dha suicide care pathway
Suicide Risk Care Pathway in the Military Health System (DHA-US1214) review: universal screening, C-SSRS and risk stratification, safety planning, lethal means safety counseling, caring contacts, tracking high-risk patients, DoDSER reporting and the 2024 VA/DoD suicide risk guideline. The JKO course itself is CAC-only and not used. Sources: DHA-AI 6025.06 (2022), DoDI 6490.16 (2023), VA/DoD CPG (2024).
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01Who must receive training on the suicide risk care processes and procedures?
All healthcare providers. MTF directors must ensure that all healthcare providers are trained on these processes and procedures.
VERIFIED AGAINST THE SOURCE
“Ensure all healthcare providers are trained on the suicide risk care processes and procedures in this DHA -AI.”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 9 ↗02Which tool standardizes suicide risk level determination in the pathway?
The Acute Risk Stratification Table. Providers use this table for standardized risk level determination.
VERIFIED AGAINST THE SOURCE
“Use s tandardized risk level determination using the Acute Risk Stratification Table (Appendi x 1)”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 10 ↗03Which acute suicide risk levels require a safety plan?
Intermediate acute and high acute risk. A safety plan is required for all patients in these categories.
VERIFIED AGAINST THE SOURCE
“U se a safety plan (Appendix 2) for all patie nts with intermediate acute or high acute risk (Appendix 1)”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 10 ↗04What tracking mechanisms must providers implement for at-risk patients?
An at-risk tracking list and established tracking teams. Providers must implement and use both mechanisms.
VERIFIED AGAINST THE SOURCE
“Implement and use an at -risk tracking list and established tracking teams , as described in paragraph 7 of this E nclosure”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 10 ↗05How should providers incorporate individual patient needs when following the pathway?
Use clinical judgment and consider each patient's specific needs. The pathway encourages both when providing suicide risk care.
VERIFIED AGAINST THE SOURCE
“Providers are encouraged to continue to use their clinical judgment and to consider the specific needs of individual patients when providing care for suicide risk .”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 10 ↗06Does suicidal ideation alone necessarily indicate imminent risk or require a warm hand-off?
No; it requires thorough exploration. Suicidal ideation alone does not necessarily suggest imminent risk or warrant a warm hand-off.
VERIFIED AGAINST THE SOURCE
“Note that s uicidal ideation alone does not necessarily suggest imminent risk or warrant a warm hand- off, but it does require thorough exploration.”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 11 ↗07When BH or PCBH resources are unavailable for a patient with suicide warning signs, what transfer and observation actions are required?
Coordinate a warm hand-off to the nearest emergency department and establish direct observation by healthcare staff. Both actions are required.
VERIFIED AGAINST THE SOURCE
“provider will coordinate a warm hand -off to the nearest emergency department and ensure direct observation by healthcare staff is established.”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 11 ↗08Which forms of communicating suicidal intent are listed as suicide warning signs?
Verbal, electronic, and written communication. Communicating suicidal intent in any of these forms is listed.
VERIFIED AGAINST THE SOURCE
“Communicating suicidal intent verbally, electronically, or in writing ;”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 11 ↗09What behavior involving lethal means is listed as a warning sign when paired with suicidal ideation?
Seeking access to lethal means, such as firearms. The warning sign pairs this behavior with suicidal ideation.
VERIFIED AGAINST THE SOURCE
“Suicidal ideation paired with seeking access to lethal means, such as firearms;”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 11 ↗10What preparatory behavior is given as an example of a warning sign when paired with suicidal ideation?
Putting affairs in order prior to death. This is an example of preparatory behavior paired with suicidal ideation.
VERIFIED AGAINST THE SOURCE
“Suicidal ideation paired with preparatory behaviors, s uch as putting affairs in order prior to death.”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 11 ↗11Is telemedicine permitted for suicide risk care?
Yes, when clinically appropriate and consistent with the cited guidance. Face-to-face contact remains preferred.
VERIFIED AGAINST THE SOURCE
“While face -to-face contact is preferred for suicide risk care, health care providers may use telemedicine in accordance with E nclosure 4 of Reference ( k) when clinically appropriate.”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 11 ↗12Outside BH specialty care, which C-SSRS version should providers use when suicide risk screening is clinically indicated?
The past-month screener version. Providers use the past-month Columbia Suicide Severity Rating Scale screener when clinically indicated.
VERIFIED AGAINST THE SOURCE
“When clinically indicated, health care providers will screen patients for suicide risk using the past -month screener version of the Columbia Suicide Severity Rating Scale (C-SSRS)”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 12 ↗13Which past-month C-SSRS items should be completed for all patients?
Items 1, 2, and 7. These items should be completed for every patient.
VERIFIED AGAINST THE SOURCE
“For all patients, Items 1, 2, and 7 should be completed.”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 12 ↗14What constitutes a negative C-SSRS screen, and is follow-up required for that negative screen?
