Perspectives on clinician and VA involvement in prevention of firearm injuries

So, the VA can very much have resources on hand that if the Veteran needs it, say, "Here, this is a resource, get yourself a refresher course on how to be safe with that firearm," and have them, have those resources just as available as the suicide resources. Because I think that, like me, I tend to think suicide when you ask the question as opposed to somebody having an accidental discharge with the weapon. Because that's what Veterans deal with more is suicide. We don't think about the other stuff so I think that the resources need to be just as readily available.

I think I was almost naïve in the thinking that, “Oh, it could never happen to a military person.” Maybe if you heard like, “We’ve helped this many people recover from accidental discharge,” you may be a little bit more aware of a problem, or if it’s happening around you. I think it’s just almost taken for granted, firearm safety is sometimes. And if you heard, not personal stories, but like it still does happen. So, please still be careful and observe what you’re doing. It may help some people take a step back and realize, “Well, if it happened with these guys, it could happen to me too.”

So, off the cuff, I’m just thinking perhaps if in any communication or in some communication, at least once in a while, a one-time letter. And then, of course, as you get new Veterans, you’d have to mail the letter to them. Just something in the letter to say there have been Veterans who have been injured by handguns. Sometimes even their own handgun, accidentally after service. Sometimes of course, you have to go by the results of your survey. At least in my case, it’s just a matter of carelessness. Just not respecting the tool with the respect that it deserves. Just carelessness. So just—we just like to remind all Veterans, it can be worded much better than I could work it, better writer. But something to the effect of we care for Veterans. And we have Veterans who have lost their life or at least been wounded, injured. And we’d just like to encourage you, if you own firearms, to just please, don’t get careless. You’ve been around firearms maybe for many years. And you’re familiar with firearms, but just—and maybe put in there, I don’t know if this would be allowed or not, that we’ve done a survey. And something we’ve learned in the survey at least for many, whatever percent, that some say, “be careful.” If I received a letter like that, it would cause me to think. I do think it would. I just—and we’re just sending it. We’re not picking on anybody. We’re sending this out to all Veterans, combat Veterans, non-combat Veterans. Old Veterans, young Veterans, and even handsome Veterans like me.

I think everybody that has been in the military needs to be sat down and explained the facts of life. We were trained to do a job, and we did it. Now it’s time to go home. And guns kill. They need to know that.

Force the military to set aside days, not hours or minutes, about the danger of firearms. Teach some people how to ask for help. That was one of my problems. I would never ask for help till later in life. Help is there for you, they just have to…you have to ask for

So, I think accessibility to information needs to be better when it comes to Veterans, as a whole. And then, number two, speaking specifically to that, I’m not sure if they do classes. I haven’t heard of it. But I think there needs to be a program the same way that you – it’s funny because there’s a checklist you have when you come into your first unit that you have to check off all of these things. You have to get certified in all these different categories, right? I think it needs to be a – the same checklist when you come home. But it needs to be more extensive. They do have one, but it’s not extensive enough, I feel like. I think it needs to be a full, you know, you need a full checklist of everything, you know? Like, every single thing. Firearm training. Firearm safety. How do you feel about firearms? Like, you know, actual specific focused therapy, conversation, presentation on firearm safety and the effects that it’s had on you, needs to be had for sure. That’s something that just needs to be created.

That’s one thing I really appreciate. I don't know if all VAs do it, but I do know the VA here is very big on, if any Veteran walked in, and said, "I need a gun lock," I don't care if it's a behavioral health clinic or the women's clinic or the dental clinic, they're going to hand you a gun lock. And they're going to say, "Do you only need one? Because you can have ten.” So I am, I hope all VAs do that, but I'm very proud of the VA for providing that for Veterans.

That’s where I get my meds filled. That’s who gets me new...you know. So, if there is already this kind of connection around resources, there could at least be that connection made. It could be used as a cookie, too. “Hey, VA is giving away gun safes if you agree to talk to, you know, somebody who is going to call you up and ask you questions monthly for one year. And then it’s yours, we’re not going to bug you again.” But maybe those questions around— “Over the last month have you worn your firearm holstered? Have you put it in the safe every night? How many nights out of the week do you A, not bother, B, forget?” And kind of do something along those lines. 

Mental healthcare—100%, because 95% of firearm injuries are self-inflicted. It’s something stupid like that. I might not be exactly right on the number, but I know it’s something stupid high like that. Matter of fact, not too long—well, a year and half ago, I had—a brother of mine is in that statistic now. So, I’ve had a few of them the last—I think we’ve lost more to self-inflicted gunshot wounds from my old battalion that we did to the enemy. Yeah. Mental health is a serious, serious—there is a serious need for good mental health in the VA system. And I don’t see it changing because they’ve known it for 15 years or more that it’s been a shortcoming, and they’re not fixing it.

