Recent Supreme Court Rulings Could Increase Risk of Intimate Partner Violence

Clinicians should be on the lookout for more people of childbearing age experiencing intimate partner violence following two recent U.S. Supreme Court decisions. So wrote Elizabeth Tobin-Tyler, J.D., an associate professor of health services, policy, and practice at Brown University, in a perspective article in the New England Journal of Medicine. Dobbs v. Jackson Women’s Health Organization allows states to ban or restrict access to abortion; New York State Rifle & Pistol Association v. Bruen struck down state limits on who may carry a firearm in public.

“[Intimate partner violence] encompasses physical and sexual violence and intimidation, as well as psychological abuse,” Tobin-Tyler wrote. Overall, 1 in 3 U.S. women experiences such violence, she noted.

She described several studies demonstrating the association between pregnancy, intimate partner violence, and homicide. “Most vulnerable in this new legal landscape will be people who have limited access to resources and services and inadequate protection against violence, especially those living in overburdened communities—primarily young, low-income women from historically marginalized racial or ethnic groups,” she continued. “Legal restrictions on reproductive health care and access to abortion will leave people more vulnerable to control by their abusers. Policies permitting easier access to firearms, including the ability to carry guns in public, will further jeopardize survivors’ safety.”

Clinicians have a vital role to play in supporting and helping to protect patients experiencing such abuse, Tobin-Tyler concluded. “Health care systems should provide training to all staff to help them understand the dynamics of [intimate partner violence], especially during pregnancy and the postpartum period, and to assess risk of homicide; should implement best practices for creating safe, supportive, and empowering environments for patients to disclose [intimate partner violence] and seek assistance; and should fund partnerships with domestic-violence experts and lawyers to facilitate protection, safety, and independence from abusive partners.”

For related information, see the Psychiatric News articles “Restricting Rights to Abortion Is Direct Assault on Women’s Mental Health” and “Congress Passes First Significant Gun Safety Bill in Decades.”

(Image: iStock/Minerva Studio)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

APA Implores Congress to Act to Prevent Firearm Violence

The overwhelming majority of people with mental illness are not violent and are far more likely to be victims of violent crime than perpetrators, APA said in a statement released today.

“A vast majority of firearm violence is not attributed to mental illness,” APA said. “Rhetoric that argues otherwise will further stigmatize those who need treatment for mental illness without addressing the root causes of firearm violence. Although there is no single cause of firearm violence, individuals can and have been emboldened to act violently by inflammatory public discourse and provocative, hateful, and destructive rhetoric.”

The statement condemned the senseless loss of lives from firearm violence that has become all too common—most recently in mass shootings in Uvalde, Buffalo, Houston and more than 200 other locations across the country in 2022 so far. APA called firearm violence preventable and urged elected officials to take action to keep communities safe.

“APA is committed to federal efforts to protect our youth and all citizens from gun violence and implores Congress to enact firearm safety legislation that will promote safe communities and reduce morbidity and mortality due to firearm-related violence. We stand ready to work with Congress on sensible legislation that increases research into firearm violence, requires background checks, waiting periods, safe storage of firearms, and that allows physicians to make clinically appropriate inquiries regarding access to firearms.

“We implore our elected officials to act on meaningful, common-sense measures and begin to heal the divisions that have prevented progress in this area of public health for far too long. This senseless loss of life must end, and as a nation, we should expect action from federal and state legislative and executive leaders. Our children and communities deserve better.”

For related information, see the APA’s Position Statement on Firearm Access, Acts of Violence, and the Relationship to Mental Illness and Mental Health Services and the Psychiatric News article “Researchers Discuss Policy Solutions to Firearm Violence, Suicide.”

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

What Can Physicians Do to Prevent Firearm Violence?

Physicians should routinely ask patients about firearms in their home and whether guns are locked and safely stored, writes James S. Kahn, M.D., a professor of medicine at Stanford University, in an editorial published today in the Annals of Internal Medicine. The editorial was published alongside a position paper from the American College of Physicians on reducing firearm injuries and deaths in the United States.

“Firearm-related violent death is an extraordinary problem made even more alarming by the prevalence of guns in the households of persons with dementia and the variation in firearm injuries related to racial disparities,” Kahn writes. “Yet, many physicians have been unengaged or silent during this epidemic. Why? Perhaps we think firearm violence is outside our realm of influence.”

