Suicide rates for Veterans are higher than for the general population1 and suicide prevention remains a high priority for the VA nationally and within VISN 16. Rural Veterans are at greater risk for suicide; they have higher suicide rates and firearm deaths are more common in rural suicides.2 VISN 16 is the 4th most rural VISN; 41% of VISN 16 healthcare users are classified as rural or highly rural. To reach Veterans without mental health diagnoses and/or who are not engaged in mental health care, we are proposing to implement an evidence-based suicide prevention intervention, Caring Contacts, in [a non-mental health setting, the emergency department.] Caring Contacts (CC) is a simple intervention that involves sending suicidal patients brief, non-demanding expressions of care and concern over a year or more. Studies of CC have demonstrated significant reductions in suicide deaths,3,4 attempts, and ideation at one and two year follow-up.5?7 CC have been found to be feasible and acceptable12 with military and Veteran populations and effective with active duty Soldiers and Marines.13 A review of studies on CC14 determined that ?repeated follow-up contacts appear to reduce suicidal behavior.?14 CC was found to be cost-effective as well.15 This initiative proposes use of an advisory board and a pilot of CC in the emergency department to develop a CC implementation toolkit for broader dissemination. The initiative will use [virtual external] facilitation as the implementation strategy. Facilitation is an evidence-based implementation strategy that is especially useful for facilities with demonstrated quality gaps in the selected clinical priority. The anticipated impacts of this initiative are a decrease in the number of emergency and inpatient mental health and health encounters and an increase in outpatient mental health and health encounters for Veterans at risk of suicide. We anticipate improvement on two mental health SAIL metrics: 1) PMED1 (% of patients with a mental health diagnosis who have a mental health evaluation and management encounter) and [2) HRF2 (% of patients with a new or reactivated high risk flag (HRF) who received at least four mental health visits within 30 days of flag initiation).] We will assess the costs of CC and of implementation. To assess return on investment, we will use service utilization data to estimate cost of services. Provider and Veteran perspectives will be measured through key informant interviews.
Caring Contacts a simple and effective suicide prevention intervention that involves sending patients who have been suicidal brief, non-demanding expressions of care and concern at specified intervals over a year or more. It has been shown to reduce suicide ideation, suicide attempts, and death by suicide. This project will 1) adapt Caring Contacts for use in the emergency department at VA and 2) create an implementation toolkit to be used by facilitators to spread Caring Contacts to other facilities. This research is important because not all Veterans who experience suicidal ideation or suicidal behavior have mental health diagnoses and/or do not engage in mental health services. Focusing on non-mental health settings such as the emergency department broadens the scope of suicide prevention and also allows reach to a greater proportion of Veterans served.
