VA Suicide Prevention leads national charge with array of strategies

Suicide prevention is frequently a matter of strategies.

In 1964, Academic Dean of the School of Medicine at Tufts University Louis Lasagna penned a modern translation of the Hippocratic Oath: “I swear to fulfill, to the best of my ability and judgment, this covenant: I will remember that there is an art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemists drug.

“I will advance the hard-won scientific gains of those in whose steps I walk, and gladly share such knowledge… and I will remember that I do not treat a fever or a cancerous growth but a human being whose illness may affect their family and economic stability.”

While the “surgeon’s knife” and “the chemist’s drug” remain essential tools, the reminder is that our mission is, first and foremost, a personal one – caring for the individual and providing resources necessary to facilitate their success. Often, the most necessary and effective instruments of healing are our relationships, and central to our calling is the development and spread of evidence-based best practices to benefit all.

Suicide is a national public health issue that impacts people from all walks of life, claiming the lives of nearly 45,000 people in the United States in 2019 and affecting countless more. The drivers of risk are complex, individualized and varied. To light the way forward, we must meet the diverse needs of Veterans with resources that have been shown to not only effectively reduce risk but also promote wellness and balance to protect against future risk.

More than three dozen projects to prevent suicide

The Suicide Prevention Program in the Office of Mental Health and Suicide Prevention (OMHSP) is leading the way forward with more than three dozen FY22 demonstration projects aligned to the goals of the White House Plan for Reducing Military and Veteran Suicide and the National Strategy for Preventing Veteran Suicide.

These efforts coordinate suicide prevention’s operational, clinical and research directions across program offices, Veterans Integrated Service Networks (VISNs), community partnerships and VA healthcare systems across the nation.

Demonstration projects allow the opportunity to quickly fund and assess innovations in suicide prevention while OMHSP continues its strategic operationalization of the 2018 National Strategy through a public health approach combining community and clinically based interventions in Suicide Prevention 2.0 and the Now Initiative.

Just one example of a prior demonstration project is VA’s collaboration with Forge VFR (Veteran and First responder) to better understand and explore potential approaches to substance use-related residential care for Veterans within a high risk and high need domain of service. Initial exploratory and descriptive data offered insightful feedback to inform prevention and intervention possibilities.

FY22 national strategic plan-aligned project priorities include the following:

• To promote suicide prevention as a core component of health care services and increase access to care across the spectrum, we are piloting integrated mental health services in pain and oncology clinics, and expanding mental health service supports in primary care and staffing among suicide prevention coordinators.
• To promote the dissemination of effective clinical practices, we are expanding the dissemination of evidence-based treatments for insomnia, short-term/intensive PTSD, anxiety, depression and substance use disorder treatments.
• To tailor solutions to at-risk subpopulations, we are implementing programs to reach Native, geriatric, LGBTQ+, rural Asian American, Pacific Islander Veterans and homeless Veterans.

Advancing emergency department safety planning

• To enhance crisis care and facilitate care transitions, we are advancing suicide prevention by bettering emergency department safety planning and post-discharge follow-up, RISK ID, and REACH VET to increase engagement for those at high-risk.
• To provide training to VHA and community staff on the prevention of suicide and related behaviors, we are developing new resources for suicide postvention, risk management consultation, early intervention/prevention.
• To engage and leverage partnerships within and outside the government, we are working across federal and state agencies, participating in governor’s challenges, and conducting community firearm safety trainings.

Piloting programs focused on early interventions

• To address upstream risk and protective factors, we are piloting programs focused on early interventions for Veterans at-risk of unemployment and establishing a National Center for Veterans Financial Empowerment to foster success amid economic stressors behind risk.
• To enhance engagement and broaden support networks, we are advancing peer-to-peer, coaching into care, and caring letter outreach programs.
• To promote healing and implement strategies to help prevent further suicides, we are providing consultation and postvention supports, suicide risk identification training, and acceptance and commitment training for health care providers.
• To promote research and expand the evidence base for effective treatment, we are supporting research in the national evaluation centers, states and Centers of Excellence.

Like the oath above, and “To the best of our ability and judgment,” we are advancing these efforts to save lives, offer hope, and light ways to combat the thoughts of suicide that threaten to overcome. We are grateful for the honor that serving this mission provides and the opportunity to facilitate the successes of Veterans everywhere.

National Suicide Prevention strategic directions, priority goals and cross-cutting principles are available at: Reducing Military and Veteran Suicide: Advancing a Comprehensive, Cross-Sector, Evidence-Informed Public Health Strategy and The National Strategy for Preventing Veteran Suicide.