Staff Perspective: They Don’t Trust Us—and It’s Our Responsibility to Fix It
Hopefully, the title hooked you. Now what am I talking about? And who is “us”? The “what” is conversations about firearm safety and suicide prevention. The “who” is healthcare providers. Let’s take a few steps back…
Why Firearm Safety Matters in Suicide Prevention
In the U.S. and military communities, firearms play a uniquely lethal role in suicide:
- Civilian deaths: Firearms account for ~52% of suicide deaths (Centers for Disease Control; CDC, 2024).
- Active-duty service members (Department of Defense; DOD, 2024):
Firearms: 7% of attempts → 65% of deaths
Self-poisoning (overdose): 54% of attempts →< 6% of deaths
- Lethality gap:
Self-poisoning: ~2 in 10 attempts end in death
Firearms: ~9 in 10 attempts end in death (Johns Hopkins, 2023; Wintemute, 2019)
Takeaway: Even if the number of attempts doesn’t change, reducing firearm access can save lives because of how disproportionately lethal firearms are. That points us toward one of the most effective interventions: Lethal Means Safety Counseling (LMSC), which includes conversations about firearm safety and suicide prevention.
The Trust Problem
If patients don’t trust us to have these conversations, we miss out on one of the most effective strategies to prevent suicide.
How do we know trust is low? Anestis and colleagues (2021) examined which messengers are most and least trusted when discussing firearms and suicide. The most trusted groups: military personnel, veterans, and law enforcement—all communities with firearm experience.
And who’s at the bottom? Us! Physicians and other medical professionals—just above casual acquaintances and celebrities. This pattern was consistent across gender, race, and gun ownership status. In other words, we are only slightly more trusted than strangers!
Other studies echo the theme. For example, half of firearm owners report believing it is never appropriate for healthcare providers to discuss firearms (Betz et al., 2016).
So—what’s driving this lack of trust, and what can we do about it? While we don’t have data explicitly outlining the pitfalls, we can extrapolate based on what we know about how trust is built (and eroded) in interactions with healthcare providers. Below four missteps are illustrated along with how to turn each into a rapport building-conversation.
Common Patient Concerns (and Solutions)
“We judge their choices.”→ Biased Communication
Example: A military spouse shares concerns about being alone at home with her children during her husband’s upcoming deployment. She’s excited about a firearm safety class she just completed in preparation for buying a gun for protection. The provider’s eyes widen:
“Wait—you have three small children at home. Is that really safe?”
Problem: The provider is communicating a biased opinion about gun owners with small children. This assumes that the patient is being inherently unsafe when she is actually discussing proactive steps to be a safe firearm owner. The message the patient hears:
“You are a bad parent; you are putting your children in danger!”
Trust building response:
“I’m glad you’re looking forward to the class. Firearm safety is especially important with kids in the home, and it sounds like you’ve already taken proactive steps, that’s awesome. So when does your husband deploy…”
Solution: Be culturally responsive. As providers, it is our responsibility to not only respect the values and norms of a patient’s culture (e.g., military-connected), but to also be aware of the intersectionality of different aspects of a patient’s identity (e.g., parent, military spouse, gunowner, etc.) within that culture.
Issue: “We want to take their guns.”→ Ignore Patient Autonomy
Example: A service member discloses suicidal thoughts without intent or plan. The provider responds:
“That’s concerning. You’ll need to turn your weapon over to your command until we can be sure you are safe.”
Problem: While reducing access to lethal means may ultimately be necessary, the unilateral approach strips autonomy and discourages future disclosure.
Trust building response:
“Sounds like things have been really difficult. Can you tell me more about what led to those thoughts? From there, we can come up with a plan together to help keep you safe during those tough times.”
Solution: Balance patient safety and autonomy. Conduct a thorough risk assessment with curiosity and concern, then collaborate to develop a Safety Plan with strategies the patient is both willing and able to implement.
Issue: “We don’t know anything about firearms.”→ Lack of Competence
Example: In 2015, an E3 preparing for a Permanent Change of Station (i.e., moving to a new duty station) worries about storing her firearms. The provider shrugs:
“That’s easy, just buy a gun safe and ship it with your household goods” (HHG).
Problem: This overlooks the cost of the safe itself, its weight, and the fact that safes counted against HHG weight allowances at the time—revealing a notable knowledge gap.
Trust building response:
“Let’s start with how you’re storing your firearms now. Then we can check local laws at your new duty station and figure out the best plan together.”