No responses to all screener items; follow-up is not required. Providers do not need to follow up on negative screens.
VERIFIED AGAINST THE SOURCE
“The screen is negative if the patient responds “No” to all C -SSRS screener items . Providers do not need to follow up on negative screens.”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 12 ↗15What should a provider do when a patient answers yes to C-SSRS Items 1, 2, and/or 7 only?
Complete the remaining items and follow up. The follow-up determines whether further clinical attention or management is required.
VERIFIED AGAINST THE SOURCE
“For patients who respond “Yes” to Items 1, 2, and/or 7 only, providers will complete the remaining C -SSRS items and follow up to determine whether further clinical attention or management is required.”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 12 ↗16Which affirmative C-SSRS responses make the past-month screen positive?
Yes to at least one of Items 3, 4, 5, 6, or 8. Any one of these affirmative responses constitutes a positive screen.
VERIFIED AGAINST THE SOURCE
“For patients who respond “Yes” to at least one of Items 3, 4, 5, 6, or 8, the screen is positive.”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 12 ↗17What clinical follow-up and referral are indicated after a positive suicide risk screen?
Immediate clinical follow-up and, unless clinical judgment indicates otherwise, referral to BH. The referral is for a clinical evaluation and comprehensive risk assessment.
VERIFIED AGAINST THE SOURCE
“Positive screens warrant immediate clinical follow -up and, unless clinical judgment indicates otherwise, providers will initiate a referral to BH for a c linical evaluation and comprehensive risk assessment.”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 12 ↗18What hand-off is required when a patient's safety concerns require immediate management?
A warm hand-off to emergency services personnel or BH, as indicated. Providers must arrange this hand-off when immediate safety management is required.
VERIFIED AGAINST THE SOURCE
“If a patient requires immediate management for safety concerns , providers will conduct a warm hand- off to emergency services personnel or BH, as indicated .”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 12 ↗19Which suicide screening tool must BH providers use at initial intake encounters in BH specialty settings?
The lifetime C-SSRS screener. BH providers must screen each patient using this version at initial intake.
VERIFIED AGAINST THE SOURCE
“For initial intake BH clinical encounters in BH Specialty Settings, BH providers will screen each patient for suicide risk using the lifetime screener version of the C -SSRS.”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 13 ↗20Which C-SSRS version is specified for follow-up, non-intake BH encounters?
The past-month C-SSRS screener. The procedure specifies this version for follow-up encounters.
VERIFIED AGAINST THE SOURCE
“For follow -up (i.e., non- intake) encounters, BH providers will screen each patient for suicide risk using the past -month screener version of the C -SSRS.”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 13 ↗21Which items should be completed for every patient receiving the follow-up C-SSRS screener?
Items 1, 2, and 7. These items should be completed for each patient.
VERIFIED AGAINST THE SOURCE
“For each patient, Items 1, 2, and 7 should be completed.”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 13 ↗22May a BH provider determine suicide risk level solely from C-SSRS screener responses?
No. Providers must review pertinent medical records and lifetime C-SSRS responses, but must not determine risk level solely from screener responses.
VERIFIED AGAINST THE SOURCE
“BH providers will review the pertinent medical records and the patient’s responses to the lifetime C-SSRS screener in their evaluation, but will not determine the patient’s suicide risk level solely on the basis of responses to the C -SSRS screener .”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 14 ↗23What risk level must BH providers assign when a patient has safety concerns requiring immediate management?
High acute risk. This level must be assigned to all patients with safety concerns requiring immediate management.
VERIFIED AGAINST THE SOURCE
“BH providers will assign the high a cute risk level to all patients who have safety concerns that require immediate management,”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 15 ↗24What is the standard documentation deadline for the current suicide risk level and its clinical basis following comprehensive assessment?
The same day as the clinical evaluation and comprehensive risk assessment. BH providers must document the risk level and its clinical basis in the medical record.
VERIFIED AGAINST THE SOURCE
“BH providers will document the current suicide risk level, and the clinical basis for this determination, in the patient’s medical record, on the same day as the c linical e valuation and comprehensive risk assessment.”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 15 ↗25What copy of the safety plan must the patient have when the clinical encounter ends?
An electronic or physical copy. The patient must have a copy to take with them at the end of the encounter.
VERIFIED AGAINST THE SOURCE
“ensure that th e patient has either an electronic or physical copy of the plan to take with them at the end of the clinical encounter .”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 16 ↗26Which safety-plan component addresses safe firearm storage and disposal of excess medications?
Means safety. This component identifies ways to improve environmental safety, including safe storage of lethal means and safe disposal of excess or unused medications.
