National Implementation of Suicide Safety Planning in the Veterans Health Administration

The authors aimed to assess the proportions of patients at risk for suicide in the Veterans Health Administration (VHA) who were offered and completed the Safety Planning Intervention (SPI).

Data on SPI completion, sociodemographic characteristics, and settings were extracted from electronic health records (December 2021-February 2023). Suicide risk was identified with the Columbia-Suicide Severity Rating Scale Screener.

Among patients with recent suicidal ideation or behavior (N=86,913), 44.2% completed an initial SPI within 30 days of screening positive; an additional 7.2% reviewed a previously completed SPI and made no changes. Of note, 69.4% of veterans were offered SPI (i.e., they completed it within 30 days of screening positive, reviewed a previously completed SPI and made no changes, completed an SPI in the previous year, or declined to complete it). Of patients mandated by VHA policy to complete SPI, 97.9% did so within the required time frame. Patients at higher risk for suicide were more likely to complete SPI, and most completed it in mental health outpatient (52.4%) or inpatient or residential (27.0%) settings. Younger, middle-aged, Black, female, Hispanic or Latine, and urban-residing patients were more likely to complete SPI.

This study is the first to examine SPI delivery in VHA. Relatively high SPI completion rates and higher completion among patients at greater suicide risk indicate widespread adoption of the intervention, particularly in mental health care settings.