Removing guns is a key suicide prevention strategy in WA

At age 49, Mike Johnson took his life with a pistol.  

Johnson, now 74, said he’s learned to cope with this family tragedy over time. And in hindsight, it is not surprising that his brother opted to use a gun to end his life. Growing up in rural Montana, the two were surrounded by guns.  

That lived experience has motivated Johnson to work to raise awareness about suicide and prevention.  

He is board president of the Jefferson County affiliate of the National Alliance of Mental Illness, or NAMI. The group works with the community to provide support and resources to those seeking to intervene when family or friends have suicidal thoughts.  

Accessibility to lethal and dangerous tools, such as guns, is a big part of that discussion, explained Johnson, who lives in Port Townsend.   

“If people have the means to kill themselves and they’re in a place in their lives to do that, it makes it a lot easier,” Johnson said.  

Indeed, statistics show that a significant portion of firearm deaths in Washington are suicides. In 2023, 66% of all firearm deaths were suicides, and just two years ago, in 2021, that number was above 69%, according to figures from the state Department of Health.  

But despite the propensity of firearm use in completed suicides, such deaths are discussed far less often among the public and in the media compared to other forms of gun violence and firearm injury, such as mass shootings and homicides.  

Far more people arrive at Harborview Medical Center with injuries related to suicide than to mass shootings, according to Arvin Akhavan, medical director of the hospital’s emergency department.  

The hospital is the state’s only level 1 trauma center, defined as a facility that provides the highest level of care for those with traumatic injury. 

“We see gun injuries at least daily,” he said. “We are not seeing mass shooting [gun] injuries daily.” 

The gun as a lethal tool  

Studies show that the availability of a firearm increases one’s capability in an attempt on one’s life, said Dr. Jeffrey Sung, a clinical assistant professor at the University of Washington’s Department of Psychiatry and Behavioral Sciences and an advisor for Forefront Suicide Prevention, a center at the university addressing suicide and mental health issues.  

“Firearms do not appear to influence a person’s decision to attempt suicide, but rather the likelihood of whether the person survives the attempt,” Sung said.  

A 2019 study in the Annals of Internal Medicine reports that 90% of suicide attempts using a firearm end in death compared to just 5% for other means combined.  

“Firearms are designed to kill,” said Dr. Akhavan of Harborview. “They’re very effective at that job.”  

The smaller percentage of people who survive a suicide attempt with a firearm can still end up with extensive physical damage, said Dr. Saman Arbabi, a critical care surgeon and Harborview’s chief of trauma. Recovery from firearm injuries may include multiple surgeries, lengthy hospital stays and long-term care.  

There are “significant issues that may be life-long and significantly life-limiting,” Arbabi said. And in addition to the personal ramifications, there are also the costs to society: taking up resources from an already strained medical system, and the public may be on the hook for paying for treatments if the patient or private insurance doesn’t pay for them. 

“It is an investment that is quite appropriate, and we should do it,” he said. “[But] if we can prevent it, it is the best way for the patient and society.”  

Study of the correlation between firearm availability and suicide 

In recent years, research has demonstrated that removing or restricting access to highly lethal tools, such as firearms, can deter someone from a completed suicide attempt.  

Julie Kafka, an assistant professor at the University of Colorado Anschutz Medical Campus, wanted to take that work a step further and determine whether there was a correlation between a higher density of gun shops and completed suicides in a given area.   

To complete this study, part of which was conducted while she was at the University of Washington as a post-doctoral researcher, Kafka and her co-authors mapped both federal firearm licenses per capita — including firearm dealers, gun shops and pawn shops — and the number of suicides for all census tracts in Maryland. Maryland was used because the way the state codes the cause of death ensures a high-quality data set.  

The study found firearm suicides were more common in rural areas where gun shop clusters were located, and that non-firearm suicides occurred more in urban areas where the concentration of gun shops was lower.  

This research hopes to discover if community-based interventions can be effective, Kafka said. Gun shops can be involved in interventions, such as providing suicide prevention literature or training employees on recognizing suicide warning signs in a potential gun purchaser.  

The research has limitations: It focused on one state rather than nationwide. Still, it’s a start, and Kafka hopes it will encourage similar research in other states and nationwide.  

“This is one incremental piece of data on thinking about gun shops and suicide risk,” she emphasized.  

Addressing the issue  

About four years ago, Johnson, the NAMI Jefferson County board president, and Valerie Phimister, the NAMI Jefferson County program manager, noticed a concerning statistic — the county’s suicide rate was among the highest in the state.  

Indeed, some of the highest suicide rates — in general, and for those specifically involving firearms — were in rural and remote counties of Washington.  

Between 2019 and 2023, Jefferson County reported a suicide rate of 30.5 per 100,000 residents, well above the statewide rate of 15.4 per 100,000, according to figures from the state Department of Health.   

Both the county and state rates were higher than the ones for the U.S., which are calculated by The Centers for Disease Control and Prevention. Over the same period, the rate ranged from 7.3 per 100,000 in 2019 to 8.2 per 100,000, the provisional rate reported in 2023.  

