Suicide Prevention and Postvention Resources: What Psychiatry Residencies Can Learn from the Veteran’s Administration Experience

Abstract

Suicide risk assessment and coping with the loss of a patient through suicide are two of the more challenging aspects of psychiatry residency. Over the last decade, the Department of Veterans Affairs has focused on a significant effort into the development of a comprehensive suicide prevention. This article aims to describe the initiatives and resources in place at the VHA to help address the issue of suicidal behavior in veterans and how residency programs can use this to enhance teaching of suicide prevention and postvention.

Application of the Zero Suicide Model in Residency Training

“…Elements of the Zero Suicide model have been adopted by the Veteran's Health Administration Hospital systems [12] and in other care settings. A recent quality improvement educational initiative at the Medical College of Wisconsin psychiatry residency program sought to incorporate elements of the Zero Suicide Initiative into clinical care, focusing on the inpatient population [12].…”

“…Elements of the Zero Suicide model have been adopted by the Veteran's Health Administration Hospital systems [12] and in other care settings. A recent quality improvement educational initiative at the Medical College of Wisconsin psychiatry residency program sought to incorporate elements of the Zero Suicide Initiative into clinical care, focusing on the inpatient population [12]. They increased use of safety plans from 10 to 52%, focused on means restriction, conducted a postvention workshop focusing on emotional and professional aspects of losing a patient to suicide, and instituted quality care rounds (e.g., morbidity and mortality rounds).…”

“…They increased use of safety plans from 10 to 52%, focused on means restriction, conducted a postvention workshop focusing on emotional and professional aspects of losing a patient to suicide, and instituted quality care rounds (e.g., morbidity and mortality rounds). This initiative was met with enthusiasm, and residents actively engaged in an adoption of comprehensive suicide prevention, which resembled the Zero Suicide approach to patient safety [12]. Currently, researchers in New York State and Columbia University Department of Psychiatry are evaluating widespread implementation of Zero Suicide into outpatient behavioral health clinics serving > 80,000 patients in a study funded by the National Institution of Mental Health [6].…”

Improving Psychiatric Education Related to Suicide

“…Several articles in this collection [4,[8][9][10][11][12][13] focus on the development of educational programs that help strengthen suicide prevention, including screening, skills, and suicide awareness/management. The abovementioned report by Downs and colleagues [4] presents a 4-year trial of the Healer Education Assessment and Referral (HEAR) program.…”

“…Two articles in the collection discuss the resources and experience from the VA institutions. Pheister and colleagues [8] bring our attention to a robust VA suicide prevention program for residents. Marshall and colleagues [9] describe the development, implementation, and evaluation of an electronic version of the Collaborative Assessment and Management of Suicidality (CAMS) program.…”