Community
It’s Hard To Predict Who Will Be Suicidal. It’s Easier To Ensure People Can’t Shoot Themselves.
It’s Hard To Predict Who Will Be Suicidal. It’s Easier To Ensure People Can’t Shoot Themselves.. Originally published by KFF Health News.
By Aneri Pattani · 2026-09-21T09:05:41.163Z
Paul Nestadt is about as steeped in suicide prevention as a person can be. He treats suicidal patients as a psychiatrist, has co authored scores of research papers on how and why people kill themselves, and teaches graduate courses on the subject. But he’ll be the first to admit: “I can’t tell you which of my patients is likely to die by suicide in the next six months.” Almost nobody can. Research shows https://psycnet.apa.org/doiLanding?doi=10.1037%2Fbul0000084 predictions of who will be suicidal are only slightly better than a coin toss. And they haven’t improved over 50 years. But that doesn’t make Nestadt hopeless. Instead, it pushes him to pursue interventions that don’t require pinpointing people at risk. Chief among them: making it harder for people to carry out the act of killing themselves. “Instead of asking every doctor to figure out which patient will die by suicide and locking that patient up, it might be that we need to make sure there aren’t loaded guns available,” Nestadt said. In an ongoing series https://kffhealthnews.org/series/eleven minutes/ , KFF Health News is examining approaches to suicide prevention that expand beyond providing people at risk with medication and therapy. Although those are lifesaving measures, many clinicians, researchers, and people who have lost loved ones to suicide agree that more is needed. The challenge is that when it comes to firearms, broad policy approaches quickly become constitutionally complicated and politically polarizing. Research shows that limiting access to lethal means is one of the most promising approaches https://www.annualreviews.org/content/journals/10.1146/annurev publhealth 071723 121359 : :text=Policies%20related%20to%20improving%20economic%20security%2C%20limiting%20access%20to%20alcohol%2C%20and%20restricting%20access%20to%20lethal%20means%20demonstrate%20the%20strongest%20evidence%20of%20preventing%20suicide%20death%20in%20the%20United%20States. to save lives. It can involve erecting barriers https://www.raisetherail.org/ on buildings and bridges https://injuryprevention.bmj.com/content/32/3/498 to prevent people from jumping, as well as decreasing the number of pills https://pmc.ncbi.nlm.nih.gov/articles/PMC526120/ someone can buy or be prescribed at once. And reducing access to guns https://pmc.ncbi.nlm.nih.gov/articles/PMC12212458/ : :text=laws%20that%20restrict%20overall%20access%20to%20guns%20may%20be%20more%20effective%20in%20reducing%20suicides%20compared%20to%20laws%20that%20aim%20to%20limit%20access%20for%20%E2%80%9Chigh%E2%80%90risk%E2%80%9D%20individuals. . “That’s the one that will save the most lives,” said Nestadt, medical director at the Johns Hopkins Center for Suicide Prevention. It may also be the most difficult to achieve. More than 28,000 people https://www.thetrace.org/2026/08/gun deaths homicide suicide cdc data/ killed themselves with a gun last year, representing more than half of all suicide deaths in the U.S., according to preliminary federal data. Even as overall suicide rates have dipped recently, gun suicides have hit record highs for five years in a row. Most Gun Deaths in the U.S. Are Suicides From 2021 to 2025, suicide deaths by gun hit record highs each year, even as homicides by gun decreased. Source: https://wonder.cdc.gov/" https://wonder.cdc.gov/" ; target=" blank" style="color: 0071ce" CDC WONDER Note: 2025 data is provisional. The following ICD 10 codes identify firearm death types: X93 95 homicide , X72 X74 suicide , W32 34, Y22 24, and Y35.0 other, which includes accident, legal intervention, and undetermined . Credit: Aneri Pattani/KFF Health News Many of the deaths are among middle aged white men and veterans https://suicidology.org/who is most affected by suicide/ , two groups that have had high suicide rates for years. But more recently, gun suicides have risen among women https://publichealth.jhu.edu/sites/default/files/2026 07/2024 