An update on efforts by VA to prevent veteran suicides

The prevention of veteran suicides has been an ongoing and high priority for the Veterans Affairs Department. Efforts go far beyond hotlines.

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The prevention of veteran suicides has been an ongoing and high priority for the Veterans Affairs Department. Efforts go far beyond hotlines and other operational measures, and extend into research. Both research and operational support and have a locus at VA’s Rocky Mountain Mental Illness Research Education and Clinical Center in Aurora, Colorado. For an update, Federal Drive with Tom Temin turned to the Center’s director, Dr. Lisa Brenner.

Interview transcript:

Tom Temin: Dr. Brenner, good to have you on.

Lisa Brenner: Well, thank you so much for having me today.

Tom Temin: So let’s talk about – first of all, the question on everyone’s mind is what effect the pandemic and all of the ancillary isolation and protocols have had on suicide? Do we know?

Lisa Brenner: Yeah, I mean, I think that’s something we’re all very interested in. And we’re watching very closely. One thing we’ve been able to do is track folks in real time. And so far, it suggests that we’re doing OK, and that people have really had coming together potentially during COVID. But I think what’s going to happen next, and the downstream effect of COVID, and on mental health overall is something we’re watching very, very closely. So I wish I had definitive answers for you. But like many things it’s a watch-and-see.

Tom Temin: And tell us more about the center, what is the scope of operations there, because you have a research side and a clinical support side. So that’s a big order.

Lisa Brenner: Yeah, it’s actually terrific because it really lets us think about research from the beginning. So conceptualizing even animal research, all the way through implementing in the real world, and helping veterans in real time. There’s actually 10 MIRECCs – each MIRECC is focused on a specific area, and ours is focused on suicide prevention, where the Rocky Mountain MIRECC is in Denver, and also in Salt Lake City, so in two different places. And that really allows us to have lots of different research projects going. And although we’re in the Rocky Mountain region, we’re really an asset to the country. And we’re able to provide both basic research human subjects, kind of typical human subjects research, but also work really closely with VA central office and identify practices and very early evidence to start to implement things nationwide in the VA that we think can make a big difference.

Tom Temin: I guess maybe one of the secrets to suicide prevention is early detection of those trends or mental conditions that might lead someone to suicide. What’s the latest thinking there? And what kind of research do you do to maybe identify those points?

Lisa Brenner: Yeah, there’s all kinds of really interesting research happening about how to better identify. But one cornerstone is really making sure we’re asking folks, and VA has undertaken something that has actually never been done at this scope before. We’re doing universal screening, and directly asking people about suicide risk. So it’s not just asking about depression, or other things around suicide, but directly asking folks if they are in crisis right now, and using evidence based measures to do that. And this is something that we have partnered with folks across the entire country. And in terms of support, also, this could never happen without leadership support. And to this point, we’ve been able to evaluate over 6 million veterans coming in for care for suicide risk, which is huge. And that’s just in primary care. This plan is happening across different settings. So really working with folks, folks don’t often think about going, let’s say to be medically hospitalized, but they asked me about suicide risks on the way out the door. But we know that transitions are risky time. So really getting everybody on board, everybody at the medical facilities across the nation on board, and having standard strategies to do this. And it’s, it’s been huge. And at first I think people were like, is this what I should be doing, is this part of what I do as a surgeon or as a physician in a sleep clinic? And I think we’ve really come a huge way in really helping folks realize we need everybody on board to do this or we can’t make differences.

Tom Temin: And with a database of 6 million individuals that have been studied, admittedly, these people have a special experience in their life having been in the military and are veterans. But it seems like with a database that wide, what you’re doing could have application to wider society.

Lisa Brenner: Yeah, absolutely. I mean, I think it’s super important to know that the VA and what happens in the VA can inform health care across the country. That’s one of my proudest things about working at the VA is I think we’re able to do things and identify things that really set the precedent for what’s happening outside the VA. And certainly, we’re working with national partners across the country thinking about, hey, we’ve been able to do this thing in the VA, because we have a huge system and we’re coordinated. Could you take it to your system and try, and could it work? And I think folks sometimes don’t realize that the VA contributes all kinds of things to the health care you’re getting every day.

Tom Temin: We’re speaking with Dr. Lisa Brenner. She’s director of the Rocky Mountain Mental Illness Research Education and Clinical Center at the Veterans Health Administration. And that’s true, VA publishes in all of the major medical journals. But I wanted to ask you also how does work being done by the Defense Department, which has its own suicide issue, and say NIH, which has a general health mission – do you work with those organizations and make sure that nobody’s duplicating effort?