Solution: Be informed. You don’t need to be a firearm expert, but you do need to demonstrate competence in firearm safety basics and relevant regulations/laws. Online courses (e.g., virtual firearm safety, LMSC training) can help, as can familiarity with DoD and local regulations.
Issue: “We act like know-it-alls.”→ Maintaining the Knowledge Gap
Example: A patient says:
“I’m thinking of buying a gun. I don’t feel safe at home.”
The provider replies:
“Trust me, that’s not the way to stay safe. Get a dog instead.”
Problem: The asymmetrical tone conveys “I know better than you—this isn’t up for debate.” It dismisses the patient’s concern, weakens rapport, and misses an opportunity to bridge the knowledge gap between provider and patient.
Trust building response:
Provider:
“No one likes feeling unsafe at home. What’s making you feel this way?”
Patient:
“There’s been more crime in my neighborhood.”
Provider:
“I understand. I do worry about relying on firearms for protection, because research shows that having a gun at home can nearly triple the risk of homicide. Other security options can reduce break-ins without increasing risk of harm. Would you be open to talking through some of those together?”
Solution: Ask, explain, collaborate. Gather more information, share rationale, and avoid assumptions. Provide explanations to reduce asymmetry.
Closing Thought
We may not earn everyone’s trust overnight. But we can take steps—through cultural responsiveness, collaboration, competence, and transparency—to be worthy of the trust we are striving for. The trust it takes to save lives.
Resources
CALM (Counseling on Access to Lethal Means): Training offered by the Suicide Prevention Resource Center that provides information on how to have a discussion with patients about lethal means. (https://sprc.org/online-library/calm-counseling-on-access-to-lethal-means/)
Means Matter: Website from the Harvard T. H. Chan School of Public Health with resources & trainings on the topic of reducing suicidal individuals’ access to lethal means. (https://www.hsph.harvard.edu/means-matter/)
Defense Suicide Prevention Office: Webpage with a suite of lethal means safety tools. (https://www.dspo.mil/Home/Tools/Resource-Library/Lethal-Means-Safety/)
VA Lethal Means Safety & Suicide Prevention: Webpage with resources, including information on secure firearm storage. (https://www.va.gov/reach/lethal-means/)
“Let’s Talk about Your Guns” Podcast: A series of podcasts from the Center for the Study of Traumatic Stress about gun safety. (https://www.cstsonline.org/suicide-prevention-program/podcasts/lets-talk-about-your-guns)
Project Child Safe: Firearm safety education program that offers free educational resources, including gun locks. (https://projectchildsafe.org)
Stanford University - Clinicians and Firearms 2.0: This CME/CE course equips clinicians with the knowledge and communication strategies needed to discuss firearm injury prevention with patients effectively. It includes modules on firearm basics and safe storage. (https://online.stanford.edu/courses/som-ycme0051-clinicians-and-firearms-20-curriculum-firearm-injury-prevention-medical?utm_source=chatgpt.com)
BulletPoints Project - Preventing Firearm Injury: A free, self-paced course that takes about 60 minutes to complete. It provides an opportunity for participants to earn one Continuing Education (CE) credit. The course covers firearm injury prevention and safe storage options. (https://continuingeducation.bulletpointsproject.org/courses/preventing-firearm-injury/)
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Adria Williams, Ph.D., is a Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) with the Uniformed Services University of the Health Sciences. Dr. Williams is a suicide prevention subject matter expert and trainer.
References
- Anestis, M. D., Bond, A. E., Bryan, C. J., Bryan, A. O., & Knox, K. L. (2021). Trust in healthcare providers and willingness to discuss firearm safety: Results from a national survey. Preventive Medicine, 145, 106445. https://doi.org/10.1016/j.ypmed.2020.106445
- Betz, M. E., Miller, M., Barber, C., Beaty, B., & Miller, I. (2016). Lethal means access and assessment among suicidal emergency department patients. Depression and Anxiety, 33(6), 502–511. https://doi.org/10.1002/da.22486
- Centers for Disease Control and Prevention (CDC). (2024). Suicide mortality in the United States, 2000–2022. NCHS Data Brief, No. 509. https://www.cdc.gov/nchs/products/databriefs/db509.htm
- U.S. Department of Defense, Defense Suicide Prevention Office. (2024, November 14). Annual Report on Suicide in the Military, Calendar Year 2023 (ARSM CY 2023). https://www.dspo.mil/Portals/113/2024/documents/annual_report/ARSM_CY23_final_508c.pdf
- Wintemute, G. J. (2019). The epidemiology of firearm violence in the twenty-first century United States. Annual Review of Public Health, 40, 5–19. https://doi.org/10.1146/annurev-publhealth-031914-122535
Hopefully, the title hooked you. Now what am I talking about? And who is “us”? The “what” is conversations about firearm safety and suicide prevention. The “who” is healthcare providers. Let’s take a few steps back…
Why Firearm Safety Matters in Suicide Prevention
In the U.S. and military communities, firearms play a uniquely lethal role in suicide:
- Civilian deaths: Firearms account for ~52% of suicide deaths (Centers for Disease Control; CDC, 2024).
