Mikelle Moore: Hi, I'm Mikelle Moore, senior vice president of Community Health for Intermountain Healthcare and I'm pleased to be here talking about suicide and firearms with some friends and colleagues in our community. I'd like for them to introduce themselves. Clark, let's start with you.
Clark Aposhian: Certainly. My name is Clark Aposhian. I chair the Utah Shooting Sports Council, which is essentially Utah's gun lobby.
Morissa Henn: And I'm Morissa Henn and I'm the Community Health program director at Intermountain Healthcare.
Kim Myers: Hi. And I'm Kim Myers. I oversee our suicide prevention and crisis services initiatives for the State Department of Human Services.
Mikelle Moore: Thank you for spending some time with me today. I think it's best for us to start, why are we talking about these issues together? Suicide prevention and firearm safety and you are, perhaps are unlikely friends, we may say, why are these issues related?
Clark Aposhian: The only reason that we should come together on these very divisive issues is if we're committed to reducing, if not eliminating suicide and especially by firearms.
Mikelle Moore: So let's review some of the data. What do we know about suicide in Utah in particular? Suicide overall?
Morissa Henn: Yeah. Well, here in Utah and really in the Intermountain, West as a whole, the issue of firearms and the issue of suicide are inseparable. So firearms are the leading method of suicide. 51% of suicides are by firearm here in Utah. And also, if you look at gun deaths in Utah, among all gun deaths, 85% of those are suicides. And so while that may be sort of a depressing reality, it also creates a sense of opportunity because if we can take a practical step, which is what we call lethal means reduction. What it describes as putting time and distance between someone who may have a suicidal impulse now or in the future and a lethal method like a gun, we can oftentimes save a life and ensure that that person has the opportunity to go get help and live a great healthy long life. And so it's kind of a very simple but highly evidence based strategy that we have available and that's why we've come together.
Kim Myers: And just to sort of build on that, when we look at successful initiatives for suicide prevention, one of the things that stands out is that you really need a comprehensive approach. That it takes multiple strategies occurring at sort of multiple levels of society at one time to really get a handle on this issue and start bringing down suicide rates to as Clark said, our goal of protecting people from dying by suicide. And also though within that comprehensive strategy, if you look at, is there any one strategy that has any standalone support for, that it works in and of itself? It is this idea of reducing access to lethal means. And so it's such an important part of suicide prevention generally, but also as part of a comprehensive approach which we are committed to here in Utah.
Mikelle Moore: And when you describe a comprehensive approach Kim, what other things does that include besides access to lethal means?
Kim Myers: Yeah, so one of the other core strategies that we have is that we want to shift sort of social norms around help seeking. So making it as obvious to go to a doctor when your brain tells you that people would be better off without you as it is when you break your arm. So that it's just something that, oh, you know what, I know that that is my brain telling me lies and I need to get some support for that. We also want to help people increase coping skills and life skills in order to manage the ups and downs of life that are inevitable. We also want our health care to be more, both behavioral health and physical health care to be more responsive when people come through our doors and are considering suicide or had had an attempt or other risk factors associated. And then also providing good support after a suicide death does occur, not only because people need and deserve that kind of support, but because it also helps reduce risk among suicide loss survivors.
Mikelle Moore: Thank you. Is Utah unique in kind of where we find ourselves with our suicide rate?
Morissa Henn: I mean we are very similar to our neighboring states here in the West. So Utah's suicide rate is about 20 deaths per hundred thousand people. We measure it in this sort of a funky way because it's fortunately still a relatively rare event and yet it's a leading cause of death, especially for youth. And so the rates that we see in other neighboring states, Montana, Wyoming, Idaho, New Mexico, are quite similar. And the research we have available suggest that while there's never a single cause of a high suicide rate and a single cause of an individual taking his or her own life, guns and access to guns are a major driver. And so that seems to be why we see this higher rate. I think where we are unique is in terms of this type of collaboration that we're so proud to continue and hopefully learn and grow and bring in others.
