Be Brave for Prevention of Suicide by Firearms

In this episode, our host Mighty Fine talks with Russell Krumnow and Dr. Emmy Betz about suicide prevention and firearm safety. In the United States, suicide is the 10th leading cause of death among adults. When we talk about suicide, we also need to talk about firearms as 1/2 of all suicides are by firearms and 1/2 of firearm deaths are suicide. It is so important that conversations take place about how suicide and firearms interconnect - even if those conversations may be difficult. Listen in to learn more about what efforts are taking place in addressing these public health issues.

Russell Krumnow is Senior Director at Convergence, an organization that convenes groups with divergent views to build trust, identify solutions, and take action on critical national issues. He oversees much of the organization's programmatic work including their recent Dialogue on Guns & Suicide Prevention resulting in a set of strategies from a diverse group that can be found here: https://reports.convergencepolicy.org/

Emmy Betz, MD, MPH, is an emergency physician and researcher at the University of Colorado School of Medicine, where she directs the Firearm Injury Prevention Initiative. She also co-founded the Colorado Firearm Safety Coalition and gave a TEDx talk on firearm suicide prevention. This podcast reflects her views, not those of her employers. Follow her on Twitter: @EmmyBetz

 This podcast is sponsored by the American Foundation for Suicide Prevention (AFSP). The American Foundation for Suicide Prevention (AFSP) was established in 1987, and is a  voluntary health organization that gives those affected by suicide a nationwide community empowered by research, education and advocacy to take action against this leading cause of death. Their mission is to Save Lives and Bring Hope to Those Affected by Suicide.

AFSP is dedicated to saving lives and bringing hope to those affected by suicide.  AFSP creates a culture that’s smart about mental health by engaging in the following core strategies:

• Funding scientific research
• Educating the public about mental health and suicide prevention
• Advocating for public policies in mental health and suicide prevention
• Supporting survivors of suicide loss and those affected by suicide

Transcript

Mighty Fine  0:08  
Welcome to the injury and violence prevention INdepth podcast. My name is Mighty Fine and I'm the host of this Safe States Alliance production. In this space, we'll engage in dialogue with IVP professionals on a variety of issues to help inform our listeners on the latest trends and hot topics. Today's episode is sponsored by the American Foundation for Suicide Prevention, which was established in 1987. AFSP is a voluntary health organization that gives those affected by suicide in nationwide community,  research, education and advocacy, to take action against this leading cause of death. Their mission is to save lives and bring hope to those affected by suicide. AFSP celebrates 30 years of service to the suicide prevention movement. Learn more about them at afsp.org - you can check out their annual report, get the links to their Facebook, Twitter, Instagram and YouTube. 

Today we'll be talking about suicide and firearms. We recognize that this is a huge topic and our intention isn't to touch on all aspects of this matter. Instead, we'll be uplifting our perspectives and adding to the ongoing and important conversation about prevention. I'm very excited to be joined by two phenomenal guests. Today we have with us Russell Krumnow, who's a senior director at Convergence. It's an organization that convenes groups with divergent views to build trust, identify solutions and take action on critical national issues. He oversees much of the organization's programmatic work, including their recent dialogue on guns and suicide prevention, resulting in a set of strategies from a diverse group. And that report can be found at https://reports.convergencepolicy.org. Be sure to check it out. We're also joined today by Dr. Emmy Betz, who's an emergency physician and researcher at the University of Colorado School of Medicine, where she directs a firearm injury prevention initiative. She also co-founded the Colorado Firearm Safety Coalition and gave a TEDx talk on firearm suicide prevention. This podcast reflects her views, not those of her employers, and be sure to follow her on Twitter @EmmyBetz. 

So let's kick things off. As you know, we're here today to talk about suicide, and firearms. And we've all heard the expression suicide as a major public health issue, or major public health problem. Emmy, can you just help us unpack that a little bit? kick us off and talk to us about suicides? Yes, why that's a problem, but specifically suicide in firearms.

Emmy Betz  2:29  
Thanks for having me. Such an important first question to start with. So we know that in the United States, suicide is about the 10th leading cause of death, although it's something we don't talk about nearly as much as we need to. And when we talk about suicide, we really have to talk about firearms as well in the US, because about half of all suicides are actually by firearm, excuse me. And if half of all suicides are by firearm. And if you flip this statistic actually to look at firearm deaths, about half of them are suicides. So firearms and suicides are so intrinsically linked in the US that there's really, we have to talk about both together. And the other reason we have to talk about them is because it's a public health problem in that it's affecting large parts of our population, and it's preventable, there are things that we can do to prevent these deaths. And so I think it's great we're having this conversation today.

Mighty Fine  3:31  
Awesome. And you elevated a critical component of the conversation, I think, is the prevention. Right. And as you mentioned, it's a leading cause of death here in the US. But Russell, we also know there's a diversity in perspective around this issue, right? Prevention is clearly a part of it. There are those of us who know the research practice  has shown us that this is preventable. But it'd be great for you to talk to our listeners about the Convergence dialogue on guns and suicide prevention. And let us hear a little bit of what came out of that dialogue.

