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The silent epidemic of America’s problem with guns

BBC

Mass shootings dominate the national conversation on gun control, but two thirds of gun deaths are suicides. How do you solve a problem hardly anyone talks about?

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Kase Dietrich lost his closest friend to suicideImage copyright
Don Bartletti/BBC

Image caption

Kase Dietrich lost his closest friend to suicide

BBC

BBC

The night Brayden died was a cold, clear night in Helena, in the foothills of the Rocky Mountains in Montana. Snow had fallen lightly on the city and lay drifted around the houses. Brayden was in his bedroom with his mother Melissa, watching reruns of his favourite TV sketch show. Across town, Brayden’s best friend Kase was with his own mother at the home of a family friend.

By that point, in early February 2016, Brayden Schaeffer and Kase Dietrich had been friends for nearly half their lives. They met aged nine, when Brayden joined late at the local high school in Helena and needed someone to show him around. Brayden was a bright-eyed boy with a wide, toothy smile and a fondness for practical jokes. Kase was a quiet boy with a shy manner. He was drawn to Brayden’s easy confidence.

The boys began hanging out every day, at school and after school, growing closer with time. Seven years went by like that, until, aged 16, Brayden and Kase were living a few miles apart in Helena, filling long summer days with each other’s company — playing basketball, swimming at the lake, or driving aimlessly in Brayden’s black ’91 Chevy pickup.

On a rare day they didn’t see each other they texted, exchanging hundreds of messages over the years. That night in February was no different. Kase texted to say he’d left a pair of jeans at Brayden’s house; Brayden replied saying he hadn’t finished his homework. Kase pulled his friend up on the homework.

“Dude, you need to do that,” he wrote. “Don’t fail school”.

“I won’t dude,” Brayden wrote back. “Okay, just making sure,” Kase replied.

It mattered to Kase that Brayden kept it together. Kase’s own future felt uncertain — his father was in prison and his mother had moved him from home to home, always fighting to make rent. He had dropped out of school the summer before, aged 15, and was working in a taco restaurant. The two boys felt like brothers; they looked out for one another.

Kase’s phone lit up with another text. “Yo dude,” it said. “You’re an awesome friend dude.”

Kase sensed a change in tone. “Thanks bud, what’s going on?” he replied.

“Dude I don’t feel it anymore,” Brayden wrote back. “I don’t feel like continuing.”

Kase had never suspected his friend was suicidal. “He was just this happy-go-lucky guy,” Kase said, as he told the story of what happened to Brayden. “He played sports, he helped his friends. He brought other people up when they were down. He was just a great guy.”

But sitting in his room that night in February, Kase began to worry. He texted back: “Do I have to come over there bro?”

At Brayden’s house, Melissa had grown tired and got up from the TV. She told Brayden she loved him and told him not to stay up late, then she went to bed. Alone in his room, Brayden sent Kase a string of increasingly hopeless messages. “Dude I’m just sitting with my dog now thinking,” he wrote. “Like, I have nothing with me now but I don’t know”.

Kase replied, “Do you need me bro?”

Then Brayden told his friend not to come to his house, “no matter what”.

“Don’t come over if I stop responding,” he wrote, “call the cops dude.”

Kase bounded out of his room and down the stairs and grabbed his mother’s car keys. “Brayden needs me now!” he shouted as he ran out the door.

At Brayden’s, Melissa heard her son get up. She called out to him from her room, and he said that he was just getting a movie, and he loved her and he would see her tomorrow.

As Kase raced the few miles across town, his phone flashed in his pocket with a final message, one that he wouldn’t see until after he reached the house, until it was too late.

“Yo dude, call me plz.”

He is still bewildered by the speed with which he lost his friend. “It was just an ordinary conversation on an ordinary night,” he said. “Suddenly it went from light to dark.”

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brayden school

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Suicide rates in the US have risen dramatically over the past two decades, stubbornly defying prevention efforts and morphing quietly into a nationwide public health crisis. Brayden was one of nearly 45,000 Americans who killed themselves in 2016. Even at a conservative estimate, that was twice the number of homicides that year. According to data published last week by the Centers for Disease Control and Prevention, the national suicide rate rose 35% between 1999 and 2018, rising in all states. In Montana, where Brayden lived, it rose 38% in two decades and people killed themselves at a rate that surpassed any other state in America.

