Article written by Kathleen Anderson
Social workers have long been on the front lines of gun violence and play a critical role in gun violence prevention. Despite the surge in gun sales, shootings, homicides, and firearm suicides, the profession has been slow to respond, hindered by research and funding bans due to the politicization of gun issues and a myriad of competing – if intersecting – priorities. Gun violence was recently named one of the “Grand Challenges” of social work policy and practice due to this gap. The paper also reflects on the tremendous opportunity for social workers to use their unique training and experience to affect change.
Access to firearms plays a significant role in the potential misuse of firearms. One key area for social workers to make a difference is in understanding that role. When children, people in danger of hurting themselves and/or others, and those who are otherwise prohibited from having firearms have easy access to such a lethal weapon, tragedy often occurs. There are small steps and more extreme measures that can be taken to reduce access, depending on the severity of the crisis and the individual’s willingness to seek and accept help. Social workers are in a prime position to screen for access, educate clients and loved ones on risks and options, and support clients and loved ones in navigating complex systems and connecting with resources. We can only offer this support, however, when we feel equipped to have these conversations.
Gun violence in our community
Gun violence is an urgent problem affecting American communities, staggering in its scope and scale. Every day, approximately 125 people are shot and killed, with another 200 being shot and wounded. This translates to roughly 44,000 deaths and nearly 97,000 injuries each year due to gun violence (Everytown Research & Policy, 2022). Millions more live with the trauma of losing a loved one and/or witnessing a shooting. One in five of adults report losing a loved one and one in six have witnessed a shooting (KFF, 2023). Approximately three million children witness a shooting annually (Finkelhor, 2015). In surveys of the public, over half of individuals report anxiety about gun violence and one-third report limiting their participation in large events or crowds due to fear of being the victim of a mass shooting (Kottke et al., 2025).
This pervasive fear is well-founded. Gun violence shatters bodies, psyches, and lives across racial, social, geographic, and economic lines, although it is important to note that Black Americans are twelve times more likely to be victims of gun homicides than their white peers (Everytown Research & Policy, 2024). It is a leading cause of premature death and, in 2019, gun violence became the leading cause of death for children and teens nationally. While mass shootings garner the most attention and news coverage, the reality is that the majority of gun deaths happen in the home. Specifically, two-thirds of gun deaths in the United States are firearm suicides (Everytown, 2024). While white males in rural communities are often thought of as the most at-risk demographic for firearm suicide, the rates of firearm suicide are rising dramatically amongst youth (Everytown, 2024) and people of color. The presence of a gun also escalates the lethality of domestic/intimate-partner violence, community/inter-group violence, and confrontations with law-enforcement.
The question of whether there is a lethal weapon (and who is carrying it) in our homes; schools; and places of worship, consumption, and entertainment has wrecked our sense of safety and our trust in others. Gun violence has eroded our social fabric. When safe spaces no longer feel safe, the entire community suffers. In addition to the very heavy psychological, emotional, and social burdens of gun violence, there is enormous strain on our public resources, including healthcare, emergency services, blood banks, and law enforcement. Finally, the financial cost of gun violence alone is staggering: an estimated $557 billion a year (Everytown, 2022).
There is good news and bad news when we think about the epidemic of gun violence in our county. The bad news is that it is far worse in our country than those of our peer countries: we have the highest per capita rate of gun ownership in the world, with almost half of the world’s civilian-owned guns despite being less than five percent of the world’s population (Council on Foreign Affairs, 2022). We are awash in guns. The good news is that the staggering number of guns and the ease of access to them is a policy choice. We can do something about it and social workers are in a unique and privileged position to lead the charge.
Social Workers and Gun Violence
Social workers have long worked at the front lines of gun violence. Our mission of particularly serving those who are vulnerable, oppressed, and living in poverty has us already connected to and serving those at high-risk of being victims or perpetrators of gun violence. Our training also prepares us to address the most sensitive and controversial issues in our clients’ lives. Like medical workers and teachers, we have access to nearly every American in the country, regardless of race or political affiliation. Many of us are also skilled advocates for policies at the local, state, and federal levels to address complex social problems, like firearm violence.
