and gun violence prevention advocate
Each year, 23,000 Americans die by suicide.
Firearm suicide is a significant public health crisis in the United States, claiming the lives of 23,000 Americans every year, including nearly 3,000 young people and 4,400 veterans.1Centers for Disease Control and Prevention. National Centers for Injury Prevention and Control, Web-based Injury Statistics Query and Reporting System (WISQARS). A yearly average was developed using five years of most recent available data: 2014-2018. Young people defined as ages 10-24. Nearly two-thirds of all gun deaths in the US are suicides, resulting in an average of 64 deaths a day.2Ibid. Firearm suicide to all firearm deaths ratio and daily average developed using five years of most recent available data: 2015 to 2019. And the problem is getting worse: Over the past decade, the United States firearm suicide rate has increased 13 percent.3Centers for Disease Control and Prevention, National Center for Health Statistics. WONDER Online Database, Underlying Cause of Death. A percent change was developed using 2010 to 2019 age-adjusted rates for all ages. This trend is of particular concern among young Americans, whose firearm suicide rate has increased 42 percent over the past 10 years,4Centers for Disease Control and Prevention, National Center for Health Statistics. WONDER Online Database, Underlying Cause of Death. A percent change was developed using 2010 to 2019 crude rates for young Americans (10-24). and for veterans, who have a firearm suicide rate one and a half times higher than nonveteran adults.5US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention. 2019 National Suicide Prevention Annual Report. https://bit.ly/2DCQeRB. September 2019.
In a recent national poll, 16 percent of respondents—or roughly 40 million American adults—reported that someone they care for attempted or died by suicide with a gun.6SurveyUSA Market Research Study. Data collected from December 7, 2018 to December 11, 2018. https://bit.ly/2ExxpyZ. See question 36. But suicide, including firearm suicide, can be prevented. Removing access to firearms, a particularly lethal means, is the easiest and quickest intervention. Policies and practices that limit or disrupt access to firearms, such as those outlined later in the Recommendations section, have been shown to save lives.
Americans should be aware of the prevalence of firearm suicide, how having access to a gun increases the risk of suicide, and steps they can take to mitigate risk. Research shows that having access to a firearm triples one’s risk of death by suicide. This elevated risk applies not only to the gun owner but to everyone in the household.7Grinshteyn E, Hemenway D. Violent death rates in the US compared to those of the other high-income countries, 2015. Preventive Medicine. 2019;123:20–26. People who live in US states with high rates of household gun ownership are also almost four times more likely to die by gun suicide than those in states where fewer households have guns. This relationship remains strong even when controlling for other factors associated with suicide, like poverty, unemployment, serious mental illness, and substance abuse.8Anglemyer A, Horvath T, Rutherford G. The accessibility of firearms and risk for suicide and homicide victimization among household members: a systematic review and meta-analysis. Annals of Internal Medicine. 2014;160:101–110.
Access to a gun robs a person in crisis from a second chance at life.
There is a popular misconception that suicide is inevitable, that suicidal ideation is a permanent condition. But most people who attempt suicide do not die—unless they use a gun. Across all suicide attempts not involving a firearm, 4 percent result in death. But for gun suicide, those statistics are flipped: Approximately 90 percent of gun suicide attempts end in death.9Conner A, Azrael D, Miller M. Suicide Case-Fatality Rates in the United States, 2007 to 2014: A Nationwide Population-Based Study. Ann Intern Med. December 2019:885-895. And the vast majority of those who survive a suicide attempt do not go on to die by suicide.10Owens D, Horrocks J, House A. Fatal and non-fatal repetition of self-harm. Systematic review. British Journal of Psychiatry. 2002;181:193–199. Everytown’s recent analysis of hospital records strongly reaffirms this research on the lethality of firearms. More than 60 in 100 gun deaths each year are by suicide, while just three in 100 hospital visits each year due to a nonfatal gunshot wound are the result of a suicide attempt. A reduction in suicide attempts by firearm would result in an overall decline in the suicide rate.11Soffen K. To reduce suicides, look at guns. The Washington Post. July 13, 2016. https://wapo.st/2I7MCUx. Yip PS, Caine E, Yousuf S, Chang SS, Wu KC, Chen YY. Means restriction for suicide prevention. The Lancet. 2012;379(9834):2393–2399.
Firearm suicides follow sharply divergent demographic patterns.
Men represent 86% of firearm suicide victims.