CGVS gun violence in the united states.pdf?nvep=&hmac=&emci=8288e977 1e8c f111 b337 000d3a1558ce&emdi=ea000000 0000 0000 0000 000000000001&ceid= and among some Black https://www.tandfonline.com/doi/full/10.1080/13811118.2022.2098889?src= and Latino https://jnhma.scholasticahq.com/article/159413 converging crises depression and suicide among immigrant latino men in the united states men. Researchers say a surge in first time gun buyers https://hsph.harvard.edu/news/nearly 30 million acquire guns amid pandemic including 11 million first time owners/ during the covid pandemic underscores the need for prevention efforts that can be applied widely. Some people assume it’s futile to restrict access to bridges, pills, or guns. The thinking goes: Those who want to kill themselves will simply find another way. But research refutes that https://pmc.ncbi.nlm.nih.gov/articles/PMC6191653/ : :text=Means%20substitution%20after%20restriction . Creating barriers for one method doesn’t typically push people to another. Suicide risk can surge quickly, with people spending less than an hour https://hsph.harvard.edu/research/means matter/means matter basics/duration of suicidal crises/ or even five minutes between deciding to die and acting on it. Anything that delays such action — for example, having to unlock a safe to access a gun — gives them time to reconsider or for someone to intervene. A Sharp Rise in Gun Suicides Among Black Women White women had the highest rates of gun suicides by women in 2015 and 2024, but among women of other races and ethnicities, the increase was faster and steeper over that time. Source: https://publichealth.jhu.edu/sites/default/files/2026 07/2024 CGVS gun violence in the united states.pdf?nvep=&hmac=&emci=8288e977 1e8c f111 b337 000d3a1558ce&emdi=ea000000 0000 0000 0000 000000000001&ceid=" https://publichealth.jhu.edu/sites/default/files/2026 07/2024 CGVS gun violence in the united states.pdf?nvep=&hmac=&emci=8288e977 1e8c f111 b337 000d3a1558ce&emdi=ea000000 0000 0000 0000 000000000001&ceid=" ; style="color: 0071ce" The Firearm Mortality Epidemic: Examining the U.S. Data From 2024, Johns Hopkins Center for Gun Violence Solutions Note: Rates represent gun suicide deaths per 100,000 people. Credit: Aneri Pattani/KFF Health News However, in the U.S., discussion around guns — even in the context of a traditionally bipartisan topic such as suicide prevention — is a political lightning rod. Mentions of background checks, waiting periods, or red flag laws often send people running to their respective corners. Gun owners and the firearm industry say many of the policies suicide prevention advocates seek threaten their Second Amendment rights, and many policymakers see the topic as a nonstarter. President Donald Trump has been a strong ally https://www.whitehouse.gov/presidential actions/2025/02/protecting second amendment rights/ of gun owners. His administration has rolled back https://www.nytimes.com/2026/07/05/us/politics/trump gun rights laws.html?ae=oa&emc=edit nn 20260706&nl=the morning&segment id=222586 dozens of firearms regulations and rescinded a previous surgeon general’s warning https://www.cnn.com/2025/03/18/health/surgeon general gun violence advisory removed that called gun violence a public health crisis. It has also revoked grants focused on addressing community gun violence https://www.kff.org/mental health/tracking key mental health and substance use policy actions under the trump administration/ and cut federal staff https://www.thetrace.org/2025/04/cdc layoffs gun violence prevention trump/ working on the issue. The White House did not respond to specific questions about how these actions may affect the nation’s high rate of gun suicides or what it’s doing to prevent such deaths. But spokesperson Lauren Bis said in a statement that “President Trump is committed to Making America Healthy Again and that includes mental health.” She pointed to the administration’s support for developing psychedelic treatments https://www.whitehouse.gov/fact sheets/2026/04/fact sheet president donald j trump is accelerating medical treatments for serious mental illness/ for mental illness and an announcement of $52.5 