Study Shows REACH VET Program Effective for Veterans at High Risk for Suicide
• Research Highlight
Veteran suicide rates have long exceeded those of other U.S. adults. To address this issue, the Department of Veterans Affairs (VA) created a suicide risk prediction algorithm to identify Veterans Health Administration (VHA) patients with the highest statistical risk for suicide.
Research has shown that among at-risk patients identified by the model, those identified in the top 0.1% tier of predicted risk die by suicide at a rate 30 times that of the overall VHA patient population. To help enhance clinical approaches for suicide risk assessment, the VHA rolled out the Recovery Engagement and Coordination for Health–Veterans Enhanced Treatment (REACH VET) program nationally in 2017. The program is the nation’s first clinical use of a validated algorithm to help identify suicide risk.
The VHA uses the algorithm to identify patients at the highest risk for suicide. This risk information is provided to the patient’s local REACH VET program coordinators. The coordinators then inform the patient’s clinicians so both can work proactively to enhance the patient’s care.
Though REACH VET has been used across the VA, until recently, no study formally evaluated the program’s impact. However, in a new study, researchers assessed the program's impact on health care use, safety planning, treatment engagement, suicide attempts, and mortality outcomes. Their findings show that the program helps enhance treatment engagement and care processes and reduces the risk of nonfatal suicide attempts.
The study was conducted by a team of VA scientists led by John McCarthy, Ph.D. , of the VA Office of Mental Health and Suicide Prevention. Study co-authors included Michael Schoenbaum, Ph.D., of the National Institute of Mental Health. In the study, researchers applied the suicide risk prediction algorithm to data from 173,313 individuals who used VHA services before and after the implementation of REACH VET. The researchers compared differences in outcomes among pre-REACH VET and REACH VET veterans in the top 0.1% tier of predicted suicide risk, examining VHA mental health visits and safety plan documentation. For the same cohort, they also measured inpatient mental health admissions, outpatient encounters, emergency department visits, and nonfatal suicide attempts.
The authors found that inclusion in the REACH VET program was associated with having more new suicide prevention safety plans and completed outpatient appointments. Patients in the program also had fewer inpatient mental health admissions and emergency department visits. Notably, participation in REACH VET was associated with a 5% reduction in documented suicide attempts. The findings did not identify differences in suicide or all-cause mortality.
The study’s authors identified several limitations. The cause of death data were not available for all patients in the study, so more mortality data would be helpful in future studies. Further, while the study looked at the REACH VET program as a whole, individual components were not assessed, so understanding if specific parts of the program affected outcomes would be beneficial. Assessing outcomes for longer durations also could be helpful.
Despite these limitations, the current findings suggest that REACH VET shows promise as an intervention to enhance veteran care, and that further program research would be of benefit.
McCarthy, J. F., Cooper, S. A., Dent, K. R., Eagan, A. E., Matarazzo, B. B., Hannemann, C. M., Reger, M., Landes, S. J., Trafton, J. A., Schoenbaum, M., & Katz, I. R. (2021). Evaluation of the recovery engagement and coordination for health–veterans enhanced treatment suicide risk modeling clinical program in the veterans health administration. JAMA Network Open, 4(10), e2129900. https://doi.org/10.1001/jamanetworkopen.2021.29900