Stakeholder Perspectives On Improving Access to Vha's Suicide Prevention Services

Introduction: Veterans using VA health care services are at heightened risk for death by suicide. Among those Veterans who die each year by suicide, it is still unknown how many of these deaths are among community-dwelling Veterans who do NOT go to VA for care.  Epidemiological data on previous combat Veteran cohorts and data on underutilization of VA services among Veterans suggest that suicide risk among our newest cohort of Veterans, as well as other Veterans not enrolled in VA care is of great concern.  The overall objective of the study is to examine the need for suicide prevention services in the local communities where Veterans live from the perspective of a diverse group of VA and community providers.  The study will identify provider and organizational barriers to care with a focus on those unique to Veterans living in rural areas that are at risk for suicide. 

Methods: Using purposeful sampling, this mixed-methods study recruited and gathered survey and interview data from a diverse group of stakeholders (N=72) that represent key VA and non-VA community-based agencies that provide a range of health and psychosocial services to veteran and/or military populations living in the Central and Eastern Regions of the State of Missouri.  Interview questions focused on the perception of Veteran's needs for VA and/or community-based services and more specifically, suicide prevention services, as well as referral mechanisms to address service needs and potential barriers to receiving services. Survey questions assessed participant demographics, including information about the organization (number and age of clients served), participant veteran status, and proximity to suicide, professionally and personally. 

Results: Preliminary analyses of the survey data indicate that the majority of our participants were white (89.8%), male (53.3%), and educated (75% with a Master’s degree or greater education), with less than 15 years of clinical / medical experience (65.3%). Broad themes from a preliminary qualitative analysis suggest that both community and VA providers perceive a need for increased services, both generalized and suicide prevention-specific. Generalized needs include financial support, transportation, mental health care and increased support during a Veteran’s transition from the military back to civilian life. Suicide prevention services should be tailored to reach each generation of Veterans where they are most comfortable.

Conclusions: More can be done by the VA system to improve connections with community providers in several different service sectors.  A variety of platforms for communication, including targeted interventions for providers, public service announcements, and smart phone aps, are discussed. These results will inform a future research on the design and feasibility testing of an innovative organizational barrier-breaking intervention study. These results will help create an infrastructure for suicide prevention that is in line with national strategies for suicide prevention, including sustaining and strengthening collaboration among agencies, and reduce barriers to access to suicide prevention services.