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View Diary: Guns and Suicide: Introduction (265 comments)

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  •  What laws would you propose to limit (10+ / 0-)

    firearm related suicides? A shotgun works just as well, if not better, than a handgun and usually they're regulated even less than a handgun. Same thing goes for, say, a hunting rifle.

    •  Subject for another diary (12+ / 0-)

      Today we only want to introduce the topic of guns and suicide, and to let readers know that we will be writing a series of diaries on this topic.

      Frankly, I hadn't thought about writing about changes in law as part of this series.  Your question is making me re-think that, and that perhaps a dedicated diary on my suggestions for changes in laws should be part of the series.

      I will say here that I am against a law that forbids a doctor from discussing guns in the home with a patient.  Psychiatrists can and do get sued if one of their patients commits suicide, and so psychiatrists in Montana are between a rock and a hard place: the law that prevents them from asking their suicidal patients about guns in the home on the one side, and the risk of having a patient commit suicide using a gun (and the resulting lawsuit) on the other.  

      What do you suggest psychiatrists in Montana do?

      "The fool doth think he is wise: the wise man knows himself to be a fool" - W. Shakespeare

      by Hugh Jim Bissell on Tue Oct 29, 2013 at 12:25:17 PM PDT

      [ Parent ]

      •  There are plenty of ways to commit suicide (6+ / 0-)

        in the home. You're making it sound like not being able to talk about firearms means they're not able to start working on the underlying reasons their patient is suicidal.

        I'm not saying I agree with the law, by the way.

        I'm interested in seeing what laws you propose to curb firearm related suicides.

        •  I am allowed to ask abut pills (14+ / 0-)

          You are correct that there are many ways to kill oneself.  the fact of the matter is that guns are using in something like 60% of completed suicides - far and away more frequently that the number two suicide method (pills and poisons).

          As a psychiatrist in Montana, I will be allowed to ask a suicidal patient: "do you have dangerous medicines in your house?"  but I cannot ask "do you have guns in your house" (specifically I can ask, but I am not allowed to insist on an answer).

          So it makes no sense to me that doctors should be prohibited from asking suicidal patients about the most common method of suicide, yet be allowed to ask about all the other methods of suicide.

          "The fool doth think he is wise: the wise man knows himself to be a fool" - W. Shakespeare

          by Hugh Jim Bissell on Tue Oct 29, 2013 at 01:01:39 PM PDT

          [ Parent ]

          •  Where are you getting that? (4+ / 0-)

            I ask that below in this comment.

          •  Related: The Military’s Epidemic Of Suicide (4+ / 0-)
            ... In fact, suicides have become an epidemic. This year, more soldiers, seamen, airmen and Marines died by their own hand than died in battle. Suicide was the No. 1 cause of death for U.S. troops. More than two-thirds of suicides involved firearms, and nearly three-quarters of those cases involved personal weapons, not military weapons.

            Reversing this epidemic is among the military’s highest priorities. In that regard, one of the things we learned during our careers is that stress, guns and alcohol constitute a dangerous mixture. In the wrong proportions, they tend to blow out the lamp of the mind and cause irrational acts. Commanders and noncommissioned officers need the tools to prevent this mixture from turning lethal.

            One of the most effective measures of suicide prevention is to ask those perceived to be under duress: “Do you have a gun in your home?” If the answer is yes, we might then suggest that the individual put locks on the weapon or store it in a safe place during periods of high stress — things that any responsible gun owner should do.

            Unfortunately, that potentially lifesaving action is no longer available to the military. A little-noticed provision in the 2011 National Defense Authorization Act (NDAA) has had the unintended consequence of tying the hands of commanders and noncommissioned officers by preventing them from being able to talk to service members about their private weapons, even in cases where a leader believes that a service member may be suicidal.

            We both strongly believe that this prohibition interferes with every military leader’s obligation to ensure the health, welfare, morale and well-being of the troops under his or her command and care...

            By Dennis J. Reimer and Peter W. Chiarelli
            Published: December 7, 2012, The Washington Post

            Gen. Reimer (Ret.) was chief of staff of the Army from 1995 to 1999. Gen. Chiarelli (Ret.) was vice chief of staff of the Army from 2008 to 2012.