VERIFIED AGAINST THE SOURCE
“(6) Means safety . Ways to improve the safety of the environment (e.g., safe storage of firearms and other lethal means, safe disposal of excess or unused medications),”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 17 ↗27An intermediate- or high-acute-risk patient misses an appointment without prior communication. When must the provider call, and what should the call address?
The same day, preferably during the appointment time. The provider must determine the reason for the no-show, screen current BH symptoms and suicide risk, and arrange appropriate follow-up.
VERIFIED AGAINST THE SOURCE
“providers must call the patient on the same day, preferably during the appointment time, to determine reason for no- show, screen for current BH sympt oms and suicide risk status, and arrange for appropriate follow -up.”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 18 ↗28What three components must a standard inpatient BH discharge plan include for a patient with suicide risk?
A referral plan, a safety plan, and a discharge summary. All three are components of the standard discharge plan.
VERIFIED AGAINST THE SOURCE
“A standard discharge plan from an inpatient BH setting for patients with suicide risk will include three components: a referral plan, a safety plan, and a discharge summary.”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 18 ↗29How soon after inpatient BH discharge must outpatient or partial hospitalization follow-up be planned?
Within 7 days, optimally within 72 hours. The discharge plan must include referral information and follow-up plans meeting this timeframe.
VERIFIED AGAINST THE SOURCE
“T he discharge plan must consist of referral information with follow -up plans to include outpatient or partial hospital ization follow -up within 7 days of discharge (optimally within 72 hours ).”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 19 ↗30Discharge from psychiatric or BH hospitalization or residential treatment within what period requires placement on the at-risk tracking list?
The previous 30 days. This includes discharge from residential substance use disorder treatment.
VERIFIED AGAINST THE SOURCE
“all patients discharged from a psychiatric or BH hospitalization or residential treatment (including SUD treatment) within the previous 30 days on the at -risk tracking list.”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 19 ↗31A suicide attempt within what look-back period is a criterion for considering placement on the at-risk tracking list?
The previous 60 days. A history of suicide attempt within that period is the specified criterion.
VERIFIED AGAINST THE SOURCE
“(2) A history of suicide attempt within the previous 60 days;”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 19 ↗32What firearm-storage practices are listed as ways to reduce access to lethal means?
Use gun locks and safes, store ammunition separately, and store firearms unloaded. These are listed methods for reducing access to lethal means.
VERIFIED AGAINST THE SOURCE
“such as using gun locks and safes, storing ammunition separately from firearms, storing firearms unloaded,”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 21 ↗33Who must establish procedures for reporting mandated suicide events among active duty Service members, and which system is used?
Leadership at each MTF, using the DoD Suicide Event Report surveillance system. Procedures must cover suicide deaths, suicide attempts, and other mandated-reporting suicide events.
VERIFIED AGAINST THE SOURCE
“leadership at each MTF will develop and follow procedures to report suicide deaths, suicide attempts, and any other mandated -reporting suicide events among AD SMs via the DoD Suicide Event Report surveillance system.”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 21 ↗34When must BH providers at MTFs complete the required suicide risk care training, and how often must they repeat it?
Within 90 days of the policy's issuance or of first assuming clinical duty at the MTF, then every 3 years. The training covers the core requirements of DHA-AI 6025.06, including screening, assessment and safety planning.
VERIFIED AGAINST THE SOURCE
“BH providers working at MTFs will complete training focused on the core requirements established in this DHA-AI, including screening, assessment, and safety planning, within 90 days of issuance of this policy or within 90 days of initially assuming clinical duty at the MTFs, as well as every 3 years thereafter.”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 21 ↗35What suicide risk care training must health care providers other than BH providers at MTFs complete, and where is it accessed?
Core training on risk screening and referral to BH, projected at about one hour and accessed through Joint Knowledge Online. It is due within 90 days of issuance or of first assuming clinical duty, then every 3 years.
VERIFIED AGAINST THE SOURCE
“Training is projected to take approximately one hour. This training can be accessed via the Joint Knowledge Online system.”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 21 ↗36How does DHA-AI 6025.06 define preparatory behaviors?
Acts or preparation toward imminently making a suicide attempt. The definition concerns preparation for an imminent attempt.
VERIFIED AGAINST THE SOURCE
“preparatory behaviors . Acts or preparation towards imminently making a suicide attempt.”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 27 ↗37What defines a suicide attempt under DHA-AI 6025.06?
Nonfatal, self-directed, potentially injurious behavior with intent to die as a result. The definition requires intent to die from the behavior.
VERIFIED AGAINST THE SOURCE
“suicide attempt. A non- fatal, self -directed, potentially injurious behavior with an intent to die as a result of the behavior”
— DHA-AI 6025.06, Suicide Risk Care Pathway for Adult Patients in the DHA, 9 Aug 2022, p. 27 ↗38When selecting a suicide risk screening tool, what type of measure does the CPG suggest?
