shows, from behind, a young boy holding up a firearm/ gun. No gun locks in sight.
Credit: Greg Westfall/ Flickr Creative Commons

Note: This story contains references to suicide and firearm violence.

By Rose Hoban

The mass shootings in Uvalde, Buffalo and most recently Highland Park have elevated the national conversation about firearm access and brought added pressure on lawmakers to take actions that could help slow the frequency of such gun violence.

Gun safety advocates point out that while mass shootings get the attention, more than 50 percent of firearm fatalities in the U.S. are the result of suicide. 

The Centers for Disease Control and Prevention recently announced that firearm-related injuries have become the leading cause of death for children from 1 to 19 years old in the United States.

Each year since 2018, the North Carolina Child Fatality Task Force has put forward a recommendation that lawmakers launch and fund a statewide firearm storage awareness initiative. 

“It started years ago, where the task force convened a work group made up of gun advocates and advocates for gun safety and gun restrictions, and brought them together to try to find some common ground on how we keep our children safe and homes with guns,” said Karen McLeod, a children’s health lobbyist who was chair of the task force when the idea was first introduced.

“The focus wasn’t around ‘should you or should you not have guns in the home?’ That wasn’t the conversation,” said McLeod, a gun owner who said she grew up in a family where she learned to shoot at a young age. The conversation was ‘if you have guns in the home, how do you keep your youth safe?” 

The task force decided it was important to educate gun owners on how to safely store and lock their firearms to help prevent accidental and intentional shootings.

In 2019, lawmakers included such a policy recommendation in the state budget with a $160,000 expenditure attached. That budget, though, was vetoed by Gov. Roy Cooper because it did not include funding for Medicaid expansion and increase teacher salaries as high as he had proposed. An impasse between lawmakers and the governor ensued and the gunlock education campaign never got off the ground.

In 2021, Bobby Hanig, a Dare County Republican, introduced a bill in the state House of Representatives that would have led to a two-year safety storage initiative that would have cost $86,500 the first year and $69,200 this fiscal year. It passed in the House with only one opposing vote.

The Senate never heard the bill, so it remained parked in committee. 

In North Carolina, at least 525 children ages 17 and under died as a result of firearm-related injuries from 2011 to 2020. Most were the result of domestic violence, accidents and suicides, which have seen a sharp uptick in teens and preteens in recent years.

In 2019, the number of teen suicides accomplished by firearm was 15, that number more than doubled in 2020 to 31. All told, in 2020, 105 children in North Carolina lost their lives to a firearm. 

Graph shows a sharp uptick in the number of suicides by firearm from 2019 to 2020
Number of youth suicide deaths by lethal means, ages 10-17 in North Carolina 2016-2020. Graph courtesy: NC Child Fatality Task Force

graph shows NC's rate roughly parallel to the overall US rate for most of the decade. Both rates increased in 2020, but NC's rate went up sharply.
Firearm-related mortality rates, children ages 0 to 17 in the US (green line) and North Carolina (blue line), 2011-2020. Graph courtesy: NC Child Fatality Task Force Credit: NC Child Fatality Task Force

Guns, easy access and suicide 

Days after the Uvalde massacre, House Speaker Tim Moore, a Republican from Kings Mountain, was asked about the firearm storage and awareness initiative. 

Moore discounted gun locks as deterrents.

“If you’ve got someone who’s going to do harm, either to themselves, or to someone else, and they’ve made that affirmative decision that they’re going to do it … I think whether there’s a lock on their gun or not, I mean, the person who has the gun’s gonna have a key to the lock,” Moore mused to a group of reporters. “They just take an extra step to unlock it. I don’t know that that accomplishes anything.”

Moore was expressing a belief espoused by many that people who make a decision to harm themselves or to harm someone else are not going to be dissuaded. 

But, at least when it comes to death by suicide, the data tell a different story. 

Contrary to what people often believe, many suicides can be averted if there’s a delay between the decision and the act, research has shown. A growing body of studies done worldwide has found that many suicide attempts are not planned, but instead are decisions hastily made in the midst of a crisis that became more deadly depending on the means at hand. 

Bar graph shows what percentage of young people who die by suicide had a history of suicide attempts (14% for males, 27% for females), how many had disclosed intent (27% for males, 33% for females) and how many left a note (27% of males, 37% of females).
Research has shown that almost three-quarters of people who attempt suicide make the decision impulsively, often within minutes of the attempt. In this graph, blue bars represent males, purple represent females. Overall, males are three to four times more likely than females to die by suicide. Graph, data source: Precipitating circumstances of youth suicide, 2010-2019. NC Injury and Violence Prevention Branch.

Multiple studies have found that around half of people who attempted suicide made the decision within minutes of taking action. 

In one study, researchers interviewed 153 suicide-attempt survivors between the ages of 13 and 34. They were asked how long it took between the decision to commit suicide and the actual attempt. About a quarter said it was less than five minutes. Nearly three-quarters of the survivors said they deliberated for less than an hour before actually attempting to take their lives. 

Other studies tell a similar tale, with people who have survived attempts at suicide describing an impulsive decision, usually made in the heat of a personal crisis. 

