Implementing Caring Contacts for Suicide Prevention in Non-Mental Health Settings

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Suicide rates for Veterans are higher than for the general population and suicide prevention remains a high priority for the VA nationally and for VISNs. This is a particularly critical issue for rural Veterans who are at greater risk for suicide; they have higher suicide rates and firearm deaths are more common in rural suicides. To reach Veterans without mental health diagnoses and/or who are not engaged in mental health care, we are proposing to implement an evidence- based suicide prevention intervention, Caring Contacts, in a non-mental health setting, the emergency department. Caring Contacts (CC) is a simple intervention that involves sending suicidal patients brief, non-demanding expressions of care and concern over a year or more. Studies of CC have demonstrated significant reductions in suicide deaths, attempts, and ideation at one and two-year follow-up. CC have been found to be feasible and acceptable with military and Veteran populations and helpful with active duty Soldiers and Marines. A review of studies on CC determined that “repeated follow-up contacts appear to reduce suicidal behavior.” CC was found to be cost-effective as well. This initiative proposes use of external facilitation as the implementation strategy to implement CC across VISN 16 and sites within VISNs 5, 6, 12, 17, 19, 22, and 23. Of note, the participating VISNs include three of the five most rural VISNs (23, 16, and 19). Facilitation is an evidence-based implementation strategy that is especially useful for facilities with demonstrated quality gaps in the selected clinical priority. The anticipated impacts of this initiative are a decrease in the number of emergency and inpatient mental health and health encounters and an increase in outpatient mental health and health encounters for Veterans at risk of suicide. We will assess the costs of CC and of implementation. To assess return on investment, we will use service utilization data to estimate cost of services. Provider and Veteran perspectives will be measured through key informant interviews.