A thematic analysis of perceptions of VHA emergency care and suicide risk assessment among Veterans experiencing homelessness

Introduction: Veterans who are homeless are at elevated risk for suicide, and often access Veterans Health Administration (VHA) emergency services to address their health needs. We sought to explore experiences of homeless Veterans utilizing these services, and barriers and facilitators to suicide prevention engagement. Methods: Semi-structured interviews with 25 Veterans who self-reported past 12-month history of homelessness and accessed VHA emergency services. Interviews explored perceptions of VHA emergency care and suicide risk assessment. Results: Interviewees described a complex array of factors contributing to housing instability. Participants detailed challenges navigating interrelated, yet at times disconnected, systems of healthcare and homeless services. Veterans' experiences receiving care and suicide risk screening in VHA emergency services were generally positive. However, some described rare, striking experiences, feeling stigmatized for "being homeless". Services following discharge tended to be fragmented. Given numerous contextual factors (e.g. transportation difficulties, timeliness of referrals) complicated by homelessness, individuals tended to routinely rely upon VHA emergency service for future acute care needs. Conclusions: Overall, perceptions of emergency services, including suicide risk screening in this setting, were largely positive and deemed acceptable. However, findings illustrate multiple avenues for optimizing service delivery, including post-discharge services, among homeless Veterans accessing VHA emergency services.