Topic: College of Sciences and Humanities

October 31, 2011

Psychiatric nurses could play a role in preventing firearm suicides and homicides among the mentally ill, but few receive training on this issue, says a new study from Ball State University.

"Graduate Psychiatric Nurses' Training on Firearm Injury Prevention" found that in spite of the concrete recommendations from American Psychiatric Nursing Association, only 9.4 percent of psychiatric nursing programs in the U.S. reported training their students to look for signs that patients might shoot themselves or someone else, said study co-author Jagdish Khubchandani, a community health education professor in the university's Global Health Institute and Department of Physiology and Health Science. 

This study is a part of a series conducted by Khubchandani and his colleagues, examining efforts by medical education to reduce firearm trauma. Their research has found that 80 to 90 percent of firearm suicides and homicides are committed by people with a mental health need.

"Firearm morbidity and mortality are major public health problems that significantly impact our society and especially harm those with mental health problems," Khubchandani said. "Psychiatric nurses can and should be involved in the prevention of firearm trauma to their patients and their patients' families. Suicide rates are higher among those with mental illness than among the general population."

He pointed out that the nation's gun violence is largely attributed to the extensive presence of firearms. A recent national survey found that 38 percent of households and 26 percent of individuals reported owning a gun.

Firearms in the home have repeatedly been linked to increased risks of violent death. Compared to people without access to guns, individuals with access to firearms have a 17-fold higher risk of suicide, Khubchandani said.

The study analyzed the responses of 85 directors of psychiatric nursing programs around the country to better understand how to reduce the dangers associated with guns.

As a result of the research, the authors found:
• About 87 percent of the directors reported that they had not seriously thought about providing firearm injury prevention training.
• Almost half (48 percent) reported they did not routinely screen patients for firearm ownership.
• About 66 percent thought that the American Psychiatric Nurses Association (APNA) should provide curriculum guidelines regarding firearm injury prevention training.

The study also found that 58 percent of the program directors perceived firearm control issues as a serious problem for the mentally ill, yet 5 percent believed that providing firearm injury prevention training to their students would save lives.

"This would seem to imply that such an important violence issue is not a priority for psychiatric nursing programs, in spite of the fact that mentally ill patients and mental health care providers are at an increased risk of victimization by firearms," Khubchandani said. "However, it could also be that the widespread absence of training on firearm injury prevention was because 39 percent of nursing directors perceived that firearm ownership is not more dangerous for the mentally ill than for society members in general."

He pointed out that this perception stands in stark contrast to the authors' findings from previous studies with clinical psychologists and psychiatrists, where both groups reported a greater belief in the dangers of firearm ownership for the mentally ill.

Because of the higher risk of harm to patients and their families, Khubchandani said, graduate psychiatric nurse, psychiatrist and clinical psychologist training programs should include firearm injury prevention.

Psychiatric nurses also should be trained to conduct brief clinical interventions to assess firearm violence risk in patients and assist patients in reducing this risk, he said.