Suicides and homicides with service firearms. An analysis of the 'Security Guards' population in Italy.

Is recent the publication of the article by Carlo Alfredo Clerici, Roberto Invernizzi, Laura Veneroni and Angelo de’Micheli "Suicidi e omicidi con l’arma di ordinanza. Analisi della casistica nelle guardie particolari giurate in Italia" on Giornale Italiano di Medicina del Lavoro ed Ergonomia [2009;31:1 (10-15), Suppl A, Psicologia].
An English translation "Suicides and homicides with service firearms. An analysis of the 'Security Guards' population in Italy" is available here: Download pdf of translation

Why www.ricercawar.com ?

www.ricercawar.com is a site for scientific research in cinical psychology and criminology dedicated to prevention of firearm’s abuse and contains scientific articles, news and other materials about Italian and worldwide situation of this problem.
In Europe, the EU Council Directive 91/477/EEC of 18 June 1991 on the control of the acquisition and possession of weapons establishes that Member States “shall allow the acquisition and possession of firearms only by persons who have good cause and who: ... are not likely to be a danger to themselves, to public order or to public safety”.
Remains however to be defined what kind of psychopathological approach is needed to prevent the risk of weapons abuse. An effective assessment of people applying for firearms permits should ideally cover both the diagnostic aspects of their current psychopathological conditions and also, implicitly, a long-term forecast of the related risk of their damaging themselves and/or others.
This kind of assessment clearly demands a more complex evaluation than is usually necessary in routine clinical activity. The clinical-diagnostic concept of “Weapons Abuse Risk” (WAR), presented in this site, is in development within a framework of multidisciplinary - psychiatric, psychological and criminological –cooperation.

Authors
The research is promoted by:
- Carlo Alfredo Clerici, a physician specialized in clinical psychology and researcher at the Psychology Section of the Department of Biomedical Sciences and Technologies of the Faculty of Medicine of the University of Milan;
- Angelo de’Micheli, psychologist and clinical criminologist occupying the Criminology chair at the Faculty of Medicine of the University of Milan.

Other work group members include:
- Laura Veneroni, a psychologist specializing in clinical psychology;
- Cesare Albasi, a psychologist specialized in clinical psychology and researcher at the Department of Psychology of the Faculty of Psychology of the University of Turin;
- Valeria Pirro, a psychologist specializing in clinical psychology;
- Roberto Invernizzi, a solicitor;
- Annamaria Cescon, a physician specialized in clinical psychology at the Niguarda Ca' Granda General Hospital in Milan;
- Isabella Merzagora Betsos, associate professor of Criminology at the Faculty of Medicine of the University of Milan;
- Roberto Carlo Rossi, vice president of the Professional Association of Physicians, Surgeons and Dentists in Milan;
- Antonio Vitello, director of the Forensic Medicine Service at the Città di Milano Local Public Health Unit.

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The risk of abuse of legal firearms

The incidence of the abuse of firearms varies from one country to another, but it generally constitutes a primary cause of death in the more industrialized countries (WHO 2000).
The assessment and certification of fitness to possess firearms is a complex medical procedure, due partly to the scarcity of empirical studies from which to glean suitable assessment criteria (Clerici 2006), and partly to a presumably scarce specific training of the clinicians involved.
The problem is important in Italy, given the number of people (4,800,000 according to the latest estimate) who possess firearms or use them for recreational or sporting purposes (with an estimated total number of 10-12,000,000 firearms in circulation).

Their fitness to own such weapons is assessed by means of a clinical history certificate issued by their general practitioners and a subsequent certificate of psychophysical suitability issued by a public health officer at the Local Public Health Unit, or a physician in the Armed Forces, or a physician in the state police. For the time being, these clinicians undertake no specific training on this issue during their university or specialty medical studies. Physicians working as general practitioners, psychiatrists, psychologists or psychotherapists have to deal with clinical situations involving patients at risk of suicidal or homicidal behavior without being able to access any information on whether or not they possess any firearms.

