Guns stir debate on veterans’ mental care
The suicide rate among military veterans keeps edging higher, andto address it, Congress passed a major bill this fall, namedin 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 also would 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 howto reduce that risk — a strategy knownas 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 overwhelmingly are firearms.
The suicide rate among veterans has been climbing for more than a decade and now is roughly double that of the nation as a whole. Americans who die by suicide use a gunabout half the
time, but among veterans, the figure is 70 percent.
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.”
Slow progress
The Veterans Affairs Department 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 don’t 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 under
stands 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 amongmajor 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 deterthemfromseeking 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.”
Anything that smacks of gun control is political kryptonite for conservatives.
Despite White House backing, Underwood was unable to find a Republican co-sponsor for the lethalmeans safety provision.
House Democrats added the provision to the bill, but it was removed during negotiations with the Republican-controlled Senate, according to two people familiar with the negotiations.
Experts’ view
Despite the setback, prevention experts say it makes sense to continue to expand lethal-means safety, whether or not it is mandated by law.
“If you want to really make a dent in preventing suicide, this would have the most impact,” said Russell Lemle, the formerchief psychologist for the San Francisco Veterans Affairs hospital system.
For years, he said, the medical profession generally has tried to reduce suicide by treating patients’ underlying mental health issues. But epidemiologists have realized that impressive gains can be made by making the physical act of suicide more difficult and less lethal.
“Suicide is often an impulsive act,” Lemle said. “If we can put distance between the impulse and the means, we can make a real difference.”
When access to an especially lethal method is restricted, the suicide rate often drops. Up until the 1960s, the ovens and stoves in many British homes used coal gas, which was rich in dangerous carbon monoxide and was implicated in many deaths, accidental or intentional. As the country transitioned to safer natural gas, the suicide rate fell by one-third.
Those conversations, though, carry their own risk. Opponents say required lethal-means safety stigmatizes mental illness and may deter people from seeking care, which also is a criticism of so-called red flag laws that allow police in several states to temporarily confiscate firearms from people who are deemed by a judge to be a danger to themselves or to others.
A survey of veterans who served in the military after 2001 found 21 percent were hesitant to get mental health care from Veterans Affairs because they were worried their guns would be confiscated.