Gun suicides hit a record for the fifth year running — and the fix that works does not require predicting who is at risk

If you or someone you know is in crisis, call or text 988, the Suicide & Crisis Lifeline. It is free, confidential and open 24 hours a day.

Paul Nestadt runs the suicide prevention center at Johns Hopkins, treats suicidal patients and has co-authored scores of papers on why people kill themselves. He will still tell you, flatly: "I can't tell you which of my patients is likely to die by suicide in the next six months."

That admission, in a KFF Health News investigation published this week, is the most useful sentence in American mental health right now. If the experts cannot pick out who is at risk, then a prevention plan that depends on picking them out will keep missing people. And the numbers say it is missing a lot of them.

Why "find the person at risk" keeps failing

Most suicide prevention in the U.S. is built like a screening program: spot the warning signs, get the person to therapy or medication, and hope the net catches them. That net matters, and it saves lives. But the people most likely to die by gun suicide are often the least likely to be in it.

Research cited by KFF shows that people who die by gun suicide were less likely to have sought mental health care beforehand, and that most veterans and service members who die this way never tell anyone about their suicidal thoughts in the months before. "The people most vulnerable to firearm suicide usually aren't identified as such by family members or clinicians," said Michael Anestis, who directs the New Jersey Gun Violence Research Center.

Dorothy Paugh lost her father to a gun suicide in 1965 and her 25-year-old son, Peter, in 2012. She helped pass Maryland's red flag law and believes it saves lives. But she is honest about its limits: "It wouldn't have saved my son." Nobody saw a warning sign.

The seat-belt approach

Nestadt's alternative borrows from road safety. We did not cut car deaths by testing every driver's reflexes; we added speed limits, seat belts and air bags that protect everyone. For suicide, the equivalent is "lethal means safety" — making the deadliest methods slower and harder to reach, for everybody.

The logic rests on two findings. First, suicidal crises can be brief: people can spend less than an hour, sometimes five minutes, between deciding and acting. Anything that adds delay — a locked safe, a gun stored at a friend's house — buys time for the urge to pass or for someone to step in. Second, blocking one method does not usually push people to another. Bridge barriers and smaller pill packages work for the same reason.

The policy evidence points the same way. A permit-to-purchase law in Connecticut was associated with a roughly 15% drop in gun suicide rates; Missouri's repeal of its law was linked to a 16% increase. About three dozen states require guns to be locked up in homes where children live, which has been shown to reduce youth suicides.

Where the politics stand

Gun owners and the firearms industry generally oppose permits and waiting periods and favor education instead. The National Shooting Sports Foundation has partnered with the American Foundation for Suicide Prevention on materials for gun shops. The NRA told KFF that policy should focus on "the underlying causes, not on political efforts to restrict the rights of law-abiding Americans."

At the federal level, the administration has rolled back dozens of firearms regulations and rescinded a previous surgeon general's advisory that called gun violence a public health crisis. The White House pointed instead to $52.5 million in grants for veteran suicide prevention.

Here is the part both sides can live with, and some communities already do: gun shops, public health departments and even libraries handing out free locks, and lists of places that will hold someone's guns temporarily during a crisis. No new law required.

What to actually do

Save 988 in your phone, and in the phone of anyone you worry about. You can call or text for yourself or for someone else. Our 988 crisis line guide explains what happens when you call, what it costs (nothing) and when a mobile crisis team may come instead of police.

If there is a gun at home and someone is struggling, add distance. Store it locked and unloaded, with ammunition kept separately, and consider asking a trusted friend or relative to hold it for a while. Many police departments hand out free cable locks, and some gun shops and ranges offer temporary storage — call ahead and ask. This is a family safety decision, not a confession.

Do the same with medications. Keep only what you need at home and dispose of leftovers at a pharmacy take-back kiosk. Ask the prescriber or pharmacist whether smaller fills make sense — that is their call, not ours.

Use the mental health coverage you are paying for. Under federal parity rules, most plans cannot make therapy harder to get than a visit for a physical condition. If your plan's network is a list of therapists who never call back, our mental health parity guide shows how to push back, and sliding-scale therapy is an option if you are uninsured.

Someone in America dies by suicide every 11 minutes. We are not going to predict our way out of that number. A lock, a friend's closet and a three-digit phone number do not require anyone to see the future — they just require someone to act before the worst five minutes of a person's life.