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Abstract
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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.
Lethal Means Safety in Veteran Populations
Veterans are 1.5-fold more likely to die of suicide than nonveterans, and for women veterans, the risk is even higher--2.1-fold that of nonveterans. From 2005 to 2017, the annual number of veteran suicides rose from 6065 to 6435. Easy access to a firearm is arguably the most important modifiable factor associated with suicide mortality in veterans.2 In 2017, 69% of veteran suicides involved self-inflicted gunshots compared with 48% for nonveterans. Evidence suggests that most veterans are unaware of the association between guns and suicide risk. In a 2019 survey, only 6% agreed with the well-established finding that guns in the home increase suicide risk.3
Such unsettling statistics underscore why clinicians need to counsel veterans about safe gun storage practices and the risks of guns in the home. In 2015, 8 professional medical health associations published a statement supporting the value of lethal means safety counselling in reducing firearm-related deaths.4 Such conversations may be the last opportunity to intervene before a suicide attempt--64% of people who attempt suicide have seen a health care professional within the month before the attempt...
Language: en |