Center for the Study of Traumatic Stress
CSTS | Department of Psychiatry | Uniformed Services University | 4301 Jones Bridge Road, Bethesda, MD 20814-4799 | www.CSTSonline.org

Personal Firearm Safety Counselingfor Primary Care Providers
patients are receptive to it, most
BackgroundEstablishingbarriers
betweenanat-riskclinicians do not engage in meansThere are approximately 30,000
restriction counseling. In one study,
firearm fatalities in the United States
individual and their firearm can act as aneven though clinicians estimate thateach year. The majority of theseeffective means of preventing suicide orless than half of gun-owning patients
deaths are due to suicide or accidental
would take active steps to store theirfirearm death. However, evidence
accidental firearm death.
guns locked away and unloaded, 63%
suggests that adopting safe storageof counseling recipients reported
practices can reduce the likelihood
taking steps to secure firearms when recommended by aof deaths due to firearms. For example, in a study of suicide
medical provider.2,3
attempters aged 15–34, nearly 25% of participants reported
Complete removal of firearms is preferable, but motivatingthat the time between the decision to complete suicide andthe patient to increase the number of barriers between
the attempt was less than five minutes.1 Establishing barriers
themselves and firearms is also effective. Motivational
between an at-risk individual and their firearm can act as aninterviewing is a useful technique to help the patient “createeffective means of preventing suicide or accidental firearmand engage” their own reasons to restrict firearm access.
death.
This fact sheet provides useful information for primary care
Primary care providers are in the unique position toproviders to consider in discussions with their patients about
promote safe firearm storage practices as a means of healthsafe firearm storage practices.
promotion and reducing health risk behaviors. Althoughstudies to date indicate that counseling is effective and mostWho can benefit from this intervention?
Any individual who…
■ Maintains personal firearms, especially handguns.
x Handgun owners are twice as likely to keep their guns
loaded at least some of the time.4■ Stores guns unlocked in the house.
■ Stores guns loaded in the house.
x Especially those who owned their weapons primarily
for protection from crime (since they are more likely
to keep guns loaded than those who owned guns forother purposes).
■ Lives in a home where children live or visit.
■ Is experiencing a personal crisis that may put them at risk
for suicide.
What are the main steps to Motivational
Interviewing?5■ Engage: Establish a balanced and trusting relationshipwith your patient. Learn and understand their current
practices and beliefs about firearms and safety without

immediately applying correction. “While we are talking
about health behaviors, we should discuss any weapons you
keep in your house and your reasons for keeping them.”■ Focus: Guide the patient to the target discussion. Somepatients may need to address an underlying problem inorder to better focus on their firearm safety. “It sounds likehunting and caring for your guns have been a part of yourlife for some time. Can we talk about safety practices?”■ Evoke: Reflectively listen to your patient and ask open
ended questions. Help the patient identify their own
motivation to change their firearm safety practices.
Reinforce this motivation. “I see that you are concerned
about ensuring your home is protected, but at the same time
you worry that your children might find your pistol andhurt themselves or their friends.”■ Plan: Help the patient identify concrete steps that will
increase safety by setting reasonable barriers between an
individual and their firearm. “Let’s discuss some ways thatyou might consider to make your home safer if you plan tokeep your gun in the house.”
Continued

Key Elements of Dialogue■ Discuss whether your patient maintains personalfirearms.
■ Inquire about current storage practices and discuss safe
firearm storage methods.				
Safe storage practices include:
x Storing the firearm in a locked cabinet.
x Storing the firearm with a locking device installed.
x Storing the firearm unloaded.
x Storing the ammunition in a separate, locked 		location.
■ Ensure gun owners teach age-appropriate safety practices
to children in their home.
For children:
1. Stop.
2. Don’t touch.
3. Leave the area.
4. Find an adult.
For adolescents:
1. Never handle a gun without the permission and 		supervision of an adult.
2. Assume every gun is loaded.
3. Never point a gun at another person.
■ Discuss alternative storage plan.
x If the patient should experience a personal crisis thatputs them at risk for suicide, ask if there is anotherperson or organization who would take custody of
their firearm.

Continuing the Dialogue■ Remember to follow up with your patientin subsequent visits to provide support andencouragement to execute the plan agreed upon.
■ Work with the patient to identify and overcome
barriers to safe storage (e.g., lives in an unsafeneighborhood).
For more information:
http://www.projectchildsafe.org/talking-to-kids
https://pediatrics.aappublications.org/content/130/5/
e1416
https://www.cstsonline.org/assets/media/documents/
PFSManual12.5.14.pdf

References
1. Simon, R. I. (2007). Gun safety management withpatients at risk for suicide. Suicide and Life-Threatening
Behavior, 37(5), 518-526.
2. Kruesi, M. J., Grossman, J., Pennington, J. M.,
Woodward, P. J., Duda, D., & Hirsch, J. G. (1999).
Suicide and violence prevention: Parent education in theemergency department. Journal of the American Academyof Child and Adolescent Psychiatry, 38, 250 –255.
3. Bryan, C. J., Stone, S. L., & Rudd, M. D. (2011). A
practical, evidence-based approach for means-restriction
counseling with suicidal patients. Professional Psychology:
Research and Practice, 42(5), 339.
4. Weil, D. S., & Hemenway, D. (1992). Loaded guns in
the home: analysis of a national random survey of gunowners. JAMA, 267(22), 3033-3037.
5. Britton, P. C., Bryan, C. J., & Valenstein, M. (2014).
Motivational interviewing for means restriction
counseling with patients at risk for suicide. Cognitive andBehavioral Practice, doi:10.1016/j.cbpra.2014.09.004.

Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University
4301 Jones Bridge Road, Bethesda, MD 20814-4799
www.CSTSonline.org