Clinicians have trouble convincing parents of troubled children to lock up firearms at home.

Rural Americans between the ages of 10 and 24 are twice as likely as their urban counterparts to commit suicide. And while youth suicides have declined across the country in recent years, suicide rates in sparsely populated areas have remained steady. While it is hard to pinpoint the reasons for this disparity -- access to mental health treatments is a major contributor -- one reason may be tied to gun culture.

According to a recently published survey of Midwestern mental health clinicians, one of the challenges rural therapists face is telling parents of troubled youths to lock up their guns. The Midwestern counselors in the survey "agreed that nearly everyone owned and used guns," and said that in a lot of their clients' homes, guns were so commonplace that they became "part of the furniture."

Parents in these areas often need to be reminded that guns are involved in half of all youth suicides, and that having them in the home makes it easier for young people to end their lives. A 1992 report in the New England Journal of Medicine linked the presence of the firearms on a property to the likelihood of a suicide occurring there. More chillingly, it found "few victims acquired their guns within hours or days of their death; the vast majority had guns in the home for months or years."

But an excerpt from the report shows how difficult it can be to convey this to gun-owning parents. (In the transcript below from a therapist focus group, "M" and "S" are two different mental health clinicians.)

M.: I think there's a cultural component too to this particular area. 'I'm a gun-toting American and I'm free to do my own thing.' And that's just the way a lot of people feel in this area.

S.: The [U.S.] Constitution says I'm allowed to have that gun.

M.: That's right.

Facilitator: Well, we're not here to talk about that. . . .

M.: But that is a factor when you're talking to the parents because that's a main thing that you sometimes come up against. You do have to talk about, "Ok, yes, we all have rights, but we're talking about suicide here, potentially your child killing themselves." You sometimes have to refocus them in on that because they sometimes see more globally their rights rather than the issue at hand.

So how can therapists tell gun-owning parents to lock up their deadly "furniture"? The authors of the current study suggest empathy: Therapists should tell the parents that they understand, being from the same rural area, why guns are perfectly acceptable to keep in the home. But they then have to dive further into safety concerns.

As one therapist in the survey put it, "In the time that my husband and all three boys were there, there could have been 40 hunting guns in my house. ... That stuff has to be secured -- it can't be part of the furniture anymore."