Russell Krumnow  4:02  
Definitely, it's so good to be a part of the conversation. And this is a really heavy topic and thrilled to be connected to the network that listens to it. I'm also here today with I think, some doses of hope or on this difficult issue. Because I've just completed leading a project that we're thrilled that Emmy was a part of that brought together a diverse set of leaders, as you just said from an organization I work for Convergence who's aimed at preventing firearm suicide. What we do as a small nonprofit, we work behind the scenes doing quiet, difficult work which is bringing tables together folks with very different perspectives, and intentional facilitated conversations that go on typically for several months or even up to a year where people work together to develop a deeper mutual understanding, and ultimately to come up with a set of solutions or strategies they can put out into the world they believe would move the ball forward on that particular challenge, even if there's a lot of places they don't agree, where is the Venn diagram of agreement they can find after spending that intensive time together. So we've done this at a whole bunch of different issues as an organization. And for years, folks have suggested we tackle the issue of guns in some way, right? Like if there's any national issue that feels stuck, that feels like people talk past each other, or yell at each other, you know, it's guns in America.

Mighty Fine  5:15  
It's got lots of yelling, unfortunately. Right?

Unknown Speaker  5:18  
Exactly. Well, so then the question is, what does that look like? And so we began to investigate how we can bring this dialogue model to bear. There's a lot of people doing good work on this issue. But there aren't that many spaces held for folks with different perspectives to sit together, right. And so for us, that meant doing a whole bunch of learning and listening and informational interviews prior to this dialogue we can be, which led us to focus for the reasons we just outlined on firearm suicide. So over half of the deaths every year by guns in America, are suicides. I think this is an under discussed fact, among the general public. There's important work happening to reduce other types of gun deaths, we're not here to stigmatize that work, it's critical, and we need more of it. But I think the average person on the street if asked would think that maybe mass shootings or some other type of gun crime would comprise the largest number of deaths, that's actually not the case. So the although that's tragic, and and, and the heart rending for all of the folks impacted who've lost a loved one. It's also a solvable challenge, we can bring these numbers down. We all know people we can have hard conversations with we can connect them to support, we can level up things like safer storage practices. So we're not going to get into all of that today. But so that's what led us to this challenge is really the data. And after interviewing so many people far and wide impacted by the issue personally, folks with very strong gun rights perspectives, folks with on more of a progressive gun violence prevention perspective, many people who work on suicide prevention, left right center, cross sectoral we brought this table together, they met for an entire year in intensive dialogue, and have now produced a report that I think is going to be linked here in the notes for folks to check out the reports great, it's digestible. Convergence is not academic Think Tank, we try to produce things that are really accessible to lay people. It's something you can kind of scroll through, you can see the data, you can see the why you can see the who was involved. And you can see the resulting strategy. So we're thrilled to have concluded the process. And the strategies are important. We'll dig into those today. But I'll end my kind of initial comment by saying demonstrating the conversation is possible is also equally important around guns. It's just not true that someone who owns guns or has a very strong gun rights orientation connected to culture and values, it's not true that they are unable to have a conversation with someone for whom guns feel very foreign, or they're afraid of them, or for very good reasons they have been devastated in their own life by the misuse of a firearm of the United States has very high levels of gun ownership. And whether you think that that's good or bad, or you're indifferent about it, it's a fact, we have to grapple with a lot of people live in a house today, at least 40%. We think that the numbers are a little hard to track with based on the survey data right close to half of the country. And those numbers are rising because many gun purchases have occurred in just the last couple of years. So many, many of our fellow Americans, whether they are the gun owner or not live in a home with a firearm. And so we need to think hard about not stigmatizing people. This is a normal part of life, many gun owners are safe and responsible with their guns. But all of them aren't. We know we have guns that are unsecured, that are being misused in accidents that are being found by kids, there's a whole bunch of things going on. And certainly as it relates to suicide, because of the lethality of that method. It's not that there's anything wrong with a gun owner, that they're more likely to have a mental health crisis, but they have introduced into their home a lethal method. And so someone is almost certainly not going to survive a suicide attempt by firearm, which is of course not the case with other methods. So that's the other urgent piece of why we focused the dialogue here. Because if you put that time and space between a person in an acute crisis, and that lethal method, we can save these lives. So it was it was a powerful process to work through.

Mighty Fine  8:54  
Yes, definitely. I mean, just having read it, I can only imagine what it was like to actually be a part of it. So thank you for sharing that. And folks, certainly click on those links and check out this content. So you brought up a point that I wanted to focus in on it's about the access to firearms and why that should be a critical focus in this conversation in the work and suicide prevention. So I don't know who wants to take that on first, but just sort of emphasizing the importance of focusing on access and particularly access to lethal means like a firearm?

