How Veterans at an elevated risk for suicide perceive their mental health care: A thematic analysis

BACKGROUND: Suicidal behavior in Veterans is a significant public health concern. In 2007, the Department of Veteran Affairs (VA) implemented a number of suicide prevention measures to combat rising suicide rates. Since these measures have been implemented, some reports have suggested a decrease in the relative suicide rates of Veterans who utilize Veterans Health Administration (VHA) services when compared to Veterans not utilizing VHA services. However, in 2010, the suicide rate for Veterans was still nearly three times higher than that of non-Veterans. The objective of this study is to examine how Veterans at an elevated risk for suicide perceive their mental health care. METHODS: Veterans were outpatients whom suicide prevention coordinators of the VA Pittsburgh Healthcare System had placed on a “high risk” list for suicide. The Veterans participated in a semi-structured interview assessing their current treatments for their depressive and suicidal symptoms, preference for providers, and thoughts on using technology in their treatments. Coders analyzed the interviews using thematic analysis with a realistic method and inductive approach to identify themes. RESULTS: Fifteen Veterans participated in the interviews. The median age was 51 years with a range of 24 to 71 years; 20% percent were women; and 53.3% were non-Hispanic whites. The four themes identified were: 1) Perceived Benefits of Treatment for Suicidality, 2) Perceived Barriers to Successful Treatment, 3) Perceived Facilitators of Successful Treatment, and 4) Technology May Help Remove Barriers and Promote Facilitators of Successful Treatment. PUBLIC HEALTH IMPACT: Veteran participants reported that treatments for suicidality can positively impact factors theorized to be necessary for suicidal behavior. We also identified a number of factors Veterans believe help or hinder their mental health treatment. Chief among these is that providers need to foster trust with the Veterans they see and listen to their input in their mental health care. Additionally, technology and text-based communication may be beneficial in helping Veterans communicate and be open and honest about their psychiatric symptoms to providers. Findings from this study may help shine light on questions we need to ask Veterans to further improve the VA’s suicide prevention measures