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Overlooked risk factors and warnings signs are also a hazard programs such as media campaigns and suicide risk assessments,
59
in which cross-cultural considerations are not incorporated it has done little in actually implementing such programs.
into the evaluation process. 63 There is a clear need for the VHA to integrate psychotherapy
and psychopharmacology in a manner that is more effective in
The suicide assessment instruments used in the United States treating and preventing suicide in the veteran population. 59
are primarily based on norming samples that consist predomi-
nantly of male, Caucasian, English-speaking, North American, VHA has made headway in partnering with non-profit vet-
and Christian subjects. This leaves out numerous other races, eran service and support organizations such as Vet-to-Vet,
ethnicities, and religions. Women are also underrepresented Wounded Warriors, The American Legion, Veterans of For-
62
58
in the norming samples against which individual patient re- eign Wars, and Disabled American Veterans. However, these
sponses are compared for diagnostic purposes. The VHA partnerships lack centralized direction and clear roles for each
62
utilizes many of these same mental health assessment and di- partnered organization in the effort to prevent suicide among
60
agnostic instruments and therefore is also determining mental the American veteran population. Current progress is posi-
health conditions and risks based entirely on a single-gender tive, but the literature indicates a need for more work on the
and cultural norm. 58 designation of specific roles to be performed by partnered
agencies and non-governmental organizations (NGOs) in pro-
The majority of the available literature reviewed by the au- viding education, resource linkage, risk factor assessment, and
thors indicate a number of possible obstacles to both pro- crisis intervention resources. 58,60
active and reactive treatment approaches that exist outside of
the controlled clinical environment. These complications in- The VHA also has a significant shortage of trained and li-
clude lack of cross-cultural awareness, competence training, censed clinical counselors, clinical psychologists, and clinical
64
cultural considerations in assessment and treatment appli- social workers throughout the country. This is contributing
cation training, and inconsistent adherence to the treatment to a backlog of veteran patients requesting behavioral health
64
protocols. 58-60, 63 treatment. The implementation of out-sourced psychological
care has served a positive role in alleviating the backlog and
ensuring prompt and consistent treatment for veterans with
Conclusion
behavioral health needs. 20
The most recent data report that 6,139 veterans died by suicide
in 2017, and 541 Servicemembers died by suicide in 2018. 5,65 High-risk factors such as cultural minority, gender minority,
It should be noted that DoD, VA, and the VHA have made and LGBT Servicemembers continue to be all but ignored in
strides in establishing policy and guidance such as implement- both the VHA and DoD. It is essential that assessment and
ing national strategies, developing improved evidence-based treatment approaches include consideration and modification
clinical interventions, and identifying risk factors aimed at that account for and accommodate cross-cultural and LGBT
eliminating veteran suicide. The examination of current re- factors. Current assessment and psychometric instruments are
search indicates that while the DoD, VA, and VHA have made normed on North American, European, heterosexual, male-
significant strides in efforts aimed at suicide prevention, the skewed norming samples. This leads to inaccurate assessments
number of completed suicides continues to rise, warranting for patients who are not part of the predominant cultural fac-
further opportunity for improvement. 58,60 tors of the norming sample used in the diagnostic comparison.

At present, the US government, particularly the VHA and
DoD, has plans for collaborative efforts to share information Implications
on active duty, transitioning Servicemembers, and veterans to Empowering veterans and eliminating suicide will require a
directly assist MSMV personnel who have high suicide risk comprehensive approach aimed at advancing knowledge and
factors. However, congressional testimony, Government Ac- understanding of veteran suicide and suicide risk factors,
58
countability Office (GAO) reports, and limited research liter- increasing the use of effective evidence-based treatment ap-
ature indicate that these plans are not being implemented to proaches, and ensuring the availability of trained and licensed
the extent necessary to be beneficial in identifying and treating clinical counselors. The researchers suggest the following:
MSMV at risk of suicide. 58,60,62,64 The primary reason behind
hindered collaboration and sharing of essential information • Use of federally budgeted funding for suicide prevention
between the VHA and DoD is integrating the VHA and DoD media and interactive programs to further the positive
electronic medical record (EMR) systems. According to VHA outcomes of proactive prevention of suicide.
and DoD congressional testimony, synchronous communica- • Use and develop experimentally proven approaches
tion between the VHA and DoD EMR systems is problem- drawn from existing treatment therapies such as CBT-SP
atic because each government agency utilizes incompatible and CBT-I to address the need for customization to meet
platforms and software. Additionally, while Congress has specific mental health conditions that are often linked to
60
set standards for rapid integration of systems, there has been increased risk of suicide behaviors in military veterans.
insufficient funding to execute the changes in software, hard- • Increase interagency collaboration between the VHA and
ware, and personnel needed to accomplish full integration. 60 DoD that facilitates the early detection of risk factors and
coordinates crisis response procedures and resources.
The VHA has identified a need for proactive and reactive • Continue development and refinement of proactive ed-
approaches to reducing the rate of suicides in the veteran ucation and risk assessment to maximize the linkage of
community, but has fallen short of acting effectively in the pro- at-risk patients with resources before crises arise, thereby
active element of suicide prevention. 60,62 Although US Congress reducing the number of per-day veteran suicides over
has identified funding to implement and maintain proactive time.

138 | JSOM Volume 22, Edition 1 / Sping 2022