Emmy Betz  9:30  
Yeah, sure, I can. I will tackle that. So as Russell mentioned, access to a firearm for a person who's at risk of suicide significantly increases the likelihood that they'll die. We know across studies that homes that have firearms, the risk for suicide death by suicide is about three times as high in homes without guns and it's really important to know that that's not because the presence of a gun make someone suicidal. It's that if they reach for it in that moment of crisis, they're more likely to die. And that's because you know, guns are highly lethal - they're intended to be. So if somebody attempts suicide with a gun, about 90% of the time they die, there's no second chance to call 911 regret having taken pills. If they're found by someone, usually it's too late, you know that, as opposed to other kinds of methods. And we know there are other highly lethal methods too, like jumping off high bridges. That's why we put barriers on bridges, for example. And so it's, when we think about suicide risk, many people say well, oh, but they will just find another method. And so it's important to know, not just the lethality but also the time course of suicidality. We know suicide is very complex. And we're not going to dive deep into it today, in terms of what, what triggers a suicide attempt, there can be long standing, mental illness or social other kinds of stresses and issues that lead up to that point, but the period of highest risk of suicide can be in the space of hours, or days sort of, if you think about a time in your life, when you've been so tired or so angry, or so upset, you sort of can't think straight. That's kind of what we're talking about here. And so, so it's really about in those highest risk periods, making sure someone can't reach for a gun, because then there's no chance to undo what, what, undo that sort of bad decision. And we know from studies of survivors of suicide attempts, that only about 10% later died by suicide. So it's not inevitable, people don't automatically find another method. And it's not forever, people get better. So really, the conversation we're having is about how to make the environment around someone safer, while they also get the treatment they need, they still need whatever it is to address the underlying issues, if it's substance abuse, or mental health treatment, or financial issues, and so forth. But but just like having, being a designated driver to get your friend home from the bar, it's about making sure that when that person is not thinking as clearly as usual, they don't have access to something that they could use to end their life.

Mighty Fine  12:12  
For sure, and it makes me think of just we're having a conversation today, right? Among friends in our all of our listeners, right? And suicide is as ever present as it is, Emmy, you've spoken about this before it sort of doesn't get the attention that it requires. Right? So how do we change that? How do we shift that? How do we make conversations around suicide and firearms, particular, less polarizing, let's say, for example, because people are very wedded to their positions around guns and access to firearms and, and the like, and and even just folks like us who are working in suicide prevention, others that are not how do we generate or cultivate conversations where we can elevate these varying perspectives? And also, sort of course correct or I don't wanna say fact check, but provide an opportunity to just to discredit really the myths that are out there around suicide, firearm access, etc. So so again, repackage that to say, what what is it that we need to be doing more of to have really truthful, genuine and productive conversations around suicide in firearms?

Russell Krumnow  13:31  
Well, I'll just add that in some of the folks doing this innovative work participated in this dialogue, there are a number of ways to think about access, that can be led by people in the gun community, because they best understand the reasons people have guns in their home, which are very diverse and broad and differ, and the different ways to store them. And so that could look like somebody else temporarily holding on to that firearm during a period of crisis that can look like taking a part of the gun, the firing pin or something that essentially makes it inoperable out and someone else hanging on to that. There, there are safes, that that, you know, your spouse or partner could have the code maybe for the week, and you can access it. So there are a number of creative ways that folks can temporarily involuntarily not have access to that firearm, and then have it have it again in the future. We know for many people, this can be challenging. If you think about, well, well, I never have this again, this is something that I use for hunting or I enjoy or it brings me peace of mind connected to safety, or it's a part of my identity. If I work in law enforcement, or maybe if I was a part of the military, you'd have, you know, high levels of gun ownership among veterans. So there are ways to allow folks to be empowered with information around temporary voluntary ways to to have some space between them in that firearm, and then and then to get it back later after they've gotten that additional support. And so that's on all of us to have those hard conversations. And you're not going to plant the notion in somebody's mind that they should think about self harm. If you ask them if they need help. The data shows us and I think this is one of the biggest myths I've been learning about as a non expert who led this dialogue, right? I'm not, I'm not, I'm not a doctor like Emmy. But it was really powerful for me to learn that asking somebody, if they're going through a tough stretch and helping them connect with resources, will not send them spiraling or introduce the idea of self harm. In fact, it will be a lifeline to somebody who's sort of silently privately struggling, and maybe getting to a place of acute crisis, maybe not. But if you can intervene with that conversation, you can disrupt that process, and make sure they get a little bit of support. So I think that's another really important point for people.

Emmy Betz  15:33  
Yeah, so I think it starts with being ready to listen and learn and think about different perspectives. And I will say in this divisive climate we live in right now that can be really hard, but it's also incredibly rejuvenating and refreshing to, to be part of it. I think hearing challenging your worldviews can can be good. I remember Kathy Barber from Harvard, who's a legend in this field.

