ST. LOUIS — Joe Gilbert remembers Kurt Dudenhoeffer coming into the gun shop he manages in Columbia, Missouri, last winter. He carried posters and brochures about suicide, wallet cards and magnets with hotline numbers to call.

Dudenhoeffer promised Gilbert that he wasn’t anti-gun, just interested in saving lives.

He pulled out a brochure containing the 10 rules of safe gun handling — guidelines promulgated by the National Shooting Sports Foundation (NSSF) — but the “10” was crossed out.

“I work for a nonprofit,” Dudenhoeffer, 57, of Jefferson City, told him. “Part of my grant is to place this material in gun shops that talks about the 10 commandments of gun safety, and we also want to add an 11th ...”

The 10 rules are designed to prevent accidental gun deaths, but the 11th could save hundreds more lives: Consider temporary off-site storage if you or a family member may be suicidal or going through a tough time.

Amid a nationwide push by grassroots organizations to limit access to guns, Gilbert was skeptical. He told Dudenhoeffer he would have to do some research on his own before putting materials in his store.

He went home and looked up Safer Homes Collaborative, the nonprofit Dudenhoeffer represented. He found nothing about lobbying, legislating or protesting.

“It’s just about reducing access to lethal means when a person is at risk,” Gilbert said, “and that is something I agreed with wholeheartedly.”

The Safer Homes Collaborative is an initiative led by the Missouri Institute of Mental Health at the University of Missouri-St. Louis. It launched in the summer of 2018 with a three-year $867,000 grant from the Missouri Foundation for Health.

Since then, five part-time field coordinators have visited hundreds of gun shops, pawn shops and firearms training facilities across the state to enlist partners in the effort to prevent suicide.

The coordinators are tasked with convincing retailers to display educational materials, provide temporary storage of firearms and further complete a one-hour training to identify signs a customer might be suicidal and delay the sale of a gun or encourage safe storage.

Similar programs have spread across Missouri and at least 20 other states after Harvard University’s injury research center’s Means Matter campaign joined with gun retailers in New Hampshire about 10 years ago.

Preventing suicide often tries to address the “why” someone wants to die, but these efforts focus on the critical “how.”

Six of every 10 suicides in Missouri involve a firearm, data shows. More people attempt suicide using other means, but they often survive. Using a firearm is fatal 85-90% of the time.

Research also shows that while someone can think about suicide for a long period of time, they decide to act in a brief and vulnerable moment, most in less than an hour.

“If we’ve learned anything from suicide research is that having a gun in the home when you’re dealing with a suicide crisis is probably one of the biggest risk factors for a fatality that you can come up with,” said Dr. Bart Andrews with Behavioral Health Response, which provides mental health crisis services in the St. Louis region. “The data is overwhelming. Guns don’t make people suicidal, but people who are suicidal who have access to firearms are a lot more likely to end up dead than people who are suicidal who don’t have access to firearms.”

Debates over access to guns are driven by reports of mass shootings and street violence, but most gun deaths in the U.S. — nearly two-thirds — are suicides. Last year in Missouri, there were 726 suicides and 557 homicides involving firearms.

Firearm-related suicide is a leading cause of death and on the rise in Missouri, which has the 13th highest suicide rate in the nation. Over the past decade, suicides have increased by 53.5%, according to state data released last month.

More than a dozen studies show that access to firearms triples one’s risk of death by suicide, not just for the gun owner but for everyone in the household.

A recent children’s health report shows that in the past three years in Missouri, the suicide rate among teens ages 15 to 19 increased 54% — from 9.7 to 14.9 deaths per 100,000, much higher than the nationwide average of 10.5.

The Safer Homes Collaborative aims to partner with gun owners in reducing access to lethal means during times of risk. Field coordinators are even required to be gun owners themselves.

But with gun safety regulations heating up as a major 2020 presidential campaign issue, coordinators say some people respond to their efforts with suspicion.

“The perception is that this is gun control,” said Katie Ellison, the collaborative’s director. “Another challenge falls under the fear and stigma categories. They say, ‘I’m here to sell a firearm, I’m not a mental health professional. This is not my expertise.’”

Gilbert is an exception.

He not only put the materials in his store, he became a board member. He is one of the few shop owners who took the training on how to spot suicidal customers, and even became a trainer himself so he could teach others.

“I have the ear of a lot of people,” Gilbert said, “and I thought I could be impactful.”

Resistance

Linda Fehrmann, 71, of Cottleville, didn’t know her son had a gun. He told friends he got it from someone he worked with, she said. The day after a Valentine’s Day breakup, he bought bullets at a Walmart.

Ten days later, Joel Fehrmann, 23, shot himself at his mobile home in O’Fallon, Missouri.

“He had all the classic signs,” his mom said, including being agitated and missing work. “No one knew to talk to him about it. No one knew to be concerned about the gun he had.”

Since her son died over 19 years ago, Fehrmann’s mission has been to educate others. She is now president of the Eastern Missouri Chapter of the American Foundation for Suicide Prevention.

Almost three years ago, the foundation partnered with the NSSF, the trade association for the firearms industry.

With both sides promising to leave politics at the door, they developed educational materials and a website to help retailers understand suicide and encourage firearms storage options.

Fehrmann and other volunteers now visit gun retailers with the materials and set up booths as gun shows in addition to lobbying for better mental health care and giving talks to schools and other groups.

