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.
Article info
Publication history
Published online: January 17, 2023
Publication stage
In Press Corrected ProofIdentification
Copyright
Published by Elsevier Inc. on behalf of Emergency Nurses Association.
