A national environmental scan of postvention services in Veterans Affairs healthcare systems

Background Suicide loss impacts up to six million Americans annually and is associated with increased suicidal ideation and mental health conditions among survivors. Postvention is an innovative public health intervention for suicide prevention that provides organized support services to loss survivors. U.S. Department of Veterans Affairs (VA) healthcare facilities have developed local postvention services that may serve as blueprints for healthcare settings at large. The structure, breadth, and types of services provided at these facilities, however, have never been assessed or described. Methods This environmental scan surveyed all 140 VA healthcare facilities nationwide to describe existing postvention services. Facilities were classified post-hoc as high-service (providing support across broader circumstances and to a wider range of survivors), and limited-service . Barriers and facilitators to implementation and structural components were examined as predictors of service category. Results Most facilities (88%) reported having postvention response processes in place. Support for both loved ones and VA employees was available at over 90% of facilities following suicide deaths; just over half offered support to impacted veterans. Eighty-three percent of facilities reported the ability to provide postvention following veteran suicides, 53% following employee suicides, and 59% in the rare event that a suicide occurs on a VA campus. A total of 26% of facilities met the criteria for a high-service facility. Facilities with written standard operating procedures (SOPs), leadership support, and staff interest in postvention were more likely to be high-service facilities; those that perceived low suicide rates in their region to be a barrier to postvention implementation tended to offer fewer postvention services. A multivariable model found that facilities with written SOPs still had greater odds of being high-service facilities after controlling for leadership buy-in and staff interest, whereas the latter two variables were not independently associated with high-service status. Conclusion VA postvention programs varied considerably in structure and scope, though proactive advance planning and outreach to both loved ones and staff were common features. Future implementation efforts could include assisting facilities with documenting their postvention preparation plans in written SOPs, broadening interdisciplinary engagement in providing postvention services, and engaging leadership support.