Social workers—on the forefront of providing trauma-informed services—are also intimately involved with so many gun related tragedies. As gun violence continues to erupt on American streets and in homes, places of worship, and schools, social workers are among the first responders. We are still there, years later, supporting victims’ family members and communities. As witnesses to gun violence injuries and deaths and their aftermath, we should all be called to play a powerful role in preventing gun violence through their role in educating the public, increasing public awareness about the devastating effects of gun violence, promoting education on and screening for secure gun storage and the responsible use of firearms, conducting research on the subject, and crafting effective policies to reduce gun violence.
Unfortunately, to date and proportionate to the scale of the problem, there has been little dedicated scholarship, education, and ongoing training on gun violence prevention in practice and policy. At the practice level, very little is known about effective and equitable gun risk assessment practices and what social work practitioners might do when they identify a client at significant risk of gun violence or victimization. At the policy level, more can be done to educate social workers on interventions and policies at their disposal while also engaging their support in implementation and advocacy. The specific – and life-saving – options available along the continuum of gun access interventions illustrate this opportunity for the profession.
The Continuum of Gun Access Intervention
Many gun violence prevention organizations have identified a spectrum of options available to loved ones and helpers who are concerned about someone who is armed. Everytown for Gun Safety, the gun violence prevention research, education, advocacy, and legal parent organization, outlines the spectrum as a “Continuum of Gun Access Interventions”, or “a chain of actions that can be taken depending on the severity of the crisis and other factors, including whether the person in crisis owns firearms, how many firearms are in the home, how those firearms are stored, and how willing the person is to voluntarily reduce their own access to firearms” (Everytown, 2022). Effective gun violence (and suicide prevention, in particular) depends on natural helpers being engaged, educated on, and empowered to implement these interventions. Natural helpers are defined as those closest to the individual approaching or in crisis and include partners, family members, friends, clergy, healthcare professionals, and clinicians, including social workers. Once engaged, natural helpers can work with the individual to determine which intervention best fits the situation, partnering in keeping the individual and the community safe.
Secure storage
58 percent of guns in America are left unsecured (Anestis et al., 2022). When guns are not stored securely, they are more likely to get into the hands of someone who should not have them, namely children, those experiencing suicidal ideation or another mental health crisis, or those who are otherwise prohibited from having them. The outcomes are frequently tragic, as outlined below.
Children
4.6 million children live in a household with at least one unlocked and loaded firearm (Miller and Azrael, 2022). Many of those children report knowing exactly where that gun is stored, even when parents think it is hidden. Children also report handling the gun, many without their parents’ knowledge. Given our professional training in and knowledge of child development, it should come as no surprise that curious, impulsive children are not ready for the responsibility of staying away from guns. In fact, even those who have gone through weeklong “gun safety” training courses are still just as likely to approach a found gun as those who did not attend such a training (Hardy, 2002). Sadly, children as young as two years old are capable of pulling a trigger, often with fatal outcomes, as firearms have a very high case fatality rate. Everytown’s Not an Accident Index tracks annual cases of unintentional shootings by children. Children under the age of 12 are most at risk of accidental shootings, ages 13-15 are most at risk for firearm suicide, and ages 15+ for assault (Naik-Mathuria et al, 2023). When children access a gun, it is almost always (approximately 80%) easily accessed from a parent or relative (Barber et al, 2022). The Secret Service estimates that 76% of guns used in school shootings are accessed from the home of a relative (National Threat Assessment Center, 2019).
Suicide and other mental health crises
Access to a gun when someone is experiencing a mental health crisis can mean the difference between life and death. We know that most people who attempt suicide do not die, unless they use a gun. In fact, over 90 percent of suicide attempts with a gun result in death, while only 3-4 percent of those not involving a gun are fatal (Connor et al., 2019). Nearly two-thirds of all gun deaths in the U.S. are gun suicides: an average of 71 deaths a day (CDC, 2024). And the problem is getting worse: Over the past decade, the firearm suicide rate in the US has increased 21 percent (Everytown Resarch & Policy, 2024). This trend is of particular concern among children and teens, whose firearm suicide rate has increased 36 percent over the past 10 years (Everytown Research and Policy, 2023) and for veterans, who have a firearm suicide rate one and a half times higher than nonveteran adults (US Dept. of Veterans Affairs, 2019).