            (Some emphasis added)

            Read full article here...

            REIMER AND CHIARELLI ON THE MILITARY'S EPIDEMIC OF SUICIDE...
            •  This is really important (3+ / 0-)
              Recommended by:
              WakeUpNeo, Glen The Plumber, suesue

              and I suspect that similar prohibitions exist in practice in every police/fire/EMS department. The prohibition against asking may not be a matter of law, but it is likely a matter of practice because everyone knows that admitted suicidal thoughts could mean the end of a career.

              "They did not succeed in taking away our voice" - Angelique Kidjo - Opening the Lightning In a Bottle concert at Radio City Music Hall in New York City - 2003

              by LilithGardener on Tue Oct 29, 2013 at 08:03:58 PM PDT

              [ Parent ]

            •  It's a horrible form of (3+ / 0-)
              Recommended by:
              WakeUpNeo, Glen The Plumber, suesue

              Don't ask/Don't tell...

              ... that way we don't have to measure it or be responsible for it in the early stages....

              "They did not succeed in taking away our voice" - Angelique Kidjo - Opening the Lightning In a Bottle concert at Radio City Music Hall in New York City - 2003

              by LilithGardener on Tue Oct 29, 2013 at 08:05:12 PM PDT

              [ Parent ]

      •  That was my first reaction. (12+ / 0-)

        If I have a depressed/suicidal patient, the first question asked is what is their plan? Followed by do you own a gun? If I didn't ask these questions and the pt. Committed suicide, I'd lose my license and everything I own. Even with a $3,000,000 malpractice policy. Same thing with homicidal pts. But in that case, if I haven't assert aimed if they have a gun, I lose everything and go to jail.

        Cats are better than therapy, and I'm a therapist.

        by Smoh on Tue Oct 29, 2013 at 12:34:52 PM PDT

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        •  Assert aimed!? - asked. (6+ / 0-)

          Cats are better than therapy, and I'm a therapist.

          by Smoh on Tue Oct 29, 2013 at 12:39:59 PM PDT

          [ Parent ]

        •  Assert aimed!? = asked. Gotta love Apple. (6+ / 0-)

          Cats are better than therapy, and I'm a therapist.

          by Smoh on Tue Oct 29, 2013 at 12:42:06 PM PDT

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        •  Psychiatrists are trained to do exactly that (11+ / 0-)

          Yes, indeed.  Psychiatrists are trained that when confronting a suicidal patient to ask: do you plan to kill yourself? how will you do it? what method will you use? do you have the pills (or the gun) at home? etc, etc.

          The failure of a psychiatrist to ask those questions of a suicidal patient is a gross misconduct of psychiatric practice, and creates a liability for a lawsuit.

          "The fool doth think he is wise: the wise man knows himself to be a fool" - W. Shakespeare

          by Hugh Jim Bissell on Tue Oct 29, 2013 at 12:53:02 PM PDT

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          •  Yes. I'm a psychologist - same thing. (9+ / 0-)

            Cats are better than therapy, and I'm a therapist.

            by Smoh on Tue Oct 29, 2013 at 12:58:26 PM PDT

            [ Parent ]

          •  Perhaps I misunderstood the law. (6+ / 0-)

            You can't ask "Do you have the means to kill yourself at home?"

            In fact, the bill text itself suggests that "as a condition of receiving health care" is a huge part.

            NEW SECTION.  Section 1.  Privacy in health care -- ownership of firearms. (1) No health care provider or health care facility may:    
                 (a) refuse to provide health care to a person because the person declines to answer any questions concerning the person's ownership, possession, or use of firearms; or
                 (b) require that a person, as a condition of receiving health care, complete an application or other form that contains questions about a person's ownership, possession, or use of firearms.
                 (2) For the purposes of this section, the terms "health care", "health care facility", and "health care provider" have the meanings provided in 50-16-504.
            Where do you get that shrink can't ask questions about firearms in the course of their normal duties, presumably after the person has started receiving health care from said professional?
            •  No - your understanding is good (12+ / 0-)

              As you know, there is theory and there is practice.

