Q&A: Advancing the Public Health Approach to Suicide Prevention for the VA and DoD
DSS fully supports the theme of “Reimagining Suicide Prevention: Evolving and Innovating to Meet Diverse Needs” for the 2024 VA/DoD Suicide Prevention Conference
This week kicks off the 2024 VA/DoD Suicide Prevention Conference, which focuses on the need to reimagine suicide prevention by highlighting innovative ways to increase the reach to at-risk Service members and Veterans.
Suicide prevention for both the Department of Veterans Affairs (VA) and the Department of Defense (DoD) is a complex challenge that requires a public health approach that leverages science, innovation, and best practices to protect Veterans and improve population health efforts.
In the following Q&A, Dr. Barbara Van Dahlen, a strategic advisor to DSS, CEO of WeBe Life, and a renowned clinical psychologist and mental health consultant, dives further into the topic of advancing the public health approach to suicide prevention at the VA and DoD.
The following has been edited for length and clarity.
Q: The theme for the upcoming VA/DoD Suicide Prevention Conference is “Reimagining Suicide Prevention: Evolving and Innovating to Meet Diverse Needs.” What does that statement mean to you on how might the VA reimagine its suicide prevention efforts?
Dr. Van Dahlen: For nearly a decade now, the field of suicide prevention has been steadily moving toward adopting a public health approach. This approach combines science, innovation, and best practices to protect and improve population health through education, service, and prevention.
Historically, suicide prevention has focused on identifying individuals contemplating suicide by trying to find the so-called "needles in the haystack." However, this method has proved ineffective.
First, suicide remains a rare event that leaves a devastating impact on those directly affected. Thinking about suicide, however, is not a rare event. In any given year as many as a third of Americans have thoughts of suicide – because of stress, strain, trauma, loss – but the vast majority do not take action.
Finally, there is no single cause, risk factor or sign of suicide, making it extremely difficult to predict who may or may not make the decision to die. In 2021 a total of 6,392 Veterans died by suicide – out of the total population of 18.5 million.
Today, our focus has shifted to reaching people upstream, identifying those in need or at risk, and helping them address their pain and struggles earlier to improve overall health and well-being. Education, early identification, and targeted preventative measures are now prioritized. The VA has been a leader in this transition, advocating for a more holistic approach to suicide prevention.
This means thinking differently about finding at-risk individuals, identifying appropriate programs that fit specific subgroups of individuals, and forming effective community partnerships. This reimagined strategy represents the VA's commitment to evolving and improving its methods over time.
Q: Can you tell us a bit more about the current state of suicide prevention – in general and for Veterans in particular.
Dr. Van Dahlen: Suicide prevention today embraces a public health approach as noted above. In addition to shifting the focus to education about risk and protective factors, early identification, and intervention, we are looking beyond the individual who might be at risk to engage the larger community.
The VA has absolutely adopted this approach and is expanding efforts to focus to include family members, peers, and subgroups within the broader Veteran population such as LGBTQ+ Veterans, Asian American and Pacific Islander Veterans, Native American Veterans, and homeless Veterans.
Veterans are a diverse group, not a monolithic entity, and effective strategies must reflect that diversity. For instance, we’re seeing a welcome emphasis on reaching and serving women Veterans – in part because the suicide numbers for our women Veterans have risen – but also because women Veterans have very different needs and challenges as compared to their male counterparts. They require different approaches and resources.
As you can see, the VA is moving toward a more comprehensive and individualized approach which increases the likelihood that all Veterans will receive the specific support they need.
Q: Let’s dive more into the “innovating” theme of the conference. What are some advanced technologies that can support the VA’s suicide prevention efforts?
Dr. Van Dahlen: When considering a public health approach, technology can be a game changer as we continue to work to save lives. AI is a great example of one area of innovation which could transform our work in several ways.
For example, AI could help identify Veterans in distress who call VA access points. By analyzing a caller’s tone of voice, the questions they ask or the answers they provide, we may be better able to respond to specific needs and concerns – directing Veterans to immediate care through resources like the Veterans Crisis Line.
In addition, AI can analyze massive amounts of aggregate data using machine learning to help us understand which veterans benefit from which resources, interventions, and opportunities. AI can also use databases to identify those Veterans that have a history of specific challenges or risk factors – improving our chances of finding those needles in the haystack. AI is a prime area of interest and focus not just for the VA, but for everyone working in the field.
Technologies can also provide easy and quick access to valuable information Veterans need to take better care of themselves or their families. This includes apps and portals that allow Veterans to directly access their VA records or services more efficiently.
Q: Please tell us about DSS’ solutions that are focused on advancing mental healthcare.