Men, white Americans, and those living in rural areas are disproportionately affected. Men represent 86 percent of firearm suicide victims; they are six times more likely than women to die by firearm suicide.12Centers for Disease Control and Prevention, National Center for Health Statistics. WONDER Online Database, Underlying Cause of Death. A yearly average was developed using five years of the most recent available data: 2015 to 2019. White defined as non-Hispanic white. For men, firearm suicide rates largely increase with age, and are especially high for males 65 and older.13Centers for Disease Control and Prevention, National Center for Health Statistics. WONDER Online Database, Underlying Cause of Death. A yearly average was developed using five years of the most recent available data: 2015 to 2019. For women, firearm suicide rates are highest in the 40-to-60 age range.14Centers for Disease Control and Prevention, National Center for Health Statistics. WONDER Online Database, Underlying Cause of Death. A yearly average was developed using five years of the most recent available data: 2015 to 2019.
White Americans represent 85 percent of all firearm suicide victims, and have the highest rate of firearm suicide by race.15Centers for Disease Control and Prevention, National Center for Health Statistics. WONDER Online Database, Underlying Cause of Death. A yearly average was developed using five years of the most recent available data: 2015 to 2019. White defined as non-Hispanic white. American Indians / Alaska Natives also have a disproportionately high rate of firearm suicide, with the second-highest rate of firearm suicide among the country’s five major racial and ethnic groups.16Centers for Disease Control and Prevention, National Center for Health Statistics. WONDER Online Database, Underlying Cause of Death. Racial and ethnic breakdowns developed using five years of most recent available data: 2014 to 2018.
Americans living in rural areas experience far higher rates of firearm suicide than those living in urban areas.17Centers for Disease Control and Prevention, National Center for Health Statistics. WONDER Online Database, Underlying Cause of Death. A yearly average of each CDC classified urbanization level was developed using five years of most recent available data: 2015 to 2019. The average firearm suicide rate increases as counties become more rural,18Centers for Disease Control and Prevention, National Center for Health Statistics. WONDER Online Database, Underlying Cause of Death. A yearly average was developed using five years of the most recent available data: 2015 to 2019. and the rate of firearm suicide in the most rural counties is 2.5 times higher than in the most urban counties.19Centers for Disease Control and Prevention, National Center for Health Statistics. WONDER Online Database, Underlying Cause of Death. A yearly average was developed using five years of the most recent available data: 2015 to 2019.
For further discussion of factors related to firearm suicide in each of these demographic groups, see Firearm Suicide by Congressional District.
Firearm suicide can be prevented. There are actions we can take to mitigate the risk of suicide and save lives. Effective suicide prevention in the United States requires a multi-faceted approach that addresses the complex interplay between individuals, groups, community, and larger societal factors that impact firearm suicide. As such, the following policy recommendations are categorized by these four overlapping points of intervention.
A multi-faceted approach is needed to address the complex interplay between individuals, groups, community, and larger societal factors that impact firearm suicide.
Individual-level interventions promote behaviors and attitudes that can mitigate the risk of gun suicide among those most at risk.
In-Home Secure Firearm Storage.
Over 80% of child firearm suicides involved a gun belonging to a family member
Policies and practices that disrupt the easy and immediate acquisition of firearms have been shown to save lives. Secure firearm storage can help mitigate the risks of firearm suicide, especially for children. Approximately 5.4 million American children live in households with at least one loaded, unlocked firearm.20Personal communication from Deborah Azrael and Matthew Miller based on 2021 National Firearms Survey, August 11, 2021. When American children die by firearm suicide, over 80 percent use a gun belonging to a family member.21Johnson RM, Barber C, Azrael D, Clark DE, Hemenway D. Who are the owners of firearms used in adolescent suicides? Suicide and Life-Threatening Behavior. 2010;40(6):609-611. Study defined children as under the age of 18. Over 80 percent of children who died by gun suicide used a gun belonging to a family member. One study found that households that locked both firearms and ammunition were associated with a 78 percent lower risk of self-inflicted firearm injuries and an 85 percent lower risk of unintentional firearm injuries among children, compared to those that locked neither.22Grossman DC, Mueller BA, Riedy C, et al. Gun storage practices and risk of youth suicide and unintentional firearm injuries. Journal of the American Medical Association. 2005;293(6):707-714. And researchers estimate that if half of households that store at least one unlocked gun moved to lock all of their guns, 251 youth fatalities from firearm suicide and unintentional shootings could be prevented in a single year.23Monuteaux MC, Azrael D, Miller M. Association of increased safe household firearm storage with firearm suicide and unintentional death among US youths. JAMA Pediatrics. 2019;173(7):657-662. These lives saved would make up one-third of all preventable youth deaths from firearm suicide and unintentional shootings that year.
