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BACKGROUND/RATIONALE:
Preventing suicide is a VA priority. Although suicide is a serious public health challenge, only a few prevention strategies have reasonable evidence for effectiveness. One is reduction in access to lethal means. 66% of VA patient suicides are currently completed with firearms. Implementing interventions to slow gun access for vulnerable patients may be critical to the VHA's goal of reducing suicide among its patients. However, it may be challenging to develop interventions that are acceptable to veterans and logistically feasible in the VA.
OBJECTIVE(S):
The specific aims of this project are to: 1) better understand veteran and other stakeholders' perceptions and concerns regarding gun accessibility and safety, 2) elicit ideas regarding interventions that might slow gun access and improve safety, and 3) develop and extensively pretest a survey that will document the prevalence of gun availability among VA patients, current efforts to ensure gun safety, and patient willingness to participate in a variety of interventions to increase safety.
METHODS:
We are using qualitative methods to explore stakeholders' (mental health patients, clinicians, family members, and Veterans Service Organization (VSO) members) perceptions and concerns regarding gun accessibility and safety and their ideas about acceptable interventions to slow gun access for at-risk patients. We are conducting semi-structured interviews and focus groups consisting of members of each of these important stakeholder groups. Five investigators from different disciplines (psychiatry, psychology, social work, social science) are reviewing focus group transcriptions, identifying important themes and developing content codes through a consensus process. Structured summaries based on these codes are produced by study staff and themes are reviewed by the full study team in a consensus process. A survey is being developed that taps important domains related to gun accessibility, suicidality, and other themes emerging from the focus groups. This survey will be pretested and fielded to a representative sample of mental health patients receiving treatment at the study site.
FINDINGS/RESULTS:
Thus far, we have completed five mental health patient and two clinician focus groups, consisting of 23 patients and 12 mental health clinicians.
Few patients had been asked about guns by their clinicians, although many reported periods of being suicidal or homicidal. Many paients had made their own arrangements to reduce access to their guns during periods of suicidality. Patients indicated that the VA health system and its clinicians could and should play a role in decreasing gun access for patients during periods of vulnerability. Systematic screening for gun access was considered acceptable and almost universally recommended. Almost all patients considered involvement of family and friends in efforts to reduce access during high-risk periods to be acceptable. Trigger locks and involving veteran service organizations in efforts to slow access were also generally acceptable. However, patients expressed concern about accurately identifying patients who were truly at-risk.
Clinicians generally reported making inquiries about guns only during suicide assessments rather than routinely screening for access. They noted difficulty in convincing veterans to relinquish their guns when suicidal or homicidal. Many indicated personal discomfort with guns. Clinicians were in favor of routine screening for guns and prefer that patients completely remove guns from their homes.
IMPACT:
This study will provide important information as the VA health system considers how it might reduce suicide among its patients. Thus far, study data indicate that both patients and clinicians consider determining access to guns and increasing gun safety to be a legitimate role for the VA health system and its clinicians. Systematic screening for gun access was widely accepted. More intensive measures to promote safety, particularly involving friends and family, were also accepted if at-risk patients were accurately identified.
PUBLICATIONS:
None at this time.
DRA:
Mental Illness, Military and Environmental Exposures
DRE:
Prevention, Diagnosis and Prognosis
Keywords:
Risk factors, Operation Enduring Freedom, Operation Iraqi Freedom
MeSH Terms:
none
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