Eliot Nelson: The value of a waiting period
Over the past 28 years as a practitioner and teacher of primary care pediatrics at UVM's Larner College of Medicine, and as a member of Vermont's Child Fatality Review Team, I have had the opportunity to learn much about suicide and gun violence prevention. I have seen more than I wish I had of how these public health problems affect too many Vermont individuals and families — in spite of strong commitment to safety by most gun owners.
Vermont's firearm suicide rate is higher than the nation's average. Startlingly, that rate has increased more than 30% when we compare the period 2000-2009 with the most recent eight years (2010-2017) for which data is available. I commend our legislature's current effort to prevent future suicides through legislation that would require a waiting period before firearm purchase. This effort has resulted not merely from one case of firearm suicide, but from those high and rising rates, coupled with scientific evidence that suicidal behavior often occurs as an impulsive reaction to temporary crisis.
Why does a waiting period make sense for suicide prevention? Let's first be clear about what a waiting period does and does not do. Ultimately, it has no power to prevent gun ownership for people who have a legitimate right or desire to keep or bear arms. It does provide a brief period of time for a prospective buyer to consider further whether buying a gun is a wise and safe decision. This period of time could be lifesaving for someone in a vulnerable mental state.
Studies show that for many suicidal individuals, their suicidal behavior is precipitated by a crisis. For example, research from the Harvard Injury Control Research Center found that a precipitating event had occurred within two weeks of completed suicide in 36% of cases. In 61% of cases, victims had not disclosed any intent to kill themselves. Suicidal urges can be terribly intense but may also be brief.
In cases where there is a sudden life crisis, a suicidal individual may be especially susceptible to irrational thoughts, fear, anger or desperate grief. Even then, he or she may be highly ambivalent about suicidal urges — but may act impulsively. The urge to reach for a gun seems far too common. Studies show that actual suicidal attempts frequently occur within minutes to hours of an impulsive decision to act — making it critical to reduce a suicidal person's access to lethal means. The waiting period for firearm purchase is one way to do this — one that can allow a period of time for an individual to calm down, and to find other ways to work through a crisis.
There is unfortunately a widespread misconception that once a person decides to attempt suicide, his or her decision is fixed and permanent, so that "if we remove one method, that person will simply find another." In some cases that will happen; yet long-term follow-up research finds that there is a high probability (90%) that even individuals who have made serious life-threatening suicide attempts — such as jumping in front of subway trains — do NOT subsequently die by suicide. Why does that make sense? Because neither emotional crises nor mental illnesses are static or necessarily permanent conditions. Treatment and compassionate support from individuals and systems can help people to recover and prevent them from making future lethal mistakes. Even a short-term reduction of access to the most lethal common means of suicide in a crisis can ultimately allow long-term prevention.
There is good reason to be confident that this legislation will save lives. A recently published study of the effects of waiting period laws enacted in states from 1970-2014 showed robust evidence that they reduced gun homicide by 17% in those states, and only slightly less robust evidence of a 7-11% reduction in gun suicide. This would mean 5-6 Vermont lives saved per year. Preventive interventions aimed at complex and rare events like suicides are hard to study, in part because one rarely hears of successfully prevented cases. We do know that some gun suicides occur soon following purchase of a gun, and may occur within hours. In such cases, the potential to prevent suicide is clear.
A waiting period will not prevent all firearm suicides. We must remember the importance of safe storage measures for guns already possessed (e.g., storing guns unloaded and locked away). Still, this law can strike a reasonable balance around society's expectations — both reflecting and helping to shape social norms for safety and public health. Importantly, it offers an upstream, proactive way of reducing access to lethal means. It also reminds us that our society recognizes the responsibilities as well as the rights of owning guns. Over time, it will save many lives.
Eliot Nelson, MD, is professor emeritus of pediatrics at the University of Vermont, Robert Larner College of Medicine. The opinions expressed by columnists do not necessarily reflect the views of the Brattleboro Reformer.
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