Just like the Safer Homes field coordinators, the response she gets has been mixed. Most say they are willing to take materials but not learn more through the foundation’s “Talk Saves Lives” training.

Sheila Hatcher, 40, from House Springs, has visited about 125 shops and facilities from south St. Louis to as far south as Ste. Genevieve as a field coordinator. The former St. Louis police officer says the owner at her first stop had two close relatives die by suicide.

“He was the first, but really the only one that has been open to what I have to say,” Hatcher said.

She helped staff a booth at a gun show in St. Charles and not one person stopped, she said, even though they were raffling a gun safe, which cost about $200.

Bill Mays, another field coordinator covering areas north and west of St. Louis, is a certified concealed carry instructor for the National Rifle Association and still gets pushback. As a “gun guy” himself, he understands.

“We think you are trying to do something with our guns,” Mays said. “And if you give an inch ...”

They find that some shops and police departments are willing to store guns temporarily, while others will only do so if the gun owner is the one turning in the gun. Some fear being held liable if something bad were to happen after returning the gun. Others just offer gun locks.

Gilbert says it’s ironic that other gun retailers fear the program as infringement. He feels the program actually helps protect gun rights.

“By doing this, we are keeping government out of it and having friends and family take care of you,” he said, “rather than having the government say, ‘This is an epidemic, and we need to pass legislation.’”

About two or three times a month, he said, customers come in the store appearing distraught. Employees ask if they are upset or afraid, why they want a gun, if they need help, Gilbert said. If a person shows warning signs, like giving vague answers or just wanting any type of gun, employees are usually able to convince them to delay the purchase.

“It’s an uncomfortable subject,” Gilbert said, “but when you reach out to people and you are genuinely empathetic … they will talk to you. When someone looks like they are having a rough day or are not well, you can tell. And people are just open to taking the information. You’d be surprised how receptive people are.”

Andrews says having the help of gun retailers is incredibly important.

“Imagine, if you are a gun owner in rural Missouri, and a Ph.D. from the university comes to you and says, ‘You need to get the guns out of your house, because it’s unsafe for you,’ versus your buddy from the shooting range saying, ‘You know, really, while you’re dealing with this crisis, it’s probably better if you have the gun out of the house,’” Andrews said. “We are much better to find partners and collaborate with people in the gun culture. They should be our best friends in this process.”

Buying time

The biggest myth when it comes to efforts to prevent suicide prevention, Andrews said, is that if people want to kill themselves, they will find a way.

But research has shown that restricting access to the means of self-harm — such as putting Tylenol pills in blister packages of six and or adding barriers on bridges to constrain would-be jumpers — helps prevent suicides.

“Means safety efforts really strike at the heart of that myth,” Andrews said. “The truth is that when we reduce access to lethal means, we save lives.”

People will also not keep trying until they die. Long-term studies have found that 90% of people who survive a suicide attempt will not go on to die by suicide. “If you can get people through that tough spot,” Andrews said, “they’re going to live.”

Anything that puts time and distance between the person and lethal means is helpful, advocates say. State laws requiring gun permits with background checks and waiting periods before purchasing a gun, as well as locking guns when not in use, have been associated with lower suicide rates.

“The goal is we want to buy time,” Andrews said. “Means safety is really about saying, ‘Hey, this risk is real. You’re really struggling. These thoughts are real. Let’s make your environment a little safer and buy us some time.’”

Emergency department physicians at Barnes-Jewish Hospital recently made counseling about access to lethal means an important part of caring for their patients with thoughts of suicide — which amount to about 1,300 patients in 18 months.

In a 2015 research project, Dr. Kristin Mueller and a resident discovered that providers asked only 3% of suicidal patients that came through their doors about access to lethal means.

“It was a wake-up call that we should be doing better,” Mueller said. “We hadn’t done this very vital risk assessment. It is a vital piece of suicide prevention planning.”

She garnered funding to train hospital staff how to assess suicide risk and come up with a plan for storing the lethal means, whether using a lock or safe, or storing guns or medications outside the home. The counseling began in January 2018 and includes follow-up calls a few days after discharge to see if patients are following the plan. Because of the difficulty of getting a quick appointment with a mental health provider, the hospital created a partnership with therapists at Provident to reach out to patients still feeling suicidal.

The hospital will study if more patients are being asked about lethal means, and if it’s making a difference, Mueller said. “The more we talk about it, the more normal it becomes, and that is how we are going to move the needle on this.”

Ellison, the Safer Homes director, said since most gun shop owners have not participated in the training to help identify and talk to someone who may be suicidal, the collaborative is looking to provide versions of the training to other groups such as mental health professionals, veterans, first responders, unemployment workers or divorce attorneys. Training sessions have been held at a public library in western Missouri, for staff at a school in Columbia and for 50 counselors and social workers in St. Louis.

“If you are a neighbor, have family or if you go to school or go to work, you will come across someone with thoughts of suicide,” Ellison said.

Fehrmann said the night before her son died, she learned he dressed up in a white shirt and tie and went next door to a friend’s house.“Don’t I look great?” he told the neighbor. “I’m going out in style.”

He came home and told his roommate there would be a surprise for him in the morning. He shot himself at 6:40 a.m. in his room.

“Most will give us these clues, these invitations they are thinking about it,” Fehrmann said. “That’s why it’s so important to educate people.”

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