The key implementation gap I will focus on is related to the utilization, or lack thereof, of an effective standardized assessment and response protocol to address suicide risk within the Veteran population.
Suicide is a leading cause of death and a growing public health problem within the U.S. Access to firearms among Veterans at risk of suicide is of particular concern as Veterans own and use firearms as a means for suicide at higher rates than the general population (Kaplan, McFarland, & Huguet, 2009; WISQARS, 2016). A review of suicide prevention approaches recognized lethal means counseling as an effective way to decrease suicides (Mann et al., 2005); and national bodies governing public health and psychology (APHA and APA, respectively) support the utilizations of firearm inquiry and counseling. Further, the VA is currently considering a mandate requiring firearm inquiry during risk assessments. While most clinicians (66%-84%) identify firearm safety as a critical issue and recognize responsibility to address this topic with patients (Butkus & Weissman, 2014; Cassel et al., 1998), few routinely inquire about firearm ownership/access (Betz et al., 2013; Butkus & Weissman, 2014; Walters et al., 2012). A recent study indicated only 15% of Veterans endorsing risk for suicide were asked about firearm access (Dobscha et al., 2014). While the main consequence of interest is mortality, it is currently unknown how many lives could be saved by greater adoption of this approach. However, it is known that within the month prior to suicide, approximately 50% of Veterans seek medical services, and 20% utilize mental health services (Basham et al., 2011) indicting a significant opportunity for clinical intervention and potential to save lives.