VA Workgroup Consensus Statement on Suicide among Homeless Veterans and What We Still Need to Learn
Rates of suicide among Veterans remain high, with age- and sex-adjusted rates 1.5 times greater for Veterans relative to non-Veteran adults. This risk is especially pronounced among Veterans experiencing homelessness, who have particularly high rates of suicidal ideation and suicidal self-directed violence. Veterans experiencing homelessness are a complex subset of the Veteran population whose risk for suicide may be exacerbated by numerous factors (e.g., multimorbidity, residing in rural settings). This article serves as a consensus statement by the recently formed VA Suicide Prevention among Veterans Experiencing Homelessness Workgroup – and provides a brief overview of current initiatives to prevent suicide among homeless Veterans. This consensus statement also discusses methods of conducting research within this complex subset of the Veteran population, as well as future research endeavors necessary to inform gaps in knowledge.
VA continues to implement strategies to integrate suicide prevention efforts into its service operations for Veterans experiencing homelessness. For example, VA has implemented universal screening for suicidal ideation and recent suicide attempts among all Veterans using VA healthcare; this initiative also has been implemented in settings that provide services to Veterans who have previously or are currently experiencing homelessness, e.g., the Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH). VA also provides Suicide Prevention Gatekeeper Training to help providers recognize when a Veteran is at increased risk for suicide – and to make appropriate referrals or connections to care. Moreover, this training has been expanded to non-VA organizations in local communities. In addition to these efforts, there is a need to understand the extent to which Veterans who do not use VA care experience homelessness, which requires VA and community-based collaboration and communication of risk and treatment planning. There also is limited research on which factors drive risk for suicide among Veterans experiencing homelessness and how these factors differ from those impacting suicide risk within the broader Veteran population. Longitudinal studies are needed to identify modifiable risk factors that could inform the development or enhancement of evidence-based practices to reduce such risk among Veterans experiencing homelessness. Given the time-intensive nature of this research, methodological designs (i.e., hybrid models) that assess therapeutic benefit while also implementing interventions to at-risk populations may be warranted.
- While VA has implemented several initiatives to prevent suicide among homeless Veterans, there is a continued need to understand how best to tailor these initiatives. Further, because homeless Veterans often access various community services (e.g., homeless shelters, community emergency departments), an effective collaboration between VA and the community is needed.
Drs. Holliday and Brenner are part of the Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Veteran Suicide Prevention in Aurora, CO, and Dr. Liu is with VA’s National Homeless Program Office in Washington, DC.
Holliday R, Liu S, Brenner L, et al. Preventing Suicide among Homeless Veterans: A Consensus Statement by the Veterans Affairs Suicide Prevention among Veterans Experiencing Homelessness Workgroup. Medical Care. April 2021;59(4 Suppl 2):S103-105.