Chattanooga Times Free Press

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.”

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