Mother’s Day 2012 was agonizing for Dorothy Paugh. Months earlier, her heart had felt so full. Her son, Peter, had just purchased his first home with his girlfriend, welcoming family and friends inside to a birthday celebration for his brother. But now, the 25-year-old was gone, dead from suicide. Paugh was blindsided. “I did not know that my son was suicidal. I didn’t have a clue,” she told KFF Health News.

Paugh’s loss points to a hard truth: It is nearly impossible for anyone, experts included, to predict who will die by suicide. Research finds such predictions are barely better than chance — and they haven’t improved in 50 years. Psychiatrist Paul Nestadt, medical director of the Johns Hopkins Center for Suicide Prevention, has spent his career studying how and why people kill themselves, and admits that not even he can be certain which of his patients is most at risk of suicide within the next six months.

“Instead of asking every doctor to figure out which patient will die by suicide and locking that patient up, it might be that we need to make sure there aren’t loaded guns available,” says Nestadt. “That’s the one that will save the most lives.”

Research and data further support his position. Though overall suicide rates have fallen, gun suicides have met record highs every year since 2021. Firearms were used in more than half of all suicides in the country last year, claiming more than 28,000 lives, according to preliminary federal data. 

That’s the impetus behind what are known as red flag laws, now on the books in some form in 22 states and Washington, D.C. Focusing on individuals, they allow judges to temporarily remove guns from someone who poses a danger to themselves or others. Research suggests that one suicide could be averted for every 10 to 20 guns removed. Tragically, Paugh knows those stakes firsthand, too – her father also used a gun to kill himself.

But red flag laws are not a catch-all. They depend on someone spotting the danger, so they can’t help people like Paugh’s son, who showed no warning signs. And people who die by gun suicide are less likely to have sought mental health care. Suicide prevention advocates argue that these facts make broader gun policy, aimed at the whole community, all the more crucial.

The firearm equivalent could include requiring permits, background checks and waiting periods before a gun purchase is complete. Connecticut’s permit-to-purchase law was linked to a roughly 15% drop in gun suicide rates, while the repeal of a similar law in Missouri was tied to a 16% increase. Moreover, safe-storage laws, adopted in about three dozen states, have been shown to reduce youth suicides.

Politically, such laws remain a hard sell with influential gun rights groups like the National Rifle Association. And the Trump administration has rolled back dozens of firearms regulations, rescinded a former surgeon general’s warning calling gun violence a public health crisis and cut federal grants and staff dedicated to reducing community gun violence.

Even so, common ground exists. In some communities, gun shops, public health experts and even libraries work together to distribute free gun locks and offer temporary storage to people in crisis. Such efforts keep Paugh going. She continues to press for better mental health care, candid talk about suicide, and limits on access to firearms. “It’s not a cure-all,” Paugh said, but “it does save lives.”