By Richard Knox
The elegantly dressed woman looked out of place at Riley’s Sport Shop, the largest gun dealer in New Hampshire. Owner Ralph Demicco was behind the counter. He noticed she didn’t make eye contact.
“I’d like to buy a gun,” she said. “Could I see that one?”
Demicco sensed something was amiss. “Should you really be buying a gun?” he asked.
She immediately broke into tears. “I took her into the backroom,” Demicco recalls. “She confided that she’d been released from the state mental hospital in Concord that morning. She said she told her doctor she wasn’t ready to go and if he discharged her she was going to take her life. Apparently he didn’t put any stock in that.”
Demicco asked the name of her psychiatrist, then told her to go home and wait for the doctor to call. Then he called the doctor, who intervened. It was a suicide that didn’t happen.
The incident stuck with Demicco. But it wasn’t until later that he realized that gun dealers could take more concerted action to prevent gun suicides -- by far the nation’s leading cause of firearm fatalities. That came after a Dartmouth Medical School injury prevention researcher alerted him that three different customers had killed themselves in a single week within hours or days of buying their guns at Riley’s.
The partnership is a rare instance of common cause between gun enthusiasts and public health proponents, amid increasingly polarized public views.
“That was stunning,” Demicco says. He started meeting with the Dartmouth researcher and other gun retailers and health workers. They decided to create a group called the New Hampshire Firearms Safety Coalition. Their idea is catching on -- in Massachusetts, Vermont, Maryland, New York, Virginia, Tennessee, Texas, Colorado, Utah, Nevada and California, according to Elaine Frank, chair of the New Hampshire coalition.
Frank is the Dartmouth injury-prevention specialist who alerted Demicco to the problem. Early on in the coalition's work, a public health worker came to a meeting after talking to gun shop owners around the state. She expressed surprise they were so positive.
One of the gun dealers in the group said, "I could be insulted by that," Frank recalls. "He said, ‘Why would you think we’d be less interested in suicide prevention than you are?’ It was absolutely an ‘aha!’ moment.”
The partnership is a rare instance of common cause between gun enthusiasts and public health proponents, amid increasingly polarized public views on how to reduce the nation’s death toll from firearms. It's not embraced by all gun proponents; some fear it's a stalking horse for more gun controls.
But it's a real-life example of what President Obama and others are calling for: a public health approach to the nation's gun violence crisis.
“The concept of collaboration, which is often lost, is very much alive in this area of suicide prevention,” says Bill Brassard, spokesman for the National Sport Shooting Foundation, which represents gun dealers.
A prominent gun control advocate at the Harvard H.T. Chan School of Public Health agrees. “What you want to do are the things that are easiest to do — the low-hanging fruit — and show we can work together,” says David Hemenway, author of "Private Guns, Public Health." “It takes a long time to build trust. But this is happening.”
The payoff could be large — potentially bigger than gun control measures proposed to stem homicides.
Looking at it another way, on an average day guns are involved in 58 suicides, compared with 32 homicides.
But how much can gun dealers reduce suicide deaths? Harvard’s Hemenway admits there’s no solid evidence yet on how effective these relatively new programs are. But lots of research backs them up, and suicide specialists say there’s good reason to think point-of-sale prevention at gun shops can make a meaningful dent.
First, research on suicide shows that the the way someone chooses to end his or her life, the means of suicide, is crucial. This is a departure from previous thinking, which focused on the suicidal person’s intent -- the often-complex and hidden risk factors that lead a person to a life-ending decision. As Harvard researchers put it, “means matter” -- the name of a website they’ve created to get the word out.
For instance, when Britain eliminated nearly all the carbon monoxide from domestic cooking gas after 1958, suicides plummeted -- it was no longer easy to die by closing the windows and turning on the stove. Similarly, Sri Lanka had a big drop in suicides when a particularly toxic pesticide became hard-to-get. In Israel, suicides among soldiers dropped 40 percent after the Israeli Defense Forces banned them from taking their guns home on weekends.
