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Emergency Departments Treating Veterans for Suicide: Ensuring Quality Care for Veterans Outside of Department of Veterans Affairs Health Care Facilities

Published:January 17, 2023DOI:https://doi.org/10.1016/j.jen.2022.12.004

      Abstract

      Introduction

      Veterans die by suicide at higher rates than nonveterans. Among veterans, those receiving Department of Veterans Affairs (VA) health care are less likely to die by suicide than veterans not enrolled with the Veterans Health Administation (VHA). Although data are available on the demographics, diagnoses, and treatment associated with higher suicide rates among VHA patients, less is known about the care of suicidal veterans at non-VHA health care facilities. This study aimed to identify assessment and referral practices of emergency departments at rural community hospitals related to care for suicidal veterans and explore the feasibility and acceptability of identifying veterans in need of postdischarge aftercare.

      Methods

      This qualitative exploratory study involved content analysis of semistructured interviews. Ten emergency clinicians from 5 rural Arkansas counties with high suicide rates were interviewed about their experiences working with suicidal patients within the emergency department and perceptions of assessment, management, and referral practices.

      Results

      Although most of the emergency departments had a process for assessing for suicide risk, emergency clinicians did not always feel confident in their knowledge of assessing and caring for suicidal patients. Military history was not included in assessment, treatment, or aftercare planning, nor were brief interventions such as safety planning or lethal means safety education provided.

      Discussion

      Best practices for suicide assessment and management of veterans exist; however, challenges specific to the emergency department regarding staff training and engaging the community to effectively link at-risk veterans to needed care hinder implementation. Veteran-inclusive assessment and intervention practices could enhance the quality of care provided in community emergency departments.

      Key words

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      Biography

      Angie Waliski is a Health Research Scientist, Health Services Research and Development, Central Arkansas Veterans Healthcare System; and an Assistant Professor, Division of Health Services Research, PRI, University of Arkansas for Medical Sciences, Little Rock, AR. ORCID identifier: https://orcid.org/0000-0002-6596-2038.

      Biography

      Monica M. Matthieu is a Research Social Worker, Mental Health Service, Central Arkansas Veterans Healthcare System, North Little Rock, AR; and an Associate Professor, School of Social Work, Saint Louis University, St. Louis, MO. ORCID identifier: https://orcid.org/0000-0003-2218-9484.

      Biography

      M. Kathryn Allison is a Research Assistant Professor, Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR. Twitter: katyallisonphd. ORCID identifier: https://orcid.org/0000-0001-6178-0352.

      Biography

      Michael P. Wilson is Associate Professor, Department of Psychiatry, University of Arkansas for Medical Sciences; and Associate Professor, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AR. ORCID identifier: https://orcid.org/0000-0003-3069-2274.

      Biography

      Elisabeth M. Skaggs is Technical Writer, Central Arkansas Veterans Healthcare System, North Little Rock, AR. ORCID identifier: https://orcid.org/0000-0002-6631-9466.

      Biography

      David A. Adkins is Research Health Science Specialist, Central Arkansas Veterans Healthcare System, North Little Rock, AR. ORCID identifier: https://orcid.org/0000-0002-6237-6826.

      Biography

      Richard R. Owen is a psychiatrist, the Director of the Center for Mental Healthcare and Outcomes Research, and Associate Chief of Staff for Research and Development, Central Arkansas Veterans Healthcare System; and Professor, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR. ORCID identifier: https://orcid.org/0000-0003-2548-2264.