Originally published on the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics Bill of Health blog.
Suicide is one of today’s most pressing public health issues. It’s the second most common cause of death for those ages 15-34, and claims over 40,000 lives every year. Of those, a staggering 20,000 are the result of firearms. To put that in perspective, there are about 30,000 gun deaths overall in the United States each year, which means that self-inflicted fatalities make up over 60% of total domestic gun deaths. Of the most prevalent means of attempting suicide, firearms are by far the most lethal. Firearm suicide attempts end in death more than 85% of the time, whereas attempts by drug overdose — the most common method — are only fatal 3% of the time.
While suicides by firearm have been on the rise in recent years, there may be an easy way to substantially reduce their incidence. A new study out of the University of Alabama Birmingham by Vars, et al., suggests that allowing individuals at risk of suicide to put themselves on a voluntary “Do-Not-Sell’ list, which would result in a waiting period before they could acquire a firearm, could be effective in preventing suicide attempts. The researchers surveyed 200 patients at both in- and out-patient psychiatric facilities who had disorders associated with anxiety and depression, and found that nearly half of them would put themselves on a list which would preclude them from quickly accessing firearms in the event that they were contemplating suicide. This is particularly notable given that these were all Alabama residents — a state that ranks in the top 10 of Guns and Ammo’s list of the best states for gun owners. In other states with more robust gun control and fewer gun enthusiasts, the Do-Not-Sell rate could very well be higher.
The theory behind the potential efficacy of such a list is that, for many, serious suicidal contemplation is a temporary experience which passes. Research suggests that a majority of those who attempt firearm suicide only contemplate it for less than a day. One study found that almost 50% of those who attempt firearm suicide wait less than 20 minutes between deciding to take their own life and attempting to do so. The majority of those who survive don’t end up dying of self-inflicted injuries. Thus, if a Do-Not-Sell list can prevent potential suicide victims from acquiring firearms immediately, there is a significant chance those suicides will never happen. While there is some evidence to suggest that decreasing access to firearms for those at risk of suicide could lead to increases in other forms of self-harm, the comparatively low success rates of other suicide methods suggest that lives would be saved simply by taking guns out of the short-term equation.
If actual Do-Not-Sell signup rates were to be consistent with what Vars and his colleagues found, the number of lives saved by such a list would be substantial. Vars, et al., found a signup rate of about 46% in the at-risk pool they surveyed. Assuming a similar rate among those who would attempt suicide by firearm nationwide — which, granted, may be a self-selecting pool less likely to register for such a list — a voluntary Do-Not-Sell list would prevent over 9,800 potential suicide victims from obtaining firearms when suicidal thoughts arise. Given that 90% of those who unsuccessfully attempt to commit suicide end up not committing suicide later, allowing people to delay their acquisition of firearms could save nearly 9,000 lives every year. That means 30% of all gun-related deaths that happen in the United States each year would never have the chance to occur.
While the potential efficacy of a Do-Not-Sell list shouldn’t be particularly surprising — people have been self-binding since Odysseus tied himself to the mast of his boat to avoid heeding the sirens call as he passed their island — its potential impact on the number of gun deaths each year is remarkable. Those of us in favor of stronger gun-control laws would likely advocate for a federal mandatory waiting period for all gun purchases, but we shouldn’t let the perfect be the enemy of the good. The voluntary Do-Not-Sell list has shown that it has the potential to substantially decreases the number of needless deaths a year that result from readily accessible firearms, and it likely represents a far less politically polarizing step than further-reaching gun-control measures.
When talking about suicide, it’s easy to get lost in the statistics, but the human cost of even one life lost to suicide is unimaginable. Given the ease with which it could be implemented, if the Do-Not-Sell list could save even one life, I would say it was a no-brainer. But the fact that it could save thousands of lives makes it one of the most promising avenues for reducing suicide and gun-related violence currently available — and makes it too important for policymakers to ignore. Hopefully, as the Do-Not-Sell idea receives increasing attention, states will seriously consider implementing it. For some, it could literally make the difference between life and death.