As a parent of elementary school children, every mass shooting, particularly ones killing school children like in Uvalde, jolts my doing-the-mom-thing-just-keep-busy-can’t-stop denial. On the last day of school before summer vacation, when the bus doors squeaked open, and my kids hopped off, I experienced a momentary sense of relief. They were safe for one more day, at least from school shootings. I hugged my kindergartener and patted the head (that’s all I’m allowed to do) of my fifth grader. Now that a new school year is looming, it’s all I can do not to click on the article about bulletproof backpacks. One common refrain when discussing what can be done to reduce gun violence is a focus on mental health. While that’s a good start, and necessary, addressing mental health adequately does not equate to addressing gun violence. As a physician who has cared for patients with mental health concerns for almost 15 years, I know that we are missing part of the solution, potentially stigmatizing mental health treatment, when we don’t address access to guns. Let me take you into the patient room to demonstrate the limits of what I can do. When I have a patient with mental health concerns, one of the key questions I ask is: Do you feel you may harm yourself or harm someone else? I also ask patients: Do you feel unsafe in your relationship? If my patient answers yes to any of those questions, I will ask specific questions about access to guns or other methods of harm. Should doctors be asking about guns? Absolutely. If there is a critical question that will potentially save a life, I’m going to ask it. Suppose there is a gun in the home. In that case, it increases the likelihood of lethality: 90% of suicide attempts involving a gun result in death, and the presence of a gun in a domestic violence situation makes it five times more likely that the woman will be killed. More than half of mass shootings involve the shooting of an intimate partner or family member. Next question: if there is a gun in the home, are the gun and ammunition stored separately and locked? Again, this is a critical question that can save lives; three-quarters of school shooters obtained their guns from the home of a parent or close relative. Now let’s say my patient says yes, they have thought of suicide. I’ve worked with mental health clinicians to hospitalize patients, but not all patients can be hospitalized; it depends on the level of severity and other clinical considerations. We get them connected to mental health treatment, involve their support people, and give them the number of a crisis suicide hotline. And that is about as far as I can go within the walls of the clinic that day. Once my patient leaves the clinic, the truth is that it’s quite easy for them to get a gun. I can’t follow my patient as they walk out of the clinic and keep them from getting a gun. Or keep their abuser from getting a gun. This is where laws and access measures come in, like background checks on all gun sales, waiting periods, and curbing access to assault weapons. There are glimmers of hope that we as a country are moving towards change that protects my patients and our community. This summer, President Biden signed the Bipartisan Safer Communities Act, which helps close the “boyfriend loophole” to prevent domestic abusers from buying a gun, adds enhanced background checks for young adults, allocates funding for “red flag” laws to temporarily disarm at-risk individuals and increases mental health funding for schools and clinics. All of this is good progress, and we need to keep working together to address the other piece of the puzzle: easy access to weapons that cause deadly, rapid damage. It took nearly thirty years and far too many lives taken by gun violence for this gun safety legislation to pass. We can’t wait another thirty years for parents all over the country to send their children back to school in the coming weeks and for the parents who have lost their children to gun violence. As Dr. Roy Guerrero, the Uvalde pediatrician who treated children after the mass shooting, testified to Congress, “In this case, you are the doctors, and our country is the patient. We are lying on the operating table, riddled with bullets like the children of Robb Elementary and so many other schools.” Let’s not fool ourselves into thinking we’ve treated the patient without looking at what was used to make the bullet holes. There are actions we can take that make a difference. At home, we can store guns securely and have conversations about gun storage with friends and family. Physicians and health care professionals can ask about mental health and safety at home, including access to guns. As voters, we can urge Congress to pass the Assault Weapons Act, endorsed by the American Academy of Pediatrics and law enforcement organizations, and stay informed and vigilant. It will take all of us to save this patient. Source
