Study Suggests Promoting Gun Safety and Delayed Gun Access to High-Risk Patients is Acceptable to Veterans and Providers
High levels of access to firearms may be an important risk factor for suicide among Veterans: 62-66% of all Veteran suicides are completed with guns. In addition, Veterans have extensive firearm familiarity and training; many VA healthcare users who have mental health diagnoses also own firearms; and older VA primary care patients are more likely to have access to guns than other primary care patients. This study explored VA stakeholders' perceptions about gun safety and interventions to delay gun access during high-risk periods. Between 9/07 and 8/08, investigators conducted 10 focus groups and four individual interviews with key stakeholders, including VA mental health patients (n=24), mental health clinicians (n=11), family members (n=12), VA facility leaders (n=8), and Veteran Service Organization members (n=8) from one large Midwestern VAMC in a state where gun ownership (42%) was somewhat higher than the national average. Clinician focus groups were multidisciplinary and included social workers, psychiatrists, and clinical psychologists. To participate in the study, Veterans were required to have a mental health diagnosis, be in active VA mental healthcare, and either have current access to guns — or have had access to guns in the prior five years.
- Several measures to promote gun safety and to delay access to guns for high-risk patient groups are acceptable to VA patients and providers, if judiciously applied. For example, most patients and clinicians in this study indicated that routine screening for gun access was acceptable, particularly for patients receiving mental healthcare.
- Clinicians and patients reported having very little discussion regarding gun ownership during the course of routine treatment. Both groups indicated that gun access was typically discussed only during suicide or homicide risk assessments, and then only if the patient expressed suicidal/homicidal ideation that involved guns. However, nearly all patients felt that clinicians should routinely speak to their patients about guns.
- One of the most widely suggested and accepted interventions — across all stakeholders — was further education on suicide including risks related to guns for VA patients, family members, and clinicians.
- Findings from this qualitative study should be viewed as a first step in characterizing attitudes about gun safety and interventions to delay access.
- The authors note that new VA suicide prevention initiatives, which encourage clinicians to conduct more formal standardized suicide assessments for mental health patients, now often include direct queries regarding firearm access that might increase discussion regarding these issues.
This study was funded through VA/HSR&D Quality Enhancement Research Initiative (QUERI; RRP 07-284). Drs. Walters, Forman, and Valenstein are part of HSR&D Center for Clinical Management Research, Ann Arbor, MI.
Walters H, Kulkarni M, Forman J, Roeder K, Travis J. and Valenstein M. Feasibility and Acceptability of Interventions to Delay Gun Access in VA Mental Health Settings. General Hospital Psychiatry September 7, 2012;Epub ahead of print.