Preventing child firearm mortality

October 16, 2013

Guest blog post by Kevin Dwyer, MA, NCSP ~

In the U.S.A. access to firearms within the home is far greater than comparable countries.  And so are children’s deaths by firearms, particularly suicides. In fact, among children’s firearm deaths, suicide is the leading “reason.”  Accidental child firearm deaths are second, followed by homicide. Our country is unique in this danger to children. The danger of firearms in the home remains unaddressed in child protection laws.   We are almost obsessive about protecting children from injury and death. Seatbelts, car seats, childproof medicine bottle caps, electric outlet covers, bike helmets, even television parental control are but a few of the accepted protections we have either legislated or support to prevent injury, accidental deaths or exposure to violence. Trigger locks and firearms lock boxes are not among these legislated protections although that legislation has been recommended by the American Academy of Pediatrics (AAP) (among others) for decades. The AAP also urge Pediatricians to include inquiry about firearms in the home and how those firearms are secured in their patient intake questions to better protect the children they serve.  

The availability of firearms can and do increase the chances that a tragedy will result.  And our country more than any other comparable country enables availability of firearms in homes where children live. Here are some data comparing our country to 3 others (Canada, England & Australia):    

  • The number of privately owned firearms is highest in the USA
  • The number of all deaths by firearms is highest in the USA
  • The number of suicides by firearms is highest in the USA
  • The number of homicides by firearms is highest in the USA
  • The number of firearm tragedies involving 4 or more victims is highest in the USA
  • The number of children killed by firearms is highest in the USA
  • Most firearms deaths occur among persons who have legal access to the firearms, most frequently from their home.
  • Firearms are used in most completed child suicides.

Youth Suicide and Firearms
As reported in a National Association of School Psychologists’ fact sheet, the Youth Suicide by Firearms Task Force (1998), a group that included representatives from the American Medical Association; American Firearms Association; National Shooting Sports Foundation; National Center for Injury Control and Prevention Centers for Disease Control; and Children’s Defense Fund reported the following:

  • Firearms are the most common method of suicide by youth. This is true for males and females, younger and older adolescents, and for all races.
  • The increase in the rate of youth suicide (and the number of deaths by suicide) over the past four decades is largely related to the use of firearms as a method.
  • The most common location for the occurrence of firearm suicides by youth is the home.
  • There is a positive association between the accessibility and availability of firearms in the home and the risk for youth suicide.
  • The risk conferred by guns in the home is proportional to the number and accessibility (e.g., loaded and unsecured) of guns in the home.
  • Guns in the home, particularly loaded guns, are associated with increased risk for suicide by youth, both with and without identifiable mental health problems or suicidal risk.
  • If a gun is used to attempt suicide, a fatal outcome will result 78-90% of the time.
  • Public policy initiatives that restrict access to guns (especially handguns) are associated with a reduction of firearm suicide and suicide overall, especially among youth.

Accidental childhood deaths and injuries are also too common when firearms, particularly handguns are accessible in the home. Children at a young age do not understand the difference between real and toy guns. Young children do not understand the true dangers of firearms. Many children, particularly boys are enamored by guns. Children hear parents and other adults talk proudly about their guns and may “show them off” to friends. Adult behaviors are models for children. Adults may think their children find or reach their guns. Older children know where in the house guns are kept and how to access them. They know that handguns are primarily for protection, for shooting people. Like adults children enjoy showing guns to their friends and it is these occasions that sometimes result in accidental tragedies.

Children and youth with emotional and behavioral problems
Children and youth with emotional and behavioral problems are more prone to impulsively handle an accessible firearm. When a child or youth is suicidal access to a firearm in the home significantly increases the chances that that child will use that firearm to complete that desire. A suicide attempt with a firearm is far more likely to result in death than any other method.

I have known of and worked with youths who have developed elaborate plans to access a firearm in their home to commit suicide. More than one has completed a suicide with a handgun from the home (or a relative’s home). Many accidents with firearms, according to CDC occur because the firearms were not secured and locked but in view and reach of a child.       

For gun control advocates it is clear that lowering the number of privately owned firearms will lower the number of deaths by firearms. Seems logical. It is very clear that if you lower the availability of firearms to children and youth suffering from mental illness you will reduce the number of violent acts, particularly suicides. Personally I support these efforts and efforts to reduce access through mandatory trigger locks and lock boxes, storage requirements.

What can we do beyond better gun control laws?
We must block access to firearms by children in our homes to prevent tragedies. We must particularly block access to firearms by children and youth who are angry, depressed, or impulsive or have other mental illnesses that blur judgment and thinking. 

We can help people better address anger, stress and, yes, mental illness. If a teen is despondent, anxious and bullied that teen can be helped and supported by counseling and caring peers, family and teachers. Access to treatment must be improved. All children and youth can be taught social skills to improve their problem solving and coping skills.        