              In practice, many psychiatrists will tell their patients "under these circumstances will I provide treatment for you".  See, a psychiatrist cannot MAKE the patient do anything.  The only leverage the psychiatrist has on a uncooperative patient is to say "I cannot be your doctor if you refuse to adhere to my recommendations for your treatment"

              So when the manic patient says they refuse to take the prescribed meds, the psychiatrist can say "your choice, but I will not be your doctor if you behave that way".

              Almost all psychiatrists will insist AS A CONDITION OF TREATMENT that a suicidal patient honestly and frankly tell the doctor about deadly risks in the patient's home.  The Montana law takes that away from doctors.

              "The fool doth think he is wise: the wise man knows himself to be a fool" - W. Shakespeare

              by Hugh Jim Bissell on Tue Oct 29, 2013 at 01:13:39 PM PDT

              [ Parent ]

            •  There is an aspect of this that you might not (3+ / 0-)
              Recommended by:
              coquiero, Glen The Plumber, suesue

              be appreciating.

              (b) require that a person, as a condition of receiving health care, complete an application or other form that contains questions about a person's ownership, possession, or use of firearms.
              There is the practice of running through a list of detailed questions and/or checking off a self assessment survey every time they see the doctor, which could be daily, weekly, monthly, quarterly...

              Depending on the reason treatment is sought, the list will include symptoms and various risk factors, both of which can change from one visit to the next.

              From my perspective the law is written based on the supposition that where people may not volunteer the information, they will be more likely to answer when asked by an authority figure.

              "They did not succeed in taking away our voice" - Angelique Kidjo - Opening the Lightning In a Bottle concert at Radio City Music Hall in New York City - 2003

              by LilithGardener on Tue Oct 29, 2013 at 06:19:35 PM PDT

              [ Parent ]

              •  An aspect I've not seen. nt (1+ / 0-)
                Recommended by:
                LilithGardener
                •  Let's step back a notch - a little less personal (4+ / 0-)

                  I appreciate your openness about your family, but I'd rather discuss this issue in less personally specific terms.

                  E.g. You know that veterans are surviving injuries that would have killed them in past wars, right? Many survivors of IEDs have traumatic brain injury and/or PTSD, and/or...?

                  We've come a long way with neuroscience and have much better tools now to diagnose and keep people alive after stroke/accident/head trauma. With functional MRI we can measure some of what happens in the brain, but there is a lot about the brain we still don't have a clue about, and all our tools are still relatively blunt instruments. Have you heard of personalized medicine? E.g. there now known some specific genetic factors that demark a whole classes  of meds that will be ineffective in patients with that genetic variation. It doesn't mean that it's all genetically predetermined though. It's more complicated than that. But I digress.

                  Treatment for cognitive dysfunction (e.g. traumatic brain injury, stroke, dimentia) or chronic mental illness(e.g. PTSD, schizophrenia, bipolar disorder, depression) will include a practice of assessing symptoms/risks at the initial assessment AND track symptoms over time.

                  An important part of the therapeutic benefit in anything involving the brain involves a doctor teaching a patient how to pay attention to the stuff that matters and makes a difference for them. Individually. Treatment compliance is paramount before treatment effectiveness can be assessed.

                  There are many types of "brain illness" symptoms and the severity will vary. Memory and cognition can be compromised, either by the injury/illness or in some cases by medication/hormonal issues. So the doctor will ask the same questions each time. Or the patient will check off the list each time, marking the severity of each symptom. Part of how the doctor/patient relationship becomes therapeutic is they collaborate to track symptoms and reduce risks. It's not just about feeling better or thinking more clearly. It's about functioning better in the whole picture.

                  How do they know whether treatment is working or needs to be changed? By tracking symptoms and reduction of risks and other complicating factors over time.

                  Many people with cognitive impairments and/or mental health disabilities also have other co-morbid conditions and risk of disrupted relationships, lost jobs, poor functioning with paying bills, etc. Almost all the meds used to treat problems in the brain carry some risk of cardiac/liver/kidney toxicity. Doctors treating brain issues  will often use a form that helps to track the symptoms/risks that are prevalent for their patient population. I'll leave it to any physicians in the house to give some specific examples.

