Understanding the Intersection of Homelessness and Justice Involvement: Enhancing Veteran Suicide Prevention Through VA Programming
Background: Veterans with a history of homelessness and justice involvement are at greater risk for mental health sequelae, including suicide.
Observations: A bidirectional relationship exists between criminal justice involvement and housing instability (ie, the institutional circuit). Homelessness and justice involvement often represent a vicious cycle that is difficult to escape. The US Department of Veterans Affairs (VA) has a number of programs focused on connecting homeless and justice-involved veterans to health and social services. This paper reviews existing programing and initiatives within such services to detect risk for suicide and connect these veterans to appropriate evidence-based mental health care.
Conclusions: The VA currently has several programs focused on enhancing care for homeless and justice-involved veterans, many of which currently incorporate suicide prevention initiatives. Understanding of factors that may impact health service delivery of suicide risk assessment and intervention may be beneficial in order to enhance veteran suicide prevention efforts.
Despite these ongoing efforts, several gaps in understanding exist, such as for example, elucidating the potential role of traditional VA homeless and justice-related programming in reducing risk for suicide.10 Additional research specific to suicide prevention programming among these populations also remains important.11 In particular, no examination to date has evaluated national rates of suicide risk assessment within these settings or elucidated if specific subsets of homeless and justice-involved veterans may be less likely to receive suicide risk screening. For instance, understanding whether homeless veterans accessing mental health services are more likely to be screened for suicide risk relative to homeless veterans accessing care in other VA settings (eg, emergency services). Moreover, the effectiveness of existing suicide-focused evidence-based treatments among homeless and justice-involved veterans remains unknown. Such research may reveal a need to adapt existing interventions, such as safety planning, to the idiographic needs of homeless or justice-involved veterans in order to improve effectiveness.10 Finally, social determinants of health, such as race, ethnicity, gender, and rurality may confer additional risk coupled with difficulties accessing and engaging in care within these populations.11 As such, research specific to these veteran populations and their inherent suicide prevention needs may further inform suicide prevention efforts.
Despite these gaps, it is important to acknowledge ongoing research and programmatic efforts focused on enhancing mental health and suicide prevention practices within VA settings. For example, efforts led by Temblique and colleagues acknowledge not only challenges to the execution of suicide prevention efforts in VA homeless programs, but also potential methods of enhancing care, including additional training in suicide risk screening and evaluation due to provider discomfort.12 Such quality improvement projects are paramount in their potential to identify gaps in health service delivery and thus potentially save veteran lives.
The VA currently has several programs focused on enhancing care for homeless and justice-involved veterans, and many incorporate suicide prevention initiatives. Further understanding of factors that may impact health service delivery of suicide risk assessment and intervention among these populations may be beneficial in order to enhance veteran suicide prevention efforts.