And the increases are most acute in America’s adolescent population, outstripping all other age groups. According to the CDC, the rate of teenagers and young adults taking their lives rose 47% in two decades.

The CDC points to a wide variety of driving forces behind suicide: social and geographical isolation, financial hardship, drug and alcohol dependency and mental health problems. But it also highlights a common factor in the majority of American suicides: a gun.

Most people who kill themselves in the US use a gun. Brayden used a gun. Suicide is the silent epidemic of America’s problem with firearms — it accounts for roughly two-thirds of all gun deaths, while the national conversation around gun control is dominated by mass shootings, which account for less than 1%. In 2018, on average, 67 people died by firearm suicide every day, a figure that has risen every single year since 2006.

Part of the problem with guns is that they are by far the most fatal means. There are three statistics which together paint a stark picture of the role of firearms in American suicides: about 85% of people who use a gun will die; about 95% of people who use another means will survive; and about 90% of those who survive will not go on to try again.

“Too many people think that if you want to take your own life you will, and the means don’t matter. But a gun in the home increases the chance of suicide probably threefold,” said David Hemenway, the director of the Harvard Injury Control Research Center (HICRC) and one of the country’s leading suicide researchers.

“If you were to ask what’s the one thing we really know from suicide research in the US, that would be it,” he said.

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Helena, the capital of Montana. The state where Brayden lived sees more suicides than any otherImage copyright
Louise Johns/BBC

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Helena, the state capital of Montana, where Brayden lived until he was 16

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Suicide prevention efforts have historically focused on what Hemenway called “the why” — social, financial, and mental health triggers. He and his fellow researchers at the HICRC in Boston would like to shift some of that focus to a more easily modifiable part of the phenomenon: the means people use, “the how”.

“It is natural to focus on the why, to try and understand how someone got to that point,” said Catherine Barber, a colleague of Hemenway and associate director at the HICRC. “But at some point you have to stop and think about what’s a more actionable approach to saving lives,” she said, “and that’s the how.”

Guns — the most prevalent ‘how’ in American suicides — take away time. They are fast and lethally efficient and leave little room for a change of heart or a life-saving intervention. And yet study after study shows that suicide is a dramatically impulsive act.

In a 2009 study, 48% of people who made a near-lethal attempt on their life said they started thinking about suicide less than 10 minutes before the act. Another study from 2001 showed the same percentage deliberated for less than 20 minutes. Researchers say putting even a short amount of time, or a small obstacle, between people and the means to kill themselves can prevent a death.

“It’s actually pretty darn hard to take your own life, because your body rejects it or your mind struggles against it,” Barber said. “Most suicide methods give you that opportunity, because they take time. And sometimes just a small amount of time is enough.”

If you ask Brayden’s dad Steve, he’ll tell you his son only needed a minute.

“That’s what I always say, ‘He just needed a minute’. And the more you talk about this issue the more you find people who were going to do it and didn’t, because they got that minute.”

Steve Schaeffer still lives in Helena, where he has taken on an active role in raising awareness around suicide and mental health. One wall of his apartment is adorned with framed memories of his son — photographs, childhood drawings, a basketball jersey. Brayden’s name is embroidered on his motorbike vest, over his heart. The night Brayden died Steve was in Sacramento, fast asleep in a hotel room after a sales job that day. His phone — on silent but programmed to ring after repeated calls from the same number — eventually woke him, and he heard down the line from an old Helena High classmate-turned-police officer that his son was dead.

Steve still dwells on the final message his son sent to Kase that night.

“Yo dude, call me plz.”

It was Brayden looking for that minute, Steve said.

“There are lots of ways to kill yourself but a gun is the most instantaneous. It’s the easiest, it’s the quickest.

“I’m not saying get rid of guns, I’m not saying get rid of rights, but we have simply got to have better laws.”