Many cities and states have laws that require or encourage secure storage. Twenty states and the District of Columbia have some form of secure firearm storage law.24CA, CT, DC, DE, FL, IL, IA, HI, MA, MN, MD, NV, NH, NJ, NY, NC, RI, TX, VA, WA, and WI. And 15 states have passed Child Access Prevention (CAP) laws, which impose criminal penalties when a person fails to securely store a firearm and a child gains unauthorized access to it. States with laws mandating secure storage or with CAP laws saw an 8 percent decrease in overall suicide rates and an 11 percent decrease in firearm suicide rates among adolescents aged 14 to 17.25Webster DW, Vernick JS, Zeoli AM, Manganello JA. “Association Between Youth-Focused Firearm Laws and Youth Suicides”. JAMA. (2004). https://doi.org/10.1001/jama.292.5.594
Not all firearm storage options are equal. There is a wide variety of firearm storage devices, including lock boxes, cable locks, trigger locks, and gun vaults. However, there is limited guidance on which storage devices are most effective at reducing access, by minors and other unauthorized users in particular. The federal government should provide such guidance, focusing on which devices are most effective at reducing firearm access across different populations at heightened risk for suicide — such as teens or young adults in the home — and what is represented in advertisements for storage devices.
Out-of-Home Firearm Storage.
Individuals in crisis can also choose to securely store their firearms outside of the home with an eligible friend, relative, or law enforcement, or at a storage facility or shooting range. States, cities, and community organizations can facilitate and spread awareness of out-of-home storage options by developing and publishing maps that display the specific locations where secure out-of-home gun storage is offered. Local gun storage maps are available in Colorado,26 https://coloradofirearmsafetycoalition.org/gun-storage-map/ Washington,27https://hiprc.org/firearm/firearm-storage-wa/ and Maryland.28https://mdpgv.org/safestoragemap/ The federal government should embrace this model and develop maps for states across the country.
As a secondary alternative to storing firearms out of the home, individuals can reduce their access to firearms by securing their firearms in a key-locked storage device (lock box, gun safe, gun vault) and, in a time of crisis, give the keys to the device to a friend or family member. This can, in effect, remove access to firearms without the individual turning over the actual firearms.
Relationship-level interventions engage and empower others to educate about the risk of firearms and help limit an at-risk individual’s access to firearms.
Extreme Risk Laws.
To protect individuals in crisis, several states have passed Extreme Risk laws as a way to temporarily remove firearm access. Extreme Risk laws give immediate family members and law enforcement a way to intervene before warning signs escalate into tragedies by petitioning a court for an order to temporarily remove guns from dangerous situations. If a court finds that a person poses a serious risk of injuring themselves or others with a firearm, that person is temporarily prohibited from purchasing and possessing guns, and any guns they already own are held by law enforcement or another authorized party while the order is in effect. Studies in Indiana and Connecticut estimate that one suicide is prevented for every 10 to 11 firearm removals under Extreme Risk laws.29Jeffrey W. Swanson et al., “Implementation and Effectiveness of Connecticut’s Risk-Based Gun Removal Law: Does It Prevent Suicides?” Law and Contemporary Problems 80 (2017): 179–208; Jeffrey W. Swanson et al., “Criminal Justice and Suicide Outcomes with Indiana’s Risk-Based Gun Seizure Law,” Journal of the American Academy of Psychiatry and the Law 47, no. 2 (June 2019): 188–97. Nineteen states and DC currently have Extreme Risk laws in place.30Cal. Penal Code § 18100, et. seq.; CRS § 13-14.5-101, et seq.; Conn. Gen. Stat. § 29-38c; 10 Del. C. § 7701, et seq.; DC Code § 7-2510.01, et seq.; Fla. Stat. § 790.401; Haw. Rev. Stat. Ann. § 134-61, et seq.; 430 ILCS § 67/1, et seq.; Ind. Code § 35-47-14-1, et. seq.; Md. Public Safety Code § 5-601, et seq.; Mass. Gen. Laws ch. 140, §§ 121, 129B(C), 131(C), 131R-Z; NRS § 33.500, et seq.; NY CLS CPLR § 6340, et seq.; N.J. Stat. § 2C:58-20, et seq.; N.M. Stat. Ann. § 40-17-1, et seq.; ORS § 166.525, et seq.; RI Gen. Laws 8-8.3-1, et seq.; 13 VSA 4051, et seq.; Va. Code Ann. 19.2-152.13 et seq.; ARCW § 7.94.010, et seq.
Examples of Extreme Risk laws being used to temporarily remove firearms from dangerous situations.
