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Tragic Treads: Suicide Prevention Among Veterans

Testimony before the House Committee on Veteran’s Affairs

Presented by Shelli Avenevoli, Ph.D.
Deputy Director, National Institute of Mental Health

April 29, 2019

Good evening, Chairman Takano, Ranking Member Roe, and distinguished Members of the Committee. I am Dr. Shelli Avenevoli, the Deputy Director of the National Institute of Mental Health within the National Institutes of Health. It is an honor to appear before you today alongside my colleagues from SAMHSA and the VA.

Given the troubling rise in the national suicide rate in the past decades, suicide prevention research is an urgent priority for the NIH. As the lead federal agency for research on mental disorders, NIMH’s portfolio includes projects aimed at identifying who is most at risk for suicide, understanding the causes of suicide risk, developing interventions, and testing the effectiveness of suicide prevention services in real-world settings. In collaboration with our federal and private partners, we work to translate research findings into evidence-based practices.

Today, I want to highlight research that has identified promising suicide prevention tools ripe for implementation within healthcare systems. When used effectively, and in combination, these tools may increase the number of lives saved among Veterans and all Americans.

Healthcare settings are important for two reasons: access and opportunity. Nearly half of individuals who die by suicide had some type of medical visit in the 30 days prior to death, and around 80% did so in the year before death. In addition, about half of people who die by suicide had at least one emergency department visit in the year before death.

Research supported by NIMH and others has identified a growing number of evidence-based suicide prevention tools that can be used right now in the healthcare system. I would like to walk you through a scenario that showcases how the healthcare system, using some of these tools, can identify more people at risk for suicide, provide effective treatment, and ensure appropriate follow-up care.

Let’s say you are depressed and considering suicide, but you haven’t told anyone about these feelings. One day, you have severe abdominal pain and go to the emergency room. Your conversation with the doctor focuses on your physical pain. But because this emergency room screens all patients for suicide risk, the doctor asks if you have had suicidal thoughts or attempted suicide. Our funded research shows that screening all patients doubles the number of people we can identify as needing help for suicide risk.

When you tell this doctor that you have been considering suicide, the doctor connects you with a social worker. The social worker asks questions to assess your level of risk, discusses treatment options with you, and works with you to develop a personalized Safety Plan. This Safety Plan describes approaches for reducing your access to lethal means, identifies specific coping strategies to decrease your risk of suicidal behavior, and lists people and resources that could help you in crisis. Safety Planning is an evidence-based intervention, and we are now supporting research on the best ways to deliver it in various settings and populations.

As part of that Safety Plan, the social worker links you with a local crisis center, that is part of the National Suicide Prevention Lifeline system. This crisis center works with your hospital to keep in contact with you by telephone over the next few months – a very high-risk time for suicide (pause). An NIMH-funded study has shown that this combination of screening, brief intervention, and follow-up contact reduced suicide attempts in the next year by about 30%.

A growing number of healthcare systems are implementing many of these evidence-based practices – but we know that more can be done.

Through the National Action Alliance for Suicide Prevention, NIMH, SAMHSA, CDC, VA, and other public and private partners are working towards a goal of “Zero Suicide” deaths in healthcare, in which health systems implement these and other evidence-based practices. The Zero Suicide framework includes comprehensive tracking of patient outcomes, so we can monitor progress and identify ways to save additional lives.

Today, I highlighted just some of the suicide prevention tools our researchers have tested in the healthcare system. We are committed to working with our partners and stakeholders to ensure that these evidence-based tools are implemented and accessible to all. Moving forward, we will continue to provide hope by supporting research to prevent suicide.

I want to thank the Committee again for bringing us together to address the challenges of suicide prevention in this country, for veterans and all Americans. I am happy to take any questions you may have.