Jul 8, 2020
Jack Rozel, MD, MSL, returns to the Psychcast, this time to
discuss with host Lorenzo Norris, MD, how to think about guns, gun
violence, and the intersection with mental health.
Dr. Rozel is medical director of resolve crisis services at the
University of Pittsburgh Medical Center/Western Psychiatric
Hospital and president of the American Association for Emergency
Psychiatry. He has no conflicts of interest but has worked for a
gun dealer to teach sales staff how to recognize people in crisis –
rather than sell a gun. Dr.
Norris has no disclosures.
- In the United States, more guns were sold in the month leading
up to the COVID-19 pandemic than were ever sold in 1 month since
gun sales were recorded.
- Suicide risk with a new gun in the home peaks in the first days
to weeks of ownership and then trails off, but there is a
measurable difference in risk of suicide in the 5 years after the
- Any surge in gun sales leads to greater accidental deaths and
homicides from firearms.
- Rozel reminds clinicians to ask their patients (again) about
guns. A good question to start is: “Are there guns in the home or
new guns in the home?” He also asks about gun storage and the
number of guns. Dr. Rozel goes through the basics of gun safety,
such as handling a gun only while sober; securing the gun in a
locked box unless the owner/responsible adult is holding it; using
a responsible means to carry the gun, such as a holster; and not
handling the gun like a toy.
- If a patient is under financial pressure, the clinician might
gently suggest that a way to remove some of that pressure might be
to sell a weapon to a licensed gun dealer.
- It is likely that fear and uncertainty of the future with broad
social disorder are influencing gun sales. Most of the gun sales
during the pandemic are to new gun owners.
- Unfortunately, the increase in gun sales tracks with other
major risks for suicide, such as unemployment and unstable housing,
which might get worse during the COVID-19 pandemic.
- During this period of unstable employment and house, people
might be moving to different houses, or relatives and friends might
be moving in. With this fluidity, it is essential to inquire about
guns in the home where they are staying or whether new people
brought in guns. Dr. Rozel also explores who is in the house with
the patient and checks in about the home environment regarding
arguments and abuse, especially as tensions run high during
- Make gentle assumptions by asking questions such as: “How do
you store your guns?”
- Get a sense of how safe the patient’s environment is while
conducting telehealth, and be aware of patients’ social
determinants of health issues.
- As psychiatrists, it is our role to talk to patients about how
their mental health influences their safety. If a patient is
experiencing acute symptoms of their illness or perhaps has
relapsed on substances, then it is imperative to ask about gun
safety and whether the gun should be temporarily moved from the
Clinical Psychiatry News. 2020 Apr 2.
Harvard School of Public Health. Means
Matter: Firearm Access is a Risk Factor for Suicide
Reger M et al. JAMA Psychiatry. 2020 Apr 10.
Rand Corporation. Gun Policy in
Show notes by Jacqueline Posada, MD, who is associate producer
of the Psychcast and consultation-liaison psychiatry fellow with
the Inova Fairfax Hospital/George Washington University program in
Falls Church, Va. Dr. Posada has no conflicts of interest.
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