Serving those who serve: Suicide safety planning with military and veteran clients

As researchers and clinicians, psychologists know that mental health interventions found to be effective in civilian populations do not always translate as well as expected when working with military and veteran populations.

Clinical scientists are tweaking gold-standard PTSD treatments and evidence-based parenting approaches, for example, for use with service members, veterans and their families. This process will help psychologists see if, how and why specific changes lead to improved outcomes with military-connected clients.

It’s important that researchers and clinicians study with equal rigor clinical practices we find successful within the military arena as they are disseminated and implemented in civilian sectors.

Treatments that work

Practicing psychologists all have at least some training in suicidal risk assessment and safety planning. Evidence points to particular factors that increase effectiveness.

Recently, several media outlets reported on suicide safety planning with military personnel and veterans, much of it funded by the Departments of Defense (DoD) and Veterans Affairs (VA) and often conducted by DoD, VA, and/or university-based psychologists.

One large-scale cohort comparison study authored by psychologist Barbara Stanley, PhD, was just published in the Journal of the American Medical Association. Stanley and her colleagues found that a brief, evidence-based safety planning intervention with post-discharge follow-up calls “was associated with a reduction in suicidal behavior and increased treatment engagement among suicidal patients following emergency department discharge.” This particular safety planning intervention “combined … a prioritized list of coping skills and strategies” with telephone follow-ups (at least two) that included an assessment of discharged patients’ suicide risk, review and possible revision of the safety strategies, and explicit support for outpatient treatment engagement.

The key to the study, from my view, is that it was conducted in a number of emergency departments within VA medical centers, which often have experience with integrated care models, embedded mental health providers, and the capability to track and contact discharged veterans in ways that private sector hospitals may not yet have in place.

Research from psychologist Craig Bryan, PsyD, ABPP, an Iraq War veteran and executive director of the National Center for Veterans Studies at The University of Utah, also shows some exciting results when therapists and military personnel work together on a specific format of personal crisis response planning. Bryan’s approach involves a client writing out (and carrying an index card with) his or her own triggers for suicidal thoughts, a range of individualized coping strategies, contacts for reaching out, and reasons for living. A number of intramural VA psychologists at centers of excellence focused on veteran suicide prevention research are doing complementary work with safety planning using approaches that include smartphone apps and a virtual “hope box.”

Many of our advances in the fields of psychological assessment and treatment have roots in the military world, and we do well by the nation and our own individual clients by keeping up with breakthroughs in the military mental health care arena. As both DoD and VA continue to prioritize suicide prevention research and programming, we have amazing opportunities and responsibilities to develop both the evidence base and clinical expertise for investigating effectiveness in the private sector.

About the author 

Heather O’Beirne Kelly, PhD, is a clinical psychologist and APA’s first director of Military and Veterans Health Policy. Watch this space for regular updates on issues ranging from protecting the VA’s integrated care system, to advocating for more attention to military sexual assault prevention, to encouraging more systematic training on evidence-based treatments.