2018 | ROSEVILLE, CA
An individual called police about a relative who was threatening suicide with a gun in his home. After trying for hours to get the man to come out with no success, police obtained an order and the man relinquished his firearms.1Koseff, “‘Best Tool’ to Prevent Gun Violence.”
2019 | NEW LEBANON, NY
Police arrested a 51-year-old man for illegally possessing a firearm and for shooting a car. Following his arraignment, the man made statements regarding self-harm, prompting authorities to obtain an emergency order. Police removed a handgun and seven long guns from the man’s possession. The man waived his right to the final hearing, agreeing to comply with a judge’s order requiring the removal of his firearms for one year.2Bob Fredericks, “Man Becomes First to Lose Guns under New York’s ‘Red Flag’ Law,” New York Post, September 13, 2019, https://bit.ly/37NqPPS.
2019 | CRANSTON, RI
Two days before Christmas, a concerned individual contacted police regarding a text message they had received, which contained an image of a man holding a firearm in a position that was threatening suicide. Police officers subsequently went to the man’s house, where he told the officers he had a firearm in the home and was intending to die by suicide. Police then obtained an order to temporarily remove the man’s firearm.3Katherine Gregg and Brian Amaral, “Police: RI‘s Red Flag Law ‘Likely Averted Potential Tragedies,’” Providence Journal, December 30, 2019, https://bit.ly/2RF2gyE.
2020 | MONTCLAIR, VA
A 33-year-old man entered another person’s home and was unable to tell police what he was doing there. Police learned from his wife that he was experiencing mental health challenges and had been exhibiting “paranoid and delusional” behavior. Police obtained an emergency order and removed six firearms, including an assault-style rifle.4Daniel Berti, “More Than 20 Guns Removed From Prince William, Manassas Residents So Far Via ‘Red Flag’ Law,” Prince William Times, February 25, 2021, https://bit.ly/32YwlOu.
2020 | VIRGINIA BEACH, VA
Police obtained an order after a man threatened to shoot himself in his ex-girlfriend’s driveway, following their break up. Police retrieved a loaded gun from his car.5Graham Moomaw, “Pro-gun Localities Accounted for Nearly Half of Virginia’s Red Flag Orders in Law’s First Months,” Virginia Mercury, October 6, 2020, https://bit.ly/3gS6iB3.
2020 | BARTHOLOMEW COUNTY, IN
A woman contacted the sheriff’s office after her husband made repeated comments about harming himself or using a firearm to provoke others to harm him. After investigating, law enforcement used the law to remove 20 firearms from the home.6“20 Guns Confiscated From Bartholomew County Man uUnder Indiana’s Red Flag Law,” WTTV, July 13, 2020, https://bit.ly/3gLEvSt.
For these laws to be effective, it is critical that families and other eligible petitioners are aware that they are empowered to take action. The federal government can support these efforts by establishing a federal grant program for states to train law enforcement and court personnel on Extreme Risk laws, develop protocols for enforcement of orders, and raise public awareness of this life-saving process. Further, federal law should establish a strong federal Extreme Risk process that can be used in federal courts in all fifty states.
Medical Counseling on Access to Lethal Means.
Physicians and other medical professionals are crucial sources of information about the risk of firearm access. By asking their patients about firearm access and counseling them about firearm suicide risk, medical professionals can help prevent these deaths. Counseling on Access to Lethal Means (CALM) is one example of a program that trains medical professionals to perform this practice.31Counseling on Access to Lethal Means (CALM). Suicide Prevention Resource Center. https://bit.ly/2tmlUCr. Accessed June 20, 2018. The federal government should develop best practices, training programs, and guidance on how and when physicians should perform suicide assessments and inquire about firearm access.
Community-level interventions engage and empower community groups, organizations, and institutions to help prevent gun suicide in their community.
Public Awareness and Purchaser Education.
Access to a firearm increases the risk of suicide for all people in a household.32Anglemyer A, Horvath T, Rutherford G. The accessibility of firearms and risk for suicide and homicide victimization among household members: a systematic review and meta-analysis. Annals of Internal Medicine. 2014;160:101–110. In many communities, gun dealers are considered trusted messengers by gun owners and can play a role in building public awareness about the suicide risk posed by firearm access and how to mitigate those risks. For example, through a program called the Gun Shop Project, dozens of gun shops nationwide have begun displaying and distributing materials with information about the risks of firearm access—particularly as it pertains to suicide.33Harvard T.H. Chan School of Public Health. Gun Shop Project. https://bit.ly/2c4QKah. Accessed August 27, 2019. To build on the success of programs like the Gun Shop Project, the federal government should require that gun purchasers and firearm permit applicants be given safety information about the suicide risks associated with firearms in the home, best practices for responsible gun storage, and suicide prevention information. More groups and institutions should be empowered to help prevent gun suicide in their communities by training and educating natural helpers to recognize warning signs for suicide respond to individuals in crisis.