Yet Kahn says physicians routinely ask patients about their unsafe activities, risky exposures, and addictions. “Nicotine abatement programs, alcohol reduction plans, and HIV prevention efforts begin with questions … about a person’s behavior and are successful when physicians provide information to empower patients, motivating them to prevent disease and avoid disability or death. Guns should be no different.”

Kahn recommends the following advice to patients about creating a safe environment when guns are in the home: 

• Remove the ammunition from the gun and lock the gun in a secure location.
• Lock the ammunition in a separate location from the gun.
• Store the keys in a different area from household keys and keep the keys out of reach of children.
• Lock up gun-cleaning supplies.
• Never leave a gun unattended after removing it from a safe storage place.

Kahn urges physicians to begin the conversation simply by asking, “Do you have guns in the home?” If a patient answers “yes,” the physician can follow up with a question such as “How or where do you typically store your guns?”

“If my patients say their guns are not secured or locked, then we can talk about how they might protect themselves and others from unintentionally finding and firing the guns,” Kahn writes. “We discuss what to teach children to do if they encounter a gun: Stop what they are doing, never touch the gun, leave the area, and tell an adult right away.” 

“It would be so easy to normalize this line of inquiry and add these questions to an electronic medical record along with questions about alcohol consumption, drug use, and sexual practices,” Kahn writes. “And it is not difficult to learn how to talk to patients about guns and how to counsel them about safety. We need to routinely ask, ‘Do you have guns in the home?’”

For related information, see the Psychiatric News article “Talking to Patients About Guns Necessary, But Examine Your Beliefs First.”

(Image: iStock/DmyTo)

Follow Psychiatric News on Twitter!

Tougher Gun Laws May Reduce Firearm Suicides, Homicides, Study Finds

Counties in and adjacent to states with stronger gun laws have fewer firearm deaths than counties in and adjacent to states with weaker laws, according to findings published today in JAMA Internal Medicine. The study suggests that strengthening state firearm policies may prevent firearm suicide and homicide, with benefits that may extend beyond state lines.

“States regulate how firearms are bought, sold, and tracked, as well as who may purchase them,” Elinore J. Kaufman, M.D., M.S.H.P., of the Department of Surgery at New York-Presbyterian Weill Cornell Medicine and colleagues wrote. “Stronger firearm policy environments have been associated with lower rates of firearm deaths, as have specific laws, such as licensing and inspection of firearm dealers, licensing and background checks for handgun sales, including private sales and laws regulating the availability of inexpensive handguns. Laws, however, vary widely among states, and evidence of their impact is limited.”

Kaufman and colleagues examined the effect of home state and out-of-state firearm laws on firearm death rates in U.S. counties between January 2010 and December 2014 by analyzing counts of death attributed to firearm suicide and homicide for 3,108 counties in the 48 contiguous states of the United States. Each county was assigned two scores, a state policy score based on the strength of its state firearm laws, and an interstate policy score based on the firearm laws of nearby states. Counties were divided into those with low, medium, and high home state and interstate policy scores.

The authors found that counties in states with high firearm policy scores had the lowest rates of firearm suicide and overall suicide, regardless of the strength of the firearm policies of other states. Counties with low state scores had the highest rates of firearm suicide. Stronger home state laws were also associated with lower rates of firearm homicide, while counties in states with weaker laws had lower rates of firearm homicide only when surrounding states had stronger laws.

“Because suicidal ideation is often transient, and because firearms are a highly lethal method of suicide, access to firearms is an important risk factor for completed suicide attempts,” the authors wrote. “Considered in the context of prior studies, our findings provide evidence that stronger state firearm laws could help to prevent firearm suicides, without an equivalent increase in suicide by other methods.”

“For homicides, the study provides evidence that when a state strengthens its firearm laws, both the state and its neighboring states may benefit,” added JAMA Internal Medicine Editor at Large Robert Steinbrook, M.D., in an accompanying editor’s note. “Because Congress has been unwilling or unable to act, the need for effective state firearm laws and policies in the United States has never been greater.”

For related information, see the Psychiatric News article “Firearms and Suicide: Risk Assessment and Management,” by Liza Gold, M.D.

(Image: iStock/DmyTo)

Follow Psychiatric News on Twitter!