The number one form of fatal gun violence in Virginia isn’t homicide. It’s suicide.

As state lawmakers prepare to reassemble in Richmond for a special session on gun control after the Virginia Beach shooting, this statistic will likely be repeated often: In Virginia, more than 1,000 people die due to gun violence every year.

That equates to almost three people every day. Guns take more lives than car crashes.

And nearly two-thirds of those gun-related deaths in Virginia are suicides.

In 2017, almost 65 percent of gun-related deaths in Virginia were suicides, according to the Office of the Chief Medical Examiner’s annual report.

While the number of gun-related homicides has crept down in the past three years — dropping by about 30 between 2016 and 2018 — the number of gun-related suicides has been slowly rising since 1999.

“There tends to be this incorrect and false sense of fatalism about suicide, and I think it makes it hard sometimes for policymakers or others to feel like we can do anything,” said Jon Vernick, a professor at Johns Hopkins University’s Bloomberg School of Public Health and co-director of the Johns Hopkins Center for Gun Policy and Research.

“And that’s just wrong.”

Fast and efficient

Though the 2018 numbers aren’t finalized yet, preliminary data shows that, of the 1,035 deaths due to guns in Virginia last year, 674 were suicides.

In 2017, about half of the 1,157 suicides that occurred in the state involved a firearm.

“There are studies that show that removing the lethal means is the best way to prevent suicide,” said Bruce Cruser, executive director of Mental Health America of Virginia. “In this country, that is guns.”

Not only are they accessible and easy to use, but guns are also terribly efficient, said Nicole Gore, Virginia’s suicide prevention coordinator. People contemplating suicide often make the decision quickly. An article in the New England Journal of Medicine pointed out that between one-third and four-fifths of suicide attempts are impulsive.

Yet studies also show that if people survive the first attempt, they are much less likely to try again, especially if they find treatment.

But guns work so fast that there’s less of a chance to reconsider.

“If you take an overdose of pills, you may be able to get your stomach pumped,” Gore said. “But the firearm is so lethal that it’s very less likely that you can reverse the effects.”

The Department of Behavioral Health and Developmental Services has been promoting a project called Lock and Talk, intended to limit access to “lethal means” like guns and pills.

“The focus is to lock up your meds, lock up your guns, and talk often,” Gore said. “We focus primarily on medication and guns because we know that firearms account for more than half of the suicides in the United States, but we’ve also seen an uptick in opioid-related suicides.”

The initiative began in 2016 and involves educating people about the importance of safely locking up firearms and prescription drugs, and providing trigger locks to the community. So far Community Services Boards, which provide mental health care to their respective regions around the state, in the western part of the state have started the project. The goal is to eventually implement the program statewide.

The case fatality rate, which means the percentage of people who die in a suicide attempt, for firearms is above 80 percent, according to a study in the American Journal of Public Health. Drug overdoses have a case fatality rate of only 1.5 percent.

“Unlike suicide attempts using most other methods, a suicide attempt with a gun is very likely to be lethal,” Vernick explained. “The really good news is most people who survive the first suicide attempt get some kind of treatment.

“If all we did — and we should clearly do more than this — but if all we did was shift peoples’ first suicide attempt from using a gun to using pills, we would save hundreds of lives.”

Policies

There are several evidence-based policies that public health experts and mental health advocates point to that would address gun violence and suicides.

One policy is a handgun licensing law. Right now, when someone wants to buy a gun they can go to a dealer, who then performs a criminal background check by calling the Virginia State Police. (There are no background checks required for private sales, a loophole Democrats have been pushing to close).

In 2017, handguns were used in about half of the suicides in Virginia.

In states with handgun licensing laws, people wishing to buy handguns are typically required to go to a law enforcement agency in person, which usually involves a more thorough background check and helps safeguard against fraud.

Licensing laws can reduce homicides, Vernick pointed out, but they also can impose a very important waiting period that can reduce suicides, as states that have implemented the laws have seen. ‘

According to the Giffords Law Center to Prevent Gun Violence, after Connecticut’s licensing law was passed, the firearm suicide rate decreased by 15 percent. When Missouri repealed its law, the rate increased by 16 percent.

Another policy option, which Gov. Ralph Northam has already identified leading up to the special session next month, are extreme risk protection orders, also known as red flag laws.

These laws would allow someone — sometimes family members or law enforcement or a medical professional — to petition a court to temporarily remove a firearm from someone who poses a danger to themselves or others.

“You’re not taking their gun away forever,” Vernick said. “You just want to keep them alive. I think that’s why it’s been quite appealing to a bunch of states.”

Vernick said that 15 states have enacted these types of laws.

The myths around mental illness and violence

Mental health advocates are open to extreme risk protection orders — with a caveat.

In his testimony to the Senate Judiciary Committee earlier this year, Ron Honberg, senior policy adviser with the National Alliance on Mental Illness, said in his written testimony that the laws “can be potentially lifesaving, particularly in preventing suicides, which are frequently impulsive acts.”

But he added that the language should emphasize that the laws are based on risk, and not “stereotypical assumptions about specific groups of people.” He also recommended states allow the subject due process protection and that law enforcement officers removing firearms receive training in crisis intervention and de-escalation.

“We would oppose efforts to deny people their rights or discriminate against people on the basis of a mental health condition,” said Cruser with Mental Health America of Virginia. “The basis has to be based on behavior, not an illness or a diagnosis.”

Advocacy organizations do not want the laws to be used as a reason to deny the rights of people with mental illness, but they fear they might be used that way due to the misguided belief that mentally ill individuals are often violent toward others.

“Overall, only 4 % of violent acts in the U.S. are attributable to mental illness,” Honberg said in his written testimony. “Most people with serious mental illness are never violent towards others and are more often victims of violence than perpetrators of violence.”

Prevention

Ultimately, advocates say that there needs to be more resources for people experiencing suicidal thoughts.

“When people die from suicide, there are normally multiple contributing factors,” Gore said. “Yes, it can be the one event that pushed people over the edge, but it’s very rarely one thing. Over half of the people who die by suicide have a mental health diagnosis, but just because they have a mental health diagnosis doesn’t make them suicidal.”

But key to that is reducing the stigma that surrounds talking about suicide in the first place.

“There is still a lot of stigma around asking for help,” Gore said. “Everybody has a role in being able to prevent suicide. One thing we need to be better at is being able to recognize when someone is showing us signs that something is not right in their life and we have to be comfortable asking questions clearly and directly: Are you thinking of suicide?”

Putting some restrictions on someone’s ability to quickly get a gun, though, would help reduce the sheer number of suicides. But, Vernick pointed out, a key part of developing strategies to prevent suicide is to overcome the sense of fatalism.

“The sense of fatalism is, ‘Well, if a gun is not available, they’ll just find some other way,'” he said. “But if that other way is much, much less lethal than a gun, and they survive it, then we can get them help and, again, the data suggests that they’re much less likely to make a next attempt.”

If you or a loved one are in a crisis, call the national suicide hotline at 1-800-273-TALK. There is also a crisis text line.