Societal-level interventions focus on how policy, social and cultural norms, and other large-scale factors can mitigate the risk of firearm suicide.
Firearm Purchase Permits.
States with permit-to-purchase (PTP) laws, which require an individual to obtain a permit in addition to a background check when buying a handgun, see reductions in firearm suicide.34Federal law requires criminal background checks for all guns purchased from a licensed firearms dealer and does not cover any sales by unlicensed sellers. A total of 20 states (and Washington, DC) have closed that critical gap for handguns, passing laws that require some form of a background check before a handgun purchase. Seven of those states require the check only pursuant to a purchase permitting process, nine require a background check only at the point of purchase, and four require background checks both in order to obtain a permit and also at the point of sale. Crifasi CK, Meyers JS, Vernick JS, Webster DW. Effects of changes in permit-to-purchase handgun laws in Connecticut and Missouri on suicide rates. Preventive Medicine. 2015;79:43–49. Connecticut’s enactment of PTP and comprehensive point-of-sale background check laws were associated with a 15 percent decline in the firearm suicide rate over the following decade.35Crifasi CK, Meyers JS, Vernick JS, Webster DW. Effects of changes in permit-to-purchase handgun laws in Connecticut and Missouri on suicide rates. Preventive Medicine. 2015;79:43–49. By contrast, when Missouri repealed its PTP law, the state experienced a 16 percent increase in the firearm suicide rate over the following five years.36Crifasi CK, Meyers JS, Vernick JS, Webster DW. Effects of changes in permit-to-purchase handgun laws in Connecticut and Missouri on suicide rates. Preventive Medicine. 2015;79:43–49.
Suicide Prevention Lifeline and Crisis Centers.
The National Suicide Prevention Lifeline (“Lifeline”)—a growing national network of over 170 local- and state-funded crisis centers—is a critical resource for individuals in crisis and can be an important intervention point for lethal means counseling. The Lifeline is staffed by trained counselors who assess callers for suicidal risk, provide crisis counseling, and offer referrals including lethals means counseling when someone mentions they have firearms or other lethal means in the home. The Lifeline’s call volume increases annually and is expected to increase even more given the recent recommendation to switch to an easier-to-use 3-digit number.37“Efforts to Stop Suicide Will Get a Boost in 2020,” NPR, December 31, 2019, https://n.pr/38F4lji. More federal and state resources should be allocated to Lifeline to ensure Americans in crisis can access immediate help—particularly in states that have higher rates of suicide.
A mandatory waiting period can also help prevent firearm suicides. A waiting-period law requires a certain number of days to elapse between the purchase of a firearm and when the purchaser can actually take possession of that firearm. Policies that create this buffer are associated with reduced rates of firearm suicide.38Luca M, Malhotra D, Poliquin C. Handgun waiting periods reduce gun deaths. Proceedings of the National Academy of Sciences of the United States of America. 2017;114(46):12162–12165. Anestis MD, Anestis JC, Butterworth SE. Handgun legislation and changes in statewide overall suicide rates. American Journal of Public Health. 2017;107(4):579–581.
Voluntary Do Not Buy Lists.
Some states have created a process for individuals who know they are at risk for suicide to voluntarily block themselves from purchasing, and in some cases possessing, a firearm for a limited period of time, known as Voluntary Do Not Buy Lists or Voluntary Prohibition Lists. Virginia established a Voluntary Do Not Buy List in 202039Va. Code Ann. § 52-50 and a similar program is being piloted in Washington.40RCW 9.41.350
Increased Access to Mental Health and Medical Services.
Roughly two in three Americans who attempt suicide visit a health care professional in the month before the attempt.41Ahmedani BK, Stewart C, Simon GE, et al. Racial/ethnic differences in health care visits made before suicide attempt across the United States. Medical Care. 2015; 53(5): 430-435. Increased access to mental health and medical services, including suicide prevention services, can help prevent a rise in suicide deaths. Efforts to increase access to mental health and medical services should consider how different populations receive medical care and how obstacles to medical care vary across populations.
National Suicide Prevention Lifeline
If you or someone you know is in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or text HOME to 741741 to reach the Crisis Text Line for free from anywhere in the US.
Everytown Research & Policy is a program of Everytown for Gun Safety Support Fund, an independent, non-partisan organization dedicated to understanding and reducing gun violence. Everytown Research & Policy works to do so by conducting methodologically rigorous research, supporting evidence-based policies, and communicating this knowledge to the American public.