Using linked individual data on concealed handgun permits (CHP), reported crimes and arrests, I examine the dynamics of gun-ownership and criminal victimization. I initially show that being male, Republican, older, born in-state and a recent crime victim increases the probability that an adult obtains a CHP. Having a CHP increases property crime victimization by 46% with the largest impact on having a firearm stolen. Individual CHP holders see no change in violent crime victimization thus dispelling any benefits in terms of protection. Obtaining a CHP has a small (2%) increase in total crime and a larger increase on violent crime using a gun (8%) within the CHP holders neighborhood. Results suggest stolen guns spillover to neighborhood crime which is an important component of the larger social costs of gun ownership.
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Healing the Healers – Supporting Physicians After Mass Public Shootings
As a disaster mental health (DMH) professional, I have responded to five mass public shootings since 2017 and have had the opportunity to provide support to hospitalized survivors as well as their loved ones. I’ve stood in emergency departments and intensive care units in Uvalde, Texas, Las Vegas, Nevada, and Lewiston, Maine. I have watched dedicated physicians work tirelessly to save the lives of fellow community members. I have heard stories of their heroism, and I have witnessed it with my own eyes. Yet, despite their significant role in the aftermath of these incidents, this group has been largely overlooked in academic literature, and their voices have often been excluded from discussions surrounding mass public shootings. In recent years, physicians have attempted to make their voices heard by tweeting photographs and stories about their experiences treating victims of gun violence using the hashtag “ThisIsOurLane,” a movement initiated by Brady Center to Prevent Gun Violence board chair and chief medical officer Dr. Joseph Sakran. Through these graphic images and narratives, it is clear that these healthcare professionals are profoundly impacted by what has been referred as a gun violence epidemic.
The Psychological Toll
Physicians are not immune to the physical and psychological effects of trauma. Due to the nature of their careers, these individuals often work long hours in high-pressure environments, frequently leading to exhaustion and burnout, particularly in emergency medicine (EM) settings. One recent study found that 15.8 percent of EM physicians and 29 percent of EM residents meet the criteria for posttraumatic stress disorder (PTSD). Additionally, up to 40 percent of trauma surgeons have posttraumatic stress symptoms (PTSS), with 15 percent meeting the full diagnostic criteria for PTSD. While these physicians frequently treat individuals affected by gun violence, when treating victims of mass public shootings, the prevalence of PTSS and PTSD among physicians may be even higher, as research suggests that exposure to human-made disasters can lead to increased levels of distress, especially considering the volume and severity of patient presentations. Furthermore, these physicians often live in the communities affected by these incidents, and some may even personally know the victims they are treating, especially in rural communities and smaller towns, potentially exacerbating their risk of experiencing both short- and long-term stress reactions. However, the needs of these medical professionals are frequently neglected during recovery efforts, and due to this, physicians have been considered unrecognized survivors of mass killings.
The needs of these medical professionals are frequently neglected during recovery efforts, and due to this, physicians have been considered unrecognized survivors of mass killings.
Recently, Dr. Craig Goolsby, Department Chair and Professor of Clinical Emergency Medicine at Harbor-UCLA, convened a group of emergency medical services (EMS) professionals, EM physicians, and surgeons who responded to six high-fatality mass shootings in the US. Their objective was to develop consensus recommendations for improving care and patient outcomes during these tragic incidents. Among their eight recommendations in the final report was the inclusion of tailored mental health services for all responders, whether present at the scene or the hospitals. While the experiences of other first responders, such as EMS, and other hospital personnel, like nurses, have been explored, less is known about physicians. Therefore, in collaboration with Dr. Goolsby, my research colleagues and I conducted a qualitative study using semi-structured individual interviews to explore the experiences and needs of physicians following mass public shootings. More specifically, our research centered on nine physicians in seven impacted communities. While a previous study examined the experiences and immediate needs of physicians working in hospitals located in communities impacted by mass public shootings, our study focused on the ongoing needs of these medical professionals across all disaster phases.
