Focusing on firearms contentious in struggle to reduce veterans’ suicides

The suicide rate among military veterans keeps edging higher, and to address it Congress passed a major bill this fall, named in honor of a Navy SEAL named Cmdr. John Scott Hannon, who was an outspoken proponent of veterans’ mental health treatment before he took his own life with a gun in 2018.

But at the last minute, lawmakers stripped the bill of a proven prevention technique that saves veterans’ lives and might have saved the life of Hannon. Why? Because the provision in question touched a third rail in Washington politics: the danger posed by firearms.

The Commander John Scott Hannon Veterans Mental Health Care Improvement Act, now awaiting the president’s signature, still does things the commander’s family said he would be proud of: funding community organizations that work with veterans and scholarships to train more mental health professionals.

But before it was modified, the bill would also have required health care workers who treat veterans to be trained on how to talk with at-risk patients about the danger of having guns in the house and about how to reduce that risk — a strategy known as lethal-means safety.

Evidence shows that reducing access to lethal means can drastically cut the risk of suicide. And for veterans, especially, the lethal means are overwhelmingly firearms.

The suicide rate among veterans has been climbing for more than a decade and is now roughly double that of the nation as a whole. Americans who die by suicide use a gun about half the time, but among veterans, the figure is 70%.

The lethal-means provision that was stripped from the bill was introduced by Rep. Lauren Underwood, D-Ill. “I’m a public health nurse, so I’m trained to look at the data and design policies that are effective and evidence-based,” Underwood said in a statement. “The data we have shows there’s no solution to the veteran suicide crisis without improving lethal-means safety.”

The Department of Veterans Affairs has been trying to develop ways to talk to veterans about guns and suicide for more than a decade, but the topic is so culturally and politically fraught that progress has been slow and uneven, in part because doctors do not want to alienate patients.

The lethal- means provision would have provided mandatory training to nearly all Veterans Affairs doctors and mental health professionals as well as private doctors who treat patients with veterans’ health benefits.

Like the conversations doctors have had for years with cigarette smokers, the approach involves making sure the patient understands the dangers of easily accessible guns and then asking whether the patient wants to come up with a plan to reduce those dangers. Suggestions include locking up the guns in the house or storing them with a friend, relative or local gun club until the patient’s risk of suicide has subsided.

The lethal-means safety approach has broad support among major veterans’ groups, and it was included in a list of 10 suicide prevention recommendations released by the White House in the spring.

But some veterans’ groups opposed the strategy, saying the mere suggestion that veterans remove guns from their homes could deter them from seeking mental health care.

“This emphasis on firearms misses the point,” Sherman Gillums, chief of strategy for veterans group Amvets, which opposed the legislation, said in a commentary posted online before the bill was passed. He said veterans’ mental health care should focus on better therapy techniques and reducing reliance on medications, adding, “I’m not encouraged by this emphasis on the action that was taken and not the underlying cause.”