New tips to help physicians reduce suicide risk among patients

Timothy M. Smith , Contributing News Writer

The topic of firearm violence often conjures images of mass shootings, and justifiably so. But the data on firearm deaths suggests the conversation on gun safety needs to be expanded. After all, mass shootings make up only about 1% of firearm deaths in the U.S., and homicide isn’t the leading cause either. In recent years, some 60% of deaths from firearms have come from suicide.

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An episode of “AMA Update” features a conversation with Emmy Betz, MD, MPH, professor of emergency medicine and director of the Firearm Injury Prevention Initiative at the University of Colorado School of Medicine. Dr. Betz discussed firearm-related suicide and the role physicians can play in prevention.

“The time period from which a person decides to attempt suicide to actually take action can be in the space of minutes to hours,” Dr. Betz said. “It's really a pretty short period of high risk.”

In addition, firearms are uniquely lethal compared with medications or other methods, with suicide attempts involving firearms resulting in death 90% of the time.

“If we can get people through those high-risk periods, it's unlikely that they will die by suicide,” Dr. Betz said, noting that only about one in 10 people who survive an attempt later die by suicide. “That's why we really talk about reducing access to firearms in particular as a core strategy for suicide prevention.”

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Ideally, older people who own firearms would make decisions ahead of time about what they want to happen to them if they develop dementia or other impairments. Obviously, this does not always take place, so caregivers need to be prepared.

“First, it's the disease, not the person—that's the problem,” Dr. Betz said. “Emotionally, I think it can be hard, but it's important for people to come to terms that dad or mom is not who they used to be.”

So again, access can be the determinant.

“We encourage caregivers to find the thing that works for them and their family, whether that's locking firearms up, moving them out of the home, selling them or so forth, depending on what the family wants,” she said.

Learn more with this AMA Ed Hub™ course, “The Physician's Role in Promoting Firearm Safety.”

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Talking with patients about suicide might seem taboo, but it is easier than many physicians suspect, Dr. Betz said. Research has shown that patients are fine with physicians broaching the subject, and there are no federal or state laws banning physicians from doing so.

“We are trained to talk about the hard things—to talk about sexual practices and substance use and all kinds of things that might make us a little nervous,” she said. “Some of this, I think, is that as clinicians we just need to get used to having the conversations.”

Dr. Betz recommended that physicians get to know—and recommend—these free firearm resources:

  • The BulletPoints Project, which equips health professionals with knowledge on firearms and their uses, benefits, risks and safety to reduce chances of firearm injury and death.
  • Lock to Live, which has tips for patients and their families about temporarily reducing access to dangerous items, such as firearms, medicines and sharp objects.
  • Firearm Life Plan, which provides downloadable toolkits to preserve firearm legacy and maintain safe firearm storage.

“Learn more, figure out what works for your practice and then start doing it,” Dr. Betz said.

Dial 988 if you or someone you know needs help. The 988 Suicide and Crisis Lifeline—formerly the National Suicide Prevention Lifeline—provides round-the-clock free and confidential support for people in distress.

AMA Update” covers health care topics affecting the lives of physicians and patients. Hear from physicians and experts on public health, advocacy issues, scope of practice and more—because who’s doing the talking matters. You can catch every episode by subscribing to the AMA’s YouTube channel or the audio-only podcast version, which also features educational presentations and in-depth discussions.