Lisa Brenner: You know, I think that the suicide prevention community is extraordinarily close. And it’s not as large as maybe some of the other communities. And we all work together very closely. So in terms of funding, in terms of priorities, in terms of projects, that there are kind of national – the national alliance and other things that are setting priorities for the nation, and then I think all of us certainly are kind of thinking about how do those apply to the different areas. VA works very closely with DoD and of course, we have particular interests in folks coming out of the military, and what we can do to help folks have that transition period, be as good as it can be, sometimes it can be challenging – all transitions are challenging, but we want to be here for folks as they come in.

Tom Temin: And you provide advice and counsel for maybe outside practitioners that might be dealing with veterans outside of the VA context. But they can call you and say, hey, I’ve got a veteran. And I have these questions. And you’re available for that, too, the center.

Lisa Brenner: Yeah, I’m so happy you brought that up. Our national consult service. So I think if you don’t have the opportunity to work with veterans, well, first of all, you’re missing out because veterans are awesome. And it has been my greatest honor to be able to work with vets in the VA for the past 20-plus years. But it is a culture. And if people do have a common experience, like you said, and that if you don’t have a sense of that common experience, if you don’t take the time to learn about what it means to people to have been in the military, or to be a veteran, it may be challenging. And so our national consult service, what we’ve been able to do is help providers work with veterans from the lens of being culturally competent about veteran status, and suicide prevention best practices. So really bringing the best evidence to veterans receiving care in the community by working with providers. The other thing that’s really important about that is for providers, having a veteran or anybody on your caseload that is really quite suicidal can be very, very stressful. And we want folks to know that they’re not in this alone, we’re here with you, we want to work with you, we want to talk with you. And we want to help you provide the best evidence based care possible, because we don’t want folks to burn out working with high risk folks, either and you shouldn’t do by yourself. You got to be together with people.

Tom Temin: And the question I’ve always had in this whole area, and we’ve covered this over the years – there are people that might have an a priori tendency to suicide because of something in their genes or whatever it is that causes that. Then there are those that have had the trauma of say, battle or combat, which can produce effects and traumatic brain injury and so forth. Is it possible to distinguish between those two? Is that a factor in the research that you do?

Lisa Brenner: I think that the all those points, and all those data points are really important. And I try to take a really cumulative vantage point, when I think about somebody’s life, I like to think about kind of what’s their family history? Or even maybe what’s their genetics, what’s happened to them in their past maybe in military or what’s happening to them right now. And I think part of the challenge with suicide prevention is that everybody’s got a different cumulative trajectory, right? And it’s not just one thing, it’s really the accumulation of things for most people, that they get to a certain point in their life where they start having challenges. And how do we do a better job, taking tons of data points, looking at tons of data points together, and then really implementing strategies and personalized strategies to meet people before they get to that kind of point that they get in trouble. There’s certainly many new strategies analytic methods that we’re using. And you asked me about NIH – we do have an NIH funded grant right now, where we’re looking at just that – how do you take tons of data points from previous, past, current childhood, the whole banana, and then put them together in a way that you can really identify folks and when they might be in trouble?

Tom Temin: Yeah, that whole idea of artificial intelligence, predictive analytics that’s coming into the mental health sphere in a pretty big way, isn’t it?

Lisa Brenner: Yes, it is. And it’s super exciting, because I think what we’re really finding is this is giving us new tools and new strategies. And, initially, we were kind of worried that folks might be put off by this or not like being identified. But what we really found is that folks really appreciate us reaching out to them, they feel really cared for, and that it really creates connections between the care provider and the care facility and people we take care of. So I think really thinking about new ways to reach out to people and help people feel helped.

Tom Temin: Sure, I guess talk will always be part of the mental health spectrum of treatment. But if you can speed things up with data, then so much the better. Fair way to put it?

Lisa Brenner: Yeah, I mean, I always want to know when’s the right time to reach out to somebody and it turns out if we can do a better job of identifying the right times, and really reaching out and having connections and relationships and helping folks know that we care, that they matter to us and that we’re thinking about them. And I think that’s one of the most important things is to let folks know, me as a clinician that I’m thinking about the people I work with, I matter about them – I may not even have talked to them for a year or two, but I really matter about them – and that they still have reason to live.

Tom Temin: So as a center director for a pretty big center, you still have a caseload of your own personal patients.

Lisa Brenner: I do, I feel like it’s really important to help be in the mix with folks. And it’s something I can’t give up working with vets and working with other folks. It’s just really meaningful to me. And, some days as a center director, you’re dealing with a lot of different administrative things, email, really important stuff that needs to get done. And it kind of gets you away from the everyday work of what we’re really doing. And so I just really love seeing folks.

Tom Temin: Dr. Lisa Brenner is director of the Rocky Mountain Mental Illness Research Education and Clinical Center at the Veterans Health Administration. Thanks so much for joining me.

Lisa Brenner: Thanks so much for having me.

Tom Temin: We’ll post this interview at Drive. Hear the Federal Drive on demand, subscribe at Apple Podcasts or wherever you get your shows. Welcome to the lessons in leadership podcast.

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