And that collaboration is really saying, as a healthcare institution like Intermountain, we bring a lot of resources and expertise, but we absolutely can't do it all. This is an issue that transcends our system. It transcends clinical facilities. And so in order to address especially this issue of access to firearms, we have to learn from and work with people most poised to make change. And folks like Kim who are fighting so hard to coordinate across state agencies and folks like Clark who are helping us understand gun owners as key messengers and helping us craft those messages, that's the only way we can do something, that we can achieve this vision of zero suicide.
Mikelle Moore: So tell me about the collaboration. What are you all working on together?
Clark Aposhian: Well, I'll tell you this, I am not a healthcare professional. I am not a clinician. I'm a gun guy. And we came into this because, hey, we are not, even the collaborative effort that we have is not out to fix suicide, not out to fix mental health even, it's to give time, to buy time, so that those folks can receive the mental health they need. But the stark reality is that firearms are extremely effective. That's good if you're a sports shooter and it's bad if you are looking to harm yourself. And so that's essentially why we do it. I mean, hey, Utah is very proud of the fact that we have a very low homicide rate, but boy, we more than make up for that in our suicide rate.
Mikelle Moore: Tell me a little bit more about that statistic because I understand that some people might see that we have a low homicide rate because we have guns in a lot of our homes and that sense of protection. How do you interpret?
Clark Aposhian: That's not necessarily consistent across the nation with that, I think it probably has more to do with culture than anything, but just the mere presence of firearms, a high firearm ownership rate, doesn't necessarily always equate with low crime. What we do know is absolutely is that we do have a lot of access to firearms here, and even more so in our rural areas and in which case that is an easy go to for someone looking to harm themselves, unfortunately, because that's an easy go to and it is so effective, you just don't get a second chance on these because they're so effective as opposed to other ways to harm yourself.
Mikelle Moore: Tell me a little bit about those statistics. I understand that gun ownership is fairly common in Utah and that it differs rural versus urban. What do we know about that?
Kim Myers: Rates of firearm ownership vary a great deal. Overall the state has 50% of households having at least one firearm, but in urban areas, it's about 35% of households having a gun. And in rural areas, it's 70% of households having at least one firearm. And so this disparity in availability of firearms is largely why, even though rural areas have lower suicide attempt rates, we see much higher rates of suicide death. It's really access to firearms that's driving that. And so the types of changes that Clark described, which are not pro-gun or anti-gun, they're just common sense much as you would take the keys away from someone who might be drinking at a bar. We're talking about temporary non-regulatory fixes that we can come together on.
Mikelle Moore: So how does that data inform your strategy or the way you're collaborating together?
Kim Myers: I mean, I think originally it informed even the process of coming together that we said this is something that we can't tackle only from a mental health side. I think historically people have seen suicide prevention as largely an issue to be solved within the confines of mental health. And we know that that's just not working. And so bringing the data and looking at things like people having a relationship crisis and easy access to a gun tells us things like, okay, we need to collaborate on, when people are going through relationship breakups, let's train and educate community members to reach out to those individuals and talk about temporary offsite storage. So it really drives kind of how we're creating buying and the strategies we're doing.
And I think just to build on sort of what Clark said about the strategies is, one of the easy places of common ground is that people who are really involved in sort of gun culture also have a very important sense of safety. Safety is a part of their culture. And so building off that to say, well, when you're doing firearm safety training courses, like even tactical or conceal carry permit or whatever, let's embed suicide prevention training into that. So people are starting to get that where they're going for their information on firearm safety and make it just one of the regular tenets of firearm safety, of which there are many. And Clark and speak to those at link, but saying suicide prevention is one of them, temporary offsite storage, reaching out to your friends who are struggling all becomes sort of embedded in these tenets of safety that exists already within the firearm community.
Mikelle Moore: How does that feel to you Clark?