Our findings revealed that these incidents significantly affected most participants in the short term. Many shared how they initially compartmentalized their emotions and struggled to process what had happened. For instance, one participant shared, “it ended up being like, oh, wow, what was that about when I ‘woke up’ two days later…I remember getting home after another busy shift and just breaking down.” Participants also described how these incidents had lasting effects on their lives. One participant shared, “it’s life-changing…it will stay with me forever. It’s changed my career.” Some participants also experienced long-term impacts, including hypervigilance and avoidance of large crowds and gatherings. For instance, one participant stated, “I used to go to college football games all the time. I don’t think I’ve been to a college football game since.… I don’t want to be in crowds as much as I used to.” Another shared, “I had a very visceral reaction to discussions around it [the incident] for months, if not years. It has had huge effects.”
One participant shared, “it’s life-changing…it will stay with me forever. It’s changed my career.”
Stigma and Help-Seeking
Despite being profoundly impacted, most participants in our study did not seek formal mental health support. While many acknowledged that mental health support was made available to them following these incidents, these services were underutilized. Instead, many physicians preferred to engage in informal peer support, including peer mentorship and gatherings in relaxed settings, such as at the homes of fellow physicians.
Our interviews reflected that reluctance to seek formal mental health support might be due to the stigma physicians often face and the fear that licensing bodies may revoke or restrict their license to practice should a mental health issue be disclosed on a licensing application or renewal. For instance, one participant stated,
I strongly identify as an emergency physician….and that could be taken away from me if when I reapply for my medical licensure, they ask, ‘have you ever had any mental health disorders?’ If I get a diagnosis because I was having issues dealing with an event and I have to disclose that, I’m placing myself in jeopardy of losing my medical license.
Another shared, “if you go and seek help and receive that diagnosis, you will have to notify the [state] medical board. You could be in danger of losing your license, so there is not only a stigma, but there’s negative reinforcement.”
Stigma related to help-seeking is not unique to physicians who treat casualties of mass public shootings, as this issue has been discussed extensively for many years. However, the demand for mental health support and tailored services is likely even greater during and after human-made disasters, such as mass public shootings. Therefore, efforts should be made to alleviate barriers to accessing support to improve overall well-being, decrease burnout, and better equip physicians to respond during these and other trauma-related incidents. Creating a culture of care and taking proactive measures to promote wellness among physicians is imperative, as “an ounce of prevention is worth a pound of cure.”
Overcoming Barriers
Physicians face complex challenges and barriers when attempting to access mental health support. While the disclosure of mental health diagnoses to medical boards was initially intended to safeguard the public from physicians who may be impaired, the Federation of State Medical Boards (FSMB) contends that such disclosure does not reliably predict the risk of harm to patients. Instead, it prevents physicians from receiving necessary mental healthcare, potentially exacerbating impairment. To help mitigate these barriers, the FSMB offered several recommendations, including urging medical boards to “evaluate whether it is necessary to include probing questions about a physician applicant’s mental health, addiction, or substance use” on licensure applications or renewals. More specifically, the FSMB made the following recommendations to be compliant with the Americans with Disabilities Act (ADA): (1) limiting mental health questions to conditions that result in impairment; (2) limiting mental health questions to conditions within the past two years or less; (3) not requiring physicians to disclose their diagnosis or treatment to the board if they are enrolled in a Physician Health Program; and (4) using supportive language about seeking mental health care. However, a recent study found that only 5 percent of medical boards were in compliance with the FSMB’s recommendations.
Access to supportive services is vital, as burnout and poor mental health among physicians have been linked to increased rates of suicide, as well as medical errors and suboptimal patient care. Therefore, to eliminate barriers to help-seeking, state licensing boards might carefully consider revising their policies to align with the recommendations put forth by the FSMB. For example, in 2020, the Texas Medical Board (TMB) revised the language related to mental health in applications for initial medical licenses and renewals. Due to these changes, the TMB is now in full compliance with the FSMB’s guidelines, fostering a more supportive atmosphere and reducing obstacles to mental healthcare. Furthermore, because mental health support is underutilized by physicians, alternative forms of support should be made available to them following mass public shootings. Facilitating opportunities for peer support, for instance, can be a valuable resource, as this can help normalize emotions and reactions to difficult experiences and has been found to increase well-being and reduce mental health stigma among physicians. To enhance support, hospitals might consider organizing formal and informal gatherings for these individuals to come together and begin to process.