                  Because many of these problems carry a lot of shame, good doctors know that patients may be reluctant to tell the truth on the first visit, the second visit, the 10th visit. Someone with a drinking problem may not realize they have a drinking problem...  I suspect a big factor in the rising suicide rate is at the intersection of alcohol/guns.

                  A good mental/cognitive health practitioner evaluates more than just the symptoms, they also assess whether the patient has the same or better social support in place to help them remain treatment compliant, and help them mitigate risks that interfere with treatment.

                  One of the reasons doctor need to be able to ask about guns explicitly is because of domestic violence. One adult in the home might not tell the truth, but the abused person is more likely to tell or reveal the truth when asked directly in the privacy of the doctor's office. A doctor is not a social worker but the primary care physician or the pediatrician is at the front line of prevention for the most vulnerable patients, which is women, kids, elders, and people with disabilities of one kind or another.

                  "They did not succeed in taking away our voice" - Angelique Kidjo - Opening the Lightning In a Bottle concert at Radio City Music Hall in New York City - 2003

                  by LilithGardener on Tue Oct 29, 2013 at 07:25:33 PM PDT

                  [ Parent ]

        •  Really? I didn't know that. (5+ / 0-)

          Is that true only if they admit they are suicidal, or would you ask the same question if you suspected they might be?

          I blog about my daughter with autism at her website

          by coquiero on Tue Oct 29, 2013 at 05:35:25 PM PDT

          [ Parent ]

          •  After 9/11 (3+ / 0-)
            Recommended by:
            coquiero, Glen The Plumber, suesue

            When I showed up with a chronic cough after a severe summer cold, I was asked a whole series of risk assessment questions by my primary doctor (an endocrinologist). I thought I was having trouble sleeping because of congestion and cough and my primary care doctor didn't take anything off the table. His risk assessment questions included mental health, stress at work, domestic violence, and detailed family medical history.

            "They did not succeed in taking away our voice" - Angelique Kidjo - Opening the Lightning In a Bottle concert at Radio City Music Hall in New York City - 2003

            by LilithGardener on Tue Oct 29, 2013 at 06:26:06 PM PDT

            [ Parent ]

    •  That's a very good question (8+ / 0-)

      As I've been reading Heller I noticed J. Breyer's minority opinion included a detailed history of the crime problem that DC was trying to address when they passed strict gun laws back in 1975. That was a decade before the crack cocaine epidemic began in the 1980s (and that peaked in the mid 1990s).

      I expect you'll agree that DC has arguably the most restrictive gun laws in the nation. As I've been trying to understand the purpose of those laws I've noted three really remarkable things about DC.

      1. It's the only totally urban geographical unit. With a population of ~ 600,000 (2010 census), it is in some ways comparable to other totally urban counties, e.g. New York County. So we err when we compare DC's public safety challenges to state challenges where state legislatures grapple with a population that is partially urban and partially rural, e.g. New York State.

      2. Additionally, the urban planners must accommodate the total population of DC on any given day, not just the people who live there. That includes all the people who commute in, and the people who are only there for a few weeks or months at a time, and all the tourists and day trip visitors. So the dynamic day to day population of DC is about a million people. The transit and the police and EMS services have to plan for that population which is almost twice the residential population. All of those people can become crime victims. Yet when we compare DC to other states we often compute a homicide rate rate using the census population to make a per capita comparison.

      3. DC has the lowest suicide rate in the nation, bar far, much lower than the national average. Firearm ownership is also low, which is easy to explain as resulting from a) strict ownership laws, b) no hunting, c) no needs for guns as utility tools, e.g. dealing with 4 legged pests.

      Here's a graph that really made me stop and think. Correlation is not causation and there are a lot of complex variables in play, but this correlation is striking. On suicide rate and gun ownership rate DC is a true outlier.

      Washington Post, March 22, 2013, by Dan Keating

      Washington Post - Gun deaths shaped by race in America - Figure ? (Image 31)
      Map of suicide and homicide rates by state - Washington Post
      We know from DC's homicide rate that there are plenty of guns in DC. So it's not just the number of guns.