- Active-duty service members (Department of Defense; DOD, 2024):
Firearms: 7% of attempts → 65% of deaths
Self-poisoning (overdose): 54% of attempts →< 6% of deaths - Lethality gap:
Self-poisoning: ~2 in 10 attempts end in death
Firearms: ~9 in 10 attempts end in death (Johns Hopkins, 2023; Wintemute, 2019)
Takeaway: Even if the number of attempts doesn’t change, reducing firearm access can save lives because of how disproportionately lethal firearms are. That points us toward one of the most effective interventions: Lethal Means Safety Counseling (LMSC), which includes conversations about firearm safety and suicide prevention.
The Trust Problem
If patients don’t trust us to have these conversations, we miss out on one of the most effective strategies to prevent suicide.
How do we know trust is low? Anestis and colleagues (2021) examined which messengers are most and least trusted when discussing firearms and suicide. The most trusted groups: military personnel, veterans, and law enforcement—all communities with firearm experience.
And who’s at the bottom? Us! Physicians and other medical professionals—just above casual acquaintances and celebrities. This pattern was consistent across gender, race, and gun ownership status. In other words, we are only slightly more trusted than strangers!
Other studies echo the theme. For example, half of firearm owners report believing it is never appropriate for healthcare providers to discuss firearms (Betz et al., 2016).
So—what’s driving this lack of trust, and what can we do about it? While we don’t have data explicitly outlining the pitfalls, we can extrapolate based on what we know about how trust is built (and eroded) in interactions with healthcare providers. Below four missteps are illustrated along with how to turn each into a rapport building-conversation.
Common Patient Concerns (and Solutions)
“We judge their choices.”→ Biased Communication
Example: A military spouse shares concerns about being alone at home with her children during her husband’s upcoming deployment. She’s excited about a firearm safety class she just completed in preparation for buying a gun for protection. The provider’s eyes widen:
“Wait—you have three small children at home. Is that really safe?”
Problem: The provider is communicating a biased opinion about gun owners with small children. This assumes that the patient is being inherently unsafe when she is actually discussing proactive steps to be a safe firearm owner. The message the patient hears:
“You are a bad parent; you are putting your children in danger!”
Trust building response:
“I’m glad you’re looking forward to the class. Firearm safety is especially important with kids in the home, and it sounds like you’ve already taken proactive steps, that’s awesome. So when does your husband deploy…”
Solution: Be culturally responsive. As providers, it is our responsibility to not only respect the values and norms of a patient’s culture (e.g., military-connected), but to also be aware of the intersectionality of different aspects of a patient’s identity (e.g., parent, military spouse, gunowner, etc.) within that culture.
Issue: “We want to take their guns.”→ Ignore Patient Autonomy
Example: A service member discloses suicidal thoughts without intent or plan. The provider responds:
“That’s concerning. You’ll need to turn your weapon over to your command until we can be sure you are safe.”
Problem: While reducing access to lethal means may ultimately be necessary, the unilateral approach strips autonomy and discourages future disclosure.
Trust building response:
“Sounds like things have been really difficult. Can you tell me more about what led to those thoughts? From there, we can come up with a plan together to help keep you safe during those tough times.”
Solution: Balance patient safety and autonomy. Conduct a thorough risk assessment with curiosity and concern, then collaborate to develop a Safety Plan with strategies the patient is both willing and able to implement.
Issue: “We don’t know anything about firearms.”→ Lack of Competence
Example: In 2015, an E3 preparing for a Permanent Change of Station (i.e., moving to a new duty station) worries about storing her firearms. The provider shrugs:
“That’s easy, just buy a gun safe and ship it with your household goods” (HHG).
Problem: This overlooks the cost of the safe itself, its weight, and the fact that safes counted against HHG weight allowances at the time—revealing a notable knowledge gap.
Trust building response:
“Let’s start with how you’re storing your firearms now. Then we can check local laws at your new duty station and figure out the best plan together.”
Solution: Be informed. You don’t need to be a firearm expert, but you do need to demonstrate competence in firearm safety basics and relevant regulations/laws. Online courses (e.g., virtual firearm safety, LMSC training) can help, as can familiarity with DoD and local regulations.
