Walters HM (Ann Arbor COE/SMITREC; University of Michigan), Kulkarni M
(University of Michigan), Forman J
(Ann Arbor COE/SMITREC), Roeder K
(Ann Arbor COE/SMITREC; University of Michigan), Travis J
(Ann Arbor COE/SMITREC; University of Michigan), Ilgen M
(Ann Arbor COE/SMITREC; University of Michigan), Valenstein M
(Ann Arbor COE/SMITREC; University of Michigan)
Of VA patient suicides, 66% are completed with firearms. Interventions that delay gun access during high-risk periods may reduce suicide risks, but it also may be challenging to implement in VA settings. We used qualitative methods to better understand stakeholders’ perceptions and concerns regarding gun accessibility and safety, and their ideas about interventions to slow gun access among VA patients during vulnerable periods.
We conducted, recorded and transcribed 10 focus groups: five with patients, two with clinicians, two with family members, and one with VSO members. Five investigators from different disciplines reviewed transcriptions, identifying important themes and developing content codes. Using these codes, structured summaries were developed and themes were reviewed by the study team in a consensus process.
Clinicians indicated they generally asked about gun access only when patients expressed suicidal/homicidal ideation and a plan that included firearms. Many patients reported prior suicidality/homicidality, but few reported being asked by clinicians about gun access. Patients and families often made their own arrangements to reduce access to guns during periods of suicidality without clinician involvement. Systematic screening for gun access was considered acceptable and almost universally recommended. Across groups, most participants indicated that family and friends should be involved in reducing access and that education on suicide and guns would be helpful. Distributing trigger locks and involving VSO’s in temporarily holding guns were reported to be generally acceptable. Patients reported that facilitating storage of guns offsite could be acceptable with more stringent controls.
Patients, clinicians, and family members consider screening for gun access and increasing gun safety to be a legitimate role for the VA health system. More intensive measures to slow access also were seen as acceptable and feasible, if used cautiously in carefully identified patients.
Several measures to delay gun access for high-risk patient groups are likely to be feasible and acceptable to VA patients and clinicians, if judiciously applied.