To Prevent Suicide Among Veterans, Their Physicians Should Discuss Gun Safety

Abstract

In mid-October, President Trump signed the Commander John Scott Hannon Veterans Mental Health Care Improvement Act, drawing praise from veterans and their families. The law memorializes former Navy SEAL Commander Hannon, a veterans' mental health care advocate who committed suicide in 2018, and seeks to reduce the suicide rate among veterans. It increases oversight of the US Department of Veterans Affairs' (VA) mental health and suicide prevention programs and allocates $174 million for these programs from 2021 through 2025. Among other strategies, the law funds research into the role of benzodiazepines and opioids in veteran suicides and mandates an efficacy analysis of VA antisuicide campaigns. It also requires that the VA and the Department of Defense (DOD) issue an update to the VA/DOD Clinical Practice Guideline for Assessment and Management of Patients at Risk for Suicide.The new law takes big steps in the right direction but does not address key aspects of the problem: the unique role of firearms in the veteran suicide epidemic, the importance of lethal means safety counseling for at-risk veterans, and the need for VA clinicians to receive training in effectively and sensitively talking with veterans at risk of suicide about firearms, as an expert policy roadmap has recommended. 1 Despite these omissions, earlier this month the VA mandated that all Veterans Health Administration health care practitioners complete a lethal means safety course within 90 days as part of its Suicide Prevention Now initiative. This is a critical advance in VA suicide prevention efforts for many reasons.Author affiliations and article information are listed at the end of this article.

“Feel the need to prepare for Armageddon even though I do not believe it will happen”: Women Veterans’ Firearm Beliefs and Behaviors during the COVID-19 Pandemic, Associations with Military Sexual Assault and Posttraumatic Stress Disorder Symptoms

“…Given the salience of fear and the perceived need for protection in driving women Veterans' firearm behaviors during the pandemic, identifying ways to assuage such fears and facilitate safety and protection in the context of recent national and global events is essential. Standardized lethal means safety counseling is now a mandated clinical practice within the VA [66]. As such guidance was not mandated at the time of data collection, it is possible that women Veterans' firearm access and beliefs have changed since then, particularly for those who have used VHA services (data indicate, however, that only 14% of those using VHA services recall ever having a conversation with a provider about firearms [67]).…”

“Lock to Live” for firearm and medication safety: Feasibility and acceptability of a suicide prevention tool in a learning healthcare system

“…Reducing access to lethal means for suicide is highly effective for suicide prevention (1)(2)(3). In the United States, this involves targeting the most common lethal meanssecuring firearms and mitigating risk for overdose (e.g., disposing of unused medications or asking a support person to dispense prescription medications during high-risk times) (2).…”

Extreme Risk Protection Orders—A Tool for Clinicians to Prevent Gun Violence

“…7 In 2019, the Veterans Administration and the Department of Defense published clinical practice guidelines for clinicians caring for patients at risk of suicide that included recommendations for lethal means counseling. 8 The ERPO laws complement lethal means counseling by providing a mechanism to remove guns when the risk is high and the likelihood of people voluntarily relinquishing their firearms is low.…”