Health providers, advocates, industry unite on revention

Bob “Buddy” Hackett, owner of Renaissance Firearms in Barrington, grew up hunting and fishing. He shot pistols and rifles competitively around the world. He served in the Marine Corps for a decade. Guns were always part of his life.

Now in his mid-50s, Hackett holds a master’s degree in social work and counsels veterans struggling with suicidal thoughts.

His two worlds — that of a mental health and a gun rights advocate —may seem incongruous. However, gun shops can play a pivotal role in suicide prevention, says Elaine Frank of the NH Firearm Safety Coalition (NHFSC) and former program director of the Injury Prevention Center at Children’s Hospital at Dartmouth.

Hackett provides brochures and posters on suicide prevention to his employees and customers on the shop floor and shooting range.

It’s a topic he doesn’t shy away from.

“We are doing everything we can legally and morally to prevent (a suicide death) from happening here or anywhere else,” Hackett says. These moves include denying a sale to anyone employees see acting distressed or nervous, or they suspect are under the influence of drugs or alcohol. Hackett also doesn’t allow customers to shoot at the range alone.

In 2009, under the auspices of the NHFSC, Frank and Ralph Demicco, then a firearms retailer, co-founded the Gun Shop Project to engage New Hampshire’s firearm community in preventing suicide. By 2011, at least 57 percent of the state’s gun shops were displaying their suicide prevention materials.

When their work began in the Granite State more than a decade ago, public health experts and gun retailers were unlikely bedfellows. Today, similar Gun Shop Projects are under way in more than 20 states, according to Cathy Barber, who directs the Means Matter Campaign at the Harvard School of Public Health’s Injury Control Research Center, which promotes reducing a suicidal person’s access to lethal methods.

Despite suicide prevention efforts, suicide rates are not shrinking. In 2020, the last year for which data is available, more than half of all gun-related deaths in the U.S. were suicides. That year, the 24,292 gun suicides hit a new record; these numbers were higher than in other years, with the exception of 2018.

States with more guns have higher suicide deaths, says Barber. That doesn’t mean there are higher rates of depression, suicidal attempts or suicidal thinking in those states. It is the simple fact that a suicidal attempt by firearm is more likely to result in death, she says.

In New Hampshire, a state with relatively few homicides, 118 out of 129 firearm deaths in 2020 were suicides, or about 91 percent, according to the NH Office of Chief Medical Examiner. From 2015 through 2019, suicide was the second-leading cause of death in the Granite State among those aged 10 to 34.

Barber says more work needs to be done to remove guns from anyone at risk of being suicidal, even if temporarily. Delving into the politics of gun control does little to get the message across to those already owning guns. Barber prefers to emphasize a message about protecting one’s family, which fits into the culture of the gun-owning community. She likens the approach to a “friends don’t let friends drive drunk” campaign, showing “you have your loved ones’ back.”

The message she wants to convey is, “Sometimes people in your situation (a crisis) think about suicide. If that’s the case for you, here’s the hotline number. And if you have guns at home, now might be a time to put them in storage.”

Ideally she’d like all the people who see someone at their lowest to put suicide ideation on the radar, whether that’s the person serving the foreclosure notice, the divorce papers or a third drunk-driving charge.

‘Start a brave conversation’

In an era of intense polarization, says Frank, it’s important that gun rights and suicide prevention groups find common ground. She remembers in 2011 talking to representatives from the American Foundation of Suicide Prevention and the National Shooting Sports Foundation (NSSF) about combining resources to promote suicide prevention.

“The suicide folks said, ‘No, it’s too controversial. We don’t want to get into guns.’ And the gun people said, ‘No, it’s too depressing. We just want to sell guns. We don’t want to be raising (the idea of) suicide.’ And then five years later, they formed a partnership and are doing exactly that.”

In 2017, the NSSF began providing training resources and literature to gun shops and ranges to spot signs of suicide ideation. NSSF CEO and President Joseph Bartozzi says gun retailers are in a unique position to ask people to safely lock their guns or remove them from a home where someone is having a mental health crisis. Gun owners are more likely to listen to firearm industry experts than authority figures who favor gun restrictions.

Bartozzi says the literature encourages retailers to ask customers more questions. “Engage them in a meaningful, human, person-to-person contact. This is not just a business transaction.”

