Patient Care Access News

VA Community Outreach, Suicide Prevention Programs Need Leadership

The suicide prevention community outreach fell by the wayside in 2017 and 2018 because of limited leadership and direction, GAO found.

community outreach

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By Sara Heath

- The Department of Veteran’s Affairs’ (VA’s) community outreach and suicide prevention efforts need better leadership and direction, the Government Accountability Office (GAO) noted in a recent report.

VA designed its community outreach and suicide prevention model in 2010 in an effort to detect and aid veterans at risk for suicide. Suicide is a significant issue in the veteran population, and community outreach and education presented opportunities to address this issue.

However, efforts to bolster that program dropped off in 2017 and 2018, GAO reported.

Leadership issues and other directional problems got in the way of the agency’s efforts to address suicide prevention, the report noted.

“GAO found that VHA did not assign key leadership responsibilities or establish clear lines of reporting, and as a result, its ability to oversee the outreach campaign was hindered,” GAO reported. “Consequently, VHA may not be maximizing its reach with suicide prevention media content to veterans, especially those who are at-risk.”

READ MORE: VA Pushes Patient-Centered Care, Patient Safety, Data Access

For example, public health messages on social media dropped off from 339 pieces of social media content in 2016 to 159 in 2017 and only 47 in 2018, GAO observed.

Other public health messages declined during that same time period. For example, a delay in developing the two mandated public service announcements (PSAs) for 2018 lead to there being no PSAs on television or radio for over a year. That issue marked the first time there was more than a month-long gap in PSA airing since June 2012.

VA also fell behind in its investment in paid media for 2018, GAO reported. The agency had allocated $6.2 million for paid advertising in 2018, but as of September of that year had only spent $57,000.

“VHA officials indicated that the reason they did not spend the remaining funds on suicide prevention paid media in fiscal year 2018 was that the approval of the paid media plan was delayed due to changes in leadership and organizational realignment of the suicide prevention program,” GAO said. “As a result, VHA officials said they limited the paid media outreach in fiscal year 2018 to activities that were already in place.”

VA also explained that its efforts for the 2017 Suicide Prevention Month, recognized each September, fell by the wayside as the agency experienced leadership turnover. As of May 2018, the agency was again behind on its Suicide Prevention Month planning, but had reportedly caught up by August 2018.

READ MORE: Integrating Mental Health and Primary Care to Achieve Zero Suicide

Additionally, VA has not been efficiently measuring the effectiveness of its media campaigns. Traditionally, VA will measure campaign efficacy by looking at the number of individuals who visit the Veterans Crisis Line website. However, VA has not been setting targets for that measure, as well as other key measures, which limits the agency’s ability to improve.

“Officials said they have not established targets because, apart from one industry-wide target they use, they lack meaningful targets for evaluating the campaign,” GAO explained.

“However, VHA could use information about how its metrics performed in the past to develop reasonable and meaningful targets for future performance. Without established targets for its metrics, VHA is missing an opportunity to better evaluate the effectiveness of its suicide prevention media outreach campaign.”

GAO offered two key recommendations for VA to improve its suicide prevention efforts. First, GAO suggested VA outline roles and responsibilities for suicide prevention media and community outreach oversight. Second, GAO said VA should establish targets for community outreach improvements. VA agreed with those recommendations and outlined how it would implement them.

Social media and other media messages are key community outreach tools, healthcare experts have recognized. A 2018 report published in the Journal of Medical Internet Research (JMIR) revealed that social media is an effective tool for publicizing public health messaging.

READ MORE: How Providers Can Address Online Physician Reviews, Social Media

The study looked at the 2011 Bell Let’s Talk campaign targeted at improving mental health awareness and community outreach. The campaign sought to reduce the stigma associated with mental health, but also donated $.05 for every retweet the @Bell_LetsTalk account received.

The analysis of over 2 million mental health care visits annually between 2002 and 2015 showed temporal increases in care access during the Twitter campaigns. This means that each year during which the campaign ran, mental healthcare access saw a spike amongst adolescent and young adult patients.

Following the month-long campaigns, visit rates either decreased or plateaued, the researchers found.

Those decreases and plateaus suggest that social media is not yet able to actually change patient behavior. However, social media remains an effective tool for increasing awareness of a public health issue such as mental health or suicide, underscoring the value of social media going forward.

“The 2012 Bell Let’s Talk campaign generated awareness related to a gradual change in behavior, rather than immediately triggering individuals with latent mental health concerns to seek formal mental health services,” the researcher concluded. “Therefore, although we hypothesized that the campaign would encourage individuals to seek mental health services, the real outcomes of this campaign were likely more related to societal awareness, rather than discrete outpatient mental health system utilization.”


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