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Director's Letter

Veteran Suicide Prevention: Beyond the Clinic Walls

VA’s recent report on Veteran suicide found that suicide rates, while decreasing in 2019 and 2020, increased in 2021. Notably, suicide was ranked the second leading cause of death among Veterans under the age of 45.

Suicide remains a persistent crisis among Veterans. An estimated 17.5 Veterans died by suicide per day in 2021. Many of these deaths occurred among Veterans who had not used VA healthcare services, and recent trends such as an increasing risk of housing insecurity and of home foreclosure, a lack of attention to the invisible wounds of war, and even loneliness, may all play a role in exacerbating this crisis.

Given the time lag in ascertaining cause-specific death data from the Centers for Disease Control (CDC), it is uncertain whether these trends will continue. Nonetheless they point to the urgent need for improving implementation of evidence-based interventions to address suicide among Veterans, especially beyond the clinic walls. A number of Health Services Research and QUERI initiatives have come to fruition in the wake of increased attention on Veteran suicide prevention in both VA and community-based settings, including Caring Contacts/Caring Letters, Services for Transitioning Service Members, and Electronic Risk assessment (RISK-ID).

Based on VA cross-agency priority goals, VHA long-range goals, and HSR&D’s updated priorities, there is increased attention to suicide prevention beyond the clinic walls, especially for at-risk, marginalized Veteran populations. There also remains the larger issue of addressing what Anne Case and Angus Deaton referred to as “deaths of despair.” Their research examined mortality trends from substance abuse as well as suicide. Innovations in programs and policies that bolster Veteran quality of life such as housing and education benefits as well as reforms to the legal system (e.g., divorce courts) have been discussed as pathways for mitigating root causes of suicide and related causes of death. Research that can tackle these complex societal issues, while challenging, will be paramount in making a difference for Veterans and their families.