In the fall, the Granite State Indoor Range in Hudson began displaying the NSSF posters and brochures with the headline, “Start a Brave Conversation.” To date, the response has been positive, says Matt Bishop, a spokesperson for the local retailer.

The brochures outline where to go for help and explain some of the risk factors, including substance use abuse and PTSD, stressors like divorce and family history of suicide.

Cam Lentz, who died by suicide earlier this year at age 22. Says his mother Becky of Nashua: ‘I love talking about him. It hurts, but it’s like, I don’t want to ever stop talking about him.’

“We address the problem just by kind of talking about it, bringing it up,” he says, although Bishop acknowledges it’s an uncomfortable conversation for a gun shop.

He only became aware of the NSSF partnership in September, and he says it will have a big impact. “I think we are getting there. I think it’s just a slow burn,” he says.

Bishop says the shop includes firearm storage lockers for people who want to keep their guns away from the house for a short while. “We don’t require them to tell us why.”

The Granite State News Collaborative reached out by phone and email to more than a dozen gun shops in the state. Several shops responded by saying their lawyer advised them not to speak to a reporter about suicide prevention. Only two, the Granite State Indoor Range and Renaissance Firearms, agreed to an interview.

Educating the range, retail and broader firearms-owning communities is critical to AFSP’s mission, says spokesperson María de los Ángeles Corral. AFSP’s Project 2025 campaign aims to reduce the suicide rate by 20 percent by 2025, making it the lowest it’s been in 30 years.

“We’re not in the space of telling people whether or not they should own guns,” de los Ángeles Corral says. “What we care most about is saving lives. To make headway on this issue, we saw that (collaboration with NSSF) as an essential step.”

Based on an analysis done with the consulting firm CALIBRE Systems, AFSP predicts its firearm education effort could save 9,500 lives in the next decade, if widely adopted.

Despite intentions to spot suicide risk, those in the firearm industry can’t be therapists. Nor can they be mind readers. About six months ago, a man in his early 20s purchased a gun at Renaissance Firearms and then used it to end his life.

“I always go back, and I think about scenarios,” says Hackett. “What words were used? How was the body language? Were there any sort of gestures? There was nothing.”

Hackett says he reached out to the deceased man’s family members to offer condolences and support. He wondered if there was anything he could do. They communicated to him the death was inevitable. “Which is sad,” he says, “because that means that someone has given up on someone who has given up.”

Renaissance Firearms training director Bill Broussard says he’s been exposed to suicide “in a very up-close and personal way” as an EMT, Air Force firefighter and volunteer firefighter in the various towns in which he lived. He has seen family members, often people he knew, process the shock and trauma of losing a loved one to suicide.

One of the more critical interventions, he says, is to give a suicidal person time to transition out of the crisis moment. Ensure they’re not alone. Get them help.

He recalls a woman in one of his classes who pressured him to demonstrate how to load a gun, saying she “wouldn’t have the gun for long.” From her demeanor and comments, Broussard saw red flags. He heard desperation. Once away from the other students, he asked more questions and determined the woman might be suicidal. He persuaded her to come to his office. They talked for an hour. The conversation ended with a call to the suicide hotline.

A mother mourns

As a child, Cameron “Cam” Lentz was a problem-solver.

His mother, Becky Lentz of Nashua, recalls him at 8 years old taking apart the family’s broken VCR with a screwdriver, analyzing the cause — a sandwich stuck in the cassette — and putting it back together. In school, he participated in robotics activities. For sports, he developed a penchant for archery and went on to win regional awards.

Cam supported himself as an auto mechanic. He lived in his own apartment in Nashua, but the lanky 22-year-old with shaggy brown hair and an engaging grin chose to cook and hang out at his parents’ home at least three times a week.

“He made me smile. He made me laugh every day,” says Lentz, who recalls her son presenting her with a heated vest after she mentioned her workplace was cold. ”He was such a caring person. Because he knew what it was like to be in pain.”

For most of his young adult life, Cam struggled with depression and bipolar disorder. After an unfortunate manic episode, a psychiatrist recommended hospitalization, but Cam, concerned about a public record, chose not to be admitted. During the Covid lockdown, he stopped his therapy sessions because he didn’t want to do them on Zoom.

