What You Can Do
After you've identified risk factors for firearm injury or death, your firearms counseling goal is to reduce that risk. The most appropriate risk reduction strategies will vary from patient to patient and will vary for the same patient as his or her circumstances change.
When firearms are in the home but there is no emergency, aim to inform the patient of the importance of firearms being stored safely. That means unloaded and locked up with a locking device, and with ammunition stored separately. Your goal for firearms counseling may evolve as you learn more about the firearms in the home and the risk factors for those present.
Starting the Firearms Conversation
You can begin the firearms conversation by saying,
“Now I want to ask you a couple of questions about firearms. Are there any firearms in or around your home?”
If the patient answers with a yes, you should probe:
“Do any of these firearms belong to you?”
"Who has access to them?”
More detail is often helpful. If there are firearms in the home, find out more by asking,
“Are all the guns and ammunition locked up in some way?”
“Are all of the firearms stored so they can’t be accessed by unauthorized users?”
Use your patient’s answers to gauge the risk of firearm injury for the patient and others in the patient’s household. If the firearms in the home are not being stored safely, explore together the appropriate actions that could be taken to reduce risk of firearm injury or death.
Recommendations to the patient can include:
- Evaluating current circumstances in the home to determine if having guns in the home is right for everyone living there or visiting at this time. Even visitors, like grandchildren, are at increased risk of firearm injury or death when they’re in a home with a gun.
- Ensuring safe storage and handling practices for all firearms in the home.
- Taking a course or training in firearm safety.
- Safely disposing of any unwanted firearms in the home.
- Using options for safe firearm storage outside of the home in your area, such as gun ranges or retailers, especially when there is imminent risk.
If a Patient is Hesitant to Discuss Firearms
As with other screening conversations, the conversation about firearms might be difficult for some patients. Be prepared to explain to your patient why you're asking the firearms questions and what you will do with the patient's answers. Be clear that you are asking in the interest of the safety of the patient and his loved ones.
If a patient is hesitant to discuss firearms with you, reassure him that the answers he gives will remain confidential unless there is an immediate emergency.
Remember to take a respectful approach, and one that is both tailored to the individual patient's risk factors and relates clearly to the patient's health and wellbeing.
Acknowledge local customs related to firearms and firearm ownership, and keep in mind that firearm ownership can be relfective of longstanding beliefs and values.
Also remember that many gun owners are knowledgeable about firearm safety and take firearm safety seriously.
After Asking the Firearms Questions
Answer your patient’s questions on firearm violence risk and risk reduction to the extent that you can, and know when and where to refer patients for additional help or information.
If no one is at extreme risk or going through a time of crisis, your counseling goal should be to inform the patient of the importance of firearms being stored unloaded and locked up with a locking device, and with ammunition stored separately.
Keep in mind the evidence that access to firearms as well as firearm ownership are associated with increased risk of violent death.1, 2 When a gun is present, risk of violent death is increased for everyone in the home.3
For more information on safe storage devices and practices, see the WYCD Resources page.
Patients in possession of unwanted firearms can dispose of them safely by giving them to law enforcement in most areas. Check with your local law enforcement agency to confirm that they accept unwanted firearms before reviewing this option with patients.
No law prohibits you from including patient information on firearms in the medical record, but you should be prepared to answer patients’ questions about what you will do with their information regarding firearms. If you think it relevant, make a note of the patient’s answers about firearm access and follow up about firearms access at the next visit.
In Extreme Risk Situations
If a patient is at acute risk of violence to self or others, it is an emergency. In these cases, for example, with patients experiencing homicidal or suicidal ideation or intent, referrals to social services or mental health services, substance abuse referrals, or lethal means counseling might be appropriate. Depending on the circumstances, you may need to contact local law enforcement or the patient’s family.
If the patient or someone in the patient’s home is in a time of crisis, you can recommend firearms be temporarily stored outside the home. Local law enforcement or a gun range or retailer might be legally able and available to store firearms temporarily, until the period of imminent risk has ended. Check to see what options exist in your area.
Some states, like California and Washington, have provisions for temporarily removing from the home the firearms of persons deemed to be at immediate risk of violence. This might include patients experiencing homicidal or suicidal ideation or intent. Find out whether a Gun Violence Restraining Order (GVRO), Extreme Risk Protection Order (ERPO), or a similar legal intervention is an option in your state by visiting the websites of the Giffords Law Center or the NRA Institute for Legislative Action.
Once you’ve introduced the topic with the patient, whether or not it was an emergency, find out what happened during the patient’s next visit. Circumstances change, and continuous evaluation of whether or not everyone in the home is safe with firearms is important for assessing risk and working to reduce risk when necessary.
Click here to continue to firearm safety basics and brief information on safe storage devices.