Primary Care and Mental Health Staff Perspectives on Universal Suicide Risk Screening and Care Coordination

Dobscha, Steven K.; Newell, Summer; Elliott, Victoria; Rynerson, Annabelle; Rabin, Sarah; Bahraini, Nazanin H.; Post, Edward P.; Denneson, Lauren M.

doi:10.1176/appi.ps.20220087

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…Many of these barriers may be difficult to address in the ED setting. Additionally, qualitative research of staff perspectives on recent universal screening initiatives in VA has shown that providers experience challenges with care coordination postscreening, particularly when they do not have access to a MH clinician for follow‐up 39 . As research shows that there is a meaningful difference between disengaging from care and not engaging in the first place, 40 it is important for ED providers to consider prior treatment engagement when recommending follow‐up care.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, qualitative research of staff perspectives on recent universal screening initiatives in VA has shown that providers experience challenges with care coordination postscreening, particularly when they do not have access to a MH clinician for follow-up. 39 As research shows that there is a meaningful difference between disengaging from care and not engaging in the first place, 40 it is important for ED providers to consider prior treatment engagement when recommending follow-up care. If establishing follow-up MH care is not feasible at the time of the ED visit, providers might consider offering brief interventions prior to discharge, such as a suicide safety plan.…”

Section: Characteristicmentioning

confidence: 99%

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Factors associated with a lack of health care utilization among Veterans after a positive suicide screen in the emergency department

Laliberte

Salvi

Hooker

et al. 2023

Academic Emergency Medicine

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Objectives: Many Veterans at high risk for suicide are identified in Veterans Health Administration (VHA) emergency departments (ED). Little is known about what may predict care utilization in this population. To address this knowledge gap, we explored factors associated with Veterans' lack of VHA care utilization following a positive suicide risk screen in the ED. Methods:In a retrospective observational study, we identified all patients who were seen in a VHA ED from October 1, 2019, to September 30, 2020. We examined factors associated with not utilizing VHA mental health (MH) and all VHA care in the 6 months following a positive suicide ED screen. Predictors included comorbidity, homelessness, and MH visit and diagnosis history. Results:We identified 23,446 Veterans with a positive suicide risk screen in the ED in fiscal year 2020. Overall, 4.1% had no VHA MH visits 6 months postscreen. The probability of not utilizing MH care was significantly higher for Veterans with no comorbidity (4.7% vs. 3.4% for mild comorbidity), no MH diagnosis (10.5% vs 2.8%), no past-year MH visits (13.6% vs 2.3%), and no past-year homelessness (5.4% vs. 1.1%).A smaller proportion of the population did not receive any VHA care 6 months postscreen (0.5%). Veterans who did not experience homelessness (0.6% vs 0.2%), had no MH diagnosis (1.6% vs. 0.3%), and had no previous MH visits (1.9% vs 0.2%) were significantly more likely to not utilize VHA care.Conclusions: Veterans who do not utilize VHA care after a positive suicide risk screen appear to have fewer documented health and housing concerns than those who do receive care. Yet, Veterans with a positive suicide risk screen who are otherwise healthy may remain at elevated risk for suicide following their ED visit. ED providers may consider enhanced follow-up care to mitigate suicide risk for these Veterans.

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Section: Discussionmentioning

confidence: 99%

Section: Characteristicmentioning

confidence: 99%