Areas of Improvement in Suicide Risk Identification, Assessment, and Risk Mitigation Documentation by Mental Health Prescribers at a Veterans Affairs Health Care System

Purpose Veterans have a suicide rate 1.5 times higher than the non-veteran population. The Department of Veterans Affairs (VA) implemented suicide risk screening recommendations in 2018. This project assessed the impact of mental health (MH) prescribers on these recommendations and identified areas of improvement. Methods Seventy MH Clinical Pharmacy Specialists (CPS) and 52 other MH prescribers were included. Patients with a positive question nine (from the Patient Health Questionnaire-9) and a same-day Columbia Suicide Severity Rating Scale (C-SSRS) between 11/01/18 and 11/01/19 at a VA system were reviewed. Completion of same-day Comprehensive Suicide Risk Evaluation (CSRE), same-day Suicide Prevention Safety Plan (SPSP), number of patients who were not offered naloxone despite access to opioids, and number of patients who were not offered a gunlock despite access to firearms were compared between groups. Time from C-SSRS to suicidal behavior was compared between those who did and did not receive a same-day CSRE. Results MH CPS were significantly more likely to complete a same-day CSRE (p = 0.0201) and SPSP (p < 0.001) when recommended. Naloxone outcomes were not assessed due to availability of only one data point. Rates of gunlock offers did not differ significantly between groups (Fisher's exact test, p = 0.3189) however there was no documentation stating why they were not offered when appropriate 40% of the time. Time to suicidal behavior did not vary across patients based on CSRE completion (p = 0.16). Conclusion MH CPS play an important role in suicide risk screening for veterans. There is a need for improvement regarding the offering and documentation of firearm risk mitigation strategies.