Harvard advice for talking with suicidal patients about firearms

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  • hoosierdoc

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    https://www.hsph.harvard.edu/means-matter/recommendations/clinicians/

    Came across this while studying for my board review. I thought it was actually very well written and addresses a lot of concerns we'd have on the subject. Firearms are a very common way of committing suicide and they are the ultimate in "impulse to action" method. Most other ways take some more planning and sustained action.
     

    hoosierdoc

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    Yep.

    i posted this as a counter argument to the constant tinfoil posts about docs helping government document gun owners and attempts to remove them
     

    Tactically Fat

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    My dad has 1 gun in his house now. A small .22 Mag revolver. He's also been on anti-depressants for a few months now. And he's just recently begun hospice care.

    This is/was a real concern of mine when I learned that he was on the anti-depressants (And before hospice). I let his wife know of my concern and could she please unload the thing and hide the ammo.

    The only consolation that I have is that I believe that he's now just too weak to physically actuate the trigger - even on an LCR. Especially if gripped the in the hand the correct way.

    Depression amongst the "older" generation is just as real as it is amongst younger people.
     

    BehindBlueI's

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    The only consolation that I have is that I believe that he's now just too weak to physically actuate the trigger - even on an LCR.

    People, including kids, who can't pull the trigger the right way put their thumbs in the trigger guard and "lemon squeeze" with their fingers wrapped around the back strap. Just Fyi.
     

    Ziggidy

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    That's a tough spot to be in and I truly do not know the answers. I do know we need to be careful as we look into this area. When a family member or anyone suggests that one remove or unload a gun in a home because they challenge the owners health, in any way - we may be opening a door we don't want to enter. Get an angry family member making claims that someone should not have a gun for any reason can lead to many false accusations and unfair labeling of the owner.

    Again, I do not know the answers. In a case of hospice, when the family and patient agree to increase the morphine knowing what will happen, what's the difference? I would imagine most, if not all, cancer patients have some level of depression. Is it suicide when they use morphine? Can it be assisted suicide if they use a gun? At what point is it considered ok and not ok - and who decides?

    We need to be careful that we do not self impose restriction upon ourselves, where none is needed.
     

    Kirk Freeman

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    People, including kids, who can't pull the trigger the right way put their thumbs in the trigger guard and "lemon squeeze" with their fingers wrapped around the back strap. Just Fyi.

    This is why I see so many face (nose and mouth) shots with kids.

    (Well, the raging a-hole with the SKS clipped the kid at the top of the forehead, but that was not self-inflicted).
     

    Ark

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    There is nothing in there that I particularly disagree with. It's a personal decision everyone has to make for themselves, and everyone has the right to high-quality counseling on that decision that isn't just "well guns are bad and you're a bad person if you don't get rid of them all".
     

    DeadeyeChrista'sdad

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    I'm going to go out on a limb and say that if Grandpa KNOWS he's pretty close to the end of the trail, and he KNOWS it's going to be an agonizing death, which during the process will strip him of any dignity...
    Who the hell am I to say him choosing to have a .38 one evening for dessert is a bad thing?
     

    Joniki

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    Absolutely. When I pass my "use by date" I will do the right thing...

    I'm going to go out on a limb and say that if Grandpa KNOWS he's pretty close to the end of the trail, and he KNOWS it's going to be an agonizing death, which during the process will strip him of any dignity...
    Who the hell am I to say him choosing to have a .38 one evening for dessert is a bad thing?
     

    Mgderf

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    People step out in front of cars/trucks/buses/trains...on purpose, every day.
    Should doctors also warn the family to keep a relative away from curbs?

    Where does it end?

    No purple implied or intended.
     

    Joniki

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    Not having the balls to kill yourself without involving someone else is just wrong...

    People step out in front of cars/trucks/buses/trains...on purpose, every day.
    Should doctors also warn the family to keep a relative away from curbs?

    Where does it end?

    No purple implied or intended.
     

    hoosierdoc

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    Do you have stats to post on suicide by stepping in front of vehicles? Suicide by gun is well documented. Start with the most common impulse method, guns.

    discussisons are had regarding ways to keep someone safe. This particular article is in regards to guns. Do you have a problem with that?

    In 2016, firearms were the most common method of death by suicide, accounting for a little more than half (51.01%) of all suicide deaths. The next most common methods were suffocation (including hangings) at 25.89% and poisoning at 14.90%.

    People step out in front of cars/trucks/buses/trains...on purpose, every day.
    Should doctors also warn the family to keep a relative away from curbs?

    Where does it end?

    No purple implied or intended.
     

    KellyinAvon

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    Do you have stats to post on suicide by stepping in front of vehicles? Suicide by gun is well documented. Start with the most common impulse method, guns.

    discussisons are had regarding ways to keep someone safe. This particular article is in regards to guns. Do you have a problem with that?

    You have to wonder how many car accidents are actually suicide attempts/suicides. If someone starts the car with the door down it's pretty much a known thing. Hitting a tree, or pulling out in front of a train or tractor-trailer? May never know.
     

    Joniki

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    That "someone" that has to clean up and remove the body volunteered for the job.

    I have personally seen many times what stepping in front of a train or semi does to the person operating the vehicle and it isn't pretty.

    If you shoot yourself, someone else is still involved.
    Someone has to find the body.
    Someone has to clean up.

    Someone is always involved.
     

    Spear Dane

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    I'm going to go out on a limb and say that if Grandpa KNOWS he's pretty close to the end of the trail, and he KNOWS it's going to be an agonizing death, which during the process will strip him of any dignity...
    Who the hell am I to say him choosing to have a .38 one evening for dessert is a bad thing?

    Exactly.
     

    hoosierdoc

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    You have to wonder how many car accidents are actually suicide attempts/suicides. If someone starts the car with the door down it's pretty much a known thing. Hitting a tree, or pulling out in front of a train or tractor-trailer? May never know.


    single car accidents are the Ss. I think I’m forgetting one

    Suicide
    Sex
    Sauce (alcohol)
    Substances (drugs)
    Seizure
    Syncope
    sleep (remembered one I forgot)
     

    brchixwing

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    From the Harvard page, "Assess the client’s compliance. Compliance is a good sign that they are trying to stay safe. If he or she is at high risk and has not agreed to remove guns (or, for example, has stockpiled medication and won’t remove it), will he agree to do so if you think it could help him avoid hospitalization?" -- How do confidentiality / HIPAA rules come into effect for doctor's reporting high risk patients with firearms?

    Read this earlier this year in the star: "Officials later discovered that police earlier that year had put Anderson under "immediate attention" at a hospital. A cache of weapons and ammunition also were seized by police."
    https://www.indystar.com/story/news...g-national-attention-but-does-work/355132002/

    The page reminded me how range I used to frequent in LA does not rent guns to new shooters flying solo after having a suicide on site.
    Travel time to the range + registering + paying would give the person more time to talk themselves out of it but a tragic risk.

    https://www.hsph.harvard.edu/means-matter/recommendations/clinicians/

    Came across this while studying for my board review. I thought it was actually very well written and addresses a lot of concerns we'd have on the subject. Firearms are a very common way of committing suicide and they are the ultimate in "impulse to action" method. Most other ways take some more planning and sustained action.
     
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