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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2023. Identifying and Managing Veteran Suicide Risk: Proceedings of a Workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/27195.

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WORKSHOP PLANNING COMMITTEE ON CURRENT PRACTICES AND CHALLENGES FOR IDENTIFYING AND MANAGING SUICIDE RISK AMONG VETERANS IN NON-VA HEALTHCARE SYSTEMS

TIMOTHY J. STRAUMAN (Chair), Department of Psychology and School of Medicine, Duke University

RACHEL SAYKO ADAMS, Department of Health Law, Policy & Management, Boston University School of Public Health

ERIC CAINE, Department of Psychiatry, University of Rochester Medical Center, emeritus

CARL A. CASTRO, Suzanne Dworak-Peck School of Social Work, University of Southern California

EDWARD R. HIRT, Department of Psychological and Brain Sciences, Indiana University

RAJEEV RAMCHAND, RAND Epstein Family Veterans Policy Research Institute, RAND Corporation

STEPHANIE RENNO, Cohen Veterans Network

JEANNETTE E. SOUTH-PAUL, Meharry Medical College

Staff

TINA M. WINTERS, Project Director

SHARON BRITT, Program Coordinator

J. ASHTON RAY, Senior Program Assistant

DANIEL J. WEISS, Director, Board on Behavioral, Cognitive, and Sensory Sciences

Reviewers

This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.

We thank JEANETTE E. SOUTH-PAUL, Meharry Medical College, for her review of this proceedings. We also thank staff member KATHERINE KORTUM for reading and providing helpful comments on this manuscript. Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by NADINE KASLOW, Emory University School of Medicine. She was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteur and the National Academies.

Contents

Acronyms and Abbreviations

1 Introduction

WORKSHOP GOALS

ORGANIZATION OF THIS PROCEEDINGS

2 Suicide Risk Among Veterans

HISTORICAL CONTEXT AND CURRENT ISSUES

THE EXPERIENCES OF VETERANS AND THEIR FAMILIES IN SEEKING CARE

3 The Policy Context for Veteran Health Care

DETERMINING VETERAN STATUS AND CRITERIA FOR VA HEALTH CARE

APPLYING THE VA/DOD CLINICAL PRACTICE GUIDELINE FOR THE ASSESSMENT AND MANAGEMENT OF PATIENTS AT RISK FOR SUICIDE

DISCUSSION

REFERENCE

4 The Landscape of Veteran Health Care and Suicide Risk

EXAMINING FACTORS THAT MAY CONTRIBUTE TO INCREASED SUICIDE RISK FOR VETERANS

EXPLORING THE CONNECTION BETWEEN THE TRANSITION FROM MILITARY SERVICE TO CIVILIAN LIFE AND THE RISK FOR SUICIDE

USING THE VA/DOD CLINICAL PRACTICE GUIDELINE FOR THE ASSESSMENT AND MANAGEMENT OF PATIENTS AT RISK FOR SUICIDE TO INFORM SUICIDE PREVENTION EFFORTS

DISCUSSION

REFERENCES

5 Best Practices, Gaps, and Challenges for Identifying and Managing Suicide Risk Across Veteran Populations

INTRODUCTION

INDIVIDUALS RECEIVING HEALTH CARE OUTSIDE OF VHA

INDIVIDUALS RECEIVING HEALTH CARE IN VA-PURCHASED COMMUNITY CARE SETTINGS

DISCUSSION

REFERENCES

6 Reflections on Workshop Themes and Paths Forward

USING RISK FACTORS FOR SUICIDE TO INFORM SUICIDE PREVENTION INTERVENTIONS FOR VETERANS

CREATING A NATIONAL MODEL FOR SUICIDE PREVENTION IN HEALTH CARE SYSTEMS

ALLOCATING RESOURCES TO IMPLEMENT INTERVENTIONS

ADDRESSING FIREARM RISK

LEVERAGING OPPORTUNITIES IN HEALTH CARE SETTINGS TO PREVENT SUICIDE

LEARNING FROM VETERANS’ LIVED EXPERIENCES

DISCUSSION

REFERENCE

Appendix A Public Meeting Agenda

Appendix B Biographical Sketches

Box, Figures, and Table

BOX

1-1 Statement of Task

FIGURES

4-1 Age- and sex-adjusted suicide rates for veterans and non-veteran U.S. adults, 2001–2020

4-2 Suicide rates by time since separation by service branch with 95 percent confidence intervals

5-1 The Community-Based Interventions for Suicide Prevention model serves as a unifying model, from national to community levels, for all community-based efforts to end veteran suicide

5-2 Suicide prevention care pathway

TABLE

3-1 VA Health Care Priority Groups

Acronyms and Abbreviations