Rural Veteran Suicide Prevention Program: A Partnership to Prevent Suicide Among Rural Veterans

Introduction: Despite successful implementation in other populations, culturally-informed, community-based suicide prevention has not been applied to rural Veterans. Suicide rates in rural areas have been consistently higher than they are in urban areas. Veterans are one population that exhibits elevated suicide rates and for whom rurality may serve as a compounding factor increasing risk and complicating the delivery of preventive services. This paper describes the Rural Veteran Suicide Prevention Program (RVSPP) project, a Veterans Health Administration (VHA) initiative to partner with rural communities to reduce Veteran suicide deaths and increase knowledge of suicide risk and prevention in rural communities. The RVSPP employs Community Based Participatory Research (CBPR) methods to collaborate with local communities on the implementation of a comprehensive public health model including universal, selected, and indicated interventions. The RVSPP focuses on six different areas: public awareness, lethal means safety, gatekeeper training, primary care, clinical services for high risk Veterans, and crisis services.

Methods: The RVSPP uses CBPR methods to support a multi-directional learning partnership to advance research, policy, and practice. We are applying mixed qualitative and quantitative methods to capture community-level change in capacity, social networks, suicide risk and protective factors, and suicide outcomes. We are also assessing implementation to support continuous quality improvement of both program administration and community implementation.

Results: This study is currently underway. Preliminary results indicate a high degree of feasibility and acceptability of the intervention model. Additionally, community partners’ input has been central to advancing our understanding how to implement rural Veterans suicide prevention. For example, early qualitative evidence has led us to think critically about the ways in which public stigma of suicide can be a barrier to effective community action and partnerships.

Conclusions: RVSPP represents a research-policy-practice partnership. Suicide prevention researchers developed the program model and identified best practice resources to support implementation in collaboration with rural communities. Evidence from the evaluation is being fed back into the program to enhance VHA policy and guide new directions for research. To date, this feedback has helped us identify innovative new services to increase access to care, led us to revise our community assessment and planning processes, and led to stronger community-based and culturally appropriate prevention strategies.