Additionally, physicians should be afforded ample space and time to decompress and grieve. In our study, five participants mentioned the challenges of dealing with the media coverage in the immediate aftermath of the incident and how they did not have an opportunity to reflect on or process their emotions before they were required to make a statement to the press, as has been seen in several post-incident news briefings in the past. Due to this, hospitals should allow physicians to decline requests for press interviews and consider designating a hospital spokesperson who is uninvolved in the medical treatment of casualties to handle any media requests.
Community support also plays a crucial role in the recovery process for physicians after mass public shootings. Hospital systems can partner with local and regional healthcare networks to facilitate shift coverage and adequate time off so that these individuals can participate in community memorials and vigils. Attending public rituals can promote community solidarity and cohesion, bolstering resilience in those affected by disasters. Additionally, hospitals should recognize the lasting effects mass public shooting incidents can have on physicians, providing tailored support and adopting a trauma-informed approach and policies across all stages of disaster recovery. Some participants, for example, expressed the desire to give back to their communities and the medical profession and found channeling their grief into action to be an important part of their recovery journey. One participant shared, “I had to figure out how I was going to make something better of this.” However, not all felt supported by their employers in pursuing these endeavors. Hospital systems should acknowledge the diverse ways in which meaning-making and healing occur and support physicians in these activities, as altruism has been found to foster post-traumatic growth.
Physicians are often overlooked following mass public shootings and may ultimately suffer in silence. These medical professionals should be offered equal opportunities to heal alongside others within their communities, as “no one who sees a disaster is untouched by it.” Ultimately, the mental health and well-being of physicians should be prioritized and help-seeking normalized after mass public shooting incidents. Additionally, while this piece highlights the needs of physicians, it is important to acknowledge that other members of the broader healthcare team, like respiratory therapists, hospital technicians, and social workers, are also often overlooked. Therefore, further studies are warranted to understand their experiences after mass public shootings. Ultimately, it is time to heed the call to care for those who selflessly care for us.
ABOUT THE AUTHOR
Rebecca Cowan is a faculty member in the College of Social and Behavioral Health at Walden University and an affiliate scholar with the Regional Gun Violence Research Consortium. As a disaster mental health supervisor with the American Red Cross, she has responded to several mass shootings, including the Route 91 Harvest Festival in Las Vegas, Nevada, Marjory Stoneman Douglas High School in Parkland, Florida, and Robb Elementary School in Uvalde, Texas. Cowan also served as a gubernatorial appointee on the Commission to Investigate the May 31, 2019, Virginia Beach Mass Shooting.
The Costs of Gun Violence and How Gun Violence Survivors Navigate Those Costs
Gun violence is an immeasurable tragedy that entails bewildering financial hardships. Scholars estimate that gun violence costs the US as much as $557 billion each year—that’s over $1,600 per American per year. Americans don’t directly pay that cost—there isn’t a “gun violence” line item on your annual tax forms to pay a share of the related hospital and counseling bills, the lifetime of lost productivity, the costs associated with the criminal justice system, and other financial burdens that gun violence entails. A great deal of this collective cost is absorbed by employers, the healthcare system and insurance companies, and the criminal justice system, and then passed down to many Americans in the form of fewer benefits, larger premiums, and higher taxes.