Mighty Fine  16:05  
She's a rock star

Unknown Speaker  16:07  
Rock star. I remember her saying once that early on, in some of her work with gun shops, one person a retailer, we're gonna looked at her and said, Why would you think that we want people to kill themselves. And that has always stuck with me, because I think it is true. And we need to really accept that it's true that nobody wants their family members to kill themselves. Nobody wants people dying from firearms, firearm owners, many of them. You know, the most common reason for owning a gun in this country is for protection of the family. And you may agree or disagree that that is a good strategy. But you've got to accept that that is the intent behind it. And so I think in public health, we have some wonderful opportunities to help them reach those communities, with educating them about this suicide risk. And I'll just share a couple years ago, I had the opportunity to speak about suicide prevention at Ladies Night at the gun club at Centennial Gun Club in Colorado. It was early in some of the coalition work we were doing. I didn't know how it's gonna go. But the owner of the gun club stood up and gave this amazing introduction about how important it was that we talked about suicide. And it was a room of maybe I don't know, 100 women who had come for ladies night for discounted shooting at the range. They were all very knowledgeable about firearms. And yet, I was shocked. And I would say even a little ashamed for us in public health at some of the questions they were asking because they were the most basic and understandable, important questions about suicide, like, really teenagers do that? Or what do I sit like? Is it going to make them do it, you know, these sort of fundamental things we need to get out and teach them. And I just felt like, we had been missing a big opportunity to get out and help educate a community so that they could take steps to make sure their families were safer. And when when I in present when it's presented in that way, I think there's not the pushback that people sometimes expect. And the last thing I'll say is I think it's very important to make it clear that generally we're not talking about policy approaches. We're not talking about extreme risk laws. We're not, we're not talking about laws that say that people with mental illness can ever buy firearms, like it's really about voluntary and temporary changes and engagement of communities. Yes, there's a role for things like red flag laws and extreme reporters. But it's kind of like the example of being a designated driver, your first step would probably not be to call the cops to take away your friend's driver's license, right, you would first get him home safely. And there may be situations where you need other other tools in the toolkit. But I think when people understand that it's really about working together to prevent these events that no one wants, I think then things actually go much more, go pretty smoothly, actually.

Mighty Fine  19:08  
Yeah, no, I think you bring up a great point. And I want folks to tap into that. It's that we're talking about interaction happening at those different levels, right, obviously, there's a policy level, a program level, etc. But if we're thinking about a cultural shift and a cultural change, we the people have to be a part of that. And so those conversations have to be person to person, where we acknowledge and recognize the humanity and one another. As you said, the gun shop owners are like, we're not selling guns for people to you know, use it on themselves or what, anyway, but I just say that to say, you that's a very poignant point that I don't want to be missed is that there's sort of a collectiveness among us in these spaces. Although we come to with varying levels of understanding about the issue. Offensively, we don't want our loved ones dying in this manner. So seeing where their commonalities are, so just sort of punctuating this idea of having these inclusive conversations, what's one thing you both would say, could help those of us in prevention and gun owners and not to say that you can't be in prevention and also own and own a firearm? Excuse me? How do we keep that dialogue going? If there's anything else you haven't already shared?

Russell Krumnow  20:22  
Yeah, I would just totally agree with me and add briefly that we need allies and the work with whom we do not agree on every aspect, on a full list of 10 priorities. If you run that down, and you disagree on eight of them. Your gut reaction in the current debate on many issues, right would be like, well, there's no space to work together at convergence. And look, this is not about papering over differences. This is not about downplaying that people have real reasons, deeply held values, they have personal experience, cutting in many different directions. And they, they get to feel that and they get to act on it, and they get to advocate for policy change, if they want to in line with it. We are not suggesting folks come and sort of watered down or set aside their own experience, I want to make that really clear. And some of these conversations we had in this year, were tough, and people disagreed and we had to come back again are, the meetings were happening because of the pandemic of resumes. So there's also like, in the chat, people trying to be gentle with it with each other and try it again with words that were more amenable, because language is really fraught around this, there are very limited number of words everyone can use and feel okay, about right. And so it's really easy to go run into your corners. But I just want to say to people, it does not mean that if you have a larger policy agenda, which we by and large, as me said did not focus on with regard to suicide prevention. It doesn't mean you can't sit down and have some conversations, we need many, many allies on this front, this is the largest number of gun deaths. And if you want to drive that number down, we need lots of folks armed with information that we need lots of folks feel included and seen. We need lots of folks having hard conversations with their friends, their fellow vet, their fellow, LGBTQ, young adult, African American, young adult, where we're seeing great rising rates across the board, but also with firearms that might be connected to you in some way in your community. We need everybody leaning in on this to bring those numbers down. And we don't need to stop and check if we agree on a whole bunch of other things in order to do that. So again, that's not about that's not about setting aside our strongly held beliefs. But where can we work together. And I think we found in this dialog, as me just laid out beautifully, that there's actually a ton of space where we can, we can sidestep the really hard political conversation that's going on. It'll keep raging, it's a free country. But there's a ton of work to be done on this front where we can really dig in and hear each other. Why did you choose to bring that gun into your home, that might be something I want to understand. And then that might help me work with you on what a storage options look like that makes sense for your family, and that respect that perspective, while you're also being given information with regard to risk that you can actually digest? That's true for doctors, that's true for therapists that are doing intake with people. And that's true for all of us have any kind of day to day conversations?

