I don’t want to send kids home to die. Perhaps that’s why I struggle to this day with the case of a 16-year-old boy I’ll call Alex, who was my patient on the adolescent inpatient psychiatry unit at a prominent Connecticut hospital. He tried to kill himself, and three weeks later I had to send him home to a house stocked with guns.

I’m a psychiatrist. I’m also a soldier in the U.S. Army Reserves. I have trained with weapons and borne them as part of my service while deployed in Afghanistan. How, I still ask myself, do I balance the Second Amendment rights of citizens to bear arms with the need to secure the safety of a mentally ill youth who lives in a gun owner’s home?

I work with severely mentally ill kids every day – and the heartbreaking reality is that some of my young adolescent patients have died because of suicide. Suicide is now the second leading cause of death among teens and young adults, and firearms play a worrisome role in this. Adolescents can be very impulsive. There isn’t much time between thinking about suicide and acting upon it. Many adolescents have told me that they were relieved to be alive after an attempt. They felt they were caught in the moment and couldn’t see a way out. But the chances of surviving a suicide attempt with a gun is very, very low — around one in 10, compared to, say, by overdose on medications where survival can be greater than nine in 10. One study found that states with more lenient gun laws had higher suicide rates, and most of the adolescents who made it to the hospital died there. When I know there are guns in the house of a suicidal patient like Alex, I am looking at a young person who, if he tried to kill himself, is extremely likely to succeed.

Alex and I met on the inpatient adolescent psychiatric unit, after he attempted suicide by overdosing on lithium. Though I work extensively with young people who have tried to harm themselves, it is not often that I find myself facing a young person who is that determined to die. Many of the adolescents I see have expressed thoughts of killing themselves. Few rise to the level of severity Alex did. He was a withdrawn and angry young man. But truly he was sad. His lack of close friends and sense of isolation within his family only added to how lonely he felt. It was just easier for him to be angry. This was something he and I talked about in the two weeks we worked together. We seemingly patched up the cracks enough to allow him to hold some hope. Then came the bigger issue.

After his two-week recovery, he looked better. The side effects of lithium, particularly the tremors and fogginess, were dissipating. His kidneys were recovering well. He was reflecting on what had happened, and looked forward to resuming life as a high school junior. I could check all the boxes for discharge, except one. Alex’s stepfather had a gun collection. He assured the hospital his 10 or more guns were locked up. But Alex had shown himself to be impulsive and determined. I feared his fragile commitment to life wasn’t compatible with a gun safe in the basement. When I brought this up with Alex’s family, his stepfather wouldn’t budge. “Why don’t you just do your job and leave my guns alone,” he said. “They don’t concern you!” Clearly, he considered my recommendation that he remove the firearms from his home a gross encroachment on his Second Amendment rights. Who was I, he demanded, to suggest that?

To be fair, I agreed with him. I understood that he legally owned his firearms and handled them responsibly. However, I also could not stomach the implicit message it sent his stepson: the guns would stay, even if Alex had to go.

Alex, who had volunteered the information about the firearms during a suicide risk screening, shrugged off the dispute. Guns or not, he planned to go home. That made me even more worried. Did he want to leave the hospital because he genuinely felt better or because he was secretly hoping to get access to the guns as soon as he got home?

The psychiatric team and I contacted Child Protective Services for the state and the local police department in the hope they could help break the impasse. The answer was no. Since the weapons were registered legally, even the fact that the minor in that household had made a near-lethal suicide attempt was not sufficient grounds to remove the firearms. True, Alex didn’t own those guns. But this was in Connecticut, where almost two years earlier, a young man had fatally shot 20 children at a Newtown elementary school. That young man, who suffered from mental health issues, didn’t own those guns either. He stole them from his mother before killing her.

As a first-year psychiatry resident, I had seen how a single error of judgment could be fatal. I had evaluated a man brought to the emergency room by his wife. She was concerned by the extent of his sadness since their 16-year-old son had shot and killed himself three days before. The parents had been away and returned to find their son dead in his room, a handgun with a spent shell casing beside him. The parents had not even believed the gun worked. There was no ammunition in their home. At the time, I was much too inexperienced to understand the nuances of that encounter, to discern grief from guilt in the tears that poured down the father’s face. But I remember clearly the enormity of his pain.

I approached Alex’s stepfather again, asking if he’d remove the firearms temporarily and store them elsewhere. Again he refused. I’d exhausted all remedies. Alex went home to a house full of guns.

I’ve talked about his case many times with my friends and fellow soldiers in the last four years. And every time I have brought up the dilemma, some people have thrown up their hands saying nothing could be done. One friend flatly told me that I am against the Second Amendment and trying to take away people’s guns. I’m not. Another colleague told me that as long as the weapons are secured safely, there’s no problem. But adolescents are as smart as they are resourceful. The young killer’s mother in Newtown was a “gun enthusiast”; he got into her gun safe with keys. There was no break-in.

Not long ago I admitted a 15-year-old adolescent whose father found him sitting beside a loaded handgun at his home. The father swore to me that the firearm had been locked in a safe. He couldn’t fathom how his son had gained access. But he had, and it was on the table, resting next to the suicide note he had written out for his parents.

I am a soldier and I consider myself a proponent of the Second Amendment. But I believe first in taking all possible measures to protect fragile children. That demands compromise in what too often is an intransigent debate with no middle ground. Removing firearms from a home for four to six weeks during the high-risk period following a hospitalization is not tantamount to stripping someone of their right to bear arms. And I can’t believe there is a parent out there who wants to present their children with the means to kill themselves. I don’t ever again want to discharge a fragile young patient into what I believe might be a lethal situation. I never heard what became of Alex. All I know is he never showed up to his follow-up appointment. 

Zheala Qayyum is a child and adolescent psychiatrist at Boston Children’s Hospital who works extensively with at-risk teens. She currently is working on her master’s degree in Medical Education at Harvard Medical School. This article was previously published in Scientific American.

Illustration by April Brust