Dr. Van Dahlen: It's critical for Veterans to have direct access to information about their own health and treatment – because we all fare better when we understand our challenges, struggles, needs, and available resources. One of the initiatives DSS is working on, in partnership with the VA, involves modernizing existing tools and products to enhance this access.
Currently, DSS is focused on developing components that, for the first time, allow Veterans to access information directly that supports their clinical care. This is a cutting-edge and exciting advancement. This new enhancement to an existing system exemplifies the innovative work DSS is doing to improve how Veterans access and manage their health information.
In addition, DSS has deployed a platform called PCM HRO in 17 facilities, which is an essential tool for VA suicide prevention coordinators. It allows them to perform several critical tasks related to suicide prevention.
First, it ensures that every Veteran receives a suicide risk assessment when it's due, which is a current requirement in the VA. This consistent screening is vital for early identification and intervention. Additionally, the platform supports Veteran suicide prevention coordinators in ensuring that Veterans who need suicide prevention safety plans receive them.
When a Veteran comes into a VA emergency room expressing concerns about their safety, if the Veteran is discharged to the community, the facility is required to create a safety plan as part of that process. Developing and implementing these plans for at-risk individuals is a fundamental part of VA efforts to prevent suicide.
The PCM HRO platform helps ensure that at risk Veterans are properly identified, supported, and tracked. We know that safety planning in and of itself can help save lives. PCM HRO has already demonstrated success in increasing the likelihood that Veterans in need of proper screening and safety planning are properly staffed and served.
PCM HRO is also helping the VA to track Veterans who receive care through community-based Emergency Departments – critical to ensure coordination of care and continuity of services.
Finally, the PCM HRO platform has been found to improve efficiency for VA suicide prevention coordinators – making their jobs easier because the automated system tracks Veterans who require specific resources. When we enhance efficiency for frontline workers, we save lives.
Q: Please tell us about emerging/future-focused innovations that might help with suicide prevention.
Dr. Van Dahlen: In line with a public health approach, we need to continue to focus on upstream efforts to improve population health and prevent suicide. This means more education to help everyone understand both the risk and protective factors for suicide.
What do I mean by that? Just as we are aware of risk factors for physical health, like heart disease, we need to recognize risk factors for suicide. For instance, I need to be mindful of heart health because of my family's history. But most of us, including Veterans, are unaware of their risk factors for suicide.
Risk factors can include lack of access to mental health care, financial challenges, relationship struggles, and pre-existing mental health conditions. While no single factor will necessarily lead someone to contemplate suicide, the combination of several of these stacked on top of each other can significantly increase risk. Understanding and addressing these factors, along with reinforcing protective factors that keep us supported during challenging times, is critical in our efforts to prevent suicide among Veterans.
AI can play a significant role in identifying individuals with high risk factors, engaging them, and reaching out to provide support. It can also help individuals identify the protective factors they have available to them. Protective factors include good physical and emotional well-being, a sense of purpose, satisfying employment, good family support, and healthy social connections.
Q: Finally, given that we are talking about the use of technology to reimagine suicide prevention, are there potential unintended consequences we need to be mindful of with respect to technology that might be explored to prevent suicide?
Dr. Van Dahlen: This is something I have discussed before, and it's a significant concern of mine. Technology presents incredible opportunities – we see it daily with life-saving measures in medicine. It can also help us save lives through suicide prevention. However, in our haste to advance technologically, we often neglect the critical step of due diligence and meaningful conversations with those we aim to help. This oversight can lead to unintended consequences.
For instance, as we develop technologies capable of identifying individuals at high risk, we must consider how to responsibly manage and utilize such sensitive information. What protocols do we establish for proper use? How do we involve the individuals themselves in decisions regarding their wellbeing and risk data?
We must proceed with caution when interpreting screening results suggesting vulnerability, as these results tell us risk – they can’t confirm that someone is planning to die by suicide. AI, if not carefully and properly developed and deployed with data reflecting appropriate diversity can create biased or distorted models due to inherent biases in the data it uses. We must carefully consider how we deploy and measure the impact of these tools, weighing their value and benefit against unintended consequences. Vigilance is essential in assessing the value and potential unintended consequences of the products we develop, as these can inadvertently harm the very people we aim to support.
We’re making great strides in suicide prevention. Advances in technology and innovative approaches will continue to help us move the needle and save lives. But we don’t need technology or innovation to make a difference. We all have a role to play in preventing suicide. Help is available. Saving lives is possible.
If you are concerned about yourself or someone you care about, reach out to give or get help. Call 988, the National Suicide and Crisis Lifeline for support, information, or assistance.
We would like to thank Dr. Van Dahlen for sharing her insights with us! To learn more about how DSS supports the VA and Veterans, please click here.