Emmy Betz  23:02  
I think I would say taking the time to think about words is a good start. If you're interested in doing more of this dialogue, you know, we've done some work, other people have put out guidelines there just to sort of understand what are some of the terms that each side so to speak, finds offensive or you know, in offensive because that could really shut down a conversation. And then I think being brave doing it and starting to have those conversations, but also being transparent about your intentions. And being open to listening. You know, I think it's a lot of it is about building trust. And so, you know, if it's your neighbor, you want to talk to just just being humble and open about what it is that you want to talk about or what you want to learn about. And I think that in my experience when you go into it with real with good intentions, and it's clear that that's what you're there for. It's been a really welcoming environment, again, recognizing you're not going to agree on everything, and you probably aren't going to change lifestyles or viewpoints. The other thing I would say is that there are many people in public health and in medicine who own firearms themselves, and I would love to see them stepping up more. And I think part of the reason some of them haven't is because to be honest, we stigmatize them a lot, you know, and we stigmatize them in ways that we wouldn't stigmatize other behaviors perhaps. So I think, you know, we need to make it okay for those individuals to talk about their experiences and and help lead the way. And I want to be clear, I'm not promoting firearm ownership. I don't own one myself. I don't think it makes sense for my family, I understand the risks, et cetera, et cetera. So I think you can do this work well, well, not sort of proactive, like proactively promoting something. But but we all do lots of you know, where we all have very different lifestyles, and we're very different backgrounds and that's what we need to tackle these these complex problems is really bringing all those different voices into the conversation.

Mighty Fine  25:06  
Great example, I think that sort of makes it clear to folks what we're talking about here and how accessible that interaction can be. Russell, anything you'd like to add?

Russell Krumnow  25:15  
I would just add that I think my main takeaway on this question is include the perspective of the people you want to impact or have behavior change. And so in this case, just as we would any other facet of our public life, right, we wouldn't go about doing a bunch of research on an issue or standing up a bunch of programs, and not ever talk to the most impacted population. Right, that wouldn't make a lot of sense. And so whether it's whether it's research grants to figure out the interventions that work effectively, whether it's local programming to figure out if it's effective, you know, gun owners need to be in the conversation, like they can help shape those, they can be constructive. And so I think that's a big takeaway. And again, that doesn't mean that we all suddenly think everybody should have a gun in their home. That's not what that's not what it means it means including the perspective of those who have chosen to, because when we're thinking about behavior change, that's a really important perspective. And let me be super specific and practical. Because there were some people that participated in this dialogue, doing really innovative stuff on the ground, that they wouldn't have probably come up with if they weren't themselves gun owners, right. So one is the idea that on the place where the guns are stored, the safe or whatever you might have in your home, there were some folks that are group that have like pictures of family members and be their own kids, they refer to as cause a pause, which is the idea that like, before I go and open this up, whether I'm having a great day, or a really hard day, I see those faces, this might not be the right thing for everybody to do. But it's worked well for some of them. And it's like remembering why you're here. While we want you to stay here that people care about you. And so that's a reason to sort of a way to kind of stay grounded before you go and access that thing that that can be used safely, but could also obviously cause a lot of damage if misused. We had another person in the group of MAXDB, who runs walk the talk America, another great organization folks should check out that really is trying to broker these conversations between the gun industry and mental health folks. They've now partnered with a number of gun manufacturers to put information about going and get a free and anonymous mental health screening. Right in the box. When you open it, you buy a gun, you buy some ammo. This is you know, is every new gun owner gonna run in us that that night that night? No, no, this is normalizing the idea that there's resources, it's anonymous to go do it. It's not a weird thing. It's a it's a, it's a common thing for folks to have challenging seasons in their life. And so let me just remember that since I've chosen to bring this, you know, if misused lethal thing into my home, there's a place I can go and check out to get help so that it's a start of a conversation. It's not the whole answer. But I think small steps like that in partnership with industry can actually be a way to sort of normalize the good behavior that we that we want to see. So those ideas and innovations are going to come when we bring to the table, the people kind of most directly tied to the to the issue.

Mighty Fine  28:02  
No, absolutely. I love that, that way to personalize it again, for us recognizing that where we are experiences, our identity, so much of who we are, you know, forms our decisions and how we approach a situation. So I think that's certainly true for this matter, as well. And by bringing together those diverse perspectives, we come up with innovative ways to prevent suicide. So Russell, I like to pick up where you were, where you were going. And for you and me to chime in here as we're thinking about prevention and intervention. What are some things that you all are seeing as critical components to prevention, suicide prevention, particularly with firearms? What's the science telling us? Or what perspectives? Can you just share from your own experience in this space? So Emmy, Russell?

Russell Krumnow  28:50  
Sure, I can give a short answer. And then I'll let me maybe let Emmy get into more of the the technical piece that she's so close to, but we know that connection and belonging are major protective factors for people right connection, belonging can be a bulwork against going down a path of self harm, or ultimately, a suicide attempt. And so there's lots of ways to provide that for people, right. And so in the group, in the dialogue that we held, we dug into different subpopulations, as me said, the universe of gun owners is evolving. There's, you know, certainly still a predominant white men and in the US who own guns, but the but that's not the only population group that right, that's changing a lot. We're seeing a lot of women and people of color, buy a gun for the first time, especially as we've highlighted the past couple of years. There might be more young adults that are open to that. And there are lots of, again, different reasons. LGBTQ folks might be buying one, and maybe it connects up with their own personal sense of safety. Right? So finding ways to have outlets for folks that have connection and belonging, and for a lot of young adults, they may have found that in school and the school was disrupted the past. You know, by and large right now, you know, schools are pretty much back open but we No, for a good long stretch during the pandemic, that was not the case. So we kind of need to redouble our efforts because a lot of social services and nonprofits were closed. You know, community centers, places where people can connect, were disrupted. And so that's part of the solution. That might be a, you know, House of Worship might be the place folks connect in some communities. It'll differ for everyone. But that's one, I think, broad just sort of theme to think about. And something that a lot of the folks in our group we're working on, is trying to build those communities. And then just to repeat what I said before, credible messages and credible messengers. That means meeting people where they are speaking in language they can access they can understand that respects them. And it's not jargon heavy, and it's something that feels like connected to their life. So that might mean a veteran connecting with a veteran showing up to places where gun owners are. And he was talking earlier about, yeah, that might be going to a gun shop or a gun range, or a place in a community where gun owners might gather to really connect with people on that turf kind of on their terms. I think we find those to be, you know, broadly effective. Strategies. Yeah. And