One study published in JAMA Pediatrics in 2019 estimated that a “modest increase” in the number of homes that store firearms safely could prevent up to 32 percent of youth suicides. 

Many suicide attempts are hastily decided upon and involve little or no planning, and 90 percent of those who attempt suicide and survive do not go on to die by suicide later the JAMA authors noted. About 85 percent of attempts with a firearm are fatal compared to much lower lethality rates of many of the most widely used suicide attempt methods.

Prevention through safe storage 

In 2020, according to available state data for North Carolina, of the 1,436 people who died by suicide, 60 percent used a firearm to complete the act. The number of homicides in the same year was 867. 

That’s a consistent trend. Both 10-year and five-year trends show that firearm suicides were close to 60 percent of all firearm deaths in the state. 

“Many suicides are just impulsive, and people thought about it five minutes ago,” said Jeff Swanson, a psychiatry and behavioral sciences professor at Duke who’s part of the Center for Firearms Law at Duke’s law school. “They’re, you know, in this moment of hopelessness and despair, and they’re probably intoxicated, and they’ve got this incredibly lethal instrument in their hand.”

Other methods for death by suicide are not always as lethal.

“Everything else is much more survivable,” Swanson said. “I mean, you’ve got about a 90 percent chance of surviving, on average, if you use anything else. With a firearm, it’s just the opposite, people almost never survive. It’s a catastrophic injury to the brain usually.”

Swanson said safe storage could help reduce the number of accidental firearm deaths, but he suggested that such a practice would go much further in helping to prevent self-inflicted gunshot wounds. 

“Households that have access to guns are more likely, people who live there, they’re more likely to die of suicide,” he said. 

“When guns are present in a home with youth, storing all firearms locked as opposed to unlocked, unloaded as opposed to loaded, and storing all ammunition locked and separate from firearms have each been associated with a reduced risk of intentional self-inflicted and unintentional firearm injuries,” the JAMA authors wrote, noting that repeated studies have shown that simply having a firearm in a household puts the people living there at greater risk of suicide and accidental death using a firearm. 

Getting it done locally

Across North Carolina, some communities have started their own initiatives. 

“I support the Second Amendment in its entirety. I’m a hunter, but I don’t hunt with an AR-15,” Durham Sheriff Clarence Burkhead told NC Health News. “I’m a gun owner, I have a gun safe, I have gun locks. If you’re going to own weapons, we want you to be responsible.”

Durham County Public Health has had a gun safety initiative called Durham County Gun Safety Team, the sheriff said. Recently, with them, Burkhead’s department gave out 200 gun locks “in a very short period of time.”

“People were very thankful,” Burkhead said. “They don’t have gun safes, but they have weapons, they have small kids. So this is a way to put that barrier and make it tougher for those children or anyone else to get access to those weapons and be able to operate them. Gun locks save lives.” 

A 2015 national survey found that there’s a gun in about one in three U.S. households. Of those homes with children in them, about 21 percent of owners store a firearm in the least safe way, namely unlocked and loaded. About one in three homeowners with firearms store them safely while the rest fall somewhere in between. 

In Pitt County, a multipronged campaign is urging parents to lock up their firearms when they’re not in use. Sue Pilgreen, a nurse with the Eastern Carolina Injury Prevention Program, works with the campaign. At a conference in December, she told how she’s from a hunting family in which her 8-year-old nephew has “probably killed more deer in his short little life than many adult hunters will ever kill in their lifetime.” 

Her family has instilled in him firearm safety rules.

“He is still a kid and friends that come over may not know these rules and children are naturally curious,” Pilgreen added. “They have a natural desire to show off, you know, things that are nice and new and shiny. 

“Without firearms being locked up and put away the outcomes can obviously be catastrophic.”

Flyer uses a gun with a lock as the L in Lock it for Love.
Flyer from the Pitt County firearm safety campaign. Courtesy: Eastern Carolina Injury Prevention Program

One of the Pitt County programs encourages parents to ask about the availability of guns at the houses where their kids play and hang out. 

Her county sheriff’s office has been promoting several other campaigns, including the “Lock it for Love” project through which gun locks have been distributed and the Project Child Safe campaign that gives families information about gun safety.  

“Prevention is not about who does or who does not support owning a firearm,” Pilgreen said. “It’s about helping firearm owners to understand the importance of locking their firearms up and helping them to find a locking method that works best with their lifestyle.”

Child Fatality Task Force leaders say that’s the point of their initiative, to reach and create a menu of options that communities can use to create local initiatives tailored to its needs. But the initiative needs that funding to get off the ground.

Swanson, the Duke physician who said he’s grown discouraged by the tenor of the political discourse on guns in the past decade, said locks and education campaigns are not the entire response to gun violence, but they could help whittle away at the death toll. 

“If that’s the only thing that ends up on this square inch of common ground where Republicans and Democrats could actually do something to make safe storage at least more common and more prevalent, I’m all for it,” Swanson said. 

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (800-273-TALK).

If you would like mental health support, referrals, or information, dial the NAMI NC HelpLine at 1 (800) 950-6264 (1-800-950-NAMI) between 10 a.m.- 6 p.m. EST, Monday through Friday.

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Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...