Is the Veterans Affairs Suicide Prevention in Emergency Department Intervention associated with improved mental health attendance and all-cause mortality outcomes?

In late 2018, the U.S. Department of Veterans Affairs (VA) implemented the Suicide Prevention in Emergency Department (SPED; 116th U.S. Congress, 2020; VA, 2018) initiative to protect veteran lives and promote follow-up with mental health services. SPED mandated the use of safety planning, a suicide prevention intervention, for those assessed as at-risk of suicide in emergency departments. To assess implementation and potential SPED benefits, we extracted from medical records an archival sample (N = 14,743) of patients' first VA emergency department visit between October 1, 2018, and May 13, 2023, in which they were screened as at-risk of suicide and evaluated a subgroup of these patients who discharged to home (n = 7,024). Overall, implementation of the risk assessment triggering the SPED requirements and safety planning intervention administration was high with room for improvement. Exploratory logistic regressions revealed safety planning was associated with 26% reduced odds of all-cause mortality (i.e., death from any cause, including suicide-specific and nonsuicide-specific causes) within 1 year but was not associated with increased 30-day mental health encounter attendance. Suicide mortality was not examined as an outcome. Findings suggest safety planning may be relevant to a broader range of patients assessed as at-risk in VA emergency departments than initially targeted. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Duke Scholars

Author Jonathan Zhang Sanford School of Public Policy