Vets At Risk Of Suicide Not Getting Adequate Post-Discharge Care

May 8, 2013
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Nearly a third of veterans deemed at high risk for suicide don’t receive the recommended follow-up care after they’ve been discharged from Veterans Health Administration inpatient mental health facilities, according to a new report from the VA inspector general.

The report — which comes as the U.S. Department of Veterans Affairs grapples with a rise in suicides that claim an estimated 22 veterans’ lives a day — recommends that the VA take action to improve post-discharge follow-up for patients with acute mental health problems.

The VA requires its mental health clinicians to evaluate patients considered at high risk for suicide at least weekly for the 30 days after their discharge from Veterans Health Administration (VHA) mental health care. But of 215 patients whose medical records were examined by the inspector general’s office, 65, or 30 percent, did not receive all of their follow-up evaluations, the report shows. Records of 33 percent of the 215 patients did not contain documentation that a suicide-prevention coordinator or other case manager had made attempts at contact.

“Although MH (mental health) providers scheduled follow-up appointments prior to patient discharge, timely post-discharge MH evaluations were not consistently provided,” the report says. It recommends that the VHA improve efforts to reach out to patients who don’t report to scheduled appointments and document those contact attempts.

Among veterans not deemed at high risk for suicide, 78 percent of the sampled group had some type of mental health evaluation within seven days after discharge, as required by VA policy. But some of those patients received only phone calls and were not evaluated in person or via “telemental health” services within two weeks of discharge.

Also, while VA policy “encourages” facilities to provide follow-up evaluations within 48 hours of discharge, only a quarter of patients received such services. Missed appointments were an added problem, the inspector general’s office said.

Dr. Robert Petzel, the VA’s undersecretary for health, said his department would direct facilities to create “a local patient registry for follow-up on all patients discharged from inpatient mental health units.”  He said the agency also would remind facilities that they need to contact veterans who miss appointments and to document those attempts in patients’ medical records.

The VA has a number of studies and programs underway aimed at suicide prevention, but has been under fire for failing to care for veterans with mental health problems in a timely manner. Every VA medical center now has at least one suicide-prevention coordinator, responsible for tracking patients at risk for self-harm.

At the West Haven VA, a policy is in place requiring follow-up of all veterans deemed at high risk for suicide, to ensure that four visits occur within the first 30 days of discharge, said Maureen Pasko, suicide prevention coordinator for the West Haven facility. Also, she said, clinicians contact veterans who are at high risk when they do not show up for appointments, and document those attempts in the medical record.

The need for follow-up “relates to a potential high-risk period following inpatient admissions,” Pasko said. After the 30-day period, high-risk veterans are seen “as often as clinically indicated, and continue to be monitored by the Suicide Prevention Program.”

The new inspector general’s report prompted U.S. Sen. Barbara Boxer, D-Calif., to send a letter to Secretary of Veterans Affairs Eric Shinseki, urging the VA to ensure that all veterans who have been hospitalized for acute mental illness and deemed at risk for suicide receive the required post-discharge evaluations.

“The OIG report is alarming because VA requirements for follow-up care are clear, yet they are not being followed. This is putting some of our most vulnerable veterans at further risk for self-injury,” she said in a May 6 letter.

Boxer noted that an inspector general’s report from 2010 similarly had found that the VA struggled to ensure veterans discharged from inpatient mental health care received proper follow-up.

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