By the same logic, suicide-by-gun is a glaringly obvious prevention target. It’s by far the most lethal means of suicide; up to 90 percent of attempts succeed. By comparison, deliberate drug overdoses succeed less than 3 percent of the time. Even hanging results in death less often, around 70 percent of the time, because people sometimes manage to loosen the noose if they have sudden second thoughts, and most of those who do survive.
Research also shows that only 10 to 15 percent of suicidal people are implacably determined to end their lives. “Most suicidal people are actually hoping you will stop them,” says University of Washington psychologist Paul Quinnett in a training video for gun dealers. “They’re ambivalent.”
Most suicides, moreover, are not long-planned. One in 4 people between 13 and 34 years old who attempt suicide do it within five minutes of making the decision. Experts say many act within hours or days, not weeks or months.
Another important finding: Among those whose suicide attempt is thwarted, the great majority -- 9 out of 10 -- will not kill themselves later.
All this means that putting time and distance between a suicidal person and the means to end life -- especially a gun, the most lethal means -- can achieve a permanent “save.”
But how is a gun shop clerk supposed to know if a customer is contemplating suicide?
“Most suicidal people send warning signs,” Quinnett says. “They communicate with someone about their desire, plan or intent to die.”
Some cues are behavioral -- lack of eye contact, appearing distraught or nervous. Some are verbal asides -- statements like, “Can I buy just one bullet?” Or “This will take care of the alimony payment.”
But Demicco, the now-retired New Hampshire gunshop owner, says a customer’s response to a few practical questions, of the type gunshop owners routinely ask, can be flashing neon signs.
“You have to ask: What are you going to use this for? Do you have experience with guns? Do you need a cleaning kit?” Demicco says. “We’re not acting as psychiatrists. But you can often tell people who may not be thinking clearly or thinking of taking their life. And at the end of the day, I don’t have to go home with regrets -- 'Gee, I wish I hadn’t sold that person a gun.' ”
Demicco acknowledges a retailer’s intuition isn’t foolproof. “There are some you can catch and some you simply cannot,” he says.
Many gun retailers have embraced their role in suicide prevention -- either by spotting possible suicide risks in their shops or by educating regular customers to be alert to danger signs among their friends and families and to consider temporarily removing gun access from a troubled person.
Regina Schneider owns gun shops with her husband Steve, who is president of the Maryland Licensed Firearms Dealers Association. She also does volunteer work in mental health crisis intervention.
She says Maryland gun dealers have been very receptive to suicide-prevention efforts. “I haven’t had any opposition at all from the people I’ve talked to,” she says. “People are very concerned about this problem. We do not want to sell a firearm to someone who shouldn’t have one.”
But it would be a mistake to think everybody in the gun business is on board.
In New Hampshire, for instance, half the state’s 70 or so gun retailers participate in the New Hampshire Firearm Safety Coalition; but half don’t. Demicco says that’s because “a pro-firearms attorney got wind of this effort and went around to shops and said, ‘Don’t subscribe to this, it’s a subterfuge, it’s just a gun control scheme.’ "
“But we don’t see this as being perverted in that fashion,” Demicco adds. “We won’t let it.”
There’s opposition -- or at least strong skepticism -- on the national level too. One gun lobbyist, who did not want to discuss suicide on the record, said the industry is “uncomfortable with putting the retailer in the position of being a gatekeeper and determining if the person on the other side of the counter is a suicide risk or not.”
Another industry worry, as the gun advocate put it, is that public health arguments about suicide prevention are part of “an attempt to demonize guns and the gun industry.”
Harvard’s Hemenway has heard this before.
“There’s been great opposition to all the successes in public health,” he says. “Vaccinations. Anti-smoking efforts. Seat belts and airbags. Water fluoridation. All public health successes take much longer than you hope. But being in public health, you’ve got to be optimistic.”