Tuesday, November 10, 2020

Implementing Suicide Screening in VHA Settings Can Help Identify Veterans at Risk

When incorporated into Veterans Health Administration (VHA) medical settings, a population-level, suicide-risk screening may help identify veterans at risk of suicide who may not be receiving mental health treatment, according to a study published in JAMA Network Open.

“Emerging evidence suggests that suicide risk screening in AC [ambulatory care] and ED [emergency department] or UCC [urgent care center] settings may provide critical opportunities to identify risk among patients who are not receiving or seeking mental health treatment,” wrote Nazanin Bahraini, Ph.D., of the Rocky Mountain Regional Veterans Affairs Medical Center in Aurora, Colo., and colleagues. “Although the feasibility and utility of screening in the ED or UCC setting and medical settings [have] been demonstrated in community hospitals, it has yet to be examined in the VHA, the country’s largest integrated health care system.”

The researchers analyzed data from the VA Suicide Risk Identification Strategy (Risk ID), a screening and evaluation process that includes three stages: the primary screen (Patient Health Questionnaire-9), the secondary screen (Columbia Suicide Severity Rating Scale Screener), and the VHA’s Comprehensive Suicide Risk Evaluation. Individuals who screen positive at one level move into the next level of screening or evaluation.

Risk ID was implemented throughout all VHA facilities from 2018 to 2019. Patients were screened in ambulatory care settings if they had at least one outpatient visit and they did not have an existing diagnosis of depression, bipolar disorder, or posttraumatic stress disorder. All patients visiting an emergency department or urgent care center were also screened.

During the first year of Risk ID’s implementation (from October 1, 2018, to September 30, 2019), 4.1 million veterans in ambulatory care and over 1 million veterans who visited emergency departments or urgent care centers received the primary screening. The prevalence of suicidal ideation was 3.5% for primary screenings and 0.4% for secondary screenings in ambulatory care, and 3.6% and 2.1%, respectively, in emergency departments or urgent care centers. Those screened in emergency departments or urgent care centers were more likely to endorse suicidal ideation with intent, specific plan, or recent suicidal behavior during the secondary screening, compared with those screened in ambulatory care.

“The higher acuity of risk among veterans presenting to ED or UCC compared with AC settings highlights the importance of scaling up implementation of brief evidence-based interventions designed for ED or UCC settings to promote treatment engagement and reduce suicidal behavior,” the authors wrote.

Earlier this year, President Donald Trump signed the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 (S 785), and the House passed the Veterans Comprehensive Prevention, Access to Care, and Treatment (COMPACT) Act of 2020 (HR 8247). The bills both focus on preventing veteran suicide and address a range of issues related to veterans’ mental health care, including ensuring veterans can access the care they need.

“APA was pleased to see Congress focusing on veterans’ suicide prevention and mental health, and we are encouraged that lawmakers have recognized the importance of addressing this urgent issue,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “We will continue our work with the VA, Congress, and partner organizations to improve the mental health and substance use care available to our veterans through the VA and beyond.”

For related information, see the Psychiatric News article “Telephone Counseling May Offer Needed Boost to Veterans With Depression.”

(Image: iStock\Chinnapong)

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