Training, patient follow-ups are part of new policy
October 22, 2008, Spokane, Washington – Following a marked increase in the number of veterans who killed themselves in the first half of this year, the Spokane Veterans Affairs Medical Center has taken steps to reduce the risk of suicide among its patients.
A policy recently adopted by Spokane VA outlines procedures for saving the lives of high-risk veterans. Among the efforts: appointment of a suicide prevention coordinator. Also, every medical center employee receives mandatory suicide awareness training. Veterans at risk of suicide now are placed on a 90-day watch list, and VA staff members follow up on patients who fail to show up for appointments.
Crisis hotline: Veterans in crisis or those concerned about them can call the 24-hour suicide prevention hotline through the Department of Veterans Affairs and the Substance Abuse and Mental Health Administration: (800) 273-8255.
The July 7 death of Lucas Senescall, a 26-year-old former Navy fireman with a history of mental health problems, was the sixth suicide in 2008 of a veteran who had been treated at Spokane VA. The previous year had seen just two such deaths.
In the second half of this year, no suicides have been reported among veterans who had been in contact with the medical center, VA officials said.
“We needed to raise awareness about suicide and suicide risk among all of our employees,” said Dr. Gregory Winter, chief of behavioral health at Spokane VA. “We had certain patients who we knew were a high risk for suicide and the important thing to do was to remain in contact with them.”
Since the death of Senescall, who sought help from Spokane VA on the day he killed himself, the medical center has adopted a comprehensive suicide risk reduction policy that includes identifying veterans at high risk and “flagging” their medical records so that any clinical staff are aware of that risk.
As part of a nationwide Department of Veterans Affairs initiative, Spokane VA has appointed a suicide prevention coordinator who oversees mandatory training for every hospital employee.
The spike in suicides at the Spokane VA mirrored an alarming national trend.
In testimony before the House Veterans Affairs Committee in May, VA Secretary James Peake said male veterans ages 18 to 29 had a suicide rate more than double the rate of men in that age group in the general population.
A 2007 VA memo, entered as evidence in a federal lawsuit by Veterans for Common Sense, a Washington, D.C.-based organization that has led efforts to correct perceived deficiencies in VA mental health care, said 1,000 veterans a month were attempting suicide while in VA care.
Suicide prevention policies adopted by Spokane VA resulted from investigations, called root-cause analyses, into the veterans’ deaths, said Sharon Helman, the medical center’s director. Spokane VA is reaching out into the community, including other medical facilities and veteran service organizations, to find at-risk veterans.
For the past few months, the Spokane VA’s eight-bed inpatient psychiatric facility has been full, and patients who cannot get in have been sent to Sacred Heart Medical Center’s psychiatric facility, Helman said. She attributed this to an increased awareness of the risk of suicide among veterans.
At the center of the VA’s policy is a watch list of veterans at high risk who are monitored for at least 90 days.
“Any patient who was admitted to our inpatient ward for suicidal ideation is placed on the high-risk list at the time of discharge,” Winter said.
For their first 30 days on the list, patients are seen by behavioral health professionals at least weekly. A personal safety plan is developed in cooperation with patients. If patients fail to show up for appointments or cancel them, a behavioral health care provider follows up immediately.
“We track down the patient, try to find out where they are and make sure they are OK,” Winter said.
For the next 60 days, veterans on the list remain in close contact with professionals but are seen less often. No-shows are still contacted immediately. After 90 days, a committee, including the suicide prevention coordinator, the Iraq and Afghanistan veterans program manager and others from behavioral health, meets to determine whether it is safe to take veterans off the list.
The importance of follow-up with veterans who fail to show up or cancel appointments became tragically apparent in March, when Spc. Timothy Juneman – a 25-year-old National Guardsman and former Stryker Brigade soldier who had been injured in a roadside explosion in Iraq – killed himself.
Juneman, who was apparently despondent over imminent redeployment to Iraq with the National Guard, was discharged from psychiatric care at Spokane VA and never had contact with the medical center again. His body was found three weeks after he had hanged himself in his home in Pullman, where he was attending Washington State University.
Juneman’s mother, Jacqueline Hergert, of Toledo, Wash., applauded the follow-up policy. “I think that’s a very positive move,” Hergert said.
But the parents of both Juneman and Senescall raised concerns that Spokane VA could have done more to save their sons.
On the day he killed himself, Lucas Senescall left Spokane VA behavioral health with an appointment two weeks away. Later that afternoon, the veteran again contacted Spokane VA and was told to seek help immediately if his condition worsened or he felt suicidal. His body was found that evening in his garage. Like Juneman, he had hanged himself.
Senescall’s father believes someone from the medical center should have called him or someone else close to the veteran.
Under current policy, patients are asked to sign a release allowing care providers to contact family or friends in the event of a crisis. If no such release is available, the VA contacts law enforcement.
Paul Sullivan, director of Veterans for Common Sense, said he is pleased the VA is implementing a suicide prevention policy at the local level, but he remains skeptical that the problem is solved. “VA must do much more immediately, both in Spokane and nationwide, to meet the growing mental health care needs of our existing and future veterans,” Sullivan said.
Hergert said her son needed more care than he received. Soldiers deserve the best care available, she said. “They deserve proactive care, not reactive care,” she said.