Successful treatment of red‐back spider bite using a Bier's block technique

1. Kellermann AL, Rivara FP, Somes G, et al. Suicide in the home in relation to gun ownership. N EnglJ Moo 1992; 327: 467-472. 2. Killias M. Intemational correlations between gun ownership and rates of homicide and suicide. Can Med Assoc J 1993; 148: 1721-1725. 3. Beautrais AL, Joyce PR, Mulder RT.Access to firearms and the risk of suicide: a case control study. AustN Z J Psychiatry 1996; 30: 741-748. 4. Baume PJM, Cantor CH, McTaggart PG. Suicides in Queensland: a comprehensive study 1990-1995. Brisbane: Australian Institute for Suicide Research and Prevention, 1998. 5. Wallace C, Mullen P, Burgess P, et at. Serious criminal offending and mental disorder: case linkage study. Br J Psychiatry 1998; 172: 477-484. Cl from the 1989 International Crime Survey," The associations are interesting, but the methodological limitations prevent causal inferences being drawn. Beautrais et al noted that firearm access increased the probability that shooting would be the chosen method of attempted suicide, with its attendant risks of being successful.3They were supportive of proposals to restrict firearms. They thought that restricted access might prevent a small number of impulsive suicide attempts, in an analogous way to the observed changes in chosen method of suicide following the detoxification of coal gas. In a recent Queensland Health publication, Baume et al note that "rates of suicide are similar today to those at the end of the last century".4In their discussion of methods they note that the Australian experience is of lower firearm suicide rates in those States with greater restrictions on firearm access. There is an association between mental disorder and violent crime, but the association is modest. Violence in a psychotic group is more likely with comorbid personality disorder and substance abuse. Further, violence in a psychotic group is associated with active symptoms and should be ameliorated by treatment. The presence of mental disorder persedoes not contribute to predictions of future offending and does not justify subjecting the mentally ill to increased institutional detention or other restriction.S Deaths per 100000 population Proportionof (firearm homicide households and suicide) with firearms