Preventing Suicide among Homeless Veterans: Examining Current VA Programing and Implementation of Novel Initiatives

Body of Abstract: Veterans experiencing and at risk for homelessness are at substantially greater risk for suicide mortality (Department of Veterans Affairs, 2023). Specifically, in the most recent VA Suicide Data Report (2023), Veterans experiencing homelessness had among the highest rate of suicide relative to Veterans not experiencing housing instability. To meet the needs of these Veterans, it is critical that we identify suicide risk early and connect these Veterans to appropriate health and social services. Nonetheless, engaging Veterans experiencing homelessness in both suicide prevention and VA housing programing remains a challenge (Holliday et al., 2022). To this end, we propose this presentation as the culmination of several federally-funded grants and projects. Notably, all grants and projects discussed below have been either approved by the local Institutional Review Board and/or been deemed as Quality Improvement/Program Evaluation and were therefore exempt. First, we will discuss evaluations of suicide risk assessment within the VA. In particular, 72.6% of Veterans identified as being homeless in the VA were evaluated for suicide risk. Moreover, these data regarding screening and evaluation efforts occurred VA wide (including myriad settings outside homeless programs), suggesting that suicide risk assessment is feasible among clinically complex homeless Veterans. Nonetheless, nearly a quarter of Veterans experiencing homelessness did not receive a suicide risk assessment. Given this, we will further delve into methods of enhancing screening and evaluation efforts for these Veterans. For example, we will discuss critical VA settings for identifying homeless Veterans, including non-mental health care settings such as emergency departments. Building upon this, we will then report suicide risk stratifications for homeless relative to non-homeless Veterans. We will highlight that homeless Veterans, on average, had more severe suicide risk stratifications; nonetheless, nearly half of these Veterans were not referred to VA homeless programs. Further, of Veterans referred, only a small minority accessed this care within a year following identification. To explain this finding, we will discuss key themes from qualitative interviews with homeless Veterans and their providers. We will note the stigma and distrust that homeless Veterans experience as well as the empathetic burnout and feelings of hopelessness experienced by providers. We will conclude by presenting a novel clinical resource developed to guide VA emergency service provider experiences. We will discuss next steps for piloting this resource, including evaluation of acceptability, feasibility, and implementation to increase suicide prevention efforts and referral to VA homeless programs. We will conclude by discussion with the audience of how they can best tailor the care and service processes they provide to individuals experiencing concurrent homelessness and suicide risk.

Learning Objectives:

• Summarize rates of suicide risk assessment, as well as risk stratifications, among Veterans experiencing and not experiencing homelessness.
• Define key themes of facilitators and barriers to engaging into suicide prevention and VA homeless programs among Veterans experiencing homelessness.
• Discuss how to integrate a novel clinical resource to enhance service delivery among homeless Veterans accessing VA emergency services.