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About 18 veterans die by suicide daily, and while many received health care services in the year prior to their death, half did not receive a mental health diagnosis.
To address this, the Veterans Health Administration (VHA) has updated or initiated programs and policies aimed at identifying at-risk veterans. Since May 2018, the VHA introduced the Suicide Risk Identification Strategy (Risk ID) program, which includes screening patients using the Columbia-Suicide Severity Rating Scale (C-SSRS). Positive screenings call for a licensed independent clinician to document a comprehensive suicide risk evaluation.
Despite these measures, challenges persist in implementation and effectiveness, outlined in reports issue by the VA Office of Inspector General (OIG) during the Biden Administration. Michael Missal, who had served as VA Inspector General since 2016 was recently dismissed by President Trump.
Risk ID
The OIG report surveyed 137 facilities regarding Risk ID processes, training, and monitoring. Findings from that review revealed gaps in training: suicide prevention training does not adequately address Risk ID requirements, leaving staff unprepared to conduct screenings and evaluations. Although the VHA has developed additional training related to Risk ID, the training is not required and the VHA does not monitor staff training completion.
The VHA requires annual screening for all patients and has established a screening clinical reminder in patients’ electronic health records. Despite this, the national screening metric remained below 60% in 2023. Conversely, same-day evaluations after positive screenings reached 82%, though this metric excludes patients who were not screened. In 2024, the VHA added Risk ID evaluation metrics to leadership performance plans, aiming to clarify standards and promote adherence.
Mental Health Treatment Coordinators
A second OIG investigation from December 2024 reviewed VHA requirements related to suicide risk identification processes and also evaluated national compliance with mental health treatment coordinator (MHTC) role requirements.
Suicide risks peaks after discharge from mental health units, with 40% of suicidal behaviors occurring within 90 days. The VHA requires suicide risk screening within 24 hours of discharge and safety plans for high-risk patients using the C-SSRS, but the OIG found adherence issues. In a review of 200 patients discharged between October 2019 and September 2020, staff failed to complete the required screening for 27% of patients and safety plans for 12% of patients.
The VHA also requires clinicians to develop a safety plan with patients who recently attempted suicide or expressed suicidal ideation, are at risk of suicide prior to mental health unit discharge, or are determined to be at “high or intermediate acute or chronic risk” of suicide. For those patients, staff must flag the electronic health record.
OIG also found that over half of surveyed patients with an assigned MHTC were not able to identify the MHTC or another VHA staff member to contact for help with care. One-third of assigned MHTCs did not participate in patients’ transitions from inpatient to outpatient care. Despite the VHA no longer requiring 7-day follow-up appointments as of 2023, the OIG emphasized the need for guidance on scheduling postdischarge mental health appointments to promote engagement.
Consistent with VHA’s discontinuation of a required 7-day follow-up appointment, the OIG recognizes that postdischarge follow-up appointments are most effectively scheduled in consideration of a patient’s treatment needs, preferences, and availability rather than an arbitrary timeliness expectation. Patients flagged as high-risk must attend 4 mental health visits within 30 days of discharge. However, the OIG found that only 48% met this requirement, while 34% attended 1 to 3 appointments, and 18% attended none. Among surveyed patients, self-motivation and encouragement from family or friends were key drivers of attendance.
The OIG concluded that failures in suicide risk identification and care coordination could lead to underestimated suicide risk, overestimated discharge readiness, and unmitigated risks. Inadequate safety planning may also leave patients ill-equipped to manage crises. While the VHA has updated guidelines for MHTC involvement, these measures have not significantly improved continuity of care.
About 18 veterans die by suicide daily, and while many received health care services in the year prior to their death, half did not receive a mental health diagnosis.
To address this, the Veterans Health Administration (VHA) has updated or initiated programs and policies aimed at identifying at-risk veterans. Since May 2018, the VHA introduced the Suicide Risk Identification Strategy (Risk ID) program, which includes screening patients using the Columbia-Suicide Severity Rating Scale (C-SSRS). Positive screenings call for a licensed independent clinician to document a comprehensive suicide risk evaluation.
Despite these measures, challenges persist in implementation and effectiveness, outlined in reports issue by the VA Office of Inspector General (OIG) during the Biden Administration. Michael Missal, who had served as VA Inspector General since 2016 was recently dismissed by President Trump.
Risk ID
The OIG report surveyed 137 facilities regarding Risk ID processes, training, and monitoring. Findings from that review revealed gaps in training: suicide prevention training does not adequately address Risk ID requirements, leaving staff unprepared to conduct screenings and evaluations. Although the VHA has developed additional training related to Risk ID, the training is not required and the VHA does not monitor staff training completion.
The VHA requires annual screening for all patients and has established a screening clinical reminder in patients’ electronic health records. Despite this, the national screening metric remained below 60% in 2023. Conversely, same-day evaluations after positive screenings reached 82%, though this metric excludes patients who were not screened. In 2024, the VHA added Risk ID evaluation metrics to leadership performance plans, aiming to clarify standards and promote adherence.
Mental Health Treatment Coordinators
A second OIG investigation from December 2024 reviewed VHA requirements related to suicide risk identification processes and also evaluated national compliance with mental health treatment coordinator (MHTC) role requirements.
