White men in small towns are most at risk.

When we talk about gun violence in the U.S., we usually look at homicides, at urban crime and mass shootings. But two-thirds of gun deaths in America don’t involve bad guys with guns. They’re caused by suicide, by people deliberately harming themselves. Even many pro-gun activists say that has to change.

If you or someone you know may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (en Español: 1-888-628-9454; for the deaf and hard of hearing: 1-800-799-4889) or the Crisis Text Line by texting 741-741.

One woman's story, a nation at risk

When Dorothy Paugh was nine years old, her father bought a pistol and started talking about ending his life. Her mother was terrified but didn’t know what to do. "She called our priest and called his best friend. They came and talked to him and they didn’t ask to take his gun away," Paugh said.

Her father was 51 years old. A few days later, she saw him alive for the last time.

"One morning, it was a hot August day, he said take the kids to the pool. There were five of us and she piled us in the station wagon. We had a great time until they announced over the loudspeaker that the police were there to take us to the hospital."

Six years ago, in 2012, it happened again. Paugh’s son Peter was 25. He bought a pistol, walked to a nearby park and shot himself. "It was so shattering, so catastrophic," she recalled.

"He made a 911 call to the police because he said he didn’t want any children playing in the woods or the park to come upon the gun and his body."

More than 20,000 gun-suicides in America every year

We’re hearing Dorothy Paugh’s story because this happens a lot. Using the latest data, the Centers for Disease Control found that over a single decade nearly 220,000 Americans shot themselves to death.

"As I looked into suicide more and more it became very clear that access to lethal means, specifically guns, was one of the most important risk factors that we could address," said Paul Nestadt a psychiatrist at Johns Hopkins who researches suicide with the School of Public Health.

He says the data shows that having a gun available in the home or workplace makes suicide attempts far more likely to succeed. "A firearm ends in death in a suicide attempt about 85% of the time, compared to something like poisoning which only ends in death about 2% of the time."

What the research shows

Suicide is a really impulsive act. Studies show that if you limit access to the deadliest means of self-harm, like a pistol or a shotgun, people usually won’t go looking for another way to harm themselves. Also, people who survive one suicide attempt rarely try again.

One other important finding, Nestadt says, is that people most at risk of gun suicide tend to be white men in America’s small towns.

"Since it tends to be more rural, more white, definitely more male, somewhat older that have more firearms, they also have the higher suicide rate by firearms," he noted.

Some inside gun culture are acknowledging the risk

We of all people would like to solve this problem more than anybody

People inside gun culture and the firearm industry have often downplayed these risks, arguing that guns are safe if they’re in the hands of good people. But that’s starting to change.

"It’s touched close to me," acknowledged Alan Gottlieb with one of the oldest gun rights groups in the U.S. called the Second Amendment Foundation, based in Washington state. He said one of his employees shot himself.

"We of all people would like to solve this problem more than anybody. It would surely help us in the gun debate from our side. And likewise, it would save a lot of lives."

Related stories: Suicide prevention groups and gun industry team up to curb rising violence With more than 20,000 Americans dying in gun-related suicides year after year, Gottlieb says people in gun culture are talking more about the dangers.

"Our hunter safety manual now talks about suicide prevention in it. Our concealed-weapon permits, when people get renewals in the state of Washington, there’ll be messages about suicide prevention."

The gun industry mostly favors education and voluntary risk-reduction efforts over regulation.

But Dorothy Paugh, who after her son’s death emerged as a leading gun control activist in Maryland, says pro-gun groups have shown some flexibility when it comes to government's role in suicide prevention.

She helped push through a so-called red-flag law earlier this year that allows police to temporarily confiscate guns from people at risk.

"The state NRA did not oppose what finally came out," Paugh said, "and the governor had spoken up and he’s a Republican. You know [he said] let’s get this done."

With so many firearms now in homes, it’s unclear whether modest measures like education and red flag laws will put a serious dent in a suicide rate that continues to rise, climbing dramatically in the most rural parts of the country.

Tomorrow, we'll look at some of the efforts around the country to raise awareness about the high risk of gun-related suicide, with more education programs aimed at people inside America's gun culture.