By Andrea Austin, MD, FACEP, FAAEM, CHSE

The views expressed in this article are those of the author and do not reflect the official policy or position of the Department of the U.S. Navy, Department of Defense, nor the U.S. government.

Some details have been slightly altered to protect the privacy of the individuals.

It was a busy night in the emergency department. There was a man in his early 20s, brought in for concern for his safety by his father. The patient was experiencing episodes of depression and angry outbursts. Prior to arrival, he became so angry, he punched a wall and fractured his hand. My emergency medicine resident interviewed him, and appropriately determined that he would benefit from evaluation by a mental health professional. A psychiatry resident evaluated him and felt that he was safe for discharge.

Throughout my shift, I continued to observe my patient out of the corner of my eye. He seemed on edge and I was concerned that his anger was so uncontrolled that he broke his own hand. I interviewed him, and thanks to my work with AFFIRM,

I remembered to ask…

“Do you have access to firearms in your home?”

To my surprise, he replied, “Yes, they belong to my dad.”

“Are the guns locked up,” I followed.

He said, “One is locked up, but I know where the key is. The other one is not.”

I asked, “Do you think there’s a chance you could hurt yourself or someone else with one of the guns in the house?”

He said, “I’m feeling pretty out of control tonight. I don’t know.”

I thanked him for his honesty and assured him that we would do our best to keep him safe. I spoke with his father about his guns, and he confirmed that one was accessible. I recommend he keep all weapons secured, especially when his son is in crisis. Though our conversation, it was unclear to me whether his father had planned to secure the firearms by the time his son returned home.

I pulled the emergency medicine and psychiatry residents together and discussed this additional history. We discussed that access to firearms increases the risk for homicide and suicide about two to three times, respectively.1 Our patient was at risk for both. We ultimately decided that safest place for him was likely to be in the hospital. I often think back to that night. I was busy.

Thanks to AFFIRM, I paused and took the time to ask a simple question. The answer greatly impacted our plan to keep our patient safe while he received the care he needed. I shudder to think what may have happened if I didn’t work with AFFIRM and think to ask this important question.

There is a myth that most suicidal patients will find a way to kill themselves regardless of what we do as physicians and concerned citizens. The truth - most suicidal crises are temporary and most patients are waiting for a lifeline. The majority want us to reach out, show we care, and help them find the light.

The next time you confront a patient, family member, or friend who is expressing suicidal thoughts, I urge you to ask about their access to firearms. Each day, 61 people die from firearm related suicides.2 Help people understand that during moments of crisis, their firearms can be kept safe by a friend, family member, or in some cases, law enforcement. This is not a permanent removal of their guns, but a temporary action to keep everyone safe. Your question very well may save a life.

References:

1. Anglemyer A, Horvath T, Rutherford G. The Accessibility of Firearms and Risk for Suicide and Homicide Victimization Among Household Members: A Systematic Review and Meta-analysis. Ann Intern Med. 2014;160:101–110. doi: https://doi.org/10.7326/M13-1301

1. Ibid. Firearm suicide to total suicide ratio and daily average developed using five years of most recent available data: 2013 to 2017.