Earlier this year, Lentz says her son was loving his new job and received a raise. “He was on top of the world,” she recalls. Despite her son’s reassurances he was in a good place, Lentz couldn’t shake off a nagging worry. She knew Cam owned guns, and she expressed to him her discomfort about them.

On the last Sunday night in July, Cam left his parents’ house after dinner and said he’d be back in a couple of days. On Tuesday evening of the same week, Lentz and her husband took a walk around the neighborhood. When they returned home, she saw police standing by the doorstep.

Those seconds or minutes between seeing the officers and ushering them into her home are frozen in her mind. She remembers telling her husband, “This is the last moment. This is the before.”

Once inside the house, the officers delivered the news that her middle son had ended his life.

“We don’t know what was in his mind,” she says. “He always promised us he would never do this.”

Suicidal thoughts are usually short-lived and don’t involve long-range planning, says Elaine Frank. Studies that follow people over many years find that roughly 90 percent of those who survive a suicide attempt do not go on to take their lives later. The most common method of suicide attempt is a medication overdose. However, if the method is a firearm, says Frank, there’s little chance for a change of heart. The outcome is almost always fatal.

Looking back, Lentz says she wonders if a hospitalization record would have prevented him from purchasing a gun. However, mental health records in New Hampshire are confidential and are not submitted to the national database used to perform background checks.

In June of 2020, the NH Senate passed a bill, known nationally as a red flag law, which allows concerned family members and others to petition a court to remove guns and firearms from a person at risk of self-harm. Citing constitutional concerns, Gov. Chris Sununu vetoed the bill two months later.

In the future, Lentz wants to honor her son’s memory by talking to school groups about reducing the stigma of mental health and keeping guns away from anyone in crisis.

“I love talking about him,” she says. “It hurts, but it’s like, I don’t want to ever stop talking about him.”

Focus on youth

In 2020, guns, more than cars, were the leading cause of death among children and adolescents, far outpacing cancer, infections and congenital causes. Among firearm suicides in 18- to 20-yearolds, 85 percent used either their own gun or that of a family member.

Acknowledging that onethird of parents own guns, the NH Firearm Safety Coalition teamed up with the American Academy of Pediatrics to produce an online training module for pediatricians and other primary care providers.

In the past, says Barber, pediatricians typically communicated that children are safer without guns at home.

“There’s evidence to support that position,” she says. “But if you’re trying to speak with a gun-owning parent, it’s probably not a real winning way to start the conversation.”

A gun display at Renaissance Firearms.

Launched in July, the interactive course suggests ways to broach the subject of guns or other lethal means with patients.

“We have to consider where these parents and teens who may own firearms, where they’re coming from,” says Lois Lee, a Boston-based emergency medicine pediatrician who chairs the AAP’s Council on Injury, Violence and Poison Prevention. The course, she says, offers “a toolbox of things you can say without hopefully imposing your own personal beliefs or biases.”

Retired pediatrician Eliot Nelson of Burlington, Vt., helped write the suggested dialogues. Nelson says a family may not answer honestly when asked if they own guns.

“They’re worried the doctor has an agenda aimed at infringing upon their rights.”

Pediatricians need to empathize with parents who keep guns for self-protection, he says, and not debate the rationale. It’s better to talk about storage options that also allow quick access via a biometric lock, for example.

The unbiased approach is a net gain at Dartmouth Health Children’s in Lebanon.

After noticing a higher number of households with guns, the pediatric practice began offering free cable gun locks to its patients in 2017. At the time, about 10 percent of gun-owning households left their firearms unlocked. That percentage has dipped to 4 percent, says James Esdon, program coordinator for the Injury Prevention Center.

Esdon says he expects to expand the gun lock program to other Dartmouth Health facilities in the state.

“Kids hurting themselves with a firearm is a bad thing. You know, you’re not going to find a gun owner that’s not going to agree with that,” says Esdon. “We can make a difference by finding something we all agree on.”

Contact the 988 Suicide and Crisis Lifeline if you are experiencing mental health-related distress or are worried about a loved one who may need crisis support. Call or text 988. Chat at 988lifeline.org. Connect with a trained crisis counselor. 988 is confidential, free and available 24/7/365. Visit the 988 Suicide and Crisis Lifeline for more information at 988lifeline.org.

This article is are being shared by partners in the Granite State News Collaborative. For more information, visit collaborativenh.org.