title: Feasibility and acceptability of interventions to delay gun access in VA mental health settings.
abstract: OBJECTIVE
  The majority of VA patient suicides are completed with firearms. Interventions that delay patients' gun access during high-risk periods may reduce suicide, but may not be acceptable to VA stakeholders or may be challenging to implement. Using qualitative methods, stakeholders' perceptions about gun safety and interventions to delay gun access during high-risk periods were explored.
  
  
  METHODS
  Ten focus groups and four individual interviews were conducted with key stakeholders, including VA mental health patients, mental health clinicians, family members and VA facility leaders (N=60). Transcripts were consensus-coded by two independent coders, and structured summaries were developed and reviewed using a consensus process.
  
  
  RESULTS
  All stakeholder groups indicated that VA health system providers had a role in increasing patient safety and emphasized the need for providers to address gun access with their at-risk patients. However, VA mental health patients and clinicians reported limited discussion regarding gun access in VA mental health settings during routine care. Most, although not all, patients and clinicians indicated that routine screening for gun access was acceptable, with several noting that it was more acceptable for mental health patients. Most participants suggested that family and friends be involved in reducing gun access, but expressed concerns about potential family member safety. Participants generally found distribution of trigger locks acceptable, but were skeptical about its effectiveness. Involving Veteran Service Organizations or other individuals in temporarily holding guns during high-risk periods was acceptable to many participants but only with numerous caveats.
  
  
  CONCLUSIONS
  Patients, clinicians and family members consider the VA health system to have a legitimate role in addressing gun safety. Several measures to delay gun access during high-risk periods for suicide were seen as acceptable and feasible if implemented thoughtfully.
authors.affiliation: Department of Veterans Affairs, Ann Arbor Center for Clinical Management Research, Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Ann Arbor, MI, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Walters
authors.forename: Madhur
authors.initials: M
authors.lastname: Kulkarni
authors.forename: Jane
authors.initials: J
authors.lastname: Forman
authors.forename: Kathryn
authors.initials: K
authors.lastname: Roeder
authors.forename: Jamie
authors.initials: J
authors.lastname: Travis
authors.forename: Marcia
authors.initials: M
authors.lastname: Valenstein
mesh_terms: D000328:Adult; D000368:Aged; D001290:Attitude; D001291:Attitude of Health Personnel; D005190:Family / Q000523:psychology*; D005240:Feasibility Studies; D005260:Female; D005389:Firearms; D017144:Focus Groups; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D057240:Patient Preference; D061214:Patient Safety; D012307:Risk Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*; D000092864:Suicide Prevention