June 11, 2021
As gun death rates rise in Whatcom, Skagit and San Juan counties, state refocuses to public health approach
Kenneth Duncan

Never mix alcohol or drugs with firearms, advises Step 15 of a wikiHow article on firearm safety. A rise in the number of suicides involving firearms is moving policy and law makers toward a public health emphasis for prevention. (Image from “How to Handle a Firearm Safely,” Creative Commons license)

June 11, 2021
As gun death rates rise in Whatcom, Skagit and San Juan counties, state refocuses to public health approach
Kenneth Duncan

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The toll of gun deaths within Whatcom, Skagit and San Juan counties has grown over the past several years, outpacing statewide trends. The conventional approach towards decreasing the rate of gun death has focused on legal tactics, but state policy and law makers recently shifted toward public health-focused solutions that could be more effective.

From the beginning of 2015 to the end of 2019, the three counties lost 199 lives to gun deaths, according to Centers for Disease Control and Prevention data — an increase of 41% over 2010 to 2014, and more than double Washington’s 20% statewide increase over the same time period.

By contrast, the beginning of 2010 to the end of 2014 saw a 10% increase in gun deaths over 2005 to 2009 — 3% under the statewide increase.

Compounding the public health aspect, the vast majority of gun deaths in the three counties from 2015 to 2019 resulted from intentional self-inflicted gunshot wounds.

Community-led solutions

Efforts to reduce gun death should examine the social components rather than solely treating gun death as a criminal justice issue, according to Kate Kelly, director of Washington’s newly formed Office of Firearm Safety and Violence Prevention (OFSVP).

Washington’s current framework, using conventional enforcement methods of fines, imprisonment and purchasing restrictions, doesn’t fully address the underlying causes of gun death. Successful measures to reduce gun suicide, for example, will differ from strategies around repeated gun violence. 

“Historically, on-the-ground programs are important, but they try to tackle problems in communities from a very broad standpoint,” Kelly said. “They tend to measure their success by how many individuals were enrolled in a program or by how many individuals they touched. And that is not necessarily a reflection of the success of a program, or the success of the money spent on a program.” 

The OFSVP was created by passage of Senate Bill 6288 after much debate during the 2020 state legislative session, and opened in February. It approaches gun violence as a public health issue, using community-led solutions and intervention, rather than purely as an issue for law enforcement. Its focus is on eliminating “community gun violence,” a specific term for shootings occurring in public spaces between two unrelated persons.

The public health approach considers how multiple factors can contribute to the crisis, investigating and confronting the root causes of the issue, with cooperation at the state, county and municipal levels, instead of applying legal solutions that offer short-term solutions to long-term problems.

While a 2020 study by the RAND Corporation estimates that 42% of adults in Washington state live in a household with a firearm, the actual number is unknown. Gaps in county and statewide data are due to a lack of standard information-gathering procedures, with law enforcement agencies using different data strategies from system to system. Without county-specific data, it’s also difficult to determine where gun ownership is concentrated.

“We have 275 law enforcement agencies across Washington between the sheriffs, police departments, federal law enforcement and state law enforcement,” Kelly said. “All of those law enforcement agencies collect data, but they potentially categorize it and define it in different ways. So, it’s often really hard to match that data, particularly when you’re focusing on a narrow issue like firearms, injuries and homicides.”

Suicide connection

Gun deaths are overwhelmingly connected to suicide in the state. Of the 3,812 suicides that occurred in Washington from 2015 to 2019, over 78% were caused by firearms — 18% higher than the national average.

Locally, the percentage is higher still. Of the 199 gun deaths in Whatcom, Skagit and San Juan from 2015 to 2019, 92% were a result of intentional self-inflicted gunshot wounds. Skagit County has already suffered six gun suicides in the early months of 2021, according to the Skagit County Coroner’s Office. 

Amy Dunham, Suicide Prevention Coordinator at Western Washington University, said that understanding the role that mental health plays in public health is important to suicide prevention. She said many emergency services available to those in crisis apply generic solutions to complicated issues. 

“They’re a person, they have an identity, and what each person needs is going to be a little bit different,” Dunham said. “It’s the importance of seeing this person as a person, as a whole person, rather than just a suicidal patient or a mental health patient.”

Of all suicide means — the methods of self-harm an at-risk individual has on hand — firearm suicides are most successful, at a fatality rate of around 85% according to a Harvard School of Public Health Study. 

In 2019, 26 of Whatcom’s 30 gun deaths were firearm suicides according to the county medical examiner’s annual report. Of those suicides, 21 involved a handgun versus other firearms such as rifles or shotguns. 

Suicide is often the result of long-term stressors made worse by a lack of positive coping skills and the stigmatization of mental health issues. But, according to Dunham, the lethality of firearms combined with the often impulsive decision to end one’s life means many firearm suicides are successful. Making access to a firearm just a bit more cumbersome can be enough to save a life. 

