As lawmakers and mental health advocates wrestle with how to stop the avalanche of suicides by firearm in this country, some are looking to a novel idea at work in a handful of states: Register yourself as a suicide risk so you can’t buy a gun on a whim.

Mass shootings get more attention, but the smaller-scale tragedy of gun suicide represents a majority of firearm deaths in most states. In the United States, suicides make up 57% of all gun deaths, or about 117,000 out of 206,000 firearm deaths in the past five years, according to federal Centers for Disease Control and Prevention preliminary data analyzed by Stateline.

Many states are grappling with new ways to prevent gun suicide. It’s a goal of many state laws focused on gun violence in general, including storage, waiting for periods, and red flag laws aimed at removing guns from those who might be a danger either to themselves or others.

Since 2018, Utah, Virginia, and Washington state have passed Donna’s Law, registries for those who think they could become suicidal and don’t want the ability to buy a gun on a whim. Maryland lawmakers are considering such legislation this spring.

U.S. Reps. Pramila Jayapal, a Washington state Democrat, and John Curtis, a Utah Republican, sponsored federal legislation last year, but it did not advance beyond the House Judiciary Committee. Jayapal plans to reintroduce the bill during this congressional session, said Rachel Madley, a health policy adviser in her office.

Named for Donna Nathan, who took her own life in 2018 in New Orleans with a handgun she had just purchased, Donna’s Law is promoted by Nathan’s daughter, Katrina Brees.

Nathan had a long history of depression and mental illness and had made unsuccessful attempts on her life in Massachusetts by other methods before the family moved to New Orleans in 2010, Brees recalled in an interview.

“Massachusetts doesn’t have a gun store on every corner,” said Brees, adding that she has joined the registries in Virginia and Washington state as a show of support and because she doesn’t want other families to go through the same pain as hers.

Nationally, the lowest rates of gun suicide over the past five years are in Massachusetts (1.4 per 100,000 people), New Jersey (1.5), and New York (1.7), while the highest rates are in Wyoming (15.5), Montana (13.1) and Alaska (13.0). The national rate is 5.6, according to the Stateline analysis of CDC data.

In all but nine states, most gun deaths are self-inflicted. The highest proportion is in Maine, where 89% of gun deaths are suicides, and the lowest is in Maryland, where 34% of gun deaths are suicide.

Suicides are a majority of gun deaths nationally and in most states, according to a Stateline analysis of deaths reported between 2018 and early 2023.

In that time, the rate of gun suicides was 5.6 per 100,000 population, on an age-adjusted basis, and varied from 1.1 in the District of Columbia and 1.4 in Massachusetts to 15.5 in Wyoming and 13.1 in Montana.

In Maryland, bill sponsor Del. David Moon, a Democrat, during a floor debate called the measure “similar to what we in Maryland do for gambling, where a problem gambler can put themselves on a list.”

“A person who is having a moment of clarity and wishes to place themselves on a list to prevent themselves from being able to purchase a regulated firearm, handgun, may do so,” he added.

Although House of Delegates Minority Leader Jason Buckel, a Republican, during the debate said, “I like the word ‘voluntary,’” he ultimately voted against the bill during its 96-36 passage. He did not respond to a request for comment. The measure now goes to the state Senate for consideration.

As in other states, Maryland’s registry allows people to take themselves off the no-sell list without leaving a trace in the public record. In Utah, the minimum time on the list is 30 days; in Maryland, it would be three weeks.

“You’re basically creating a mandatory waiting period for yourself,” Moon said in the debate.

The self-registry is meant to draw bipartisan support by respecting the Second Amendment right to own a gun, said Frederick Vars, a University of Alabama School of Law professor who also has helped draft model legislation for Donna’s Law.

“I’m hoping bills get introduced all over,” said Vars, adding that he’s working with legislative staffers to prepare bills in Alabama and Michigan. He helped draft model legislation that Brees then helped promote.

About 100 people have signed the existing registries, he said, a drop in the bucket compared with studies he’s helped conduct showing 30% of adults and 46% of psychiatric patients want to enroll in such a registry, he said. Similar laws have been proposed in California and Louisiana, but so far, they haven’t advanced.

In Texas, state Sen. Nathan Johnson, a Democrat from the Dallas area, proposed a bill based on Donna’s Law in 2021, and again this year after reading about the idea in The Wall Street Journal. He’s optimistic that because the registry would be voluntary, it eventually will get attention from the Republican-dominated legislature.

“In Texas, there’s a tremendous political and cultural climate in support of gun owner rights,” Johnson said. “This doesn’t even create the appearance of infringing on those rights. We can prevent suicide and promote personal autonomy at the same time – everybody has the right to say, ‘I don’t want to own a gun.’”

States also are trying other options with the stated intent of cutting rising rates of gun suicide.

A Colorado bill that passed the state House this month would require a three-day waiting period for delivery of a firearm, noting that “establishing a waiting period for receipt of firearms can help prevent impulsive acts of firearm violence, including homicides and suicides.”

In Hawaii, a bill passed by the state House and under consideration by the state Senate mentions suicide prevention as a goal of required firearms safety training. And a North Carolina bill with Democratic sponsors, introduced early this month in the state House, cites suicide as the primary reason for a red flag, or extreme risk protection order, to restrict a person’s access to firearms after a court finding that they’re a danger to themselves or others.

The most effective methods of preventing gun suicide have been strict licensing requirements, said Joshua Horwitz, a public health professor at Johns Hopkins University focused on gun violence prevention, because the rules usually include waiting periods and the ability to screen for mental health issues. Gun safety legislation also plays an important role, he said.

“Suicide is under-appreciated. It’s the biggest chunk of the gun violence problem,” said Horwitz. “We can’t stop all suicide, but if we make the means less lethal, we can save lives.”

It’s too soon to say how effective Donna’s Law can be, he added.

“It’s interesting. For some individuals, it could be the solution, but we need to know more,” Horwitz said.

More mental health services also could help alleviate gun suicide rates, especially in the rural states most affected. But the return on investment would be much lower, said Thomas Wickizer, an emeritus professor of public health at the Ohio State University who has studied state firearm suicides and how the availability of mental health services can reduce them.

He has concluded that restricting firearm access would be far more effective than mental health services alone.

“For every firearm suicide death avoided, states would have to expend roughly $15 million to increase their mental health workforce,” Wickizer said. “Obviously, this is not practical.”

Mental health services are more effective in preventing other types of suicide, he added.

“Firearm suicide is impulsive and almost always lethal,” Wickizer said. “Other suicide methods are less lethal and afford the persons who do not die an opportunity to obtain help through the mental health services system.”

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