Emmy Betz  31:06  
I'll add, perhaps the the public health science perspective, I think, when you think about suicide and firearm suicide, like any sort of big topic, it's important to have a framework for how to prevent it. And I'm not going to talk in great detail about the frameworks that are out there. There. Really, there are some fantastic ones, the suicide prevention, Resource Center, National Action Alliance, you know, there's a Surgeon General's report that broadly look at everything from upstream, how do we build resiliency? How do we support protective factors? Then moving into how do you identify people at risk? What is screening look like? What how do we encourage, you know, bystander interventions? There's a whole clinical portion, what's effective treatment for people who are acutely suicidal? Medications, hospitalization? Are you sort of therapy approaches, then, you know, certainly the related pieces around substance abuse, treatment, and so forth. Also, critically important are things like postvention programs. So how do we support individuals, perhaps who've made an attempt? And how do we support survivors after someone has died to prevent the sort of subsequent waves of suicide, lethal means safety is recognized as a core component of suicide prevention, it alone is not going to fix the problem. And I think we hopefully have have have said that enough. But it is a really important factor to prevent some deaths, and to make sure people have a safe environment while they're getting better. And then, again, with the public health plans, I would say, you know, we also can really look at this using the public health approach, meaning, we need to understand the numbers, we have to look at the epidemiology and there are a lot of people doing work right now trying to understand numbers and rates and firearm suicide in different populations and demographic groups. We need to identify risk and protective factors. So what makes someone reach for a gun as opposed to something else? It's cetera, et cetera, what the people who use who tend to use firearms, how can we encourage, help seeking behavior in that population, etc. developing interventions that work for those populations and studying them, which is why it's really wonderful to finally have NIH and CDC federal funding to be able to support this kind of work, and they're really cool projects going on across the country. And then the last piece that's also critically important is scaling up what works. So there's, you know, there's lots of pockets of things happening right now that we don't totally know, for example, gunshot projects, like I talked about, we don't really know if those have big effects on rates overall, we need more research. But then we do want to know, if something does work like counseling, or providing locking devices, you know, all these things we're studying, then you want to know how to how to ramp that up and get them out to communities. And I'll just echo what Russell said, throughout all of it. Particularly given the sensitivity of this topic, it's critical that we pay attention to messaging and messengers. And, and I recognize as a as a doctor, and as a white woman, I am often not the credible messenger on this topic, and and how do we get it out through lots of things through the military and through gun shop owners and communities of color and LGBTQ, etc, etc? And how do we really get everybody engaged in the in the campaigns?

Mighty Fine  34:27  
Yeah, and I mean, you touched on something I wanted to ask you both and feel free to elaborate as you see fit. But so what I think of myself as a lifelong student, right, I'm always open to learning. And whether it's new ideas or learning more deeply about a topic, what have you, when we think about firearms and suicide? I'm sure there's so much more we need to learn but give us a snippet of maybe one area within that relationship that you think we need to explore a little further and both you and Russell so...

Emmy Betz  35:01  
I'll say I think we still there's a lot of work going on. But we still really need to know how to change home storage behaviors. So what are the behavioral approaches? Or economic incentives like free devices or messaging campaigns? How do we actually change the culture around this sort of like the friends don't let friends drive drunk message? But how do we how do we actually get people to make changes and how firearms are stored in their homes so that they're not accessible to those at risk of suicide? And that's what a lot of people are working on right now to figure out what what is the best message or the best package or the best the best way to really encourage those safer behaviors?

Russell Krumnow  35:43  
Yeah, and I think related to that, we need lots of people to be a little bit better equipped, and how to have conversations. My wife and I just had a baby, he's doing a little bit of chiming in from the other room, I mean, so you know, as a parent, you start to think, a little differently about some of this stuff. And so that could be as simple as, you know, when a kid goes to hang out at a neighbor's house, I mean, normalizing maybe checking, do you guys have a firearm? If so, is it locked up? And that can be really tough and uncomfortable? I'm not suggesting that's easy. But as we all start to normalize, asking those questions, not in a way, that's judgmental, a lot of people have them, but I'm just just double checking that it's locked in place, the kids aren't going to find it while they're playing. Okay, you know, great. And I think those could be like small steps along the way to normalizing safe practices, like Emmy just said, and I think that in parallel to that, normalizing, checking in with folks who might need some help, it's okay not to be okay, and really trying to find ways to connect them with resources, versus being afraid to do more damage by not asking, don't leave folks alone, who you think are having a particularly hard time. So I think we, that's a job for all of us. And that's something we all need to learn more. And some of that's going to be trial and error and trying things that are uncomfortable, but being so glad that we did versus hanging back. And then, you know, having a bad outcome that we can't, that we can't go back in reverse.

