Firearm Storage Maps: A Pragmatic Approach to Reduce Firearm Suicide During Times of RiskFREE

Clinicians are increasingly recognizing the utility of clinical screening, informed patient conversations, and counseling about safe firearm storage to reduce firearm injury and death (1). But preventing firearm-related injury and death requires pragmatic, community-based solutions to promote safer storage of firearms during periods of risk. Is it feasible to act locally to improve the safety of our patients? Is it practical, and will it work? Here, we describe our experience to date with a pragmatic effort in our community.

Temporary, voluntary storage of firearms outside the home is recommended for persons at risk for suicide (2) because firearm access increases the likelihood of a fatal suicide attempt and firearms are responsible for half of all suicide deaths in the United States (3). Because suicide rates are increasing (4)—and 60% of firearm-related deaths are suicides (3)—outreach to firearm owners about suicide prevention has increased. This has included “gun shop projects” (partnerships between public health professionals and firearm retailers) for development and dissemination of education about suicide warning signs and the rationale for reducing access to lethal means during times of risk (5).

How to facilitate out-of-home storage for persons at risk is an important question. Prior work found that 47.6% of firearm retailers and 74.8% of law enforcement agencies (LEAs) in the Mountain West region offered temporary, voluntary storage, and many retailers (49.8%) and LEAs (64.6%) reported having received storage requests in the past year (6). Yet, no published information existed on specific locations for firearm storage, which could pose a real-time barrier for individuals and families seeking options.

So, to support lethal means safety efforts in Colorado, we developed an online resource for the public and for clinicians who counsel at-risk patients. The statewide map displays firearm retailers and LEAs willing to consider requests for voluntary, temporary gun storage. This work was completed with input from the Colorado Firearm Safety Coalition, an organization made up of clinicians, public health researchers, and gun shop owners focused on suicide prevention and gun safety.

In total, 46 retailers (45 firearm retailers and 1 safe deposit box company) and 15 LEAs agreed to be listed on the map (Figure). Once the map was built, we disseminated our resource to targeted Colorado stakeholders, including medical and behavioral health providers, hospital groups, the crisis system, professional organizations, and the population at large (through media outreach). We specifically sought opportunities to disseminate the information through trusted messengers within the firearms community (7). Since the map's release (8), additional firearm retailers (n = 3) and LEAs (n = 2) have asked to be added.

This map is an example of a novel tool to support lethal means safety approaches for suicide prevention, and it was built through collaboration with firearms retailers and LEAs. To the best of our knowledge, it is the first resource of its kind in the nation that specifically lists options for voluntary, temporary gun storage. Ongoing evaluation of the map's effects is needed, but—with adequate dissemination—it could help translate safe storage counseling into action. It may also be useful in other scenarios when individuals might want to store firearms away from home, such as home rental, visitors, or extended travel.

The project highlighted several unaddressed concerns that warrant further attention from scholars and practitioners. Some firearm retailers and LEAs who supported the goal of suicide prevention declined participation because of perceived legal liability of offering gun storage to at-risk persons—an understandable position given the lack of clarity surrounding temporary transfer of firearms at a state and national level (9, 10). Standardized guidance or waivers might be useful in encouraging retailers to offer storage; issues to address include storage costs and deadline for pickup, whether background checks are required at pickup, and release of liability for damage during storage. A more difficult, yet critically important, issue is liability after the firearm is returned (for example, if the owner subsequently uses it in a suicide attempt). Likewise, the psychological toll on retailers and LEAs if they were to return a firearm that was then used in a suicide attempt is unknown. Even as these issues persist, it is encouraging that a substantial number of private businesses and LEAs believed that the existing legal framework was not so burdensome that it prevented participation.

Our experience provides proof of concept that developing a statewide map of locations that may offer temporary, voluntary firearm storage is feasible. The map was released in August 2019, so data about changing frequencies or patterns of gun storage requests are not yet available, although future evaluation is planned. However, since the map was released, physicians, public health practitioners, and firearm retailers from 11 states have expressed interest in creating similar resources in other regions. We are sharing guidance and lessons learned from our effort, as well as step-by-step instructions on how to build a similar map. Stakeholders from the medical, public health, and gun-owning communities have the potential to advance suicide prevention initiatives through innovative safe storage programs. We hope that our experience encourages others to champion creative and pragmatic efforts to eliminate firearm-related injury and death.