How advanced and emerging technology can help VA save lives
COMMENTARY | Veterans remain at an elevated risk of suicide. Here’s how we can fix that.
The Veterans Affairs Department has a sacred responsibility to provide health care to 9 million veterans currently enrolled in their system. To achieve this mission, the VA continuously evaluates existing efforts while exploring emerging technology and innovative approaches, all while maintaining high standards of care. Nowhere is the need for innovative tools and approaches more urgent than in the VA’s effort to prevent veteran suicide.
In November, the VA released its 2023 National Veteran Suicide Prevention Report. Sadly, 6,392 veterans died by suicide in 2021 – an increase of 114 suicides from 2020. When comparing these findings with those reported in 2020, the age- and sex-adjusted suicide rate among all veterans increased by 11.6% while the age- and sex-adjusted rate among all non-veteran U.S. adults increased by 4.5%. The increase for women veterans is especially alarming as their rate for suicide increased 24.1% – much greater than the age-adjusted 6.3% increase among male veterans. These findings clearly indicate that our veterans remain at elevated risk for suicide.
While the overall increase in veteran suicide is both tragic and alarming, the VA’s 2023 National Suicide Prevention Report also noted a few positive trends. Specifically, the suicide rate fell by 8.1% for male veterans ages 75 years and older. Similarly, the suicide rate for veterans ages 55 to 75 years old who recently received care from the Veterans Health Administration fell by 2.2% while those recent male VHA users ages 18 to 34 years old, had a decrease in suicide by 1.9%. While these trends are promising, much more work needs to be done to reverse the concerning increases reported and reach those in need.
Identifying and Engaging Those at Risk
While suicide is a complex human phenomenon with no single cause, it is preventable. We know that increasing protective factors (e.g., strong coping skills, sense of purpose, and supportive relationships) and decreasing risk factors (e.g., financial concerns, legal involvement, substance abuse, and access to lethal means) decreases the likelihood of suicide. Our challenge is to identify those veterans who might be at high risk and/or have few protective factors. Once identified, we can wrap services and support around them in order to give them the help and hope they need and deserve.
Given that suicide is not the result of one failed interaction, one challenging situation or one painful condition, we can’t know the importance of any single frustrating exchange or failed effort for a given veteran. We can and must, however, use every tool available to us to ensure that every instance of care is effective and delivered with compassion.
The VA has consistently demonstrated its commitment to improving the overall quality of veteran health care and specifically veteran mental health care. In addition, the VA continues to develop and implement efforts to identify and support at-risk veterans. One example of the VA’s efforts regarding at-risk veterans is the integration of suicide prevention coordinators into each VA Medical Center. These dedicated professionals are tasked with ensuring that at-risk veterans within the VA health care system receive timely and effective care when and how they need it.
As a result, VA caseworkers and suicide prevention coordinators typically carry heavy caseloads of high-risk patients making it extremely difficult to maintain accurate monitoring of all patients at all times. Even the most dedicated staff members might miss potentially important information on a given day. By adopting advanced software solutions, VA teams can access the right data in real-time so that staff can perform their duties more efficiently and effectively, improving the reliability of the care they provide.
To be of value, tools need to present data and analytics that reflect overall trends as well as specific information that allows individual patient care to be monitored. Sadly, a single error resulting in the failure to identify and engage an individual at high risk can have catastrophic consequences for a veteran and their family.
One promising technological advancement is now being used to track veterans who have been identified by the VA as being at high-risk. When a high-risk veteran is in a VA Emergency Department, if hospitalization is not indicated, VA staff are required to complete a safety plan for that veteran prior to discharge. The effectiveness of this process is tracked by the VA’s Safety Planning in the Emergency Department metric.
Facilities implementing advanced, clinical support software have seen significant improvement in their SPED compliance – in some cases maintaining sustained periods of 100% compliance. This level of compliance results in better care for our veterans and is consistent with both a public health approach to preventing suicide and the VA’s National Strategy for Preventing Suicide. Dramatic improvements like these are possible because of the improved situational awareness facilities have utilizing this type of advanced software.
