Suicide Risk Management Issue U.S. Department Veterans Affairs Hospital
Suicide prevention is a major national management issue in Veterans Affairs centers with a system wide suicide prevention program in place. These suicide-risk management programs include suicide crisis line, suicide monitoring and risk assessment, full-time suicide-prevention coordination efforts and medical record flags that notify on suicide risks (Desai, Rosenheck, & Desai, 2008).
Suicide risk management is an important management issue in VA Northern California Health Care System, especially among older adults. This is because statistics indicate that older adults (over the age of 65) are vulnerable to suicide and are more likely to complete suicide than younger adults in VA centers (Joung et al., 2012). The national suicide monitoring activities indicate that between 2000 and 2001, suicide rates among VA patients was high in comparison to suicide rates among the general population at 1.66 for male and 1.87 for female veterans (Eden, Le, & Maslow, 2012). A study that screened 703 patients in a general VA clinic found that 7.3% had suicidal ideation (Sundararaman, 2011). Suicide risk is also very high among white and young patients, and those who self-described poor or fair mental health, those from poor or fair perceived physical health, and those with a history of mental health (Sundararaman, 2011). According to Sundararaman (2011) statistics of 1,622 military personnel that died in 2005 by suicide revealed that almost half of them, at 47.2% were depressed at the point of death, and 26.7% were receiving mental health treatment (p.8). Of those in the study, 17.2% had an alcohol problem, with 7.7% had a problem with substance abuse. Twenty-four point five percent of those that died had an intimate partner problem, with 38.4% had a problem with their physical health, 28.0% had experienced a crisis in the previous two weeks before their suicide. Of the dead, 33.9% had written suicide notes, 13.3% had made suicide notes with previous suicide attempts, and 29.0% had disclosed their intentions to commit suicide giving enough time for someone to intervene.
There are several factors associated with the high suicide risk in VA centers, including recent psychiatric hospitalization of patients, the start of antidepressant medication, and the change of medication dosage (Eden, Le, & Maslow, 2012). Mental disorders are associated with the high risk of suicide rates in VA centers, and for those living in rural areas. Studies like that of Joung et al. (2012) identify older adults in VA centers as vulnerable to suicide since they present primary care providers unlike younger adults who are more likely to visit mental health specialists. The focus on suicide risk management in older patients in VA centers arises from the difficulty of identifying suicide risk and offering information suitable for creating intervention measures. Juang et al. (2012) identifies that suicide risk management in VA centers is a major healthcare concern since healthcare providers are faced with the challenge of identifying individual risk factors, especially in older adults than younger adults (Desai, Rosenheck, & Desai, 2008). This short report is a suicide risk management assessment of Northern California VA hospital. The center offers benefits and services to veterans in terms of rehabilitation, healthcare, community living centers, and community clinics, among others.
Steps Taken to Address Suicide Risk Management
At the Northern California Veteran Affairs Hospital suicide, risk management is detailed in the patient safety procedure to be followed by healthcare providers. The intervention plan requires healthcare providers to report any adverse events or patient incidents to patient safety officer or supervisors. Patient incidents healthcare providers are to look out for include suicide and suicide attempts, medication errors, patient abuse, missing patient, staff to patient abuse, transfusion error.
Risk management at the Northern California VA Hospital involves risk assessment in form of root cause analysis. Root cause analysis is a method used by the facility to identify the basic cause or reason contributing to the adverse event or patient incident. Root cause analysis is a method that focuses on the system and process rather than the individual performance of the healthcare providers. Root cause analysis is based on knowledge that majority of the errors are from faulty systems and human error. The analysis uses an interdisciplinary approach that involves interviews by teams over the incident. After identify the root causes of possible patient incidents, the supervisors and patient safety officers make appropriate recommendations to reduce risks associated with identified factors.
Valid Methods used by other VA Facilities
Nationally, VA centers use different approaches to suicide risk management. The most common and nationally approved is the use of the national suicide crisis line. The suicide crisis line was established by the national VA center in 2007, creating a 24/7 crisis hotline which has received over 600,000 calls and made more than 21,000 life-saving rescues by the end of 2007. To reduce the risk of suicide among veterans the national VA renamed the national suicide crisis line from the national veteran's suicide prevention hotline. This was an attempt to reduce associated stigma to the hotline and allow veterans, their families and friends to use the hotline. VA centers across the nation use hotlines and 24/7 live chats to provide callers and veterans access to a healthcare and therapeutic provider. These assist the callers and their families to identify the cause of their suicidal thoughts, the reasons for making the decisions, and assist veterans identify competencies within themselves that can eliminate the suicidal thoughts.
Veteran centers also have full-time suicide prevention coordinators committed to suicide prevention activities. These use collaborative intervention approaches with other mental health clinicians, related specialists from disciplines like psychology and psychotherapy, the community, family, and friends to provide the veteran with a supportive environment. Collaborative efforts are used to provide supportive suicide prevention efforts to veterans at high risk of committing suicide (Eden, Le, & Maslow, 2012). The providers also use collaboration to monitor and enhance the care to high-risk veterans. Suicide prevention activities used in the risk management system involve activities like the reporting and tracking of veterans with a high-risk of committing suicide and those who have already attempted suicide (Eden, Le, & Maslow, 2012). The system also has set down procedures and rules for patient care that trains all staff at VA center how to identify suicide risk factors and report them to supervisors. Staff at VA centers is also required to make immediate reports of a veteran's expression of suicide and suicide plans or intent. Lastly, suicide risk management entails collaborative efforts with partners and communities through community-based organizations that contact veterans and provide consultation to veterans to reduce the risk factors associated with suicide (Eden, Le, & Maslow, 2012). These collaborative efforts also use training and education programs that provide VA staff with knowledge and resources for assisting suicidal or high-risk veterans.
According to Joung et al., (2012), risk assessment and measures for suicide in VA entails educational programs for staff that provider staff with knowledge and skills on identifying changes in the behavior of veterans associated with suicide. Training is used to equip staff with the knowledge and skills necessary in changing the attitudes and goal awareness of veterans that reduce the risks associated with suicide. Moreover, staff is trained on collaborating with primary mental health providers like psychiatry, social work, psychology, rehabilitation, and nursing to provide care, support, and monitoring of high-risk suicide veterans (Joung et al., 2012). The training and education programs assist mental health clinicians and other staff the ability and skills to comprehend body language and words used by high-risk veterans. Another tool in the risk management of suicide in VA centers involves the use of clinical flags for high-risk veterans. These are electronic medical records, which identify veterans at high risk of committing suicide (Desai, Rosenheck, & Desai, 2008). The flag identifies are predefined factors like the history of suicide attempts, recent discharge from an mental health center, change of mental and depression medication, and recent tragic event in the veterans life, among others.
Another important tool used in risk reduction of suicides is no-suicide contracts, which is a commitment to treatment statement by a patient. This is a defined agreement used by VA clinicians and veterans, where the veteran agrees to commit to treatment and to live their life by carrying out several activities (Desai, Rosenheck, & Desai, 2008). These include the identification of expectations and roles by the patient and their mental health clinician. Secondly, is the extensive use of candid communication in all aspects of the treatment and therapy regime, including suicide. Lastly, is the use and accessing emergency services in time of crises (Amos & Robinson, 2010). This arrangement assists mental health clinicians assist suicide high-risk veterans in committing to taking medication, attending to therapy sessions on time, and using crisis centers and plans in time of a suicide crisis. The suicide plan is a detailed plan of the preventative steps the veteran makes in case of a suicide crisis or when suicide behavior is imminent (Amos…