The topic of weapons always triggers contrasting reactions and this has probably not facilitated our scientific understanding of the phenomenon and any related preventive measures.

The majority of studies on the phenomenon of weapons abuse have been conducted in the United States.
The situation in the USA is of special interest because it has certain particular features. In June 2008 the United States Supreme Court confirmed and reinforced, the individual’s right to possess firearms. It reiterated the validity of the second amendment of the American Constitution and declared that the law of the District of Colombia (which includes the US capital, Washington) forbidding its residents from owning pistols and guns was unconstitutional.
This fact created quite a fuss in the media and the question was also discussed by the main international medical journals.
Clearly, the particular legislative situation, the social, economic and cultural features of the population of the USA, and the widespread possession of firearms mean that American scientific experiences on the matter cannot be extended directly to the European context, and to Italy.

In Italy, research has also been hindered by the lack of basic information available, such as the number of weapons legally possessed over the years by its citizens. But the problem of the psychiatric assessment relating to the matter of firearms permits is likely to remain important in years to come.
The political decision concerning whether or not to restrict the legal possession of firearms suffers from doubts as to its efficacy. While some research has identified a reduction in the number of homicides and suicides since the introduction of more restrictive laws on firearms possession, such an effect has not been confirmed in all settings.
In addition, the growing demand for security that drives some citizens to purchase firearms, and the large number of people who legitimately practise sporting and recreational activities that involve the use of firearms (such as hunting and shooting for sport) make it hardly likely that any changes will be made make the legislation will restrictive in Italy.
Improving prevention methods without any pointless extra burden on the national health system and on the country’s citizens consequently becomes a priority concern.
Our work group has been studying the phenomenon for some years, and has developed the WAR (weapons assessment risk) model to assess the risk of firearms abuse as part of a cooperative scheme currently underway, involving researchers in the psychiatric, psychological and criminological disciplines.
There is an investigation currently underway on the training of clinicians vis-à-vis the problem of the risk of firearms abuse and on their perception of their capacity to clinically manage patients who legally own firearms.
The scheme involves a data collection phase, organized into several successive stages, based on the computer-based distribution of a questionnaire to physicians and psychologists.
The data collected may provide a basis for the often-announced legislative reforms on the matter of firearms and for guidelines on training programs for physicians and psychologists.

Research in the field of psychopathology

The risk of weapons abuse cannot be brought down to a syndrome (or a nosographically definable disease) and its prevention must include various domains.
Clinically relevant aspects in this setting – though they are not nosologically sensitive – concern the domains of mental functioning, e.g.: the impact of flexible, wavering or internally persecutory rules and moral ideals in the regulation of behavior; the capacity for abstract reasoning and symbolic thinking at the service of interpersonal relations (the so-called capacity for mentalization) that enables people to identify with and understand their own and others' minds (their intentions, affects and desires, their thinking patterns, and so on), the impairment of which - and there are scales to measure such a deficiency – can make individuals more or less incapable of imagining for themselves what consequences their actions may have for other people and for themselves (also in terms of pain, joy and, in the more severe cases, of life or death); the capacity to integrate and differentiate mentally between fantasy and reality, between past, present and future, between desires and the time; the capacity to govern one's own impulses; etc.
Models are therefore needed that seek to study how an individual’s functioning is organized, in order to detect whether any decompensation of his/her psychic organization might involve the abuse of firearms.
Among the diagnostic tools currently available to clinicians, there are some - such as the Psychodynamic Diagnostic Manual (PDM Task Force, 2006) - that recommend a dimensional assessment such as those mentioned above. Clinically relevant empirical tools are also currently being developed, such as the QMF-27 (Questionnaire on Mental Functioning), to facilitate the diagnoses obtained by means of PDM.
Future developments in the field of prevention may focus on our understanding of the links between these variables and the risk of abuse.