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Column: Waiting period can help prevent suicide



To the Valley News
Friday, April 19, 2019

Over the past 28 years as a primary care pediatrician and teacher at University of Vermont’s College of Medicine, and as a member of Vermont’s Child Fatality Review Team, I have learned much about suicide and gun violence. I have seen too often how these public health problems affect too many Vermont individuals and families — in spite of the strong safety commitment of most gun owners.

Vermont’s firearm suicide rate is higher than the nation’s average, and sadly has increased more than 30 percent over the past 20 years. I commend our Legislature’s current effort to prevent future suicides through legislation that would require a waiting period before firearm purchase. This effort has resulted not merely from one firearm suicide, but from those high and rising rates, coupled with scientific evidence that suicidal behavior often occurs as an impulsive reaction to temporary crisis.

Why does a waiting period make sense for suicide prevention? First, let us understand that it will have no power to prevent gun ownership for people who have a legitimate right to have firearms. It does provide a brief period of time for a prospective buyer to consider further whether buying a gun is a wise and safe decision. This period of time could be lifesaving for someone in a vulnerable mental state.

Studies show that suicidal behavior is often precipitated by a crisis. Researchers from Harvard’s Injury Control Research Center found that a precipitating event had occurred within two weeks of completed suicide in 36 percent of cases. In 61 percent of cases, victims had not disclosed any intent to kill themselves.

In a sudden life crisis, a suicidal individual may be especially susceptible to irrational thoughts, fear, anger or desperate grief. Even then, he or she may be highly ambivalent about suicidal urges — but may act impulsively.

The urge to reach for a gun seems far too common. Some gun suicides occur within hours after purchase — making prevention potential clear. Actual suicide attempts frequently occur within minutes to hours of an impulsive decision to act — making it critical to reduce a suicidal person’s access to lethal means. The waiting period for firearm purchase is one way to do this, allowing time for calming down and finding a way to work through a crisis.

There is unfortunately a misconception that once someone decides to attempt suicide, the decision is fixed and permanent, so that “if we remove one method, that person will simply find another.” That may happen; yet long-term follow-up research finds a high probability (90 percent) that even individuals who have made life-threatening attempts do not subsequently die by suicide. How can that be? Because neither emotional crises nor mental illnesses are necessarily permanent conditions. Treatment and compassionate support can lead to recovery. Even a short-term reduction of access to the most lethal common means of suicide in a crisis can allow long-term prevention.

We can be confident that this legislation will save lives. A recent study of waiting period laws enacted in states from 1970-2014 showed robust evidence that they reduced gun homicide by 17 percent, and only slightly less robust evidence of a 7-11 percent reduction in gun suicide. This would mean five or six Vermont lives saved every year. Furthermore, we may not “see” all the benefits, because one rarely hears of successfully prevented suicides.

A waiting period will not prevent all firearm suicides. Safe storage measures are critical for guns already possessed. Still, this legislation strikes a reasonable balance around society’s expectations — reflecting and helping to shape social norms for safety and public health. It offers an upstream, proactive way of reducing access to lethal means. It reminds us that we recognize both the rights and responsibilities of owning guns. Over time, it will save many lives.

Eliot Nelson is professor emeritus, pediatrics, at the University of Vermont’s Robert Larner College of Medicine. If you or someone you know is experiencing difficulties with mental health or suicidal thoughts, help is out there. National Suicide Hotline: Call 1-800-273-8255 for free and confidential support. Crisis Text Line: Text 741741 from anywhere in the U.S. to text with a trained crisis counselor.