The caller – ideally the same clinician who helped the patient develop the safety plan in the ED – checks on the patient’s mood and risk, reviews and revises the safety plan, discusses access to means, and discusses treatment engagement and helps problem-solve obstacles to getting into treatment.
"Follow-up is important, because this is a very high-risk period. We are potentially saving lives during this period," Dr. Stanley noted. "It’s very low cost – it’s phone contact." On the other hand, "it’s some burden. The big problem is that it requires a shift in the system: Provider systems are not set up for follow-up phone contact," she said.
Study details
The 222 veterans studied were 46 years old on average, and 89% were male. Overall, about one-fourth had a high school education or less and slightly more than half were unemployed.
Interim data among the 124 veterans having adequate follow-up showed that those in the SAFE VET intervention group received a mean of 7.2 follow-up calls.
Compared with their peers in the control group, veterans in the intervention group were less likely at 1 month to have suicidal intent with or without a plan (15% vs. 22%), but the difference diminished thereafter.
"It seems like we are getting our biggest effects at 1 month and then at around 3 months; the groups appear to be equal," commented Dr. Stanley.
In interviews conducted several months after the intervention, 55% of veterans in that group said that it was very helpful for staying safe; 69% and 76% were very satisfied with the safety planning and the follow-up monitoring, respectively, she reported.
Fully 61% of veterans in the intervention group had used their safety plan to avert a suicidal crisis. These users said that the plan helped them contact a professional (50%), contact social support (39%), use an internal coping strategy (26%), and recognize a warning sign of suicidal crisis (21%).
Veterans said that the most helpful aspect of the follow-up calls was regularly checking in (75%) and feeling cared for (58%).
The research was funded by the U.S. Department of Defense and the U.S. Veterans Health Administration.