3 - (IOP 22) National Implementation of Suicide Safety Planning in the Veterans Healthcare Administration

Accumulating evidence shows that Suicide Prevention Safety Planning (the Safety Planning Intervention, or SPI), a brief intervention in which patients and providers collaboratively identify coping and safety strategies for use before and during suicidal crises, can reduce suicidal behavior. Given this evidence, several health systems have implemented SPI, the largest of which is the Veterans Healthcare Administration (VHA).

To ensure equitable, effective implementation of suicide prevention interventions in VHA and inform efforts in other health systems, it is necessary to evaluate SPI implementation across VHA. In the present study, we used national electronic health record data to examine: 1) the proportion of patients at risk for suicide who were offered and completed SPI, 2) sociodemographic differences based on SPI completion.

Information on SPI completion, sociodemographics, and settings were extracted from electronic health records (December 2021-February 2023). Suicide risk was identified using the Columbia Suicide Severity Rating Scale Screener - annual screening is mandatory in VHA.

Among patients with recent suicidal ideation or behavior, 44% completed a new SPI within 30 days of screening positive; close to half (18%) were mandated to complete it. Among individuals mandated to complete SPI, over 80% completed it within the required timeframe. Of those who completed SPI within 30 days, most (52%) completed it in mental health outpatient settings, with 30% completing SPI in inpatient/residential settings, 7% in acute care, and 10% in other settings. Overall, 69% of veterans were offered SPI - they either completed SPI within 30 days of screening positive, reviewed a previous SPI and made no changes, completed it in the previous year, or declined to complete it. Patients at higher risk for suicide were more likely to complete SPI. Younger/middle-aged, Black, female, Hispanic/Latine, and urban-residing patients were more likely to complete SPI than older, White, male, non-Hispanic/Latine, and rural-residing patients, respectively.

This is the first study to examine SPI implementation in VHA and differences in SPI completion depending on patient sociodemographic characteristics. Relatively high SPI completion overall and higher completion among patients at greater suicide risk indicates widespread adoption of the intervention, particularly in mental healthcare settings. We did not find systematic disparities for minoritized patients in SPI administration, except that rural-residing patients were less likely to complete SPI despite higher risk of suicide relative to urban-residing patients. These findings suggest that mandatory screening for suicide risk in VHA may enhance equitable implementation of SPI.