It is critical for clinicians to understand and educate clients and their loved ones that the overwhelming urge to die is often impulsive and brief – it passes. The more time and distance we can put between that overwhelming urge and a fatal means, the better. Once someone begins to attempt suicide with a gun there is little to no time for them to reconsider, be interrupted, or be found and receive medical care in time.
That second chance matters: the vast majority of people who survive a suicide attempt do not go on to die from a later attempt (Owens, 2002). The research shows that the difference between living to get help, recover, and see a better day or dying by suicide is often determined by the presence of a gun. A gun leaves no room for a second chance.
It is so important that people struggling with suicidal ideation not have easy access to guns. It is also important that Americans be aware of the prevalence of firearm suicide, how simply owning a gun increases the risk of suicide, and how they can mitigate that risk. Research shows that having access to a firearm triples one’s risk of death by suicide. This elevated risk applies not only to the gun owner but to everyone in the household and remains strong even when controlling for other factors associated with suicide, like poverty, unemployment, serious mental illness, and substance abuse (Anglemeyer, 2014). As a therapist, if I’m doing a suicide screening and someone discloses easy access, that instantly changes a workable, monitored situation into a high-risk one.
While gun violence prevention organizations focus explicitly on suicidal crises and go to great lengths to remind the public that people living with mental illness are far more likely to be victims of gun violence than perpetrators, it is worth noting that having easy access to a gun is problematic for those who have a history of angry, impulsive behavior. Studies show that one in ten Americans have such a history and own guns, with 1.5 percent regularly carrying guns outside the home (Swanson et al, 2016). These individuals are typically young or middle-aged men who self-identified as prone to losing their temper, smashing and breaking things, and getting into physical fights. Importantly, respondents had rarely been hospitalized for treatment. As these individuals are otherwise eligible to own and carry firearms, when under acute stress there is a heightened risk that confrontations, setbacks, and disputes can quickly escalate.
Otherwise prohibited/stolen gun
The majority of gun homicides and assaults involve stolen or illegal guns (Fabio et al., 2016); that is, guns that have been stolen from lawful gun owners and retained by individuals who have not submitted to a background check to carry that weapon. Each year, an estimated 200,000-500,000 guns are stolen and many are funneled into the underground market (Everytown Research & Policy, 2024). These estimates vary greatly because many stolen guns are not reported to authorities and many states decline to report as well. Increasingly, those guns are stolen from cars, often parked outside of residences. The rate of gun theft from cars has tripled in the last decade and is eighteen times worse in states that have lax gun safety laws (Szkola et al., 2024). These guns are then frequently used in other crimes.
Solutions
“The American Academy of Pediatrics (AAP) concludes that the absence of guns from homes is the most reliable and effective measure to prevent suicide, homicide, and unintentional firearm-related injuries to children and adolescents. But if there are guns in the home, AAP notes that storing guns unloaded and locked, with ammunition kept in a separate place, can mitigate the risk of child firearm injury” (Council on Injury…, 2012).
Gun owners can make their homes and communities safer by storing their guns securely. Secure storage means storing them unloaded, locked, and separate from ammunition. Studies have found that households that locked both firearms and ammunition were associated with a 78 percent lower risk of self-inflicted firearm injuries and an 85 percent lower risk of unintentional firearm injuries among children and teens (compared to those that locked neither) (Grossman, 2005). Another estimated that if half of households with children that have at least one unlocked gun switched to locking all their guns, one-third of youth gun suicides and unintentional deaths could be prevented, saving an estimated 251 lives in a single year (Monuteaux et al., 2019).
Social workers are in a privileged, trusted position to screen for safety in the home and have delicate conversations with parents and caregivers, as well as adults and their loved ones. It is vital, legal, and ethical for social workers to include screening for secure storage during the intake process across clinical settings and populations. Notice that the emphasis is on secure storage, not possession of a firearm. A simple “if there are guns in the home, how are they secured?” opens the door for dialogue and education on a sensitive topic. Most gun owners are responsible gun owners and proud to share the lengths they go to to protect themselves and their families. If there is hesitation or defensiveness, that’s an opportunity to offer education on risks and normalize it as a safety step, just like we look up chemicals for young children and use seatbelts in the car. The Be SMART initiative through Everytown offers great resources on talking to parents and caregivers about the importance of secure gun storage.