million in grants https://www.va.gov/wilmington health care/news releases/va announces 52 million in available suicide prevention grant funds/ for veteran suicide prevention. The Limits of Red Flag Laws One gun policy that has gained some traction, despite pushback https://www.thetrace.org/2026/04/republican states ban red flag erpo laws/ , is the extreme risk protection order https://erpo.org/ , more commonly known as a red flag law. Adopted in some form in 22 states and the District of Columbia https://erpo.org/state by state/ , these laws allow judges to temporarily remove a person’s guns when evidence suggests they pose a danger to themself or others. Although such laws are often passed in the wake of mass shootings https://www.pbs.org/newshour/politics/red flag laws get little use even as mass shootings gun deaths soar , research suggests https://pubmed.ncbi.nlm.nih.gov/31426088/ they’re more effective at preventing suicide. Still, they require identifying someone at risk. Someone like Dorothy Paugh’s dad. In 1965, when Paugh was a young girl, her dad lost his job. He was distressed, not knowing how he’d support his wife and five children, Paugh said. He reviewed his life insurance policy, told his wife where he kept important documents, and bought a handgun. “If my mom had been able to get an extreme risk protection order or if Dad’s best friend had asked to hold his gun for a while, maybe my dad would not have shot himself. He might have lived,” Paugh said. Decades later, Paugh advocated for a red flag law https://www.wbaltv.com/article/red flag law goes into effect allowing temporary removal of guns from those who pose danger/23553565 in Maryland and sat in the legislative gallery when the measure was passed. She believes the law is saving lives. Studies https://access.heinonline.com/HOL/LandingPage?handle=hein.journals/lcp80&div=22&id=&page= across other states https://pubmed.ncbi.nlm.nih.gov/30988021/ show that for every 10 to 20 guns removed under red flag laws, one suicide is averted, saving a life https://psychiatryonline.org/doi/10.1176/appi.ps.202000317 : :text=Research%20in%20two,an%20averted%20suicide. . But Paugh also recognizes the law’s limitations. “It wouldn’t have saved my son,” she said.
Dorothy Paugh’s father died by suicide in 1965. She lost her 25 year old son, Peter, shown in the photo, to suicide in 2012. Both men shot themselves. Paugh has since become an advocate for gun policies that have been shown to reduce suicide deaths, such as red flag laws and mandatory waiting periods before completing a gun purchase. C. Allen Paugh Her 25 year old son, Peter, fatally shot himself in 2012 https://www.cnn.com/2013/04/13/opinion/paugh guns suicide irpt . He’d recently bought a house with his girlfriend and hosted a birthday celebration for his brother. He’d purchased a gift ahead of Mother’s Day — five novels by Charles Dickens, Paugh’s favorite author — that Paugh received after his death https://momentsthatsurvive.org/tribute/dorothy paugh/ . Unlike in her father’s case, Paugh said, no one saw warning signs for Peter. “I did not know that my son was suicidal. I didn’t have a clue,” she said. Even if a red flag law existed then, she wouldn’t have thought to use it. The people most vulnerable to firearm suicide usually aren’t identified as such by family members or clinicians, said Michael Anestis https://gunviolenceresearchcenter.rutgers.edu/node/11 , a clinical psychologist and the executive director of the New Jersey Gun Violence Research Center. Studies have shown that among people who die by suicide, those who used guns were less likely to have sought mental health care https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790044 in the past. And most veterans and service members who die by gun suicide never tell anyone https://econtent.hogrefe.com/doi/10.1027/0227 5910/a001067 about their suicidal thoughts in the months leading to their death. That’s why red flag laws are just a first step in suicide prevention, Anestis said. They target specific individuals at high risk — the aspect that makes such laws more politically palatable — but they do not apply to the many other people who are quietly suicidal.