Jefferson County ranked third among all counties, behind Asotin and Pend Oreille counties, both in Eastern Washington. Phimister said several other factors may contribute to this data: the county’s remote location, a lack of jobs and affordable housing, plus wet and cold winters.  

The numbers are nearly as stark for suicide involving firearms. Jefferson County reported a firearm suicide rate of 11.4 per 100,000 residents for the period between 2019 and 2023, compared to the statewide rate of 7.8 per 100,000.  

But while Jefferson County was among the top three for the overall suicide rate, it was just inside the top 10 among counties reporting reliable figures for suicides involving firearms. 

That was a concern to those at NAMI Jefferson County, which led them to develop a workshop on the issue that they have been leading for interested groups.  

Part of the workshop discusses the importance of limiting accessibility to firearms when people are contemplating suicide.  

Phimister said she compares it to taking someone’s keys at a party if that person drinks too much: “You wouldn’t let them drive home,” she said.  

A differing approach to addressing gun violence and injury  

Political polarization has made talking about gun violence and measures to address it challenging. But those who work in suicide prevention believe it doesn’t have to be that way.  

Forefront Suicide Prevention at the University of Washington has developed a program aimed at educating and working with gun owners for suicide prevention. 

Because suicides often involve guns accessed through legal means — in contrast to other gun violence — discussions about suicide prevention have to include responsible gun owners, said Brett Bass, Forefront’s program coordinator.  

Bass is a Marine Corps veteran who worked at a gun range before coming to Forefront. Now he coordinates the “Safer Homes, Suicide Aware” program, which aims to encourage individuals and households to properly store and lock away firearms and medicine to prevent easy access for those who may be in crisis.  

Bass has firsthand experience holding guns for friends in crisis. He recalls one incident in a 2021 piece he and Sung co-wrote for Crosscut (now Cascade PBS). The friend had been in crisis and called Bass to come over. Bass stored her gun for more than a year.  

Bass feels shaming other gun owners, a community he is part of, won’t address the issue. Part of the reason he got into this work is he felt public health experts seemed unable to acknowledge the cultural and personal use of guns and merely saw them as “pathogens.”  

“There are real concerns about physical safety,” Bass said, explaining why someone might own a gun.  

He believes a better path is empowering people to take action to manage the risk of potential firearm injuries rather than getting stuck in the wider debate about gun ownership.  

When he gets both gun ownership and gun control advocates together to address solutions, they try to focus on what they agree on. “We only operate when there’s common ground. If we disagree sincerely, we drop it and move on,” he said.   

One of Bass’ points of pride is being quoted in 2023 Guns & Ammo Annual, a popular publication for gun owners, about suicide prevention and mental health. He also noted that another popular publication, Recoil, has done articles on suicide prevention and how gun owners can play a role in reducing suicides. “That would be inconceivable five or six years ago,” he said.  

While much of the conversation around gun safety revolves around delaying or restricting firearm acquisition or ownership, it doesn’t acknowledge the nuance around legal guns being used to self-harm, said Sung, the Forefront Suicide Prevention advisor. 

Research says the majority of those who died by suicide obtained the firearm legally and had owned it for some time, Sung said.  

A paper on gun purchases and suicide in Washington from the June 1997 issue of the American Journal of Public Health showed that those who died from suicide had legally owned the firearm for a median period of 11 years. A 2019 study published in Health Affairs showed that 92% of those who died by suicide could pass a background check the day the suicide attempt was made.  

Kafka of the University of Colorado said that in her research, the point is that people should focus less on whether firearm ownership should be legal than on how to get people on board to mitigate risk.  

“There’s a moral imperative that most people in the U.S. agree on: We need to do better to help people who are acutely suicidal and limit lethal means [to attempt suicide],” she said.  

Firearm safety is a priority at the state level. In 2020 the Washington Legislature created the state Department of Commerce’s Office of Firearm Safety and Violence Prevention to support and coordinate firearm violence intervention and prevention strategies statewide. That work is especially crucial in addressing suicide.  

The Office is working with various agencies to collect and analyze data on firearm injuries and violence and partnering with community and public health organizations and agencies to explore solutions.  They also earmark federal and state funds for community organizations.  

Having the conversation  

When Johnson, the NAMI Jefferson County board president, travels around the Pacific Northwest, he’s often reminded about how prevalent guns are.  

During a recent trip to Mount Rainier National Park with his wife, he saw an older man taking his grandchild out of their car seat while wearing a pistol on his hip.  

But while Johnson advocates for policies that restrict access to guns in some circumstances, he emphasizes he’s not antigun. 

“I try to balance it,” he said. “I don’t think anywhere near the majority of gun owners are careless or anything of the sort.”  

He believes that encouraging friends and family to keep their guns secured and locked away would go a long way toward preventing suicide. 

Johnson believes the first step is getting more people to talk about suicide and gun safety and not to avoid it.  He and Phimister, the NAMI Jefferson County program manager, emphasize that in their training.  

As painful as his twin brother’s death was, he doesn’t shy away from talking about it, especially if it means advocating for others to have conversations with their loved ones and straight-up asking if they intend to self-harm.  

“If you see something, say something and educate in a respectful and thoughtful way,” Johnson said.  

This story was edited to correct the spelling of Dr. Saman Arbabi's name.