Clark Aposhian: Absolutely. And what Kim has said is so correct in that the firearm safety shouldn't just be about accidental discharge of a firearm and controlling the muzzle direction and making sure your finger is off the trigger and appropriate storage. But the NRA and the National Shooting Sports Foundation have embedded in their training a very short and often overlooked by instructors message that says you shouldn't handle firearms when you're drunk or shouldn't have handle firearms when you're in cases of extreme emotion. And the instructors that are teaching that have up to now glossed over it and said, well, if you're really angry, don't get a gun. But the whole thing about firearm safety is to reduce accidents and injuries and deaths. And they're always thinking about it, well, you want to make sure it's pointed in the right direction, but no, it can go so much farther, especially here in Utah, when we're reducing the means, effective means to harm yourself.
Mikelle Moore: So I'm curious Clark, when does this conversation go a fallow? When do the different perspectives get in the way? Create an emotional response on one side or the other, what are the things that make this work together hard?
Clark Aposhian: It can be divisive. And I will admit, six years ago when we all sat around the table and we were rather forced to collaborate via some legislation by representative [Steve Elson 00:12:21]. At least I know on my part, I looked very distrusting across the table to the other folks, the mental health professionals and these folks, because we have, I think gun owners have been a little gun shy, if you will, a little defensive. And when we are told that, well, this is for your own safety and we're going to take your guns and that. And that's kind of what I thought. This was just another chapter in the same book. And I am happy to report that that is not it. We were welcome to the table. Our insight was accepted and utilized in everything from PSAs to the gun lock program, to the pamphlets, to the message that was out there.
Mikelle Moore: So I'm curious, how does that then influence the way we need to think about this? Morissa, you are taking the lead on suicide prevention within Intermountain Healthcare. And just like any large organization, we have gun owners, we have people who are very concerned about suicide prevention and maybe some of those are the same people. What are the things we need to be careful of to create an environment of helping people feel welcome at the table and not create the same divisiveness or put people on the defensive as you've described, Clark.
Clark Aposhian: An understanding that the data doesn't take sides, the numbers and the suicide rate here in Utah with firearms isn't pro-gun, it's not anti-gun, it's just the sad fact, the sad reality. And Morissa has really, really come a long way and has Kim, and I'm going to mention Cathy Barbara with Harvard, have come a long way in bridging the gaps and the divisiveness that is so common.
Morissa Henn: Yeah, I mean I think one of the things I've learned from this effort is just that it requires humility on all sides and an ability to listen. It's a special kind of listening. I would say, when Clark and Kim and I are sitting around a table discussing an issue, we don't agree on everything. We don't come close to agreeing on everything. And in fact there are some areas related to gun issues and suicide for which we disagree vehemently, but we practice a style of big picture listening where we're always searching for those nuggets of common ground. Like Kim said, where values align. So, for example, the notion of friends helping friends, of wanting to protect our families, those are common goals, those are common values.
And so by finding the areas of agreement, we can then advance our common goal, which is that no person in suicidal crisis should have access to a gun. That's how we define the goal. And then we can look for avenues and opportunities. But it definitely requires humility. And I as someone who hadn't spent a lot of time around guns, had to get educated and Clark really helped me understand both the sort of philosophical role that guns play in our fabric of culture and life here in the West. But also even practical things like what part of the gun is the firing pin or the slide or how does the ammunition work? Because if we're going to be effective as health professionals, we have to have some basic knowledge of what we're actually talking about.
Kim Myers: And I'll just piggyback on that. One other comment is, I think one thing that we can all ask ourselves when we're around a table and we might be disagreeing on something and sort of questioning, if we're ever questioning the partnership or how to move forward. I think the question is where we agree, in our common ground do we believe that this is saving lives? And I think all of us say the answer is yes. And so we stay there and we be uncomfortable sometimes, but we move through and find those shared strategies and that sort of common place of alignment.
Mikelle Moore: That's really inspirational. I think particularly when we think about the number of issues that are divisive in our communities right now. What are your hopes for what you might accomplish together in the near future or maybe the long term?