Paugh’s son, Peter, fatally shot himself in 2012. Paugh says she didn’t see warning signs that he was suicidal. Peter is pictured here hiking the Appalachian Trail in 2009. Dorothy Paugh Lessons From Road Safety Nestadt, the Johns Hopkins psychiatrist, said the nation needs to approach suicide prevention the way it approaches car accidents. “You’re not trying to figure out who’s at risk of an accident” by testing people’s reaction time or cataloging who gets into fender benders, Nestadt said. Instead, governments implemented https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4818a1.htm speed limits, passed seat belt laws, and required auto manufacturers to install air bags and shatter resistant windshields. The crash death rate declined https://injuryfacts.nsc.org/motor vehicle/historical fatality trends/deaths and rates/ significantly. Applying a similar strategy to suicide might involve requiring permits and background checks to buy a gun, as well as instituting waiting periods https://pmc.ncbi.nlm.nih.gov/articles/PMC12212458/ before completing the purchase. One study https://www.sciencedirect.com/science/article/abs/pii/S0091743515002297?via%3Dihub found that enacting a permit to purchase law in Connecticut was associated with a roughly 15% decrease in gun suicide rates, while repealing such a law in Missouri was linked to a 16% increase in firearm suicide rates. Most Suicides in America Involve a Gun Suicide deaths by gun have been increasing for several years, even as suicides by suffocation — the second most common method — have been decreasing. Source: https://wonder.cdc.gov/mcd icd10 provisional.html" https://wonder.cdc.gov/mcd icd10 provisional.html" ; target=" blank" style="color: 0071ce" CDC WONDER Note: 2025 data is provisional. "All other methods combined" includes cut/pierce, drowning, fall, fire/flame, other land transport, other, and unspecified. Credit: Aneri Pattani/KFF Health News About three dozen states https://www.rand.org/research/gun policy/analysis/child access prevention.html fnb3: :text=As%20of%20January%C2%A01%2C%202025%2C%2035%20states%20and%20the%20District%20of%20Columbia%20have%20CAP%20laws.%E2%81%A0%5B3%5D have enacted laws requiring owners to lock up their guns in homes where children live, a practice shown to reduce youth suicides https://www.jaacap.org/article/S0890 8567 24 01991 9/fulltext . That’s an issue of particular importance, with gun suicide rates increasing https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2852454 : :text=Since%202014%2C%20firearm%20suicide%20rates%20have%20increased%20by%20245%25%20among%20Black%20youths%20and%2098%25%20among%20Latinx%20youths 245% among Black youths and 98% among Latino youths since 2014. Anestis said laws requiring permits and safe storage can also reduce homicides and other gun injuries. Those types of violence not only hurt people directly but also increase their risk of suicide. Research suggests https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2814568 people who are exposed to gun violence in their community experience trauma and become habituated to the idea of injury or death. That “double whammy” makes them more likely to kill themselves, Anestis said. Responsibility, Rights, and Saving Lives Gun owners and firearm trade associations generally oppose universal measures, such as requiring permits and waiting periods. They prefer education campaigns that teach people how to recognize warning signs, talk about mental health, and safely store guns — initiatives that place responsibility on individuals https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006437 . The National Shooting Sports Foundation, which represents the firearms industry, has partnered with the American Foundation for Suicide Prevention to create flyers and brochures https://www.nssf.org/download/suicide prevention asset suicide prevention brochure/?wpdmdl=52702 to be posted in gun shops. “Our purpose is to provide educational materials to the firearm owning community on how to help prevent suicide and save lives,” Bill Brassard, the NSSF’s senior director of suicide prevention initiatives, said in a statement. The National Rifle Association said policies focused on guns miss deeper concerns that make someone suicidal, such as mental illness. “Suicide is a serious issue that deserves serious solutions focused on the underlying causes, not on political efforts to restrict the rights of law abiding Americans,” NRA spokesperson Justin Davis said in a statement. “A truly dangerous individual needs to be incapacitated, not just deprived of one particular means of harm.” Some initiatives have managed to bring together unlikely bedfellows — gun store owners, public health experts, and even libraries — to provide free locks https://www.bcpl.info/blog/2026/library distribute gun safety locks all branches to secure firearms at home, identify locations that will temporarily store someone’s guns https://www.armoryproject.org/ while they’re in crisis, and educate people on how to avoid selling guns to someone who is suicidal https://hsph.harvard.edu/research/means matter/gun owners/gun shop project/ . Those efforts give Paugh hope and fuel her passion to continue advocating for better mental health care, open conversations about suicide, and policies that decrease access to guns. “It’s not a cure all,” Paugh said of those policies. But “it does save lives.” Having lost a parent and a child, she knows how valuable that can be. “If you’re that one person or that person’s family, it’s all the difference in the world,” she said. KFF Health News https://kffhealthnews.org/about us is a national newsroom that produces in depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF https://www.kff.org/about us . This article https://kffhealthnews.org/mental health/suicide prevention guns firearms red flag laws nra maryland eleven minutes/ first appeared on KFF Health News https://kffhealthnews.org and is republished here under a Creative Commons Attribution NonCommercial NoDerivatives 4.0 International License https://creativecommons.org/licenses/by nc nd/4.0/ .