Voluntary Self-Prohibition: The Suicide Prevention Tool I Wish My Doctors Could Offer Me

The BulletPoints Project July 12, 2022

 

Bryan Barks, MHS

Writer, Editor & Mental Health Advocate

 

I swore I’d never own a gun. I had worked in the gun violence prevention field for years. But on a beautiful spring day, suicidal, agitated, sleep-deprived, and consumed by a mixed episode of bipolar disorder, I changed my mind.

I knew all the reasons why someone who struggles with chronic suicidality should not own a gun. And yet, that day, buried in hopelessness and despair, I didn’t care about the data. I didn’t care about protecting myself. Using my index fingers, hitting one key at a time, I Googled, “Where can I buy a gun?”

As the map lit up with options, fear rushed in. Panic descended. A feeling of shame overwhelmed me. I was living out the scenario I had read about and written about and tried to prevent in others so often in my career.

Two scenarios unfolded in my mind. In the first, I envisioned myself walking out of a gun store with my new purchase. It would be so easy to get it. It would be so easy to use it. It would end my life.

In the second scenario, I imagined myself telling my psychiatrist what I had been experiencing and thinking, what I had Googled. It would be so hard to admit. It would land me in the hospital. I would continue living — and that sounded hardest of all.

I took a cab. I cried the whole way there. I lingered outside the building before walking in, my feet heavy with dread. Then, I told her everything. Within hours, I was taking my meds with a big gulp of water in the psychiatric unit.

Despite the pain I felt, my will to live won that day. I think of that choice — seeking help rather than seeking a weapon to hurt myself — as an act of self-preservation. I lived. But I came too close. It would have been too easy, too quick.

Voluntary self-prohibition, or voluntary waiver of firearm rights, is a law that allows individuals to voluntarily place themselves on a do-not-sell list.

As someone who was diagnosed with bipolar disorder at age 19 and has struggled with suicidal thoughts and behaviors ever since, I have often wished for a tool to prevent the unwell version of myself from acquiring lethal means, especially guns. Years before that depressed and agitated version of myself searched for where to buy a gun, the euthymic version of me had written about and advocated for voluntary self-prohibition — a law that allows individuals to voluntarily put themselves on a no-buy list, preventing themselves from buying guns from a licensed dealer. As of July 2022, voluntary self-prohibition is law in Utah, Virginia, and Washington state.

Though I would have been willing to sign up for a no-buy list in many clear-headed, euthymic moments throughout the course of my treatment, there are five key moments when voluntary self-prohibition would have been an especially appealing, appropriate, and useful safeguard if the option had been available in my state and a clinician had been able to offer it to me:

1. When voluntarily admitting to a psychiatric unit

I have never felt hopelessness and hopefulness intersect more powerfully and acutely than during the process of admitting myself to the hospital. During the voluntary admissions process, I have always felt a strong instinct to protect my life coupled with the fear that I wouldn’t be able to, that I would never get better, that suicide was inevitable. In these moments, waiting for admission to the unit, talking about my symptoms with clinicians, signing paperwork, I would have gladly signed up for a no-buy list. Doing so would have given me a sense of agency.

2. When discharging from an inpatient unit

Discharge is a vulnerable and dangerous time. Each time I’ve been discharged from a psychiatric hospital, I’ve felt relieved to be leaving the inpatient unit and scared about my ability to manage at home. What if my symptoms come back? What if I have suicidal urges? It would have provided a sense of security if the hospital social worker had been able to present me with the option to sign up for a no-buy list alongside other discharge paperwork and resources.

3. When engaging in safety planning with my psychiatrist or therapist

I struggle with suicidal thoughts and behaviors during depressive and mixed episodes. During these episodes, I often engage in safety planning with my psychiatrist and my therapist. This includes identifying triggers, coping skills, distractions, social support, emergency resources, and steps to keep me safe, which includes lethal means counseling. Offering voluntary self-prohibition as an option is a natural complement to safety planning, especially conversations involving lethal means safety.

4. When participating in support group meetings

As part of my treatment, I have attended in-person and online support groups for specific conditions as well as skill-building groups. When led by a clinician, these groups would have been appropriate settings to offer information about voluntary self-prohibition for those who are interested. This could be as simple as making the forms available at the meeting location.

5. When filling out intake paperwork for a new outpatient provider

Whenever intake or discharge paperwork is involved, there is an opportunity to offer the patient the option to sign up for a voluntary no-buy list. I have switched outpatient providers numerous times over the years, and I would have appreciated this resource being included alongside basic consent forms.

Though it is currently law in only three states, voluntary self-prohibition is an important firearm suicide prevention tool that should be offered to patients in a variety of clinical scenarios and settings – those listed above are just a few examples. Clinicians have an important role to play in the implementation and uptake of these laws in Utah, Virginia, and Washington. Over time, as other states pass these laws, it is important for clinicians to ensure that patients like me, who want to take advantage of voluntary self-prohibition and keep themselves safe, have every opportunity to do so.

To learn more about this topic, watch the BulletPoints webinar episode on “Voluntary Self-Prohibition: A Tool to Prevent Firearm Suicide” with Bryan Barks.

 

Clinical tools for preventing firearm injury

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