Show Notes
In this episode of Psychiatry Boot Camp recorded live at Saint Louis University, Dr. Mark Mullen is joined by Dr. Kristin Mueller, an emergency medicine physician and physician-researcher at Washington University in St. Louis, for a discussion on firearm violence as a public health crisis. Dr. Mueller, who works closely with the Life Outside of Violence hospital-based violence intervention program, walks through the clinical fundamentals of lethal means counseling, including a live mock counseling session demonstrating how to approach a patient in mental health crisis with access to firearms. The conversation covers practical, evidence-informed strategies for secure storage counseling, verbal de-escalation, and navigating patient resistance without leading with statistics alone.
The discussion then turns to the epidemiology of firearm injury, including findings on non-fatal firearm injury rates, recurrent injury risk among adolescents and young adults, and the structural factors that shape risk beyond individual behavior. Dr. Mueller details the design and outcomes of the Life Outside of Violence program, a hospital-based intervention that pairs licensed clinical social workers with patients ages 8 to 30 following violent injury, and shares emerging data on goal-setting, goal achievement, and patient-reported outcomes. The episode closes with guidance for clinicians seeking to identify or refer patients to hospital-based violence intervention programs in their own communities.
To find your local hospital violence intervention program, visit www.HAVI.org.
Takeaways:
Clinicians in all specialties can and should ask patients about access to firearms and medications as part of routine safety counseling, not only during acute mental health crises.
Secure storage counseling is most effective when delivered with a calm, nonjudgmental approach that avoids leading with statistics alone.
Non-fatal firearm injuries vastly outnumber fatal ones, with 93% of firearm-injured patients at St. Louis's level one trauma centers surviving and returning home.
Patients treated for a firearm injury face a 7% risk of re-injury within one year and up to 17% within eight years, with adolescents and young adults at highest risk.
The Life Outside of Violence program pairs licensed clinical social workers with patients for up to a year after injury, addressing housing, transportation, and trauma counseling alongside medical recovery.
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Chapter: 00:00 Live Show Intro00:45 Meet Dr Mueller01:36 Asking About Firearms04:12 Mock Counseling Roleplay10:28 De Escalation Secrets12:50 Legal Options And EROs14:36 Psych Care Gaps In ED18:49 Clinical Pearls And Resources23:24 Ad Break26:01 Back From Break26:40 Firearm Violence Public Health27:00 Firearm Injury Public Health28:02 Beyond Politics and Blame29:48 Data Gaps and Hospital Sharing31:34 Nonfatal Injuries and Recurrence33:49 Funding and Program Origins34:45 How LOVE Works37:39 Meeting Patients Where They Are41:50 CVI Ecosystem Partnerships43:26 Measuring Impact and Outcomes51:54 Success Stories and LOV Meaning55:27 Call to Action and Resources57:14 Outro and Listener Review
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