Historically, suicide prevention has focused on the mental health risk factors that might lead an individual to want to die. But despite the intuitive appeal of this approach, it isn't working. That is the opinion of Michael Anestis, executive director of the New Jersey Gun Violence Research Center. In 2022 there were 26,993 deaths by gun suicide in the U.S., and the rate of such suicides reached an all-time high, increasing by 1.6 percent from a year earlier. Our history of leaning on risk factors hasn't made us any better at predicting who will die, Anestis says.
That's why researchers and suicide prevention advocates have taken a different approach: making the surrounding environment safer so those at risk (whether they know it or not) are less likely to die by suicide. A similar policy in Israel brought about a 57 percent reduction in the suicide rate within the military. According to a 2016 article in the journal European Psychiatry, the change came from not just increased mental health awareness at work but also the behavioral measure of stopping people from taking their guns home when they were off duty.
Anestis thinks we could see comparable results in the U.S. From 2012 to 2020 he lived and worked in southern Mississippi, the state with the fourth-highest rate of gun deaths. Spending eight years in the Deep South made him realize that he had to find a way to reach those whom he cared for deeply even though their views about guns were much different from his own.
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People who own firearms don't want to accidentally get hurt or hurt others, he says, but they view the risk that firearms pose to their owners as one worth taking. Still, Anestis contends that common ground for widespread secure storage measures is possible. Research that Anestis and his colleagues published in the February 2021 issue of the American Journal of Public Health showed that “lethal means counseling” for gun owners resulted in wider adoption of safe storage methods.
Scientific American spoke with Anestis about a training program he is leading called Project Safe Guard, which provides neutral figures—such as heads of military units, barbers and faith leaders—with the tools to educate firearm owners about safety measures for storing their weapons, especially in times of despair.
An edited transcript of the interview follows.
People who weren't trained as psychologists have long spoken to callers on suicide hotlines, but now a new, broader approach to suicide prevention involves training those people to do what's called “lethal means counseling.” Can you explain the program?
Project Safe Guard is about training not only clinicians but also community members to talk with firearm owners about the ways they can store their firearms securely and the circumstances in which they should consider doing so. The idea behind it is to make the environment safer so that when someone is in a difficult place, they're less likely to have click-and-ready access to their firearms.
The training involves peer-to-peer counseling where individuals such as barbers and faith leaders talk with people who may be more likely to come to them in a moment of crisis. The training may also involve police and military leaders training their subordinates on how to safely store a firearm either in their homes or using outside storage facilities. We're trying to change social norms on both a micro and a macro level using credible messengers. At the same time, we're strategically training those who tend to talk to people in their most difficult moments, giving them the tools to have a reasonable, persuasive conversation with those in need.
How do you choose the types of people to train in the program?
In our first go-around, in 2023, we planned on training faith leaders and barbers. These are folks who are generally not seen as having political agendas. They're well suited to talk to people in moments of distress, and they're often trusted with personal information. Even people who are more likely to keep their pain to themselves may open up to a faith leader or a barber. In the future, we're hoping to train divorce attorneys and bartenders for many of the same reasons listed earlier.
We want people to learn to have conversations about this that don't feel awkward or political and don't resemble a public service announcement. It's all in an effort to shift social norms for how people think about their firearms. For this to happen, they need to encounter the message of secure storage from a number of convincing sources in multiple contexts for there to be an internal shift in beliefs. We're normalizing changes using people who don't feel like outsiders coming in and telling gun owners what to do.
What are some of the techniques that can be used to connect with gun owners and open their eyes to the importance of safe storage?
We use an approach called motivational interviewing, an intervention that works within a person's value system to leverage their intrinsic motivation and make positive changes in their life. Some people don't want to change, and you can't make them, but the idea is to avoid conflict, which is really important for a cultural and political issue such as firearms.
Individuals are taught to ask open-ended questions to initiate a conversation around firearm storage: “How do you store your firearms?” “What do you use or not use, and what are your reasons for it?” “Are there any circumstances in which you think it might make sense to not have quick access to your firearms?” If they respond with “I haven't really thought about that,” you might say, “What if there are kids in the home, or what if you've been drinking, or what if you haven't been feeling quite like yourself lately? Are those situations when you might consider storing your firearms a bit more securely?” It's about starting a conversation and seeing the places where a firearm owner might be willing to make changes.
You write that those who die when using firearms are less likely to engage the health-care system. Can you discuss this?
The data are pretty clear that those who die by firearms are less likely to have sought mental health care near the time of their death compared with folks who die by suicide using other methods. It's very common for those around that person to say that they never saw it coming because the person who died kept their feelings to themselves. We've got this problem in the U.S. where those who are most likely to die by firearm suicide aren't telling anyone what they're thinking, which makes it more difficult to help them. Project Safe Guard is an opportunity to reach this group in a way that mental health services seem to be falling short on. We don't have a whole lot of data on why these people don't seek care, but we think it comes from traditionally masculine ideas about solving your own problems and not openly discussing feelings, as well as a certain level of distrust in the health-care system and mental health care in general.
What are the next steps in training people?
We're planning on doing large-scale training sessions in New Jersey this year with faith leaders and barbers. And we also have plans to integrate the U.S. Army and the National Guard. Additionally, a former student of mine, Claire Houtsma, a suicide prevention coordinator at the Southeast Louisiana Veterans Health Care System, is training veterans to engage in these conversations with their peers. There are also other approaches to counseling beyond our program, such as Counseling on Access to Lethal Means (CALM), which is a training course directed at health-care and social service workers. Our end goal is to take this as far as it will go by getting it in front of people's eyes enough times that it has the potential to develop its own momentum.
IF YOU NEED HELP
If you or someone you know is struggling or having thoughts of suicide, help is available. Call or text the 988 Suicide & Crisis Lifeline at 988 or use the online Lifeline Chat.