Read the news on any given day and you’re bound to see a headline about another shooting — perhaps where several unsuspecting lives were taken in a public place, a child picked up a gun that wasn’t properly stored, or a teen died by suicide.
Despite the media fanfare for the first, the latter situations are actually much more common. According to Washington Post, since 1966, there have been 165 mass shootings (where four or more people died), which have killed in total 1,196 people. On the other hand, a Pediatrics study from October 2017 found 1,300 children die and 5,790 are injured every year due to guns; another from March 2018 states more than 1,000 10 to 18 year-olds die from firearm suicide annually.
It’s this kind of ubiquitous injury that providers need to be more aware of, says Eileen Owen-Williams, DNP, PhD, APRN, CNM, FNP, AFN-BC, FAANP, who studied the effects of gun violence on communities for her doctorate degree and has worked with patients on ways to prevent it for more than 40 years.
Owen-Williams’ experience has taught her the importance of addressing violence in a holistic manner because it’s a social determinant of health (just like safe housing and affordable, healthy food). She recommends practitioners screen for violence risk factors and stresses that clinicians in primary care have the most power to prevent gun injuries and death before they occur.
That said, knowing how to talk to patients about guns and educate them about using them safely can save lives, regardless of your point of care, Owen-Williams tells Florence Health. Here are some of her tips for assessing and helping at-risk patients.
How to Prevent Gun Violence Among Your Patients
Ask if your patients have guns in their home.
Because 1 out of every 3 U.S. homes with children has a gun, this is probably an obvious first step, but it’s crucial to know whether your patients are at risk of gun violence in their own home. If the answer is no, the conversation shouldn’t necessarily stop there, however.
Especially if you practice in an area where guns are common, advise your young patients and their parents about the importance of children knowing what to do if they see a gun in someone else’s home. They should: stop what they’re doing; never touch the gun, even if it looks like a toy; leave the area with the gun; tell an adult right away; and call their parent or caretaker to ask for a ride home.
Ask your patients about how they practice gun safety.
For example, have they received any gun-safety training? Are the guns locked up? Where are they stored? If their answers to any of these questions give you pause, then you can advise them to seek out more education about gun safety from a respectable, local resource, and/or share the basics of safe gun storage and use.
Per the American Academy of Pediatrics:
- Guns in the home should be locked, unloaded and with ammunition locked separately.
- Store the keys to the lock box or gun safe somewhere they won’t be accessible to children. If you use a lock with a combination, never share it with a child.
- Never keep loaded, unlocked guns in the car.
- When using a gun, keep the safety catch in place until you are ready to fire it. Before setting the gun down, always unload it. Never let children shoot a gun, no matter how much instruction you give them.
For parents, explain the data connecting having a gun in the home with child injury.
While it might be your instinct to tell parents to avoid guns altogether, Owen-Williams cautions against doing so. Why? Because you’ll end up immediately “cutting them off,” and parents with guns are the people who need to listen to you about gun safety the most.
The best approach, if a parent is initially resistant to locking up his or her gun, is to explain that data shows most children know where their parents keep their guns — even if the parents think otherwise. What’s more, many of these children have handled the guns without their parents knowledge, the Giffords Law Center reports. Another harrowing stat to share? Roughly 78 children (between 0 and 21 years old) are killed or injured every day by firearms.
Follow up with questions that assess if the gun is putting someone in direct danger.
Owen-Williams also recommends taking the time to screen for domestic violence and mental health concerns. According to Every Town for Gun Safety, more than half of female victims of domestic violence are killed with a gun, and nearly two-thirds of all gun deaths in the U.S. are suicides.
In both situations, it’s best to ask open-ended questions and employ standardized screening tools. Consider the PHQ-9 questionnaire from the U.S. Preventative Services Taskforce, a general mental health screening tool used in primary care. There are also various evidence-based tools to screen for intimate partner violence, such as HARK or HITS.
Similarly, if a parent still doesn’t want to store the gun safely even after you explain the danger of not doing so, Owen-Williams says “that’s a red flag.” In this case, you should evaluate the child’s home environment and his or her overall safety.
Prepare mental-health resources ahead of time.
One of the first thoughts that crosses Owen-Williams’ mind following the news of another mass shooting is that she hopes fellow healthcare providers see it as a reminder to revisit their psychiatric referral sources. These people can be family trauma counselors, mental health nurse practitioners, social workers or psychologists.
“Make sure you have mental health resources in place and that individuals have access to care when they need it,” she explains. After you do your own screening, you may find that they need to be referred immediately to a specialist for in- or out-patient psych services or for a non-urgent counseling visit.
How to Reduce Gun Violence in Your Community
Healthcare providers should understand the extent to which gun violence rips apart families and communities, Owen-Williams says. As a result, many medical professionals feel an obligation to prevent it on a larger scale. Here are some ways you can get involved.
Promote open communication between clinicians, schools and parents.
Encourage parents to ask their children’s schools or daycares about gun safety procedures, as well as how they talk to students about gun violence in general. It’s important that the message kids hear is consistent, Owen-Williams says. You can also make yourself available as a resource for schools in your community.
Get involved in political advocacy.
No matter your political persuasion, Owen-Williams recommends contacting your legislators with your concerns about gun safety, especially when they’re informed by your experiences with patients. You can also vote based on your personal views — for example, if you believe in stronger background checks, banning assault rifles or safe gun storage.
Make yourself available if gun violence trauma ever hits your community.
Because there’s a shortage of mental health professionals in the U.S., especially in rural areas, a substantial way to make a difference is to contact local government or law enforcement and tell them you’re available to volunteer. They may need you to obtain training in mass casualty triage or provide referrals for mental health conditions.
Another option is to collaborate on disaster and mass casualty plans with your local government, such as public health officials, the fire department, law enforcement and regional hospitals.
Gun violence in the United States is certainly a divisive topic, but all healthcare practitioners should agree that their goal is to keep patients healthy and safe, regardless of their feelings on the Second Amendment. As Owen-Williams explains it, “We have an obligation to be a voice for the safety of all our patients, including those who own guns.”