Ralph Demicco feels as if he has watched the 53-minute surveillance video 100 times, searching it for clues to preventing tragedy. He sees a young man walk into his gun shop in Hooksett, N.H. The man asks about buying a handgun. “He engaged the clerk in small talk, totally disarmed the clerk,” Demicco says. “No way in heck that clerk would suspect that three quarters of an hour after the conversation that person would take his life.”

And yet the 24-year-old man did kill himself, pulling the trigger soon after leaving the boxy beige building. Nor was he the only customer who did so. In one awful week in 2009, he and two other people came into the shop, which Demicco no longer owns, bought guns and used the purchases shortly thereafter to kill themselves.

The experience shook Demicco and prompted him to help found a movement that links members of the firearm community with public health experts to prevent suicides by raising awareness about gun safety, among other things. Its leaders are realists who accept that very strict, European-style gun control is not politically feasible in the U.S. and would, in any case, be a nonstarter for most gun sellers, who oppose such control. But they also know that households that keep guns and ammunition in separate, locked locations and store their guns unloaded have much lower risks of accidental or intentional deaths from firearms. In addition, as a further safety measure, the group seeks to make it socially acceptable for relatives and friends to offer to hold on to a potentially suicidal gun owner's weapons until the crisis has passed.

The public safety campaign is admittedly modest so far, consisting mainly of distributing posters and brochures about suicide to gun shops. Still, its start in a state whose motto is “Live Free or Die” shows that the long-standing political stalemate over gun-control laws need not prevent progress from being made.

Evidence-based approach

The gun safety coalition is motivated by data as well as by the distressing stories of gun shop owners. In the case of guns, the impulsive nature of many suicides, combined with the lethal efficiency of firearms, creates an exceptionally deadly pattern.

Several studies now confirm that suicide is often a decision made suddenly. If the moment somehow passes safely, the evidence suggests, lives can be saved in the short and long term.

“There's a fair amount of research showing that the suicide crisis is time-limited,” says John Mann, a professor of translational neuroscience at Columbia University who studies suicide. Two thirds of those who survived a suicide attempt, according to one 1991 study, had started planning their course of action less than an hour beforehand. Another study notes that almost half of the 82 people who attempted suicide said they had started thinking about their current attempt less than 10 minutes earlier. Moreover, in the case of guns especially, an investigation by the New Hampshire medical examiner's office showed that nearly one in 10 suicides by firearm from 2007 to 2009 involved a weapon that was purchased or rented the preceding week—often within just a few hours.

National data speak to the other half of this deadly combination. Although guns are not the most popular way that people try to take their life (this dubious distinction belongs to pills), they are the most deadly. Statistics show that 85 percent of attempts with a gun are fatal, compared with 69 percent for hanging and 2 percent for self-poisoning. Mass shootings and murders dominate the news, but 21,334—or nearly two thirds—of the 33,599 gun deaths that occurred in the U.S. in 2014 were suicides. Another 10,945 were homicides.

Guns, then, take what is often an ambivalent decision and turn it into an irrevocable one.

Won't people who are stopped from killing themselves today just find another way to complete the act later? Some number will, unfortunately. Yet most who survive do not keep trying until they succeed. Instead, studies show, the majority of survivors die a natural death many years after failing to kill themselves. The period of greatest vulnerability seems to be in the first year after an attempt, a time when treatment for those who try to end their life is critically important, experts say.

Perhaps the best evidence for the strength of this survival instinct stems from pioneering research carried out by Richard Seiden in the 1970s. Then a clinical psychologist at the University of California, Berkeley, Seiden found that more than 90 percent of the 515 people who were prevented from jumping off the Golden Gate Bridge between the year it opened in 1937 and 1971 eventually lived long enough to die of nonviolent causes. Indeed, Seiden's work spurred such a surge of scientific inquiry by other investigators who reached the same conclusion that state authorities finally agreed to install antisuicide netting underneath the famous span. Construction on the barrier has begun and is scheduled to finish sometime in 2021.

Lifesaving restrictions

Figuring out ways to limit access to particularly lethal methods of committing suicide—whether they are bridges or guns—makes sense from a public health point of view. Yet it also made sense to Demicco and a few other gun shop owners in New Hampshire, who agreed to collaborate with mental health practitioners and researchers after that devastating rash of suicides in 2009. When a public health researcher expressed surprise at the positive response from the firearm community, “a firearm instructor said, ‘I could be insulted by that,’” says Elaine Frank, who directs the Counseling on Access to Lethal Means project at Children's Hospital at Dartmouth-Hitchcock and is co-chair of the New Hampshire Firearm Safety Coalition. “'Why do you think the firearm community would be less interested in preventing suicide than you would be?'” In 2011 the group sent posters and brochures to New Hampshire's 65 retail gun shops. The goal was to encourage customers to become alert to signs of crisis in friends or household members and to make firearms inaccessible until the crisis had passed.

“Concerned about a family member or friend?” one poster asks. “Suicides in NH far outnumber homicides.” In the photograph, one gray-haired man rests his hand on the shoulder of another. A handgun lies on the kitchen table between them. “Hold on to their guns,” the poster continues. “Putting time and distance between a suicidal person and a gun may save a life.”

The leaders of the New Hampshire effort did not expect their social-marketing campaign to have a significant effect on the number of suicides right away—and it did not. But 48 percent of the gun shops throughout the state still had the handouts and other materials available for customers after the first year, according to a study published in 2015 in the journal Suicide and Life-Threatening Behavior. “That's actually a pretty incredible uptake, especially for a topic like suicide,” says Catherine Barber of the Harvard Injury Control Research Center, who is a co-author of the study, along with her colleague Mary Vriniotis, Frank, Demicco and the rest of the New Hampshire Firearm Safety Coalition. “Glancing at one poster isn't going to do the trick,” Barber says. “That's like one time seeing a poster about designated drivers. But hopefully it's lighting a match.”

Since the New Hampshire project's inception, the model has been adopted or adapted in more than a dozen states, each of which must tailor the concept to its political and legal realities. In Massachusetts, for example, only someone licensed to possess firearms could legally take a weapon for safekeeping, but attaching a trigger lock and giving the key to a trusted friend or relative would accomplish the same purpose.

Utah, which at 21 deaths per 100,000 people has one of the highest rates of suicide in the U.S., is training staff at hospitals and doctors' offices to screen patients for suicide risk and to intervene appropriately. Clark Aposhian, head of the influential Utah Shooting Sports Council, says his group is developing public service announcements aimed at encouraging friends and family of struggling loved ones to get some distance from firearms. “Go over to their house, kind of like a mini intervention at the door,” Aposhian suggests. “Put your arm around them and say, 'Let me babysit your guns for a while.'”

It is still too early to know what impact these efforts have had in Utah or elsewhere. But research indicates that Aposhian, Demicco and fellow gun enthusiasts are taking the right steps. Perhaps, as is true of the movement that formed around the slogan “Friends don't let friends drive drunk,” championing the safeguarding of guns as a way to reduce suicides will pick up steam in the years ahead.