But much of it isn’t. Gun violence survivors—those who are navigating one of the most traumatic experiences they will endure—often have to figure out on their own how to shoulder the immediate financial fallout of gun violence. This includes: paying for a funeral no one budgets for; keeping up with expenses once covered by a now-injured or deceased family member, from basic living expenses to college funds for now-orphaned children; covering months, if not years, of therapy for aggrieved loved ones; and even figuring out how to make it through the workday under the weight of trauma, bereavement, and grief. The costs can be crushing, especially for the most vulnerable survivors who may find themselves scrambling just to make it through the immediate aftermath of gun violence. The racial disparities are stark, with gun violence often concentrated in communities already disproportionately bearing the brunt of poverty and marginalization. According to 2020 CDC data, Black Americans were over 12 times as likely to be murdered by gun violence as compared to white Americans, Hispanic (twice as likely), and indigenous people (over 3.5 times as likely) were also disparately represented among the 19,000 murdered that year by gun violence.
Even victim’s compensation programs—applauded as a means of putting victims at the center of crime response—often require survivors to wade through a confusing, and sometimes demoralizing, process only to receive fewer funds than requested or even outright denial. Indeed, one investigative report found that fewer than 40 percent of Illinois gun violence survivors who applied for victim’s compensation actually received it. But what’s worse is that the same report found that only 1 in 50 eligible gun violence victims even applied in the first place—likely because they didn’t know they were eligible or found the application process all too cumbersome.
The costs can be crushing, especially for the most vulnerable survivors who may find themselves scrambling just to make it through the immediate aftermath of gun violence.
Consequently, many people turn to crowdfunding sites like GoFundMe, where at least at the onset, the barriers to setting up a campaign to support gun violence survivors seem far lower than pursuing other kinds of support. Gun violence survivors aren’t alone in turning to the crowdfunding site: since GoFundMe’s founding in 2010, over $15 billion has been raised for people campaigning for causes as diverse as vet bills, college tuition, and tattoo removal. In the absence of accessible and adequate public resources, as with victims’ compensation funds, it’s no wonder that well over 100 million people have campaigned and donated on the site. But not all campaigns fare equally. Our forthcoming study, coauthored with Catherine Burgess, in the August 2024 issue of Gender & Society examines GoFundMe campaigns started to support those impacted by gun homicides of women and girls.
Our study aims to understand how the politics of victimhood impact the financial ramifications of gun violence, as survivors turn to private help amid inadequate public support. Perhaps because boys and men are more likely to be victims of gun violence, far less attention has been focused on women and girls as gun violence victims and how both gender and race shape how survivors are both understood and are able to cope in the aftermath. We looked at two states—California and Florida—using the National Gun Violence Memorial Project to identify murdered women and girls, whose names we then searched in GoFundMe to locate campaigns. Focusing on 2016–18, our sample included 127 active campaigns on behalf of people—primarily family members but sometimes friends or witnesses—impacted by gun homicides involving women or girls. This allowed us to trace disparities across different kinds of gun violence and varying demographics of victims and survivors. Specifically, we were interested in whether or not a campaign was started, which kinds of support were asked for, and how campaign organizers framed gun violence and the victims and survivors it impacted.
Among the campaigns we analyzed that were started in response to women and girls murdered in Florida and California from 2016 to 2018, we found that people turned to GoFundMe for support at a relatively consistent rate regardless of race as compared to their representation among female gun murder victims (35 percent of campaigns were on behalf of white women and girls versus 37 percent white women and girls among female murder victims; 23 percent versus 24 percent for Black Americans; 29 percent versus 34 percent Latinx). However, we found that campaigns on behalf of white women and girls garnered six times more funds than campaigns for Black women and girls, and three times more funds than campaigns for Latinx women and girls—the average campaign for white women and girls received over $33,000 as compared to $5,457 for Black women and girls and $10,178 for Latinx women and girls.