What we have learned about addressing early warning signs preventing firearms tragedies in schools.
Since the school shooting at Jonesborough Arkansas, and more critically after Columbine, schools have been improving prevention and intervention initiatives to reduce peer violence and tragedy. One very effective prevention mechanism has been to provide easier access to school mental health staff to respond to student’s reports of concerns about their friends, about shared sadness, about stress and anger. We have successively taught students to share worries with a trusted professional. Some of these efforts have focused on suicide threats, others on bullying some on scary facebook chatter. The results have been many thousands of supportive interventions for school children and their families. Few keep records of these interventions so no one can tell if these interventions prevented killings but the general data shows reductions in both completed youth suicides and in school violence since the 1990’s.

Importantly, students themselves have become critical in preventing violence and suicides. Students now feel that “warning signs” they see or hear from a friend can be shared with trusting adults and that help will be the result rather than punishment or adults discounting their shared concerns.

Furthermore, when teachers and school staff are supported in raising concerns about a student’s stress and observed functional changes in behavior, children are saved from acting on suicidal or violent thoughts and plans. Counselors and other school mental professionals are taught to ask questions and determine level of risk of suicidal thoughts or plans.  Here the access to guns in the child’s home must be discussed as part of any intervention. There are numerous effective mentally healthy things that schools are doing with success.

But access to firearms must be addressed with families and communities particularly gun owners. Basically, if you have firearms in your home and you have a child who is angry, impulsive, depressed or has reported suicidal thoughts, removing those firearms from your home is imperative. If you are a mental health provider you should take the advice of the pediatricians and include firearms questions in your intake interviews as well as address the access issue specifically when suicidal ideation is disclosed. Warning signs can be publicly broadcast to improve awareness. We can do more to help the adult and youth who may be burdened by mental illnesses. Improvements in treatment and interventions are not sufficiently publicly understood. Access to help is not sufficiently supported.

Mental Health Workers Ask About Firearms in the Home
Most mental health professionals address firearm access at some time when warning signs are evident. Most therapists will drill down to insure that if firearms are in the home families are made aware of the added danger of depression and impulsivity and are urged to remove those firearms or at a minimum secure them. Complacency or discounting the danger is generally not tolerated.  Even securing firearms in the home is not fool-proof.  Children and youths have broken locks, found combinations, even bought bullets to use in unloaded family firearms to kill themselves, and sometimes others.

Mental Health Treatment Works to Reduce Tragedies
Proven mental health treatments have been supported through training and professional best-practice guidelines. The best-practice constructs we have used with children can be generalized for the public across the life-span. Adults, family and friends can be supported in sharing their concerns about their stressed loved ones with mental health professionals, clergy or others who are or can be trained to listen and support in confidence the shared “warning signs” that may require interventions. Connection to crisis centers is now commonly available. People can be given ways to approach a friend or family member who is in distress to seek mental health help. To make this more universal will require a responsive and effective mental health system. We know that professionally supported family interventions that are used effectively for substance abuse and can also be used to get a person into treatment and prevent tragedy. It takes planning, communication, training and changes in our view of friends helping friends to get mental health treatment. It requires a general understanding that firearms are a serious danger when available to children with early and imminent warning signs of mental illness.   

Gun Security Measures in Homes are Important
Even without new controls gun owners should routinely be given information about the dangers of having weapons in the home when a family member is in distress, has a mental illness or a history of impulsivity or rage. Gun clubs and others could support firearm storage for persons who know that removing the firearms is a preventive measure during a time of family stress. 

dwyerKevin P. Dwyer, M.A., a Nationally Certified School Psychologist, is an education and child mental health consultant.  He recently served as a principal research associate for the American Institutes for Research. For over 30 years he practiced school psychology in public schools and held several local, state and national leadership positions in the fields of mental health and education, being responsible for the design, development, implementation and evaluation of programs and practices, for improving school climate, safety, and wellbeing for the education, and mental health of children.  He has helped school staff in many districts use data to inform decisions on improving caring and connectedness with students and professional peers.  His work, publications, presentations, and practices have influenced public policy and the development of efficient, family focused collaborative child service systems.  During his 30 years as a public school psychologist he worked directly with over 10,000 children and their families as well as trained over 6000 educators. He provided psychological services to children, including those with disabilities and those whose anxiety and mental health problems blocked learning and adjustment.  He assisted teachers and staff in supporting a caring, inclusive school climate for all children.  In 2007 the Maryland Coalition of Families awarded Mr. Dwyer and his wife for their work in making schools more family friendly.  He served as president of the National Association of School Psychologist and was given its highest honor, the Life-time Achievement Award.  In 2000 he received the Tipper Gore “Advocacy award for improving the lives and mental health of America’s children” from the National Mental Health Association.

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