Can veterans lead the way on preventing suicide?

The depression that settled over Tyler Solorio after his combat tour in Afghanistan gave rise to dark thoughts. He attended counseling at a Veterans Affairs clinic in his hometown of Modesto, California, where he had returned in 2012 following a yearlong deployment with the Army National Guard. Therapists prescribed medication to level out his moods and subdue his suicidal impulses, yet as he recalls, none of them ever asked if he owned a firearm.

“That’s a difficult conversation that a lot of clinicians don’t necessarily want to have,” Mr. Solorio says. “But I wish someone had brought it up because I was a risk to myself at times.”

The polarized tenor of the country’s gun debate complicates the question of how – or whether – private clinicians and those at the Department of Veterans Affairs (VA) discuss firearms with patients struggling with a mental health crisis. Raising the topic with combat veterans poses a thornier dilemma for therapists because of the life-or-death bond that troops form with their weapons in a war zone.

“It’s like a security blanket – it’s always with you,” says Mr. Solorio, who belonged to an infantry unit. After coming home, he found that keeping a gun close at hand offered solace as he coped with panic attacks that provoked fear of imaginary threats. “It took the edge off because I knew I could protect myself.”

Guns rank as the most lethal method of suicide, with 9 in 10 attempts proving fatal. Almost 70% of veterans who take their own lives use a firearm – compared with about half of civilians who die by suicide – and one-third of former service members store guns loaded and unlocked in their homes.

In response, the VA has sought to promote firearm safety as part of its campaign to reduce suicide risk, urging veterans to consider precautions that include gun locks, removing a gun’s firing pin, or storing firearms outside the home.

The safety measures can slow a person’s ability to follow through on suicidal thoughts and preempt an irrevocable choice, explains Matt Miller, the VA’s acting director for suicide prevention. Research shows that 70% of suicide attempts occur within an hour of a person deciding to act on the idea; a quarter occur in less than five minutes.

“We know that creating more time and space within those impulsive periods can allow for a change of heart,” he says. “If we can buy some time, that can be life-saving.”

Suicide rates for veterans and the overall population have climbed over the past 20 years, and more than 6,100 former service members died by their own hand in 2017. Mental health researchers suggest that, given the public’s esteem for veterans, the VA campaign holds potential to influence civilian attitudes about lethal means safety as a deterrent to suicide.

“Veterans are venerated in our society,” says Dr. Joseph Simonetti, an assistant professor at the University of Colorado School of Medicine who has studied gun storage habits among veterans and civilians. “To the extent that they make changes in their approach to gun safety, that could have an effect on the rest of the country.”

A self-preservation tactic

A survey last year of Iraq and Afghanistan war veterans with mental health needs revealed that 20% worried that seeking care from the VA could result in confiscation of their firearms.

The concern arises from the agency’s authority to provide a veteran’s records to the FBI for inclusion in its system of national background checks for gun purchases. Federal reports show that such referrals, based on a finding of “mental incompetency,” occur in less than 1% of patient cases.

The misgivings among veterans hinder the VA’s efforts to persuade more of them to receive treatment and add to the complexity of discussing firearms with those in crisis. Clinicians work to defuse their wariness by framing gun safety as a self-preservation tactic that aligns with the military training principle of injury prevention. Several studies link unsafe gun storage to elevated suicide risk across demographic groups, including active-duty soldiers.

“We’re not talking about restrictions,” Mr. Miller says. “We’re talking about safety.”

A firearm can represent something akin to a fifth limb to veterans. The sense of attachment presents a chance for therapists to discuss secure storage practices as one element in a regimen of practical self-care. Dr. Simonetti likens the decision to apply a gun lock or stow a firearm outside the home to choosing to take medication or attend counseling.

“We’ve been treating gun safety as a separate issue,” he says. “But it should be integrated into an overall course of care.”

Broaching guns in the context of injury prevention enables behavioral health providers to learn about the storage habits of their patients. Craig Bryan, who leads the National Center for Veterans Studies at the University of Utah, advises his team of clinicians to pose open-ended inquiries to elicit relevant details.