“[Researchers asked] suicide attempt survivors how long it was before they made the full choice of ‘I’m going to kill myself’ and when they took the action to do so,” she said. “50% of those people reported that it was within 10 minutes … putting distance between someone that is in a suicidal state and lethal means is our goal.” 

Upstream prevention

In Washington state, individuals who have been involuntarily committed to mental health institutions are barred from possessing firearms until the right is restored in court. However, the bar for involuntary commitment is generally high, and information about loss of gun access does not always reach local law enforcement and gun dealers.

Dunham said that the conversation around gun ownership doesn’t capture the reality of the crisis in Washington state, focusing on gun rights rather than means safety. 

“I would love to see more upstream prevention. Teaching children to be more resilient, teaching them positive coping mechanisms,” Dunham said. “I see that as being a benefit of making it a public health issue.” 

Expanding cultural and educational efforts to curb the increase of gun death are tools in the public health approach. These also include employing lockboxes within the house, expanding gun safety training and fighting cultural trends that may result in gun death. 

Self-awareness

Tyler Williamson, a Whatcom resident and former soldier, said that at-risk gun owners need to be conscious of their own condition, and take their mental well-being seriously while also employing general gun safety. 

“Keep it out of sight. Don’t play with it, don’t load it … a damaged mind is just like a wound from battle, no matter what the cause is,” Williamson said. “Wounds need to be cared for and patched up by a professional. So should your mind.”

Despite trends in gun deaths, studies show that reduction techniques show promise. A 2018 study by the American Public Health Association found that, without reducing an individual’s ability to own a gun, limiting access to guns during personal crises would reduce gun suicides. 

“If you or someone in your household is in this place of suicidality, could you have the gun at someone else’s house until they get help?” Dunham said. “Do you have locks on the gun? Could you change the locks? Could you store different parts of the gun in different places? That’s what we try to hit hard rather than who should have what.”

While assault makes up a smaller chunk of overall gun deaths than suicide, it’s still the second largest cause in Washington state, accounting for 25% of total gun deaths from 2015-19. According to Kelly, the majority of community gun violence cases involve illegally owned guns. 

“By far the most cases where we see urban gun violence it’s using either illegal guns, guns that are on the black market or being used by someone who has no legal right to own a gun, either because they’re too young or they have criminal records that prohibit them from owning a firearm,” said Kelly. 

Ownership surge

The increase in gun death has coincided with a surge in gun ownership, which exploded in the last year. A record 1.2 million firearm purchasing background checks were performed nationally in a single week from March 15 to 21, one of six weeks since June 2020 with over 1 million background checks performed.

The current system of background checks doesn’t take the condition of the buyer into account, focusing instead on an individual’s legal background rather than mental well-being, Williamson noted. 

“There’s no real way to check on someone’s mental health for any application,” he said. “It’s all based on an honesty system anyway. You could be on the verge of literally losing your ability to cope with life, but still say you’re fine.”

The University of Washington’s Office of Gun Violence Research prioritizes the need for a public health approach, echoing the effectiveness of similar programs against tobacco usage. In the same vein, OFSVP is developing an evidence-based grant program to meet the local needs of communities that suffer from gun death.

“Our goal is to make sure that how we’re measuring and implementing these programs has real outcomes and measurable outcomes,” said Kelly. “If it’s not resulting in reductions in firearm injuries and firearm homicides, then we need to rethink how we’re doing it.” 

‘Serious disconnect’ in communication

The size of Washington’s gun-owning population means tackling this issue isn’t as simple as drafting a legislative solution. A gradual approach that emphasizes the need for gun-owning responsibility means understanding gun death on a case-by-case basis while also acknowledging the systemic issues that have led to Washington’s growing numbers. 

Williamson observed that the conversation surrounding gun death is currently too polarized to make real change, with neither side willing to understand each other. 

“What’s missing from the culture is literally common sense and the ability to listen. Nobody is listening to different opinions anymore. You’re either with it, or against it plain and simple,” Williamson said. “This is a serious disconnect. We all want to do the right thing, or so we say. Yet, nobody is willing to hear what the other side has to say. We’ve got to change this mindset.” 

Public health groups such as the OFVSP contend that past efforts to reduce gun deaths haven’t been enough, and that employing creative solutions will require a reexamination of how the state interacts with guns overall as well as collaboration. 

Margy Labellen, chair of Skagit-based gun activist group Safe and Sane Skagit, said that a reduction in gun deaths requires both patience and a willingness to confront the problem from a variety of angles. 

“It’s not one big answer. We need to chip away at this for a long time,” Labellen said. “I always tell people that to grapple with gun culture, you’re in it for the long haul.”

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