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Introduction
This proceedings presents a summary of what occurred at the Workshop on Current Practices and Challenges for Identifying and Managing Suicide Risk Among Veterans in Non-Department of Veterans Affairs (VA) Healthcare Systems, a hybrid workshop1 hosted on May 23, 2023, by the National Academies of Sciences, Engineering, and Medicine’s (National Academies’) Board on Behavioral, Cognitive, and Sensory Sciences (see Box 1-1 for the workshop’s Statement of Task and Appendix A for the workshop agenda).2 The workshop was sponsored by VA, and the National Academies appointed a workshop planning committee to organize and convene the workshop (see Appendix B for biographical sketches). This proceedings was prepared by the workshop rapporteur; the views contained in the proceedings are those of individual workshop participants and do not necessarily represent the views of all workshop participants, the planning committee, or the National Academies.
WORKSHOP GOALS
Workshop presentations and discussions were structured to address the following topics:
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1 To watch a recording of the workshop’s webcast, see https://www.nationalacademies.org/event/05-23-2023/workshop-on-identifying-and-managing-veteran-suicide-risk-in-non-va-healthcare-settings
2 The workshop was followed by a meeting of experts on May 24, 2023. For more information, see https://www.nationalacademies.org/event/39983_05-2023_expert-meeting-on-suicide-prevention-in-va-community-care-process-improvement-opportunities
- the landscape of veteran health care and suicide risk;
- strategies to identify veterans who receive their health care outside of the VHA;
- processes among states, health care systems, and community-based organizations to account for and manage suicide risk among veterans who are not engaged with VA and VHA systems;
- best practices for suicide risk identification and care for VA-purchased care in community settings; and
- best practices to inform veterans at non-VA entities about VA benefits for which they are eligible.
Opportunities and Challenges for Veteran Health Care
To begin to better understand the opportunities and challenges for veteran health care, workshop participants heard a presentation from Matthew Miller (VA Office of Mental Health and Suicide Prevention). He explained that identifying and managing suicide risk is a significant problem across the United States and abroad—in particular, within the U.S. veteran
population. He noted that the highest veteran suicide count represents veterans who are not in VHA care, but the highest veteran suicide rate represents veterans who are in VHA care. Therefore, strategies to improve mental health care for all veteran populations would be beneficial.
Miller emphasized that both opportunities and challenges for improving care for veterans have arisen over the past few years owing to several legislative actions. To embrace the opportunities fully, he said that four specific challenges should be addressed first: (a) increasing veteran access to mental health care, and to health care more broadly, including both emergent and urgent access and access for episodes of care; (b) determining how to measure and report quality of care in both VA and non-VA facilities to ensure equality across facilities; (c) understanding the experiences of both the veterans (e.g., whether care is accessible or a “bureaucratic nightmare”) and the providers (e.g., whether referrals and reimbursements can be completed with ease); and (d) managing costs sustainably, at the system level, to maintain exceptional access, quality, and experiences.
Miller highlighted the value of offering community care in mental health that is complementary and symmetrical to the care provided by VHA. For example, he mentioned the Veterans Comprehensive Prevention, Access to Care, and Treatment (COMPACT) Act of 2020, which facilitates mental health care for veterans in suicide crisis who present to any facility free of charge, and facilitates up to 30 days of inpatient care and 90 days of outpatient care for these veterans. Although the COMPACT Act has enabled a new domain of eligibility and services, he described the urgent need for an infrastructure between VA and the community. Furthermore, an opportunity exists to use this infrastructure as a model to improve American mental health care more broadly.
ORGANIZATION OF THIS PROCEEDINGS
Chapter 2 of this proceedings presents historical and current issues related to suicide risk among veterans. The experiences of three veterans and a caregiver illuminate the challenges and opportunities for veterans who seek care. Chapter 3 describes the policy context for veteran health care, with an overview of criteria for care and the guidelines used to assess and manage care for patients at risk of suicide. Chapter 4 details the landscape of veteran health care and suicide risk, with consideration for contributing factors, the transition from military service to civilian service, and suicide prevention efforts. Chapter 5 highlights best practices, gaps, and challenges for identifying and managing suicide risk across veteran populations, including those receiving health care outside of VHA and those receiving care in VA-purchased community care settings. Chapter 6 offers reflections on themes that emerged during the workshop as well as on paths forward.
