Since 2008, suicide has ranked as the tenth leading cause of death for all ages in the US, with rates of suicide continuing to rise.1-3 Suicide is even more urgent to address in veteran populations. The age- and sex-adjusted suicide rate in 2017 was more than 1.5 times greater for veterans than it was for nonveteran adults.2 Of importance, rates of suicide are increasing at a faster rate in veterans who are not connected to Veterans Health Administration (VHA) care.4,5 These at-risk veterans include individuals who are eligible for VHA care yet have not had a VHA appointment within the year before death; veterans who may be ineligible to receive VHA care due to complex rules set by legislation; and veterans who are eligible but not enrolled in VHA care. Notably, between 2005 and 2016, the number of veterans not enrolled in VHA care rose more quickly than did the number of veterans enrolled in VHA care.5,6 Thus, to impact the high veteran suicide rates, an emergent challenge for VHA is to prevent suicide among unenrolled veterans and veterans receiving community care, while continuing to increase access to mental health services for veterans enrolled in VHA health care.
Original Research
The Veterans Affairs Patient Safety Center of Inquiry—Suicide Prevention Collaborative: Creating Novel Approaches to Suicide Prevention Among Veterans Receiving Community Services
Fed Pract. 2020 November;37(11):512-521 | doi:10.12788/fp.0071
Author(s):
Bryann DeBeer, PhD
Sylvia Baack, PhD, RN
Kathryn Bongiovanni, LCSW
Elisa Borah, PhD
Craig Bryan, PsyD
Kattina Bryant, LCSW
Ruth Cassidy, LCSW, MDiv
Stephanie Clafferty, LCSW
Germaine Franciosi, RN
Jenna Heise, MA
Claire Hoffmire, PhD
Robin Keene, PhD, RN
Joseph Mignogna, PhD
Nathaniel Mohatt, PhD
Lindsey L. Monteith, PhD
Alan Peterson, PhD
Dawn Pierson, MS
Edgar Villarreal, PhD
Kimberly Weinberg, LCSW-S
Marjory Williams, PhD, RN
Samantha Synett, LCSW
Justin Benzer, PhD
Author and Disclosure Information
Bryann DeBeer is the Director of the VA Patient Safety Center of Inquiry – Suicide Prevention Collaborative and a Clinical Research Psychologist; Claire Hoffmire is an Epidemiologist and Health Science Specialist; Nathaniel Mohatt is a Research Psychologist; Germaine Franciosi is a Quality Management Specialist; Edgar Villarreal is a Clinical Psychologist and Program Manager for Suicide Prevention; all at the VA Eastern Colorado Health Care System (VAECHCS). Lindsey Monteith is a Clinical Research Psychologist; Dawn Pierson is a Program Specialist; and Samantha Synett is Suicide Prevention Coordinator; all at the Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional Veterans Administration Medical Center in Aurora, Colorado. Bryann DeBeer is a Visiting Associate Professor; Claire Hoffmire is an Assistant Professor; and Nathaniel Mohatt is an Assistant Professor in the Department of Physical Medicine and Rehabilitation; Lindsey Monteith is an Associate Professor in the Department of Psychiatry; all at the University of Colorado Anschutz Medical Campus in Aurora, Colorado. Joseph Mignogna is a Clinical Research Psychologist; and Justin Benzer is the Implementation Core Chief; both at the VA VISN 17 Center of Excellence for Research on Returning War Veterans in Waco and the Central Texas Veterans Health Care System. Sylvia Baack is the Director of Quality, Safety, and Value; Kathryn Bongiovanni and Kattina Bryant are Suicide Prevention Coordinators; Stephanie Clafferty and Kimberly Weinberg are Social Work Supervisors; Marjory Williams is the Associate Chief Nurse, Research; all at the Central Texas Veterans Health Care System in Waco, Temple, and Austin. Elisa Borah is the Director of the Institute for Military and Veteran Family Wellness and a Research Associate Professor at the Steve Hicks School of Social Work at the University of Texas at Austin. Craig Bryan is the Stress, Trauma, and Resilience (STAR) Professor at The Ohio State University Wexner Medical Center in Columbus. Ruth Cassidy is the Navy Suicide Prevention Program Manager/Lead Analyst in the 21st Century Sailor Office, Compliance and Competencies Branch in the US Navy, Millington, Tennessee. Jenna Heise is Texas State Suicide Prevention Coordinator in theOffice of Mental Health Coordination, Suicide Prevention Team, Health and Human Services Commission in Austin and Zero Suicide Faculty at Zero Suicide Institute, Education Development Center in Waltham, Massachusetts. Robin Keene is not affiliated with an organization. Joseph Mignogna is an Adjunct Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the College of Medicine, in Temple, Texas. Alan Peterson is a Professor in the Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio; a Research Health Scientist in the Research and Development Service, South Texas Veterans Health Care System; and a Professor in the Department of Psychology, University of Texas at San Antonio. Nathaniel Mohatt is a Clinical Instructor in the Division of Prevention and Community Research, Department of Psychiatry, Yale School of Medicine. Justin Benzer is an Associate Professor in the Department of Psychiatry, Dell Medical School, University of Texas at Austin.
Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article. This work was supported by a Patient Safety Center of Inquiry Grant from the Department of Veterans Affairs National Center for Patient Safety.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, any of its agencies, or any other affiliates
Background: While the US Department of Veterans Affairs has made significant strides to prevent veteran suicide, efforts have largely targeted veterans actively engaged in and eligible for Veterans Health Administration (VHA) care, which is consistent with the VHA mission. The majority of veterans are not enrolled in VHA care, and many are ineligible for services. Veterans not connected to VHA have experienced an increase in suicides in recent years.
Observations: Since 2018, VHA National Center for Patient Safety has funded the Patient Safety Center of Inquiry-Suicide Prevention Collaborative (PSCI-SPC), which has worked to develop, implement, and evaluate practical solutions aimed at curbing the rising suicide rate among veterans not receiving VHA care. PSCI-SPC has 3 guiding objectives: (1) Develop and test a collaborative, organizational structure to connect VHA and community organizations, such as national, local, public, private, nonprofit, and academic partners who provide high-quality and timely health care; (2) Build and test a learning collaborative to facilitate sharing of VHA suicide prevention best practices with community partners to increase availability, consistency, and quality of mental health services for all veterans; and (3) Implement, test, and refine a novel program to provide affordable suicide prevention interventions to veterans with mental health needs, regardless of their use of, or eligibility for, VHA services. This paper details the current progress for this demonstration project. As these objectives are met, PSCI-SPC will create and disseminate products to support broad implementation of these practices to other VA medical centers and the communities they are embedded in.
Conclusions: PSCI-SPC seeks to fill an important gap in veteran health care by serving as a national clinical innovation and dissemination center for best practices in suicide prevention for veterans who receive care in their communities.