Suicide, homicide and the prevention of gun violence
© Getty Images

As we face ever more urgent questions about controlling gun violence, it is important to look at the sources of those injuries. There are more than 30,000 deaths and more than 50,000 nonfatal injuries attributable to guns annually in the United States, costing a staggering $200 billion or more in medical expenses, lost productivity and other collateral damage. Although only a third of the deaths are attributable to homicide, it is the intersection between murder and suicide — namely mass shootings — that gains the most attention. Not surprisingly, people who plan such extreme violence surely know that their own lives will end soon thereafter unless they plan to surrender. To prevent such violence, as well as suicides and homicides, requires a clear-eyed look at the causes of each of these gun deaths and potential means of prevention.

In a recent analysis of mass shooters in comparison with other homicides, a team of experts commissioned by the National Science Foundation noted how the actors, especially young people, differ from other perpetrators of homicide. This analysis, published in American Psychologist, found that although people living in poverty disproportionately commit homicides, mass shooters are more typically from middle-class backgrounds and living in non-urban areas. Unlike shooters living in poverty, who typically gain access to weapons illegally, those who commit suicide more often have access to guns bought legally and stored at home. Indeed, the 20-year-old who perpetrated the Sandy Hook massacre had a cache of weapons that his mother knew about and encouraged him to use for recreational purposes.

Mental-health reform is often invoked to confront the threat of gun violence. This strategy gains credibility due to the connection between mass shootings and suicide. As we know, people with serious mental conditions commit most suicides. But murder-suicides are very rare. Blaming people with mental health disorders for all gun violence is counterproductive, as it will increase one of the biggest barriers to obtaining care — the stigma attached to mental illness. And it blames people with mental disorders for homicides, which by and large they do not commit. We should not confuse the much rarer murder-suicides with the more common homicides.

Nevertheless, there is little doubt that suicidal individuals could benefit from reform of our mental health system, which is poorly organized and inadequately financed. The separation of mental from physical healthcare runs rampant throughout our health system. Bills proposed in Congress would have the positive effect of uniting federal mental-health programs under one office as well as increasing funding for mental health. However, reform also requires reducing the prejudice and stigma attached to seeking care for mental illness, and a bill originating in the House promotes involuntary treatment and potential commitment, a strategy sure to enhance stigma.

To confront the use of guns by people considering suicide, we need ways to keep guns out of their hands. This is even more of a challenge given the rising display of gun violence and depictions of suicide in popular entertainment. Nevertheless, we know that even seemingly trivial measures, like putting up barriers to the means of suicide, can prevent such acts. In Britain, a simple change to the way that acetomenophine was packaged, using blister packs that are more difficult to open, reduced the use of that method to overdose. Putting up barriers at bridges and train tracks is also a useful strategy. In the case of guns, more is needed to make firearms less easily accessible to persons at risk of suicide. Trigger locks, fingerprint recognition, and other identification mechanisms could prevent inappropriate use of guns stored in homes. And greater recognition of the dangers of access to guns in households with those suffering from mental illness would be positive steps.

In the case of most homicides, there is little that the mental health system can do. But there is a clear connection between poverty and crime — those with little prospect of legitimate employment often find themselves involved in illegal activity, where the risk of gun use increases. Here we need strategies to intervene early in a person's development to prevent a trajectory toward illegal gun use, which is more likely among those in poverty. Early intervention in adolescence has been tested in Chicago in a trial conducted by Sara Heller, a criminologist now at the University of Pennsylvania. She enrolled Chicago adolescents at risk of gun violence in a trial in which they were given summer jobs and a mentor who helped steer them toward education and a legitimate career. Over a 16-month follow-up period, the program reduced violent-crime arrests by 43 percent. Thus, intervening with young people at risk of gun violence can reduce their participation in violent behavior.

Reducing the use of guns to harm oneself or others will require a variety of strategies that recognize the unique sources of these events. Relying on mental health reform is important, but it is not a stand-alone solution. Nor will relying on gun restrictions solve the problem of suicide, although if we had less access to guns in general, it would make this form of suicide less likely. A coordinated strategy of gun restrictions, interventions to help steer impoverished youth toward education and legitimate employment, and more effective mental healthcare for those at risk of suicide are needed to effectively reduce the devastating toll of gun violence.

Romer, Ph.D., is director of research at the Annenberg Public Policy Center of the University of Pennsylvania.