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About a third of veterans considered to be at high risk for suicide don’t receive the recommended follow-up care after they’ve been discharged from Veterans Affairs Department inpatient mental health care, according to a new report from the VA inspector general.
The VA study shows that of 215 cases reviewed between April and September 2012, 65 did not receive the recommended after-care of four visits within 30 days of being discharged.
Thirty-three percent did not have any record of being contacted by a suicide prevention coordinator or case manager, as also is recommended in VA treatment policies.
“Although MH providers scheduled follow-up appointments prior to patient discharge, timely post-discharge MH evaluations were not consistently provided,” VA Assistant Inspector General for Healthcare Inspections Dr. John Daigh wrote.
According to the report, patients who weren’t deemed at high risk for suicide fared slightly better: VA requires that patients discharged from acute mental health hospitalizations receive an evaluation within seven days of discharge, and the inspector general found that 78 percent of 475 patients had received some type of evaluation within the expected time frame. But 79 of those patients had received only phone calls, and 30 of them did not get an appointment with a provider or even a telehealth counseling session in two weeks after discharge.
Nearly three-fourths of patients did not receive any follow-up evaluation within 48 hours.
The inspector general found that one of the main concerns was missed appointments: More than 40 percent of the medical records reviewed of patients considered at high risk of suicide showed they’d missed at least one appointment.
“Staff did not document follow-up attempts for missed appointments for 8 percent of these patients,” the report noted.
A recent VA study found that the number of veterans committing suicide per day rose from 18 in 2007 to 22 in 2010.
VA has been building a database of suicide statistics to better understand the scope of the problem and develop programs to prevent it.
The department has been harshly criticized by veterans advocates and lawmakers for failing to provide veterans with mental health services in a timely manner. A 2012 review found that some veterans wait an average of two months to receive an initial mental health appointment.
In its response to the April 29 IG Combined Assessment Program Summary, Veterans Health Administration officials concurred with the IG’s findings.
VA Undersecretary for Health Robert Petzel said his department would issue a memo “charging facilities with creating a local patient registry for follow-up on all patients discharged from inpatient mental health units.”
He added VHA also will send a notice to remind medical facilities they need to contact veterans who miss appointments and note this contact in the patient’s electronic health record.