‘Missed opportunities’ for firearm access screening show need for change

Key takeaways:

• Of 311 mental health care clinicians, 73% endorsed screening for firearm access.
• However, most screenings were performed when certain risks emerged.
• A proactive screening approach may be a better alternative.

Many mental health care clinicians screen for firearm access and are confident in their ability to implement such screening, a research letter in JAMA Network Open showed.

However, most of these screenings were performed when a risk for violence or suicide appeared, with many clinicians screening fewer than half of their patients, suggesting that “screening is not yet a routine, standardized practice in mental health care,” Taylor R. Rodriguez, MS, MA, a PhD candidate in the department of psychiatry at Rutgers University, told Healio.

Firearm violence has significantly contributed to mortality in the United States in the last several years. As a result, Surgeon General Vivek H. Murthy, MD, MBA, declared firearm violence a public health crisis, while health organizations like the ACP and AMA have issued policies supporting providers’ roles in preventing this violence.

According to Rodriguez and colleagues, most research on screening for firearm access has focused on medical clinicians, “limiting knowledge among mental health care clinicians.”

In the cross-sectional study, they examined several factors of firearm access screening among 311 mental health clinicians who did not have medical degrees and reported providing mental health care services. Rodriguez noted that many of these clinicians were clinical psychologists, social workers, licensed counselors or marriage and family therapists.

Clinicians were asked whether they screened for firearm screening, their percentage of patients screened if they did screen, their confidence in firearm screening implementation and the extent to which several barriers prevented screening.

Over seven in 10 clinicians screen

Overall, 73% of clinicians screened for firearm access. Of these, most screened verbally (93.8%) and when a risk for suicide (87.7%) or violence or homicide (75.3%) emerged.

Almost half of these clinicians (45.8%) screened fewer than half their patients, whereas just 15.9% screened all their patients.

“Addressing this gap could help ensure that more patients benefit from proactive discussions about firearm security,” Rodriguez said.

The most endorsed barrier to screening was that the clinicians’ patients “did not need it,” while the least endorsed barrier was the lack of reimbursement.

The researchers noted that clinicians were moderately confident in their ability to implement firearm access screening and felt that conversations about secure firearm storage were important.

Proactive screening approach may help

Rodriguez told Healio that many patients do not disclose suicidal thoughts to their clinicians, “meaning a reactive approach — waiting for clear signs of risk — can lead to missed opportunities for firearm safety discussions.”

She added that taking a proactive screening approach instead, where all patients are screened regardless of risk, “can help ensure these important conversations happen before a crisis arises.”

Rodriguez acknowledged that more research is still needed to assess the feasibility of implementing this approach into clinical settings.

“A key challenge is clarifying who is responsible for follow-up after screening and ensuring that clinicians are both trained and comfortable having firearm-related discussions,” she said. “One of my next research steps is to develop a brief, targeted training for mental health clinicians to improve screening confidence and provide practical resources for firearm safety discussions.”

Still, proactive firearm screening “can be a feasible and efficient addition to clinical practice,” Rodriguez said. “I encourage clinicians to integrate firearm access questions into intake paperwork and initial discussions.”