While some are reluctant to secure a gun because they believe it will negate the self-defense purpose of a gun in the home, the reality is that there are many affordable options for secure gun storage that provide owners with access in a matter of seconds while still preventing access by children and people at increased risk of harming themselves or others. As noted, unsecured guns actually increase the risk of gun theft, thus driving more crime and violence in our communities. Research suggests that clinicians, including social workers, can positively influence secure storage practices, especially when they provide free storage devices (RAND, 2018). Free, basic cable gun locks are available through many sources, including law enforcement, the libraries and County Attorney’s offices, local gun violence prevention groups, and through the Dept. of Public Safety’s Make MN Safe and Secure Campaign.
If you are monitoring a client for suicidal ideation, screening for access to a firearm is especially important. Loved ones will likely need to be brought into the conversation and counseling and resources provided. The National Alliance on Mental Illness (NAMI) offers CEUs in Counseling on Access to Lethal Means (CALM) training for clinicians and other front-line mental health workers. This training is invaluable to better understanding the unique lethality of firearms and how to counsel individuals and their loved ones on taking steps to increase time and space between the overwhelming impulse and the lethal means. Again, the more time and space you can put between the overwhelming, brief urge and the lethal means, the better. Nine out of ten people who survive a suicide atttempt will not go on to die by suicide; 70 percent will have no further attempts (Owens, 2002). They need that second chance.
Give the Keys
While a step in creating time and space, secure in-home storage may not be the most effective intervention in a crisis. Nonetheless, the principles of secure firearm storage are the foundation for the rest of the continuum. Individuals in crisis can further reduce their access by continuing to practice secure storage and giving the keys (or code) for the locked storage device to a trusted friend or family member. By accepting the keys or code, natural helpers can disrupt a loved one’s access to a firearm without disrupting possession.
Out of Home Storage
Individuals nearing or in suicidal crisis can put even more time and space between themselves and any household firearms by voluntarily storing their firearms outside the home. Options include with an eligible family member or close friend, or at a gun dealer or shooting range. Gun storage maps are being developed throughout the country to increase public awareness of out-of-home storage options and help individuals and families in crisis navigate their options.
Locally, a research program through Protect MN has been creating a gun storage map for the state of Minnesota. They are also working with physicians and other health care professionals in Minnesota pilot regions to disseminate this resource and evaluate the dissemination of these maps in clinical settings. If clinical social workers would like to participate in this type of research, please contact: Miriam Garland, study Co-PI, miriam@protectmn.organd/or Patricia Jewett, study Co-PI, jewet050@umn.edu
Nationally, an organization named Pause to Protect works with firearm businesses and owners to create a network of partners across the country who share a common goal of improving firearm safety. Partners are willing to take steps to educate their customers on secure storage and firearm suicide prevention, as well as temporarily store firearms. In addition to aggregating a list of partners, Pause to Protect provides technical assistance and materials to interested partners.
Voluntary Prohibitor
While not an option in the state of Minnesota, some states have created a process by which individuals who know they are at a risk for suicide or other mental health crises can voluntarily block themselves from purchasing or possessing a firearm. These are known as Voluntary Do Not Buy or Voluntary Prohibition Lists. A 2016 study found that, amongst a sample of individuals surveyed who were considered high risk, 46 percent stated that they would take advantage of such an intervention were it available (Vars et al., 2016).
Extreme Risk Protection Orders (ERPOs)
The final and, admittedly, most extreme option to reduce access to firearms when someone is in or approaching a mental health crisis is an Extreme Risk Protection Order (ERPO), also commonly referred to as “red flag” orders. ERPOs are civil court orders that temporarily restrict firearm access to an individual who is behaving dangerously or presenting a high risk of harm to self or others. When a person is in crisis and considering harming themselves or others, family members, law enforcement, and other natural helpers are often the first people to see the warning signs. Extreme Risk laws allow these helpers to intervene by petitioning a court for an order to temporarily prevent someone in crisis from accessing guns, thus de-escalating a crisis. Twenty-one states (including Minnesota), the District of Columbia, and the US Virgin Islands have enacted ERPOs as of March 2024.