      Shouldn't we be asking ourselves which of DC's gun laws intersects with suicide risk and check whether that replicates in other totally urban counties?

      "They did not succeed in taking away our voice" - Angelique Kidjo - Opening the Lightning In a Bottle concert at Radio City Music Hall in New York City - 2003

      by LilithGardener on Tue Oct 29, 2013 at 01:49:08 PM PDT

      [ Parent ]

      •  Look to racial, ethnic, economic demographics. (7+ / 0-)

        In certain demographics, suicide is acceptable.  
        Others, it's a highly-stigmatized action.
        http://en.wikipedia.org/...
        #7, China. Private gun ownership rate essentially zero.
        #10, Japan: Private gun ownership rate essentially zero.
        #13, Russia. Private gun ownership restricted.
        #19, Finland.
        #33, United States.
        #35, Norway.
        #45, Switzerland
        #49, Germany
        #50, Australia
        #66, Italy
        #68, Israel

        How much does social medicine factor into this?
        Religion?
        Close family units/extended family under one roof?

        •  Kay Jamison wrote about this in her (5+ / 0-)

          book about suicide, Night Falls Fast.

          IIRC she mentioned "suicide by cop" may be more available and accepted in some populations.

          "They did not succeed in taking away our voice" - Angelique Kidjo - Opening the Lightning In a Bottle concert at Radio City Music Hall in New York City - 2003

          by LilithGardener on Tue Oct 29, 2013 at 05:45:02 PM PDT

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        •  Wait - Near zero private gun ownership? (4+ / 0-)

          If I've read it once I've read it a thousand times on Daily Kos, "Criminals will always be able to get guns." I've seen it so often it sometimes seems like it's part to some RKBA gospel truth.

          If that's true that criminals can always get guns, how can it also be true that two countries have essentially zero private gun ownership?

          What's up with that?

          "They did not succeed in taking away our voice" - Angelique Kidjo - Opening the Lightning In a Bottle concert at Radio City Music Hall in New York City - 2003

          by LilithGardener on Tue Oct 29, 2013 at 06:30:19 PM PDT

          [ Parent ]

          •  They were most likely talking about the US. (1+ / 0-)
            Recommended by:
            FrankRose

            Criminals will always be able to obtain firearms in the US. Hell some non-criminals will become criminals if firearms are banned.

            •  Of course they were making speculative (1+ / 0-)
              Recommended by:
              coquiero

              claims about the US. I was teasing 43north's serious list.

              "They did not succeed in taking away our voice" - Angelique Kidjo - Opening the Lightning In a Bottle concert at Radio City Music Hall in New York City - 2003

              by LilithGardener on Wed Oct 30, 2013 at 06:36:47 AM PDT

              [ Parent ]

          •  You mean the murderous dictatorship, and (0+ / 0-)

            the nation that was a military dictatorship until occupied by a foreign nation?

            Gee, sounds like a plausible solution for the USA.

            Those who would sacrifice liberty for security deserve neither.

            by FrankRose on Tue Oct 29, 2013 at 10:02:14 PM PDT

            [ Parent ]

          •  Perhaps they should have said (1+ / 0-)
            Recommended by:
            43north

            "essentially zero legal firearm ownership".

            If I've read it once I've read it a thousand times on Daily Kos, "Criminals will always be able to get guns." I've seen it so often it sometimes seems like it's part to some RKBA gospel truth.
            Because it is actually true, people willing to bend or break the law will always be able to get them. They'll smuggle them in from other countries, steal or bribe them away from law enforcement/military sources or just machine the things themselves.
    •  Speaking of other diaries (4+ / 0-)

      If you were away from Daily Kos recently you might have missed the beginning of our SCOTUS WATCH series.

      60 Cases and Counting: What Gun Case Will SCOTUS Take Next? (yesterday)

      Concealed Carry Law Petitions SCOTUS - Woollard v. Gallagher DENIED cert (Oct 15th)

      "They did not succeed in taking away our voice" - Angelique Kidjo - Opening the Lightning In a Bottle concert at Radio City Music Hall in New York City - 2003

      by LilithGardener on Tue Oct 29, 2013 at 05:08:52 PM PDT

      [ Parent ]

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