I mean I guess one thing you could do is just, you know, bring it up in conversation when you see a Vet. Say, you know, “Have you purchased firearms since you’ve been home? How many do you have?” Dah, dah, dah. I think bringing it up in conversation very nonchalant and smooth would be a good way. Because what people don’t understand is like vets do be wanting to talk to people. You know, it’s some –it just takes more – some of us longer to open up. But we just we want somebody to care. And one thing my therapist said is like people that join the military have a deep level of care for people. They just want to help. They just want to help people. So, to help the people that want to help people is – it’s a beautiful thing. And sometimes you gotta practice and push a little bit. But once you do and they get comfortable, they’ll –they’ll share anything with you, you know. And that’s somewhere I’m at, at this point in my life. I’m an open book because vulnerability is courage to me at this point.

Oh, gosh. I think I might be in the minority on this just because of my impression of gun culture. But because I believe that guns, and gun safety, and gun violence are a public health issue, if my primary care doctor started asking me about my decisions about how to keep and store my firearms, I would think that would be a welcome addition to my care; and for someone who takes that very seriously and who appreciates the statistics, and who thinks this is a public health issue--because it is--I would welcome that. And I would hope that others would be welcoming of it or, at least, they would treat it as something that they could decline if they don’t want to discuss, just like any other health issue, that they would have the right to decline. Because I think that’s the main thing is just having the choice to say, "Yes, I want to have the discussion," or "No, I don’t want to have the discussion." Kind of like when you go to the pharmacy, "Yes, please give me advice on this medication," "No, I declined advice on this medication." I think as long as choice is a part of it, then there would, I would hope, be less pushback on that.  

I think even for someone who believes the way I do and as comfortable as I am advocating for gun safety, as comfortable as I am not having the popular opinion about gun culture, I would still feel nervous talking to my doctor about gun safety; even though it’s a conversation I would welcome, I would still feel that, perhaps, there was an opportunity for judgment there. And I would be very nervous if they were actually able--if they thought that I made decisions that were unsafe and that they were then able to act on that with local authorities or infringed upon my freedoms in any way based on the information that I gave them.

You know, I mean personally, I would have to. “Yes, I own one.” And would have to give him, you know, if I admitted own one, I would be participating in, choosing to participate in the conversation and I would have to answer further questions he wanted. Again, that goes back to the, “Why you asking me about my gun?” Even I, I can look at what the extremist views are on a lot of things and don’t agree with them. I’m pretty center of the road libertarian, but at the same time, I am still influenced by it, because the first, when you asked that question, the first thing that popped in my head, “Why you want to know about my guns?” But I mean. I said, it’s got really, really emotional and polarizing on the firearms, so. Me personally, I don’t think I would have a problem with it, but I can see where that would be a hot button issue for an avid gun owner being asked them questions. God, I don’t know if there is any way to fix is long term with just a VA program.

I have never been personally faced with a healthcare provider asking that question. I think in general it’s wrong. You’re prying into somebody’s personal life. And in most cases, it has no bearing on their healthcare, the reason they’re in there for that reason. But there’s always going to be those cases, always going to be those cases where there’s going to be a person that’s at risk, that they’re having some kind of mental crisis for whatever reason and that might be important information.

I don't know. I know how I would feel if they started asking me questions about my guns. That has nothing to do with my healthcare. Yeah, I don't know. It's, I think some people – I mean, there are disgruntled Veterans out there. 

Maybe if those questions were asked by somebody that, like, a nurse or a tech in the office that the Veteran interacts with more; and would be more prone to be more open with than the actual PCP? I know some Veterans that would feel more comfortable with somebody they interact with more. And I think for, there are other Veterans that would appreciate having that conversation with somebody that they know is not anti-firearm. Like a, have a – I don't know if you really need to have a job in the VA, but maybe volunteers. I don't know exactly how that would be set up; I'd have to think about that. But I know some Veterans would find that an easier conversation with somebody. I think that the PCP, you just don't talk to 'em. What, 15 minutes every six months to a year? Yeah, I can see where a lot of Veterans are very uncomfortable with that. 

You know, especially for me and I know other Veterans feel this way. It’s got to be somebody that knows what they’re talking about and has had experiences. And you know has shared experiences with you. So, you know, me as a combat Veteran, if I’m going to talk to somebody about something like that, then I want to talk to somebody that knows what they’re talking about. You know, they’ve got experience with it. They can relate in a way that somebody that doesn’t have that experience or doesn’t have the training would be lost. And then, you know, you just get into psychological gobblty gook and, you know, the message gets lost.