Mighty Fine  37:00  
I think you both bring up a great point, sort of, irrespective of your of someone's position on owning a gun, or you know, how they are with in our environment, they are there. And I know a lot of folks in this space often liken it to motor vehicles. And we recognize that recognize there were challenges there. Right. And it's, again, I'm not advocating one way or another folks. So. But in all seriousness, the solution wasn't to get cars off the road, right? We figured out a way to live safely in an environment with with with that, with those vehicles. And I think that's what I'm pulling from this conversation. Again, irrespective of your position, we know they are constant at this moment. And we have to figure out a way for us to live as safe as possible, with them being there. So you both touched on this a little bit earlier recognizing sort of messaging and credible messengers, and and we know that we often hear about white men as suicide in firearms and suicide. Can you talk to us about some of the other populations where we're where there needs to be a focus as well? Yeah,

Emmy Betz  38:12  
So you know, one really concerning trend is that even you know, before even before COVID, we were seeing increasing suicide rates in young in youth and young adults of color. The rates are still lower than in other demographic groups, but the trend is what's really concerning. So that's certainly one population that there's appropriately a lot of attention to right now, as we mentioned, to LGBTQ youth, in particular, are high risk group. Again, smaller overall numbers, but but incredibly, can be incredibly high risk. And certainly messaging needs to be appropriate and thoughtful. And, you know, we heard some really interesting perspectives from LGBTQ gun owners in the process of sort of the the various stigmas they have faced from different groups, including feeling like they were stigmatized for being a gun owner, while also being identifying as gay and so forth. So I think, a lot of really interesting intersecting questions there. Another population that I've been thinking about a bunch lately is women in certain circumstances, particularly women firearm owners and women in the military. For military women just recognizing, for example, that their firearm ownership personal fire arm ownership may be related to history of sexual trauma or domestic violence, for example. And so the messaging for them around how to make their home safer might be very different because they may have a history of trauma that is driving the reason for firearm ownership that's different than a hypothetical sort of future trauma event. So those are some of the big groups that that I think about, along with still incredibly important in the bulk of this still is white men, particularly in rural areas, the population who traditionally was raised perhaps to not want to seek help or not show weakness. And so we need to, we need to think about that. And then lastly, I'll just say certainly veteran and military populations, there's a lot of great work going on right now in the VA and the DOD and really trying to get ahead of of ahead of this and really jump on the firearm connection. So hopefully, we'll see more of them.

Mighty Fine  40:27  
Anything from your perspective Russell?

Russell Krumnow  40:29  
Yeah, I think those are the big ones. Emmy hit one point that I'll add, you know, we've been so careful in the dialogue we let in obviously, today's conversation is all focused on suicide prevention, for all the reasons we've covered. I will say if we were to succeed at improving storage practices in homes, other misuse of firearms would also drop. I mean, these aren't these are related, right? So focusing where the numbers are, and trying to prevent suicides is where our heads have been, it's incredibly important. But guns can be stolen and misused if they're not properly secured. So yeah, we do see some links, I think, to other types of misuse of firearms. And as me touched on, I think, with women in particular, there's some certainly considerations about the higher rates of domestic intimate partner violence, which don't always include a gun, but when they do, obviously, are much more likely to be lethal, just like with with suicide attempt. So I just wanted to add that additional nugget. But I think I think the key population she touched on are some of the big ones, the only one I briefly add is sort of native and indigenous populations, which, of course, percentage wise of the total population is quite small, but really, when broken out by racial group, I think typically have sort of the highest rates of attempts and deaths by suicide. And really different by tribe is something we learned some tribes, you'll see different different methods used more in some more gun ownership is very high. And so there's been some really successful interventions again, as well, with some programs funded by Johns Hopkins and others, to provide safes for folks. And so were gun ownership in those communities might be heavily tied to seasonal things like hunting, giving folks either very low cost or even free safes even physically bring it to sort of remote places where it's harder to get like Amazon isn't hitting everybody's porch every day, right? equipping them with that putting it someplace in a home, where it can be accessed is actually been proven, I think, to have a, you know, an impact on those numbers and bringing it down normalizing the storage and giving people that capacity. So that's just the last one I would add.

Mighty Fine  42:23  
Awesome. Thanks to you both. Well, I've thoroughly enjoyed this conversation today. And I want to just provide space for both of you to give us some of your closing, closing thoughts. The first is, if there's anything that you didn't get a chance to elevate in the conversation, thus far, we certainly want to hear that. And then the other thing is, I like to give out like calls to action, right. So for folks who are listening in listening in, I would imagine most of them are familiar with what we talked about today, but maybe less familiar with their role or what they potentially can do, and being a part of the solution in this issue. So I'm leaving it up to you to to tell them once they listen, this is what they got to do. But in all seriousness, again, anything you haven't had a chance to share yet. And then any words or thoughts of how folks listening and can can get involved in this work.