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History tells us that reducing access to certain means of suicide can have a dramatic effect on suicide rates. In the early 20th Century, the UK began heating domestic ovens with coal gas, which contained lethal levels of carbon monoxide. Suicide rates spiked, particularly among women, and by the 1950s more than half of all suicides in the UK — about the same proportion as firearm suicides in the US today – involved a coal gas oven. Then in 1958 the government began, incidentally, to replace coal gas with a cleaner natural gas which was virtually free of carbon monoxide, and by the early 1970s gas oven suicides fell to zero and the overall national suicide rate fell by a third. The so-called “coal gas story” became a touchstone for suicide prevention experts worldwide.

There are other examples. In the early 1990s, Sri Lanka had one of the highest suicide rates in the world, driven by the ready availability of toxic pesticides. Two laws passed in 1995 and 1998 restricted access to a deadly class of pesticides and by 2005 the suicide rate had fallen by half.

In Switzerland, army reforms in 2003 halved the number of soldiers and the knock-on reduction in the availability of firearms brought about a sharp reduction in suicides among men. Similarly in Israel, in 2006, the army prohibited younger soldiers from taking their service weapons home at the weekend and the measure led to 40% fall in suicides. And legislation passed in the UK in 1998 outlawed the sale of painkillers in bottles, meaning anyone wanting a large quantity had to push them out from blister packs one by one. That seemingly small obstacle had a significant effect — painkiller overdoses fell by 43% over the next decade and overdose-related liver transplants by 61%.

Similar reductions have been observed in the US after the installation of access barriers that prevent people jumping from bridges, and studies tend to show little or no “substitution” effect — ie increases in the number of suicides at nearby bridges. In San Francisco, where dozens of people die every year after jumping off the Golden Gate Bridge, a five-year, $76 million metal suicide barrier, paid for by the state, is scheduled for completion by 2023.

But access barriers to guns are a different story. The National Rifle Association (NRA), the nation’s leading gun lobby group, exerts an enduring hold on the Republican Party and fiercely resists nearly all legislation that infringes on ready access to firearms. It denies that stricter gun laws correlate with lower suicide rates — its news arm said recently that including suicides in the annual gun death toll amounted to “fake news”. The NRA did not respond to a request to comment for this story.

“Anything that puts a barrier between a potential customer and a gun gets resistance from the industry,” said Paul Nestadt, an assistant professor of psychiatry at the John Hopkins School of Medicine. “And yet study after study shows that any regulation that limits access to firearms decreases suicide rates.”

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Steve Schaeffer has a shrine to his son in his apartmentImage copyright
Louise Johns/BBC

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Steve Schaeffer in front of a shrine to his son

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The simplest barrier to a gun is a lock. The gun Brayden used to kill himself was behind a lock, in a wooden cabinet, but Brayden knew where to find the key and the ammunition was stored with the gun. Many guns are even less safe than that. According to a 2015 national study, about two in 10 gun-owning households with children store at least one weapon in the least safe manner – loaded and unlocked. That means that about 7% of US children — roughly 4.6 million — live within reach of a loaded gun.

There are no federal laws and few state laws requiring safe storage of guns, and no federal standards for firearm locks. Only seven of the 50 states have laws requiring the safe storage of guns in the home, and they are nearly impossible to enforce without going door-to-door with a warrant, which is, as Nestadt pointed out, “frankly, un-American”.

There are other options. In the wake of two mass shootings in Texas and Ohio in August, which killed 29 people in 24 hours and briefly shook the nation from a business-as-usual approach to gun violence, so-called “red-flag” laws emerged as a rare point of agreement across the political aisle.

Red flag laws — properly known as extreme risk protection orders, or ERPOs — allow family members to petition a court to temporarily remove a person’s access to firearms if they pose a threat to themselves or others. It is telling that it took two mass shootings, and not decades of rising firearm suicide rates, to bring ERPOs into the public consciousness, but the evidence suggests they are as effective a suicide prevention tool as the US can realistically hope for. ERPOs were associated with a 7.5% reduction in firearm suicides in Indiana and a 14% reduction in Connecticut, where the proportion of gun-removal subjects receiving outpatient mental health treatment doubled within a year of the law being introduced.