Erin Bagalman
Analyst in Health Policy
Responsibility for prevention of veteran suicide lies primarily with the Veterans Health Administration (VHA), within the Department of Veterans Affairs (VA). The VHA Strategic Plan for Suicide Prevention is based on a public health framework, which has three major components: (1) surveillance, (2) risk and protective factors, and (3) prevention interventions.
No nationwide surveillance system exists for suicide among all veterans; therefore, the actual incidence of suicide among veterans is not known. Surveillance, or systematic collection of data on completed (i.e., fatal) suicides, is essential to define the scope of the problem (i.e., the suicide rate among veterans), identify characteristics associated with higher or lower risk of suicide, and track changes in the suicide rate over time to evaluate suicide prevention interventions. In the absence of a nationwide surveillance system for veteran suicide, the VHA is attempting to determine the rate of suicide among veterans in two ways, both in collaboration with the Centers for Disease Control and Prevention (CDC).
Information collected in surveillance is used to identify suicide risk factors (i.e., characteristics associated with higher rates of suicide) and protective factors (i.e., characteristics associated with lower rates of suicide). This is essential in order to design interventions that reduce risk factors and/or increase protective factors, thus lowering overall risk of suicide. Risk factors are also helpful in identifying at-risk groups or individuals so that interventions can be delivered to the people who need them most. Within the VHA, this research is supported by the Office of Research and Development; a Center of Excellence in suicide prevention; and a Mental Illness Research, Education, and Clinical Center on suicide prevention.
The intervention cycle includes three stages: design and test interventions, implement interventions, and evaluate interventions. The research components mentioned above have roles in small-scale pilot testing and large-scale evaluations of interventions. This report discusses seven areas of VHA suicide prevention interventions: (1) easy access to care, (2) education, (3) screening and treatment, (4) limited access to lethal means, (5) suicide hotline, (6) media restrictions, and (7) suicide prevention coordinators.
This report identifies challenges the VHA faces in each component of suicide prevention and discusses potential issues for Congress. A recurring theme is the need for the VHA to work in concert with other federal, state, and local government agencies; private for-profit and not-forprofit health care providers; veterans, their families, and their communities; and other individuals or organizations that might be able to help. Specific challenges in surveillance include timeliness of data, accurate identification of decedents as veterans, and consistent classification of deaths as suicides. Challenges in risk and protective factors research include a need for more collaboration and dialogue among agencies involved in suicide prevention and across other areas of public health (because suicide has some of the same risk and protective factors as other public health problems). Challenges in VHA suicide prevention interventions also include the need for more collaboration and dialogue, as well as an apparent gap between policy and practice, and misperceptions about mental illness and mental health care.
Date of Report: January 10, 2013
Number of Pages: 23
Order Number: R42340
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