This technology also saves VA suicide prevention teams significant time by improving efficiencies in key daily workflows. User-friendly functionality and features streamline critical and required prevention and care monitoring activities, easing the burden on VA staff and allowing more time for direct patient care. An analysis of time saved by VA suicide prevention teams using one particular tool found an average of 80% decrease in time required to complete several tasks, including data retrieval, care coordination, and care pathway compliance monitoring activities. Such advancements should be implemented in every health care facility across the VA.
Traditional and Emotion AI – Capabilities and Potential
Traditional AI – which focuses on identifying patterns, analyzing, and interpreting numerous large data sets – is another promising area of technological advancement that could assist VA with efforts to support and identify at-risk veterans. Emotion AI – a specific type of artificial intelligence that can recognize, understand, and respond to human emotions in real-time – could also be utilized to identify veterans at high-risk.
How might these emerging AI technologies help VA with its mission to prevent suicide?
In combination, these technologies could help the VA improve the customer service experience for veterans and their families by providing real-time feedback to customer service representatives about a veteran’s emotional state and by quickly identifying and addressing gaps in service or care.
Improving interactions and reducing gaps in services for our veterans could decrease frustration and minimize wait times while increasing satisfaction and compliance. Veterans are more likely to remain engaged in care when they feel that they are seen, heard, and being cared for as quickly as possible. As the 2023 National Suicide Prevention Report indicates, certain groups of veterans who receive care within the VA are less likely to die by suicide.
Emotion AI, which analyzes data from our voices, faces and our written text, could also be used to support the VA's Veterans Crisis Line, a 24/7 helpline providing crisis support for veterans, service members, and their loved ones. VCL responders are highly trained professionals who provide compassion, resources, and life-saving support to callers in crisis. Responders who staff the VA work tirelessly to ensure that every veteran who calls receives the specific help they deserve.
While providing support and assistance to each caller, responders must also assess risk factors and recognize signs that a veteran or service member may be considering suicide. This can be extremely challenging, especially when responders must also manually scan available records and prior evaluations to accurately assess each caller.
Of course, all new technologies – including Traditional and Emotion AI – must be developed thoughtfully, responsibly, and transparently using evidenced-based practices and veteran input to evaluate effectiveness and safety. Once fully tested and carefully integrated into existing VCL processes and practices, Traditional and Emotion AI could significantly reduce the burden on responders, enhance their efforts, and reduce their stress. Specifically, these emerging capabilities could:
- Identify early or subtle signs of distress in callers
- Provide real-time feedback on how to best respond to a caller's emotional state
- Suggest resources and interventions that are tailored to the caller's individual needs
- Help responders quickly and easily access relevant information from the caller's medical and/or mental health record
The VCL has proven to be an effective resource for veterans in need of immediate help and support. Indeed, according to the 2023 National Veteran Suicide Prevention Report, it found that those veterans enrolled in VHA who called the VCL were over five times more likely to have less distress at the end of the call than at the beginning. In addition, they were almost five times more likely to have less suicidal ideation at the end of the call than at the beginning and were 11 times more likely to have a reduced suicidal urgency at the end of the call than beginning.
Anything we do to further strengthen the VCL’s capabilities – and support the responders who provide empathy, compassion, and resources – will significantly benefit the veterans and family members who utilize the service.
The efficiencies and improvements gained by emerging technologies and advanced software tailored to the specific services and complex workflow processes of the VA directly affect patient care. Such tools also reduce the stress and strain on dedicated VA professionals – increasing the amount of time they can spend on providing direct care to our veterans. These tools – and those like them yet to be developed – will continue to contribute to VA’s intelligent software capabilities and ultimately, help save the lives of our veterans.
Barbara Van Dahlen, Ph.D, is a clinical psychologist and chief executive officer of WeBe Life Inc., a digital health company focused on improving global mental health and well-being. She is also a strategic advisor to Document Storage Systems, Inc. , a leading health information technology provider to the Veterans Affairs Department. Dr. Van Dahlen is the founder of Give an Hour®, a national nonprofit organization that provides free mental health care to those in need including service members, veterans, and their families. She is also the former executive director of the PREVENTS Presidential Executive Order Task Force.