Analyzing the text of these campaigns, we found a great deal of variation in how people framed their campaigns and, ultimately, how the problem of gun violence was differently constructed as people justified the often awkward, and sometimes downright stigmatizing, act of asking for money. Sociologists Erik Schneiderhan and Martin Lukk discuss in their book GoFailMe that campaigns may convey need, but the extent to which they successfully do so is dependent on the ability of campaigners to tap into dominant discourses surrounding worthiness and charitability, alongside a willingness to divulge personal and often uncomfortable, embarrassing, or traumatizing details about an already difficult situation. Likewise, we found stark differences in how gun violence was framed: campaigns for people impacted by mass shootings were most able to tap into narratives of gun violence that framed victims as innocent, while victims of community gun violence and domestic gun violence often downplayed or even omitted mention of gun violence altogether. Further, campaigns for mass shooting victims disproportionately involved white women and girls, effectively rendering white victims as more visible—and grieve-able—as compared to women and girls of color, even though the latter disproportionately experience gun violence.
Our qualitative analysis also showed stark racial differences in the kinds of restitution campaigns solicited. Campaigns for women and girls of color were more likely to ask for funds to cover immediate expenses, like funerals and medical expenses. In contrast, campaigns for white women and girls generally did not solicit funding for medical expenses and asked for funeral expense support less often. Instead, these campaigns disproportionately asked for support that memorialized victims through charity and, more rarely, gun violence prevention and political action—a difference that not only reflected material inequalities among gun violence survivors but also reinforced divergent constructions of gun violence as a social problem. GoFundMe campaigners navigated the discomfort of asking for money for one of the most tragic experiences a family can face through the available cultural narratives for asserting victims as worthy of compassion and support. As they did so, they confronted the weight of disparate constructions of gun violence as a social problem: as public grief (for white victims) or private trouble (for victims of color), a framework we develop in our study by critically expanding the concept of the “sociological imagination” to the issue of gun violence. The vast disparities in funding outcomes we observed both reflected and reinforced this bifurcation.
Private channels of support for financial resources, like GoFundMe, may be appealing in the face of cumbersome, inadequate, and even unresponsive public support systems.
Gun violence is, however, a public problem, a fact that can get distorted not just by the disparate media coverage of gun violence, including mass shootings, but also by the options available to survivors to seek out support in its aftermath. Private channels of support for financial resources, like GoFundMe, may be appealing in the face of cumbersome, inadequate, and even unresponsive public support systems. However, our research suggests that private initiatives reproduce, rather than ameliorate, already existing inequalities for survivors—not just in terms of financial support needed to move through the aftermath of gun violence but also in the gender-racialized discourses of worthiness that render some victims grieve-able and others invisible. Similar to GoFundMe campaigns for educational expenses or healthcare needs, the experience of gun violence is unconscionably unequal and so are the social supports in its aftermath.
Hundreds of thousands of people become gun violence survivors every year: people who are shot and survive, people whose loved ones are wounded or killed by guns, and people who live in communities impacted by gun violence. Historically, most of the debate surrounding gun violence has revolved around prevention—a crucial conversation. Alongside that conversation, however, we must talk about how to support those who are now living in gun violence’s aftermath. According to the advocacy organization Everytown for Gun Safety, at present, only nine states use federal Victims of Crime Act funds specifically for gun violence survivor support and/or gun violence intervention. But, as awareness of the broader ramifications of gun violence continues to grow, states are considering and implementing other types of programs and resources. For example, following California’s lead, a handful of states are considering bills that would fund resources for gun violence survivors by taxing guns and ammunition sales; California’s new law is set to take effect in July 2024. The extent that which these initiatives may effectively support survivors—as opposed to replicate the shortcomings of existing systems—is an open question. But one thing is clear: rather than leaving survivors to bear the burdens of gun violence alone, supporting gun violence survivors—including and especially financially supporting those most vulnerable—must be part of the policy conversation.
Ep. 95 Rahimi Reactions – Rockefeller Institute
On June 21, 2024, the United States Supreme Court issued its highly anticipated decision in the case of United States v. Rahimi. In an 8-to-1 majority, the Court upheld the federal prohibition of firearms by those subject to a domestic violence restraining order. On this episode of Policy Outsider, Jaclyn Schildkraut, executive director of the Institute’s Regional Gun Violence Research Consortium, gets initial reactions to the decision from Consortium members Liz Tobin-Tyler, associate professor of health services policy and practice at the Brown University School of Public Health, and Kaitlin Sidorsky, associate professor of political science and public policy at Ramapo College of New Jersey. The conversation provides an overview of the ruling, what the concurrence and dissent opinions signal about how the court is interpreting the Second Amendment, and what comes next on the national stage for firearm and domestic violence policy.
