Takeaway: Steven Dobscha, MD, Director of HSR&D’s Center to Improve Veteran Involvement in Care (CIVIC), worked closely with VA’s Office of Mental Health and Suicide Prevention (OMHSP) to develop a brochure and pocket card to assist primary care teams in discussing means safety with Veterans in the primary care setting. The brochure on the safe storage of both firearms and medication was made available on the OMHSP website and content from the clinician pocket card is incorporated into the pocket guide for the 2019 VA/DoD Clinical Practice Guidelines for Suicide Prevention.
Many factors come into play that heighten the risk of suicide for Veterans. For one, their access to firearms is higher than the general population. Military training also makes Veterans more skilled at using firearms. Further, half of Veterans own firearms, and 70% of those who die by suicide use firearms, so VA is also focused on promoting safe storage. Dr. Steven Dobscha, Director of HSR&D’s Center to Improve Veteran Involvement in Care (brochure and pocket card for clinicians to offer sample scripts, preferably before a suicidal crisis begins. In helping a Veteran understand the rationale for the conversation, for example, the provider might say, “I’m glad you’re not having thoughts about suicide, but sometimes a crisis hits, and people can experience suicidal feelings. There are some things you can do to help ensure your safety if that were to happen. Would it be OK if we talked about this for a minute?”
The main thrust of the brochure is to encourage Veterans to use a locking device and store firearms with ammunition removed. Cable locks are provided free from VA. Other strategies include keeping a picture of their child or a crisis line sticker on their weapon – or freezing a gun-lock key in ice. “What we’re learning from the Veterans is most are very open to these conversations, as long as they’re conducted respectfully,” Dobscha said. (Hayes E. Portland Business Journal. 2019)
Dr. Dobscha continues his work in this area by leading an ongoing HSR&D-funded study on the Impact of VA’s New Suicidal Ideation Screening Initiative that will inform the further development and implementation of VA’s suicide ideation screening processes – and that will lay the groundwork to develop and test new interventions for primary care and mental healthcare teams to improve suicide ideation screening and care engagement.