What Do We Need to Do About Gun Violence?

According to a recent report issued by the Center for American Progress, of everyone killed by guns each year, one in five was 24 years old or younger, making gun death the second most common form of morbidity for this age group, surpassed only by motor vehicle accidents. The Center is hardly the first to draw parallels between the number of automobile fatalities versus the number of gun deaths each year. But beyond the similar number of deaths in both categories (roughly 30,000+) the comparison, in terms of what it means from a public policy or public health perspective, means nothing at all.

The fact is that nearly everyone who gets killed on our highways never imagined that this would be the result of getting into their car. The fact is that just about everyone who used a gun to kill themselves or someone else picked up the gun for that reason and that reason alone. Since we know that most fatal vehicle accidents occur because people drive too fast, or drink too much, or do something else that they shouldn't do, we pass DUI laws, we set radar traps on major roads, and we even make the vehicles more crash-proof and mandate seat belts to bring down fatalities even more. But even though scores of peer-reviewed articles confirm Walter Mosley's comment that "if you carry a gun, it's bound to go off sooner or later," we make it pretty easy for most Americans to walk around with a gun. And despite NRA bombast to the contrary, the majority of gun deaths each year were committed by people who either could or had legally acquired the gun.

Given the above, it seems to me that when we look at the issue of gun violence, it gets down to choosing from one of three options:

1. We agree that 30,000+ gun deaths per year is a small price to pay for the existence of the 2nd Amendment and leave it at that.

2. We engage from time to time in a loud and basically unproductive national debate about a new gun law which, even if it were enacted, would probably do little to change the current state of affairs.

3. We try to figure out the points of contact between people at risk for using guns and those professionals who might appropriately intervene, then give the latter the necessary resources to initiate the intervention process and monitor the results.

In the case of suicides, we know that most victims saw a mental health professional within the 30 days prior to the suicide act itself. In the case of homicides, more than 75% grow out of long-standing disputes and arguments, many of which resulted in non-fatal injuries before one or the other parties yanked out the gun. Whether it was a counselor, an ER physician, a teacher or other professional, most people who shoot themselves or someone else presented symptoms or testimony that needed to be followed up. A mental health worker who alerts the police to a patient's suicide plan with a gun isn't infringing on anyone's 2nd Amendment rights. An ER physician who's told by a patient that "I'm not going to let him beat me up again" has a Hippocratic responsibility to inquire about the existence of a gun.

Despite what Rand Paul says, gun violence has been recognized as a public health issue since 1979. It is the only public health issue registering significant morbidity for which medical professionals do not have any best practices from which they can receive guidance either for identifying or treating at-risk patients who might otherwise hurt themselves or someone else with a gun. Let's be honest: the discussion and development of best practices to deal with gun violence is long overdue.