Guests
- Jaclyn Schildkraut, Executive Director, Regional Gun Violence Research Consortium
- Liz Tobin-Tyler, Associate Professor of Health Services Policy and Practice at the Brown University School of Public Health
- Kaitlin Sidorsky, Associate Professor of Political Science and Public Policy at Ramapo College of New Jersey
Examining the role of firearm involvement in repeat intimate partner violence assaults
Intimate partner violence (IPV) remains a pervasive and complex issue with significant social and public health implications. The nexus of firearms and intimate partner violence (IPV) is an especially dangerou…
Law enforcement and firearms: understanding firearm ownership and storage habits
Objective
This study seeks to better understand firearm ownership among law enforcement officers (LEO), with the goal of informing future firearm injury and suicide prevention efforts. We describe the frequency and sociodemographic correlates of firearm ownership and storage practices among, and examine the association between suicidal ideation and current firearm storage practices.
Methods
The present study used data from a large online study (n=6410) and included data from individuals who were currently or previously being employed as an LEO (n=369; M (SD) age=39.2 y (15.8 y), 75.2% male, 66.7% white). Self-report measures were used to assess for firearm ownership, storage habits and suicidal ideation. Descriptive statistics were used to describe the frequency of firearm ownership and logistic regressions were used to examine the extent to which demographic characteristics and suicidal ideation were associated with firearm ownership.
Results
Overall, 70.5% (n=261) of the sample reported firearm ownership. LEO who were older had significantly lower odds of reporting firearm ownership. Those who were married and those who reported lifetime suicidal ideation had significantly greater odds of reporting firearm ownership. Whereas firearm-owning LEO who reporting storing a firearm locked had significantly lower odds of reporting lifetime suicidal ideation, those who reported storing a firearm unloaded had significantly greater odds of reporting lifetime suicidal ideation.
Conclusion
Findings have important public health implications and can be used to increase adherence with secure storage recommendations. Increasing secure storage may help reduce suicide risk among LEO, a sample at heightened risk for suicide.
Injury Prevention Science and Firearm Injury in Pediatric Health
In this issue of JAMA, Wolf et al found that during the period from 2019 to 2021, the US experienced the greatest increase in all-cause pediatric fatalities (aged 1-19 years) in more than 50 years, with increased mortality disproportionately resulting from preventable injuries. Importantly, the authors identified widening racial and ethnic disparities across these preventable health outcomes, particularly for American Indian or Alaska Native and Black populations. The most stark differences were observed for homicide and suicide, with Black youth 10 times more likely to die by homicide and American Indian or Alaska Native youth almost 3 times more like to die by suicide compared with White youth. Among both populations, firearms remain the dominant mechanism of injury underlying homicide and suicide deaths, and firearm fatalities were identified by Wolf et al as one of the largest factors in observed disparities. Such findings are consistent with the trends that have been observed in the US throughout the past decade, where the firearm injury epidemic has continued to advance unabated and has now superseded motor vehicle crash deaths as the leading cause of death for US children and teens.
School Shootings in US Reach Highest Recorded Levels
School shootings in the US surged over the past 25 years and mass shootings that occurred at kindergarten through 12th-grade school sites became more deadly, according to a study in Pediatrics.
Local gun violence, mental health, and sleep: A neighborhood analysis in one hundred US Cities
Publication date: June 2024
Source: Social Science & Medicine, Volume 351
Author(s): Daniel C. Semenza, Ian A. Silver, Richard Stansfield, Patricia Bamwine
School Nurses’ Role in Reducing Firearm Injuries and Deaths
This article discuss the important role school nurses can play in addressing responsible firearm storage and promoting safety within schools. By viewing the problem through a public health lens, school nurses can make a significant impact on reducing violence and creating safer environments.