What We Need to Understand About Veterans and Firearms

Earlier this week, in the wake of the mass shootings in Texas and Ohio, the President of the American Psychological Association released a statement on gun violence and mental health. The broad thrust of it established that by and large mentally ill people are not violent, accurate prediction of violence based on personality profiling remains murky and unreliable, and access to guns are the primary contributor to gun violence.

It is that final pronouncement, and others like it, that are polarizing and entrenching Americans in their beliefs. More personally, I worry it will alienate a large swath of the population I am both a part of and training to treat.

To fully understand why this might be so, it is important to consider the overwhelming majority of psychiatrists (76%) consider themselves to be Democrats, or at the very least not Republican, and the left leanings of social psychology have been widely covered and their impact debated.

While there is less evidence to suggest that clinical psychologists or clinicians are similarly politically tilted, it would be unremarkable to suggest that the average American might believe it to be so.

This is important because guns are tied deeply to political identity. More specifically, gun rights are tied to the dominant political identity of the Republican Party whereas gun control is widely considered a more liberal stance.

While the political makeup of the entire American veteran population is not as clearly conservative as once widely thought and is generally held as statistically indistinguishable from non-veterans, it appears that younger veterans are more likely to identify as Republicans.

Having differing political views in a therapeutic setting does not predict outcomes—in fact, until recently the disclosure of political identity on the part of the therapist was largely viewed as a boundary violation and borderline unprofessional. But there does appear to be more appetite for understanding and navigating politics in therapy.

It remains to be seen if this translates to the area of gun ownership. However, for the time being, and especially in the wake of recent events, it is possible if not probable that veterans will avoid seeking treatment out of concern their guns might be taken away.

In particular, within in the VA system, if the VA determines a veteran is mentally incompetent, by virtue of any number of reasons to include a mental health diagnosis and appoints a fiduciary, a record is created and sent to the FBI. That record is then entered into the National Instant Criminal Background Check System which generates a flag restricting firearm access. For many, it feels like they are damned if they show up for treatment and damned if they don’t.

While political identity and views on firearms appear to be neatly tied, solely considering this issue through a political lens misses a critical component of gun ownership, particularly in the veteran population.

To understand this, you must consider a variety of complex and multi-faceted components. For starters, there simply is not a comprehensive data set that establishes firearm ownership patterns amongst military veterans.

The most extensive one to date is a cross-sectional, web-based survey from 2015, which limits cause-and-effect analysis regarding relationships between guns, veteran status, geographic location, and age of ownership.

However, within the surveyed group it found nearly half of all veterans own one or more firearms with most owning both handguns and long guns. A majority cited protection as a primary reason for firearm ownership.

Taken within the context of military training and indoctrination, a certain level of hyper-vigilance is necessarily cultivated. Non-pathological, this increased awareness is adaptive and useful in both wartime and war-training scenarios. Moreover, the training couples heightened alertness with weapon systems, predominantly firearms. Subsequently, it follows that those who have transitioned out of the military service intensely associate protection with gun proximity.

To that point, one in three veterans reports storing at least one weapon loaded and unlocked. While the majority report to do so for the rapidness of access in the case of an intruder, this also makes it readily accessible in instances of impulsivity. And certain types of stressful life events, like interpersonal loss (i.e. death, divorce, or break-up), are associated with heightened impulsivity in regards to suicide attempts.

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Furthermore, for those suffering from combat-related PTSD, feeling chronically unsafe is a hallmark of the disorder. So having a gun to feel safe both makes sense and potentially places the sufferer at risk.

However, in a study that assessed the effect of Connecticut and Indiana’s risk-based firearm seizure laws on firearm suicide rates, it found that while there was a 7.5% reduction in Indiana’s firearm suicides, Connecticut’s estimated reduction in firearm suicides was offset by increased non-firearm suicides.

Yet, for active-duty military, storing a loaded gun at home or carrying one in public was "associated with a 4-fold increase in the odds of suicide death" in a recent study. However, it notes that "existing work suggests an association between both suicide attempts and death and firearms, longitudinal and cross-sectional studies have thus far failed to identify clear associations between thinking about suicide and firearm access."

The result is, what we call in the military, a self-licking ice cream cone.

What we do know with near-certainty is that being young and male are factors directly related to diminished help-seeking behavior. And it is that very same population in the veteran space that is dying by suicide at increasingly alarming rates (women veterans are also at increased risk for death by suicide and more likely to own firearms or be in a household with firearms than their non-veteran counterparts).

Even though significant strides have been made in the reduction of care-seeking stigma, there remains a remarkable distrust of mental health services generally and the VA specifically. More so than ever, how can we expect them to show up for treatment when they feel an integral part of their lives and safety is disavowed or considered pathological?

The belief on both sides that guns are tools, neutral until held in human hands, overlooks the fact that gun ownership for many veterans is deeply woven into their psyches.

For a population that already feels at odds with the general public, guns offer a form of control and power in a current cultural setting that does not breed belongingness or systematic buy-in.

Moreover, they generate social connectivity and feelings of connectedness in a somewhat ideologically similar community–something many post-9/11 veterans long for and miss most about their time in service.

This 'brotherhood and sisterhood' deficit following the transition from active duty is likely more dangerous to well-being than previously understood.

With suicides among active-duty Marines and sailors reaching a 10-year high in 2018, and suicides among US Special Operations forces tripling, now more than ever, there needs to be consideration of the cultural components and nuance of gun ownership within the military and veteran population and how it relates to treatment-seeking behavior.

Having access to guns does not make someone suicidal but it is a highly lethal means.

Rather than coming from a place of touting the reduction of legal access to firearms, the APA might consider focusing on promoting and encouraging safety changes within the home as a more reasonable, appealing, and less political place to start.

We need our veterans to feel comfortable coming in for treatment, not alienated by rhetoric or more entrenched in their potential perception the mental health field is hostile to their way of life.