文章基本信息

标题：Implementation and Early Utilization of a Suicide Hotline for Veterans
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作者：Kerry L. Knox ; Janet Kemp ; Richard McKeon 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2012
卷号：102
期号：Suppl 1
页码：S29-S32
DOI：10.2105/AJPH.2011.300301
语种：English
出版社：American Public Health Association
摘要：Suicide crisis lines have a respected history as a strategy for reducing deaths from suicide and suicidal behaviors. Until recently, however, evidence of the effectiveness of these crisis lines has been sparse. Studies published during the past decade suggest that crisis lines offer an alternative to populations who may not be willing to engage in treatment through traditional mental health settings. Given this promising evidence, in 2007, the Department of Veterans Affairs in collaboration with the Department of Health and Human Services’ Substance Abuse and Mental Health Administration implemented a National Suicide Hotline that is staffed 24 hours a day, 7 days a week, by Veterans Affairs clinical staff. We report here on the implementation of this suicide hotline and our early observations of its utilization in a largely male population. KEY FINDINGS ▪Reducing deaths from suicide is an important priority for the VA. Beginning in 2006, the VA implemented several broadly sweeping initiatives to address the public health problem of veteran suicide. ▪Successful engagement of veterans, especially men, through use of a suicide hotline, was determined by VA leadership to have the potential to inform system-level changes to facilitate help-seeking behaviors in veterans who are suicidal or in distress. ▪We report on descriptive information available from 3 years of operation of the VA’s hotline and discuss implications for future research. Suicide has been the focus of national attention for more than a decade. 1–4 During this period, a heightened awareness of suicide in the military and in veterans has developed, largely in response to the wars in Afghanistan and Iraq. A Department of Defense task force has underscored the urgent need to address this public health problem in military and veteran populations 5 ; the recently established National Action Alliance for Suicide Prevention 6 has incorporated a work group focused on veterans as a target population for prevention. The Department of Veterans Affairs (VA) has been on the forefront of this groundswell and has implemented a comprehensive suicide prevention strategy. This strategy includes widescale enhancements for delivery of mental health care, the VA’s National Suicide Hotline, a national network of VA suicide prevention teams, and targeted programs such as safety planning and follow-up for veterans identified as at risk for suicide through both inpatient and outpatient venues. Historically, efforts have been expended to encourage suicidal individuals to call suicide crisis line telephone centers, without evidence that this approach decreases events of suicide. 7,8 Joiner et al. 9 noted that because crisis lines offer accessibility during multiple points along the path to suicidal behavior, they are uniquely poised to intervene in this pathway, including when individuals are in immediate danger of taking their own life. In a practical manner, these telephone services offer the opportunity to intervene during a suicidal crisis when no other help may be acceptable or available. Essentially, crisis lines have served as anonymous venues of contact with little or no longer-term follow-up, systematic referrals for case management, or treatment. Recent evidence has emerged regarding the potential usefulness and effectiveness of suicide crisis lines. King et al. 10 demonstrated that in a small sample of adolescents, suicidality decreased after a call to a suicide crisis line. In studies funded by the Department of Health and Human Services’ Substance Abuse and Mental Health Service Administration (SAMHSA), Kalafat et al. 11 and Gould et al. 12 provided data on the reduction in distress of callers to community suicide crisis lines at the end of a call and emphasized the need to conduct more rigorous suicide assessments. Mishara et al. 13,14 provided evidence that responder intervention styles play an important role in the outcome of the call. Despite these encouraging results, studies have reported that callers to suicide crisis lines are predominantly female and that positive effects during the course of the call are more likely to be detected in younger females. 10,12 In summary, suicide crisis lines in the general population thus far have been shown to be most effective for reaching a select population that is younger, female, and at a lower risk for self-harm. The VA’s population is largely male (representing predominantly Vietnam or returning veterans). Although evidence of the usefulness of suicide crisis lines existed at the time of implementation of VA’s suicide hotline, whether a primarily male veteran population would call a hotline was unknown. The VA’s suicide hotline is both similar to community suicide crisis lines and different in important ways. It is similar in that the hotline responds immediately to veterans in distress; it differs in that all hotline responders are trained clinicians who can access a veteran caller’s electronic medical record regardless of the veteran’s location, and records of the call can be immediately incorporated into the electronic medical record. Most importantly, a consenting veteran can be provided with an appropriate referral within the VA mental health care system.