Clark Aposhian: I'll tell you my hope. My hope is that controlling lethal means access, we're talking about firearms is so common place that it's not a thing anymore. It's like putting your seat belt on. It's like taking the keys from a drunk driver. It's ethically appropriate. It's just appropriate. It's just something we do. It's not awkward anymore. It's expected. I really hope that it's that common place to say, Hey, you're not doing so well. You're going through a breakup, a job change. You've got some health problems, you're human. Let me baby sit your gun for a week. Is that okay?
Kim Myers: And I think what that does beyond just the access to the firearm, which is so critically important, but what those conversations do is they increase people feeling cared for, they increase people feeling connected to each other. They decrease feelings of isolation or that people don't care. And so that is the heart of suicide prevention more broadly. So not only are we actually doing that meaningful action, but we are shifting how we connect to each other. And that I think is the goal outside of the goal.
Morissa Henn: No, I think beautifully said. And I think as health professionals, as caregivers, my hope is that we can take some of these lessons and apply them to other areas of wellbeing where we don't see people who are struggling as simply beneficiaries or members or patients, but we take it to that next level that our mission compels us to do and say, how can we learn from other's experiences and incorporate their voices as agents of change in these new social norms? So I think there's a lot of opportunity, whether the issue is opioids or high blood pressure or antipoverty, how can we engage the people who these efforts intend to serve as active participants in the creation of what we're doing.
Mikelle Moore: I like that. Thank you so much for your time. Is there anything you want to add that we didn't cover, that you feel like didn't get said?
Kim Myers: I just think that a lesson for me that I've taken away from this is like, it's very easy to feel defeated by both the problem of suicide and also broadly the sort of state of civil discourse. And it's efforts like these that challenge that, that makes me ultimately hopeful that not only are we going to be successful in reducing suicide in extremely meaningful ways, but that as a community we will come together on hard issues and reach out to each other and support each other and be healthier, more connected communities.
Clark Aposhian: It could be a template the way that we're doing it here with our collaboration across the nation and not just in suicide, but we're talking about suicide here in that it's an avenue to get to those people who really need it. It doesn't do any good to talk to other clinicians, to other mental health professionals, if the message isn't getting out, you may have a fantastic message, but if it's not being heard by those that need to, now I have sensed a great deal of, how shall I say, relief on the part of gun owners because it's been the elephant in the room for so long, but no one wanted to talk about it. And until it was made okay by groups like ours to talk about it, to accept it, to identify it because gun owners have experienced tragedy in their lives with firearms. Yet nobody wanted to talk about the role the firearms played in it and the access to it. And I think that this could be a template across the nation, not just here in Utah.
Mikelle Moore: So this conversation has probably prompted people to think what action can they take to make a difference in suicide prevention? What guidance would you offer?
Morissa Henn: So one of the key things we encourage caregivers, both Intermountain caregivers as well as any in the community, is to take the counseling on access to lethal means course. It's an online course, CALM Utah for short. And it equips clinicians with the right language and skills and background to have a productive conversation to help advance this lethal means reduction strategy. So you can go to train.org/utah and search CALM.
Clark Aposhian: Also they can go to utahsuicideprevention.org, utahsuicideprevention.org and I think there'll be a link there. They can get free gun locks, they can get pamphlets, they can get access to PSAs and other videos.
Great. Good resource.
Kim Myers: And on that same website people can request access to training. So for wanting to know how to identify and respond to somebody who might be experiencing a crisis. And then anytime of day, 24 hours a day, seven days a week, people can reach out to the national suicide prevention lifeline at 1-800-273-TALK(273-8255).
Mikelle Moore: Great, thank you. Well said. Thank you so much for being here today. I really appreciate the common ground you all have found. You inspire it elsewhere and I think you will be a template for many of us as we think about the complex issues we need to improve to improve health. So thank you.
Clark Aposhian: Thank you.
Morissa Henn: Thank you.
Kim Myers: Thank you, Mikelle.