There are an estimated 20.8 million Veterans living in the U.S.1 with just over 9 million enrolled in the Veterans Health Administration (VHA).2 Although Veterans comprise only 8.5% of the U.S. population, they account for over 20% of suicide deaths.3,4 Of the estimated 20 Veterans who die by suicide each day, about six received VA care.3,4,5 Little is known about the 14 decedents not engaged in VHA care because there is no nationwide mechanism to identify, track, and compare healthcare practices. Preventing suicide among all Veterans will require VHA collaboration with community stakeholders to develop innovative approaches 6,7,8 for data sharing, referrals between providers, and a community-engaged approach to intervention development. Studies investigating healthcare utilization among those who commit suicide found that many contacted a healthcare provider in the year prior to death.9-15 Emergency departments (EDs) have been identified as a viable venue to intervene with individuals in suicidal crisis.11-15 Over 500,000 people annually are treated for suicide-related issues in EDs.16,17,18 Most Veterans who complete suicide are not enrolled in VHA care. Community EDs could be a viable point of contact for those at risk of suicide and who seek care outside VHA. While EDs may be a viable point of contact to identify Veterans at risk of suicide, our preliminary studies indicate the identification of military history or Veteran status is not common practice in Arkansas hospitals and there is a knowledge gap about referral and tracking procedures post ED discharge. Therefore, while there is significant potential in using community EDs as a platform for identifying and treating suicidal Veterans not seeking VHA care, further knowledge of the barriers and facilitators to using these EDs is needed. The purpose of our qualitative pilot study is to identify military service history and suicide risk among patients reporting suicidal ideations or attempts to community EDs, and to determine the acceptability and feasibility of referring Veterans to mental health (MH) care at a VHA facility or other community organization post discharge. Outcomes will be used to address the gaps in continuity of care between suicide risk identification and aftercare treatment post discharge from EDs. The study aligns with the HSR&D Mental/Behavioral Health priority domains with suicide prevention being a top focus, and the VHA Suicide Prevention: Getting to Zero Initiative, which recommends establishing community partnerships for the purpose of reaching all Veterans seeking care for suicide crisis, to include those most at risk during the first year post military service.20 Using principles of community engagement, we will collaborate with the Central Arkansas Veterans Healthcare System, Suicide Prevention Office (CAVHS-SPO); the Arkansas Suicide Prevention Council; the Arkansas Department of Health; and 10 community hospital EDs within the state of Arkansas.
Specific Aims are to: SA1: Through qualitative interviews, document the barriers and facilitators to identifying military history, suicide risk, and post-discharge aftercare of patients admitted to community hospital emergency departments serving counties with the highest rates of suicide in the state of Arkansas. SA2: Identify acceptability and feasibility of standardized assessment, identification of military history, and referrals for continuity of care between community EDs and VHA facilities or other MH organizations. There is a gap in knowledge about Veteran suicide, adherence to provider recommendations post ED discharge, and treatment among Veterans not seeking care through VHA. This pilot study begins to bridge that gap in knowledge by establishing a platform to explore the policies and practices of EDs regarding suicide risk assessment, identification of military history, discharge planning for patients with identified suicide risk, and tracking of aftercare. Pilot results will inform an IIR application to improve continuity of care and tracking for Veterans seeking care for suicide from community ED?s.
About 70% of the Veterans who commit suicide each year do not engage in VHA care. Therefore, we have a significant gap in our knowledge about those Veterans dying by suicide because there is no nationwide system to identify, track, and compare healthcare practices. Research is needed to understand suicide characteristics among non-VHA using Veterans, adherence to provider recommendations post emergency department (ED) discharge, and treatment. This pilot study initiates that research by establishing a platform to explore the policies and practices of community hospital EDs regarding suicide risk assessment, identification of military history, discharge planning for suicide risk, and tracking of aftercare. Pilot results will inform an IIR application to improve the identification of non-VHA using Veterans at risk of suicide, continuity of care, and tracking of suicidal Veterans seeking care from community hospital EDs. It is anticipated that this research will initiate a research agenda linking the public health system with VHA for a collaborative approach to healthcare.