Issue: “We act like know-it-alls.”→ Maintaining the Knowledge Gap
Example: A patient says:
“I’m thinking of buying a gun. I don’t feel safe at home.”
The provider replies:
“Trust me, that’s not the way to stay safe. Get a dog instead.”
Problem: The asymmetrical tone conveys “I know better than you—this isn’t up for debate.” It dismisses the patient’s concern, weakens rapport, and misses an opportunity to bridge the knowledge gap between provider and patient.
Trust building response:
Provider:
“No one likes feeling unsafe at home. What’s making you feel this way?”
Patient:
“There’s been more crime in my neighborhood.”
Provider:
“I understand. I do worry about relying on firearms for protection, because research shows that having a gun at home can nearly triple the risk of homicide. Other security options can reduce break-ins without increasing risk of harm. Would you be open to talking through some of those together?”
Solution: Ask, explain, collaborate. Gather more information, share rationale, and avoid assumptions. Provide explanations to reduce asymmetry.
Closing Thought
We may not earn everyone’s trust overnight. But we can take steps—through cultural responsiveness, collaboration, competence, and transparency—to be worthy of the trust we are striving for. The trust it takes to save lives.
Resources
CALM (Counseling on Access to Lethal Means): Training offered by the Suicide Prevention Resource Center that provides information on how to have a discussion with patients about lethal means. (https://sprc.org/online-library/calm-counseling-on-access-to-lethal-means/)
Means Matter: Website from the Harvard T. H. Chan School of Public Health with resources & trainings on the topic of reducing suicidal individuals’ access to lethal means. (https://www.hsph.harvard.edu/means-matter/)
Defense Suicide Prevention Office: Webpage with a suite of lethal means safety tools. (https://www.dspo.mil/Home/Tools/Resource-Library/Lethal-Means-Safety/)
VA Lethal Means Safety & Suicide Prevention: Webpage with resources, including information on secure firearm storage. (https://www.va.gov/reach/lethal-means/)
“Let’s Talk about Your Guns” Podcast: A series of podcasts from the Center for the Study of Traumatic Stress about gun safety. (https://www.cstsonline.org/suicide-prevention-program/podcasts/lets-talk-about-your-guns)
Project Child Safe: Firearm safety education program that offers free educational resources, including gun locks. (https://projectchildsafe.org)
Stanford University - Clinicians and Firearms 2.0: This CME/CE course equips clinicians with the knowledge and communication strategies needed to discuss firearm injury prevention with patients effectively. It includes modules on firearm basics and safe storage. (https://online.stanford.edu/courses/som-ycme0051-clinicians-and-firearms-20-curriculum-firearm-injury-prevention-medical?utm_source=chatgpt.com)
BulletPoints Project - Preventing Firearm Injury: A free, self-paced course that takes about 60 minutes to complete. It provides an opportunity for participants to earn one Continuing Education (CE) credit. The course covers firearm injury prevention and safe storage options. (https://continuingeducation.bulletpointsproject.org/courses/preventing-firearm-injury/)
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Adria Williams, Ph.D., is a Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) with the Uniformed Services University of the Health Sciences. Dr. Williams is a suicide prevention subject matter expert and trainer.
References
- Anestis, M. D., Bond, A. E., Bryan, C. J., Bryan, A. O., & Knox, K. L. (2021). Trust in healthcare providers and willingness to discuss firearm safety: Results from a national survey. Preventive Medicine, 145, 106445. https://doi.org/10.1016/j.ypmed.2020.106445
- Betz, M. E., Miller, M., Barber, C., Beaty, B., & Miller, I. (2016). Lethal means access and assessment among suicidal emergency department patients. Depression and Anxiety, 33(6), 502–511. https://doi.org/10.1002/da.22486
- Centers for Disease Control and Prevention (CDC). (2024). Suicide mortality in the United States, 2000–2022. NCHS Data Brief, No. 509. https://www.cdc.gov/nchs/products/databriefs/db509.htm
- U.S. Department of Defense, Defense Suicide Prevention Office. (2024, November 14). Annual Report on Suicide in the Military, Calendar Year 2023 (ARSM CY 2023). https://www.dspo.mil/Portals/113/2024/documents/annual_report/ARSM_CY23_final_508c.pdf
- Wintemute, G. J. (2019). The epidemiology of firearm violence in the twenty-first century United States. Annual Review of Public Health, 40, 5–19. https://doi.org/10.1146/annurev-publhealth-031914-122535