Identifying and Managing Veteran Suicide Risk: Proceedings of a Workshop (2023)
Chapter: 6 Reflections on Workshop Themes and Paths Forward
6
Reflections on Workshop Themes and Paths Forward
Rajeev Ramchand shared six key takeaways from the workshop presentations and discussions.
USING RISK FACTORS FOR SUICIDE TO INFORM SUICIDE PREVENTION INTERVENTIONS FOR VETERANS
Ramchand stated that the veteran population is heterogeneous, and interventions to prevent veteran suicide should be informed by risk factors such as the following:
- veterans who receive care within the VHA (which has a higher rate but lower count of veteran suicides) versus those who receive care in health systems outside of VHA (which have a lower rate but higher count of veteran suicides);
- veterans with shorter military careers;
- women veterans;
- veterans from minority racial/ethnic groups;
- veterans with mental health and substance use disorder diagnoses; and
- veterans with other than honorable discharge status.
He underscored that additional research to understand the unique factors that increase the risk for suicide among veterans relative to non-veterans would be valuable.
CREATING A NATIONAL MODEL FOR SUICIDE PREVENTION IN HEALTH CARE SYSTEMS
Ramchand asserted that VA’s clinical efforts to prevent suicide could serve as a national model for other health care systems, especially as VA’s reach expands across communities. These efforts include universal screening; the Safety Planning in the Emergency Department program; and the 2019 VA/DOD Clinical Practice Guideline for the Assessment and Management of Patients at Risk for Suicide, which include dashboards to ensure compliance among providers and will be updated as new evidence emerges.
ALLOCATING RESOURCES TO IMPLEMENT INTERVENTIONS
Ramchand referenced three exemplary models for suicide prevention in the United States but noted that implementing such models requires significant time commitments, institutional leadership support, and financial resources. For example, to prevent suicide among veterans, the Governor’s Challenge leverages a collaboration among local stakeholders to create and evaluate a coordinated, localized plan; Cohen Veterans Network focuses on providing peer quality assurance and clinician training; and the Zero Suicide Model promotes systemwide structured care pathways (as illustrated in Figure 5-2).
ADDRESSING FIREARM RISK
Ramchand explained that although the value of addressing firearm risk is evident, questions remain about how best to address this risk. Lethal-means counseling and safety planning are considered best practices. However, are health care providers the right messengers, should gun storage practices and perceived threats be addressed, and is accurate information about veterans’ firearm rights provided transparently?
LEVERAGING OPPORTUNITIES IN HEALTH CARE SETTINGS TO PREVENT SUICIDE
Ramchand remarked that health care settings are critically important for preventing suicide, but missed opportunities abound. Presenting data from Ahmedani and colleagues’ (2019) examination of 2,674 individuals who died by suicide in 2000–2013 and were members of one of the health care systems serving eight states, Ramchand noted that 30 percent had health care encounters within seven days of their deaths. He stressed that tailored outreach for veterans transitioning from military service to civilian life, outreach in non-health care social service agencies, better networked
systems within and across health care settings, and policies that inquire about veteran status (both of self and of family members) could all improve efforts to prevent suicide among veterans.
LEARNING FROM VETERANS’ LIVED EXPERIENCES
Ramchand emphasized that veterans’ lived experiences, storytelling, and art should supplement quantitative data to better understand how to improve care and prevent veteran suicide. Furthermore, he continued, scientists could learn much from humanities scholars in their approaches to exploring complex problems.
DISCUSSION
Before concluding the workshop, Ramchand invited participants to share additional opportunities for exploration and areas for improvement in identifying and managing veteran suicide risk.
Allen Levi Simmons encouraged VA to implement new technology products to exchange patient information safely and efficiently. To prevent veteran suicide, he also envisioned the use of artificial intelligence for gun safety boxes that read facial expressions, check heartbeats, or send a message to loved ones, or for “smart guns” that will not fire when pointed at oneself.
Workshop participant Benjamin Paul proposed that VA create a 30- to 90-day program to bridge the gap during the transition from military service to civilian life. This program could help prevent veterans from falling through the cracks and raise awareness about available VA services. He also championed the development of new strategies to track involuntary hospitalizations and Coordinated Specialty Care efforts over time to better serve the unmet needs of veterans with severe mental illness and those dealing with homelessness.
Eric Caine posited that more work remains to ensure that non-VA health systems are engaged in the same “high-quality care practices” to prevent suicide as VA.
Timothy Strauman noted that providing quality care begins by building trust between clinicians and patients. Sharing an anecdote about Mary Gauthier (a singer/songwriter whose program to teach veterans to write songs has had tremendous positive impact), he demonstrated that people with very different interests and experiences can still develop the trusted relationships necessary to identify and manage suicide risk.
Jeannette E. South-Paul raised the point that being identified as having a mental health problem poses serious risks to an active-duty service member’s career, and the chaplain, rather than a health care provider, is seen as
the safe place (in terms of avoiding career harm) to go for help. She suggested studying service member engagement with chaplains and how that influences veterans’ decisions to seek behavioral health services. She also proposed research to study a VA-wide incorporation of the whole-health approach to veteran care and its effects on mental health care.
REFERENCE
Ahmedani, B. K., Westphal, J., Autio, K., Elsiss, F., Peterson, E. L., Beck, A., Waitzfelder, B. E., Rossom, R. C., Owen-Smith, A. A., Lynch, F., Lu, C. Y., Frank, C., Prabhakar, D., Braciszewski, J. M., Miller-Matero, L. R., Yeh, H.-H., Hu, Y., Doshi, R., Waring, S. C., & Simon, G. E. (2019). Variation in patterns of health care before suicide: A population case-control study. Preventive Medicine, 127, 105796. https://doi.org/10.1016/j.ypmed.2019.105796