Suicide risks peaks after discharge from mental health units, with 40% of suicidal behaviors occurring within 90 days. The VHA requires suicide risk screening within 24 hours of discharge and safety plans for high-risk patients using the C-SSRS, but the OIG found adherence issues. In a review of 200 patients discharged between October 2019 and September 2020, staff failed to complete the required screening for 27% of patients and safety plans for 12% of patients.
The VHA also requires clinicians to develop a safety plan with patients who recently attempted suicide or expressed suicidal ideation, are at risk of suicide prior to mental health unit discharge, or are determined to be at “high or intermediate acute or chronic risk” of suicide. For those patients, staff must flag the electronic health record.
OIG also found that over half of surveyed patients with an assigned MHTC were not able to identify the MHTC or another VHA staff member to contact for help with care. One-third of assigned MHTCs did not participate in patients’ transitions from inpatient to outpatient care. Despite the VHA no longer requiring 7-day follow-up appointments as of 2023, the OIG emphasized the need for guidance on scheduling postdischarge mental health appointments to promote engagement.
Consistent with VHA’s discontinuation of a required 7-day follow-up appointment, the OIG recognizes that postdischarge follow-up appointments are most effectively scheduled in consideration of a patient’s treatment needs, preferences, and availability rather than an arbitrary timeliness expectation. Patients flagged as high-risk must attend 4 mental health visits within 30 days of discharge. However, the OIG found that only 48% met this requirement, while 34% attended 1 to 3 appointments, and 18% attended none. Among surveyed patients, self-motivation and encouragement from family or friends were key drivers of attendance.
The OIG concluded that failures in suicide risk identification and care coordination could lead to underestimated suicide risk, overestimated discharge readiness, and unmitigated risks. Inadequate safety planning may also leave patients ill-equipped to manage crises. While the VHA has updated guidelines for MHTC involvement, these measures have not significantly improved continuity of care.
About 18 veterans die by suicide daily, and while many received health care services in the year prior to their death, half did not receive a mental health diagnosis.
To address this, the Veterans Health Administration (VHA) has updated or initiated programs and policies aimed at identifying at-risk veterans. Since May 2018, the VHA introduced the Suicide Risk Identification Strategy (Risk ID) program, which includes screening patients using the Columbia-Suicide Severity Rating Scale (C-SSRS). Positive screenings call for a licensed independent clinician to document a comprehensive suicide risk evaluation.
Despite these measures, challenges persist in implementation and effectiveness, outlined in reports issue by the VA Office of Inspector General (OIG) during the Biden Administration. Michael Missal, who had served as VA Inspector General since 2016 was recently dismissed by President Trump.
Risk ID
The OIG report surveyed 137 facilities regarding Risk ID processes, training, and monitoring. Findings from that review revealed gaps in training: suicide prevention training does not adequately address Risk ID requirements, leaving staff unprepared to conduct screenings and evaluations. Although the VHA has developed additional training related to Risk ID, the training is not required and the VHA does not monitor staff training completion.
The VHA requires annual screening for all patients and has established a screening clinical reminder in patients’ electronic health records. Despite this, the national screening metric remained below 60% in 2023. Conversely, same-day evaluations after positive screenings reached 82%, though this metric excludes patients who were not screened. In 2024, the VHA added Risk ID evaluation metrics to leadership performance plans, aiming to clarify standards and promote adherence.
Mental Health Treatment Coordinators
A second OIG investigation from December 2024 reviewed VHA requirements related to suicide risk identification processes and also evaluated national compliance with mental health treatment coordinator (MHTC) role requirements.
Suicide risks peaks after discharge from mental health units, with 40% of suicidal behaviors occurring within 90 days. The VHA requires suicide risk screening within 24 hours of discharge and safety plans for high-risk patients using the C-SSRS, but the OIG found adherence issues. In a review of 200 patients discharged between October 2019 and September 2020, staff failed to complete the required screening for 27% of patients and safety plans for 12% of patients.
The VHA also requires clinicians to develop a safety plan with patients who recently attempted suicide or expressed suicidal ideation, are at risk of suicide prior to mental health unit discharge, or are determined to be at “high or intermediate acute or chronic risk” of suicide. For those patients, staff must flag the electronic health record.
OIG also found that over half of surveyed patients with an assigned MHTC were not able to identify the MHTC or another VHA staff member to contact for help with care. One-third of assigned MHTCs did not participate in patients’ transitions from inpatient to outpatient care. Despite the VHA no longer requiring 7-day follow-up appointments as of 2023, the OIG emphasized the need for guidance on scheduling postdischarge mental health appointments to promote engagement.
Consistent with VHA’s discontinuation of a required 7-day follow-up appointment, the OIG recognizes that postdischarge follow-up appointments are most effectively scheduled in consideration of a patient’s treatment needs, preferences, and availability rather than an arbitrary timeliness expectation. Patients flagged as high-risk must attend 4 mental health visits within 30 days of discharge. However, the OIG found that only 48% met this requirement, while 34% attended 1 to 3 appointments, and 18% attended none. Among surveyed patients, self-motivation and encouragement from family or friends were key drivers of attendance.
The OIG concluded that failures in suicide risk identification and care coordination could lead to underestimated suicide risk, overestimated discharge readiness, and unmitigated risks. Inadequate safety planning may also leave patients ill-equipped to manage crises. While the VHA has updated guidelines for MHTC involvement, these measures have not significantly improved continuity of care.