Mental health care clinicians typically ask only certain patients about firearm access, study finds

Many mental health care clinicians don’t ask all of their patients whether they have access to firearms, an important step in firearm injury prevention, according to Rutgers Health researchers.

The study, published in JAMA Network Open, examined a report by mental health care clinicians on firearm access screening, barriers to screening, and providers’ confidence in implementing firearm safety discussions in their clinical practice.

About 42% of households in the United States have at least one firearm, which introduces the risk of firearm injury and death (e.g., accidental shooting, suicide, homicide) for all in the home. Screening for firearm access is recommended in health care settings to facilitate conversations to mitigate risks; however, there is limited understanding of screening practices within mental health care, where clinicians have opportunities to reach at-risk firearm owners.

Using self-reported data from 311 mental health care clinicians, the researchers identified clinicians’ firearm screening practices and perceptions. They found most clinicians screen for firearm access when there is a risk of suicide or violence.

“However, many estimated screening less than half of all their clients and most clinicians are not asking all clients about firearm access,” said Taylor Rodriguez, a doctoral degree candidate in the Department of Psychology at the Rutgers School of Arts and Sciences and the lead author of the study.

The most commonly endorsed barrier to screening was clinicians believing that their patients do not need to be asked about firearm access.

“This is important because it tells us that clinicians are subjectively deciding who to screen,” said Rodriguez, who also is an affiliate researcher at the New Jersey Gun Violence Research Center. Screening only when risk factors emerge is an imperfect system that can miss many patients who have access to firearms and could benefit from a discussion about firearm security.”

The study highlights that clinicians understand the importance of secure firearm storage conversations in mental health care, and they have moderate confidence in their ability to discuss firearms and implement secure firearm storage practices.

“Supporting clinicians with secure firearm storage training opportunities, and standardized protocols for proactively screening every patient for firearm access could be an important way to limit the subjectivity in screening and integrate firearm injury prevention into mental health care,” Rodriguez said.

She added that future research should investigate the implementation of firearm screening and follow-up conversations, as well as ways to increase screening frequency among clinicians.