Emmy Betz  43:17  
Sure. So I I want to also elevate the importance of preventing teen suicide, teen firearm suicide, I think that's an issue we didn't talk a ton about during this session. But you know, many firearm owners lock up guns at home when the kids are really little. And we think about asking about, you know, before playdates and things even if it's might be difficult, we ask those questions. And then I think in many families, children have been trained how to use guns, or they go hunting with their parents, etc, etc. And so parents may not think of access the same way. And they may leave firearms accessible to their kids. They mean, the kid may know where the key is right? And, and the danger, of course, is that teenagers are very impulsive and have a rollercoaster of emotions and bullying and all of the things that go with being a teen. And so we spend a lot of time talking about school shootings. But unfortunately, children are far more likely to kill themselves than be killed at school. And most often, when a youth uses a gun, it's the parents gun. So that's one thing I would really love to see happening out there and in messaging and in campaigns, but also between neighbors of just recognizing that teens are still at risk, and we talk about sex, and we talk about drugs, and we talk about drunk driving, and we need to talk about suicide. And we need to be asking if they're accessible guns when our teen is going to someone's house and making sure things are locked up in our own houses to you know, I think it's No parent wants to think that that would happen and it happens a lot, unfortunately, and but we know that teens who attempt with a gun are usually going to die if they attempt with something else. probably survive, and they get better. And, of course, as parents in a community, none of us want to see those deaths. So I think his art of thinking about secure storage in homes with teenagers is important for suicide prevention. And then, in terms of getting involved, lots of ways to do it, I would recommend, if you're not sure if there are programs and activities in your state, the Means Matter website out of Harvard has a listing of kind of state level gunshop projects, that's an easy place to start to check in and see what kinds of collaborations are already happening. Or, you know, just start having conversations with your neighbor, go to a gun club, like start, you know, start broadening your own mind and perspectives on this. And I think once you start to jump in, you'll realize there's lots of things that that we can all be doing, and it's not quite as scary as maybe people think it is to start, they'll be brave.

Russell Krumnow  45:57  
Yeah, that's all exactly right. I mean, we need we need lots of brave spaces, right? I think we there's a lot of conversation about safe spaces, but we want spaces where folks can kind of lean forward and be brave and learn. I agree with all of that on the conversations, we want to normalize. And just up at the level of leadership, the folks who sort of convenient or dialogues, I just want to emphasize again, that trying to dramatically increase the amount of education around this and dramatically increase safe storage practices and homes has nothing to do with being positional, in the larger gun debate in America, you we could be the staunchest gun rights advocate, or or the staunchest person opposed one wishing there were wishing there were no firearms. And we can agree that dramatically increasing storage practices tomorrow would save a bunch of lives. So I really hope people hear that and lean in. I hope they call for people that fund research and programs and elected officials, even if there's not a role for a policy change. The way people talk about this is very important. And so right, left and center, there's a role for all, I think people in leadership to play. And I hope that regular citizens will hold them accountable to that super brief anecdote, just again, on a hopeful note here, as we've been meeting with people, in the wake of this dialogue, concluding, we've taken some meetings with folks who, you know, some of like some staff or elected officials, right, or folks in some of the different agencies, who certainly would not be aligned with the perspective of some of the very strong gun rights and gun community leaders, we can be into this dialogue. And yet, we've been able to get to a place to broker some conversations and meetings so they can listen and hear each other, where they again, they did not have to set aside their beliefs, and they didn't have to agree on everything that's been very powerful. Hearing the reason feel folks feel dismissed or attacked, and understanding and getting underneath that, and recognizing, when I say and do this, it sends you running the other way, when when I really badly want a need is for us to work together on this. So look, it's not a utopia, we're gonna keep having big disagreements. But on suicide prevention in particular, that's my big message for people leadership is to model that, to keep reaching across to do it. You get to have your your strongly held beliefs an advocate and you also could work together with folks to save lives, and then do all the stuff he just said, as far as individual citizens on normalizing conversations, and normalizing safe practices. I think that's that's how we're going to have to get it done. And look, the need is very urgent, the need was urgent prior to the pandemic, and it's only ratcheted up. So we all have a role to try to tackle this.

Mighty Fine  48:20  
Awesome. Well, thanks to you both. I certainly got some gems from the conversation today. And I love that right? When you can engage and learn contribute. And this has been enlightening and rewarding for me. And I'm certain it's the same for those listening in. I won't hold you any longer even though I have tons more questions that I can ask. But I think this is a start of a conversation here in the space with Safe States in our folks. And I'm sure they'll take it and continue to move it forward. So again, just concluding by thank you both for joining us today.

Emmy Betz  48:54  
Thank you so much for appreciating.

Mighty Fine  48:57  
Thanks again for listening to IVP INdepth. Be sure to subscribe and listen to us on Apple podcasts, Spotify and Google podcasts. You can also follow safe states on Twitter at Safe States and LinkedIn and don't forget to check out our website Safe States.org for more injury violence prevention tools and resources. Again, I'd like to thank our sponsors the American Foundation for Suicide Prevention, for supporting Safe States and helping us to bring you programs such as this, this is your host Mighty Fine signing off and until next time, stay safe in injury free.

Transcribed by https://otter.ai