Evolving standards for suicide risk documentation in the Veterans Health Administration: A brief commentary on...

In the Veterans Health Administration (VHA), a high risk for suicide (HRS) flag is used in medical records to alert providers that veterans have recently engaged in suicidal self-directed violence or required hospitalization to keep from doing so. These flags are not intended to indicate chronic suicide risk and thus are designed to be temporary. However, as risk for suicide is volatile and can confer a chronic course, it is common for veterans to engage in suicidal self-directed violence at intervals that extend beyond the life of a HRS flag. To improve our understanding of when it may be appropriate to inactivate a HRS flag, Denneson et al. (see record 2024-23207-001) recently analyzed factors associated with suicide reattempt following HRS flag inactivation. Beyond patient, provider, and system-level factors, the lone predictor of suicide reattempt in this sample was the quality of the note that documented the decision to inactive a HRS flag. In this commentary, we offer perspective from the field to contextualize the findings and implications introduced by Denneson et al. (2023). We discuss the limitations of the available data, which warrant empirical skepticism and caution against drawing firm conclusions without further study. We also provide an update on VHA's efforts to standardize documentation of the decision to inactivate HRS flags. Finally, we discuss the ever-evolving role of providers, suicide prevention programs, and VHA more broadly in preventing veteran suicide. (PsycInfo Database Record (c) 2026 APA, all rights reserved).