“We often ask questions like ‘How do you typically store your guns?’ and ‘Why do you store your guns that way?’” says Mr. Bryan, an Air Force veteran who deployed to Iraq in 2009. Contrary to the common assumption that veterans will recoil from considering precautions, he adds, “I’ve found that, on the whole, they’re open to the idea.”

In a recent VA study, three-quarters of veterans receiving mental health care at its medical facilities endorsed at least one of four voluntary options for limiting access to their firearms. The choices ranged from clinicians providing guidance to a veteran’s family members on safe storage to VA programs for storing or disposing of guns.

The agency’s growing emphasis on firearm safety draws support from Mr. Solorio, a policy analyst with Swords to Plowshares, a veterans advocacy organization based in San Francisco. His generation has borne much of the burden of the country’s 21st-century wars, and he falls within the age group – 18 to 34 – that had the highest suicide rate among veterans in 2017.

“Guns are such a delicate topic. But they need to be talked about,” he says. “Too many of us are being lost here at home.”

Veterans as catalysts

Researchers with the American College of Physicians estimate that 4 in 5 doctors never raise gun safety measures with patients at risk of suicide. Their reluctance stems from the country’s fraught debate on firearms and the political stalemate that has blocked almost all public funding for gun violence research since the mid-1990s.

The excess of rancor and lack of fresh data have sown uncertainty among doctors about how to identify and treat patients who present a threat to themselves. As Dr. Simonetti says, “We learned a lot about diabetes prevention in medical school. We didn’t hear anything about gun violence prevention.”

Between 1999 and 2017, suicides by firearm rose 44% nationwide, increasing from 16,599 to 23,854. In the view of mental health clinicians, the VA’s advocacy for lethal means safety – an effort that extends to disposal of surplus and unneeded medication – could prove vital to reversing the trend.

Mr. Bryan suggests that the lofty perch veterans occupy in American culture, coupled with evidence-based studies showing a correlation between gun safety and lower suicide risk, creates an opportunity for a more enlightened, less combative national discussion about firearms and suicide prevention.

“Military personnel and veterans are perceived to be especially knowledgeable about these issues,” he says. An embrace of secure storage practices by more veterans “could catalyze a much needed shift in our broader society that could save a lot of lives.”

The example set by former service members could ease the trepidation of doctors who hesitate to ask patients in crisis about their access to guns at home. Dr. Christopher Barsotti has confronted that scenario as an emergency physician at hospitals in western Massachusetts and southern Vermont.

“Veterans can bring credibility to the idea of being safe and responsible with guns,” says Dr. Barsotti, co-founder of the American Foundation for Firearm Injury Reduction in Medicine, or AFFIRM. The Massachusetts nonprofit is one of several research groups formed by physicians in recent years that approach gun violence as a public health crisis. “That could open up the conversation around firearms and preventing suicide,” he says.

The scourge of suicide almost claimed Brian Vargas. His combat tour in Iraq with the Marine Corps ended in 2007 when he suffered nearly fatal gunshot and shrapnel wounds during a firefight with insurgents. A desire to escape his enduring physical and mental trauma fueled persistent thoughts of taking his life.

The ordeal moved Mr. Vargas, who lives in the San Francisco Bay Area, to help launch a suicide prevention program called Warrior Box Project. The concept involves a veteran filling a small storage case with photos of loved ones, military medals, and other mementos that serve as reminders of life’s worth.

Mr. Vargas encourages veterans who own firearms to store another item in the box. A few years ago, in a suicidal spiral, he rummaged through his own box searching for the key to his gun lock.

He saw photos of his wife. He stared at bits of shrapnel that doctors had removed from his face and body. His despair subsided. He set down his gun.

His work to bring attention to veteran suicide has taught Mr. Vargas that he and others who wore the uniform can change civilian perceptions about gun safety. “Everybody struggles – everybody,” he says. “So as veterans, because of how we’re seen by the country, we have a chance to make a difference. We have a chance to lead the way.”