Offering Lethal Means Safety Interventions to Veterans Crisis Line Callers Associated with Reduced Risk of Emergency Dispatch

BACKGROUND:
Implementing Lethal Means Safety (LMS) measures such as secure storage methods to limit access to firearms and unwanted/expired medications may help mitigate the risk of suicide, a leading cause of death among Veterans. In the Veterans Crisis Line (VCL) LMS Pilot, Veteran callers to the VCL who were at risk of suicide and eligible for LMS counseling were offered cable gun locks or medication take-back envelopes. This study aimed to assess the acceptability of offering LMS interventions to these Veterans, and to examine call outcomes, healthcare use, and mortality associated with acceptance of the intervention. The analyses used data from eligible Veterans who contacted the VCL between June 13, 2022, and March 31, 2023. Acceptability—defined as the proportion of Veterans who accepted an intervention, as well as their reasons for declining an intervention—was assessed for two groups: Veterans who could and could not be matched to VHA medical records in the Corporate Data Warehouse (CDW) based on self-reported identifiers such as name/SSN provided during the call.

FINDINGS:

• Compared to Veterans who were not offered an LMS intervention, those who were offered any intervention—regardless of whether they accepted it—had a lower risk of having an emergency dispatch by the end of the call, and had no increase in adverse outcomes.
• Among CDW-matched Veterans (n=796), 42% accepted the LMS intervention—three times the rate during calls from non-matched Veterans (i.e., those whose enrollment in VA care could not be confirmed, n=282; 14% acceptance).
• Among CDW-matched Veterans who declined a gun lock, 58% did so because their weapon was already securely stored or they reported having a way to securely store it (“secure storage”). Of those who declined a medication envelope, 29% cited secure storage.
• Among calls from CDW non-matched Veterans who declined a gun lock, 50% cited secure storage and among those who declined a medication envelope, 16% cited secure storage.

IMPLICATIONS:

• The findings suggest that LMS interventions are acceptable to at-risk Veterans and could play a crucial role in enhancing Veterans’ LMS practices. Further evaluation is needed to determine whether acceptance of an intervention has long-term impacts on Veteran outcomes.

LIMITATIONS:

• Veterans were not randomized to the intervention, so no causal estimates can be identified.

AUTHOR/FUNDING INFORMATION:
Mss. Li and Shen are with QUERI’s Partnered Evidence-based Policy Resource Center (PEPReC); Dr. Garrido is the PEPReC Director.

Li Y, Bourgeois J, Lauver MG, Shen Y, Podlogar M, Schaper E, Sadej I, Garrido M. Quantitative Evaluation of the Veteran Crisis Line Lethal Means Safety Pilot. Crisis. September 1, 2025;online ahead of print.