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 Commander 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 says 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 percent.
The lethal-means provision that was stripped from the bill was introduced by Representative Lauren Underwood, Democrat of Illinois. “I’m a public health nurse, so I’m trained to look at the data and design policies that are effective and evidence-based,” Ms. 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 the 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, Ms. Underwood was unable to find a Republican co-sponsor for the lethal-means 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.
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 former chief psychologist for the San Francisco Veterans Affairs hospital system.
For years, he said, the medical profession has generally 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,” Dr. 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.
Bangladesh struggled in the 1990s with a high rate of suicide by ingesting toxic insecticides. After the country banned the most lethal poisons in 2000, the suicide rate dropped by one-quarter.
Because so many suicides are gun deaths, they present a huge opportunity for prevention if doctors and other health workers can find an effective way to talk to veterans about guns, according to Dr. Matthew Miller, who teaches epidemiology at Northeastern University and is a leading researcher on gun violence.
“We know the risk is there,” Dr. Miller said. But studies show that only about 10 percent of gun owners are aware of the higher risk, he said, suggesting that there is enormous room to inform people and encourage them to change their habits.
Veterans Affairs has trained more than 20,000 health care workers in recent years to talk to patients about lethal-means safety. The language removed from the John Scott Hannon bill would have made that training mandatory for many more health care professionals.
“If there is a good relationship with the patient, it doesn’t have to be culturally charged, it can come from a place of real concern, just like a doctor might talk about the risks of smoking,” Dr. Miller said.
Those conversations, though, carry their own risk. Opponents say that required lethal-means safety stigmatizes mental illness and may deter people from seeking care, which is also a criticism of so-called red flag laws that allow the 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 that 21 percent were hesitant to get mental health care from Veterans Affairs because they were worried their guns would be confiscated.
The department’s first effort at lethal-means safety was to give away gun locks to veterans. The program was met with an uproar when recipients of the free locks were asked to give their addresses and say how many guns they owned. Opponents accused the department of trying to start a federal gun registry.
Dr. Lemle, who became a senior policy analyst at the Veterans Healthcare Policy Institute after leaving Veterans Affairs last year, said the system’s reluctance to speak openly about the problem of guns had only fueled disinformation.
“The idea is not to restrict anyone,” Dr. Lemle said. “This is not a gun rights issue, it’s about coming up with a mutually derived plan to be safe. For too long, I think we’ve been afraid to talk about it, to the disservice of our patients.”
Commander Hannon, whom the prevention bill is named after, may be a case in point. After a 23-year career serving around the world with the SEALs, he retired in 2011 and moved to Montana, where he struggled for years with post-traumatic stress, traumatic brain injuries and bipolar disorder. He found solace in therapy programs that used animals, and in helping other veterans.
He owned several guns. Out of concern for his safety, his family stored the guns with a fellow SEAL at one point, but he soon demanded them back. His sister, Kim Parrott, said the family never formally learned how to talk to him about the dangers guns pose to veterans with mental health disorders.
“It would have been tough,” Ms. Parrott said, indicating that her brother and other veterans were attached to their firearms. “But I see how that could change.”