Those who are eligible to directly petition vary by state. Under Minnesota law, only family or household members (defined as a current or former spouse; parent, guardian, or child; a person currently residing with a person in crisis; or a person involved in a significant dating or sexual relationship with a person in crisis), law enforcement officers, and city or county attorneys may petition for an order.
Legally, “while mental health professionals may not file a petition requesting an extreme risk protection order, in circumstances where they have a statutory duty to warn that a client poses a serious threat of physically violent behavior or when they determine that a client presents a significant risk of suicide by possessing a firearm, a mental health professional is required to communicate that threat or risk to the county sheriff where the client resides and make a recommendation regarding the client’s “fitness to possess firearms.”’ (One Thing You Can Do, Minnesota FAQ).
Practically, there are many opportunities for clinical social workers and social service agencies to support implementation of this extreme if life-saving intervention.
- Social workers can counsel family and household members on their options. Social workers have often built rapport and earned trust with clients and family. They can provide comfort, education, and support to respondents and their families while navigating the ERPO process.
- Social workers can assist with safety planning
- Social workers can connect the family to ongoing resources such as hospital social workers, outpatient mental health services, housing assistance, transportation, and other services to mitigate and/or prevent crises.
- Social workers can coordinate with law enforcement to advocate for the least restrictive means of intervention that still keep the client and community safe.
- Social workers can ensure that the underlying issues that may have led to the ERPO are addressed before the ERPO expires.
Extreme risk laws are an effective, proactive means of de-escalating a situation when someone is acting dangerously and/or making threats of harm against themselves or others. States with ERPOs in place have seen reductions in firearm suicides from 7.5% (Indiana) to 14% (Connecticutt) (Kivisto and Phalen, 2018). A 2019 review of California’s Gun Violence Restraining Order detailed 21 cases where orders were filed to prevent a threatened mass shooting and not a single case resulted in subsequent violence (Wintemute et al., 2019). For more data reviewing the first year of ERPO implementation in the state of Minnesota, please see this opinion piece published in the Star Tribune by James Densley and Jillian Peterson of the Violence Prevention Project Research Center at Hamline University. ERPOs provide a way for loved ones and other helpers to intervene and prevent incidents such as firearm suicide, school shootings, workplace shootings, and other instances of interpersonal violence. ERPOs save lives.
As extreme risk laws are passed in more states, raising public awareness about them is crucial. One Thing You Can Do is a terrific resource that provides an overview of the life-saving potential of extreme risk laws while familiarizing the general public, as well as other important stakeholders, with how they work in each state. The state by state breakdown includes FAQs and court documents, with critical information translated into Spanish. Johns Hopkins Center for Gun Violence Solutions similarly launched a National ERPO Resource Center in 2023 as a training and technical assistance hub to offer resources, education, state specific guidance, and technical assistance to implementers. Such resources are important: despite the rise in ERPO laws being passed and increase in ERPO usage, many states, counties, and jurisdictions are not using this tool to its full potential. More time and resources must be invested to develop policies and procedures and train key stakeholders, as well as continue to spread the word to the public, including at-risk families – many of whom are already system involved and connected with a natural helper. Studies of social workers in Washington State showed that many (over 80 percent) were willing to partake in an ERPO petition if the opportunity presented itself, but too few knew about the tool (Gause et al., 2022).
Conclusion
There are evidence-based interventions that we can take at the micro, mezzo, and macro levels to prevent gun violence in our clients’ lives. Given their critical role in treating victims of gun violence, doctors and healthcare workers have proudly been asserting that gun violence prevention “is their lane” – as in, is their business. Preventing firearms injuries and deaths, especially firearm suicides, and the ripple effects in our communities is very much in our lane as mental health clinicians, social service providers, and defenders of the vulnerable and oppressed. We all have a role to play in ending gun violence.
Kathleen Anderson is a clinical social worker and mother to three young children residing in Saint Paul, MN. She has spent the last 8 years volunteering with Everytown for Gun Safety as a community organizer, advocate, and educator. She currently leads their firearm suicide prevention efforts for the state of MN, as well as secure storage education.
References
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