A validated measure. The CPG suggests using a validated measure to identify patients at risk for suicide-related behavior.
VERIFIED AGAINST THE SOURCE
“When selecting a screening tool, w e suggest the use of a validated measure to identify patients at risk for suicide - related behavior.”
— VA/DoD CPG, Assessment and Management of Patients at Risk for Suicide, Provider Summary, 2024, PDF p. 6 ↗39Which three screening tools does the CPG list for the general population?
Columbia Suicide Severity Rating Scale Screener, Suicide Cognition Scale–Revised, and Patient Health Questionnaire-9. These are the tools listed for the general population.
VERIFIED AGAINST THE SOURCE
“General population ¨Columbia Suicide Severity Rating Scale Screener ¨Suicide Cognition Scale – Revised ¨Patient Health Questionnaire -9”
— VA/DoD CPG, Assessment and Management of Patients at Risk for Suicide, Provider Summary, 2024, PDF p. 6 ↗40Does the CPG recommend a specific tool or method for determining a patient's level of suicide risk?
No specific tool or method is supported by sufficient evidence for a recommendation for or against its use. Risk stratification remains an expected component of routine care.
VERIFIED AGAINST THE SOURCE
“While risk stratification is an expected component of routine care, there is insufficient evidence to recommend for or against the use of a specific tool or method to determine the level of suicide risk.”
— VA/DoD CPG, Assessment and Management of Patients at Risk for Suicide, Provider Summary, 2024, PDF p. 6 ↗41What psychotherapy does the CPG suggest to reduce suicide attempts in patients with suicidal behavior within the past six months?
Cognitive behavioral therapy–based psychotherapy focused on suicide prevention. The suggestion applies to reducing suicide attempts in patients with suicidal behavior during the past six months.
VERIFIED AGAINST THE SOURCE
“We suggest cognitive behavioral therapy –based psychotherapy focused on suicide prevention to reduce the risk of suicide attempts in patients with a history of suicidal behavior within the past six months.”
— VA/DoD CPG, Assessment and Management of Patients at Risk for Suicide, Provider Summary, 2024, PDF p. 6 ↗42What psychotherapy does the CPG suggest to reduce suicidal ideation in patients with a history of self-directed violence?
Cognitive behavioral therapy focused on suicide prevention, including problem-solving–based psychotherapies. The CPG suggests offering these therapies to reduce suicidal ideation in this population.
VERIFIED AGAINST THE SOURCE
“We suggest offering cognitive behavioral therapy (including problem solving –based psychotherapies) focused on suicide prevention to reduce suicidal ideation for patients with a history of self -directed violence.”
— VA/DoD CPG, Assessment and Management of Patients at Risk for Suicide, Provider Summary, 2024, PDF p. 6 ↗43Which medication does the CPG suggest to reduce suicide attempts in patients with schizophrenia or schizoaffective disorder and suicidal ideation or previous suicide attempts?
Clozapine. The CPG suggests it for patients with either disorder who have suicidal ideation or a history of suicide attempts.
VERIFIED AGAINST THE SOURCE
“We suggest clozapine to reduce the risk of suicide attempts for patients with schizophrenia or schizoaffective disorder and either suicidal ideation or a history of suicide attempt(s).”
— VA/DoD CPG, Assessment and Management of Patients at Risk for Suicide, Provider Summary, 2024, PDF p. 7 ↗44What adjunctive treatment does the CPG suggest for short-term reduction of suicidal ideation in patients with major depressive disorder?
Ketamine infusion. The suggestion applies to patients with both suicidal ideation and major depressive disorder.
VERIFIED AGAINST THE SOURCE
“We suggest offering ketamine infusion as an adjunctive treatment for short -term reduction in suicidal ideation in patients with the presence of suicidal ideation and major depressive disorder .”
— VA/DoD CPG, Assessment and Management of Patients at Risk for Suicide, Provider Summary, 2024, PDF p. 7 ↗45Does the CPG recommend ketamine infusions or esketamine to reduce suicide or suicide attempts?
There is insufficient evidence to recommend for or against them for this outcome. The statement specifically concerns reducing suicide or suicide attempts.
VERIFIED AGAINST THE SOURCE
“There is insufficient evidence to recommend for or against ketamine infusions or esketamine to reduce the risk of suicide or suicide attempts.”
— VA/DoD CPG, Assessment and Management of Patients at Risk for Suicide, Provider Summary, 2024, PDF p. 7 ↗46What is the CPG recommendation on lithium for reducing suicide or suicide attempts in patients with mood disorders?
There is insufficient evidence to recommend for or against lithium for this purpose. This finding applies to patients with mood disorders.
VERIFIED AGAINST THE SOURCE
“There is insufficient evidence to recommend for or against lithium to reduce the risk of suicide or suicide attempts for patients with mood disorders.”
— VA/DoD CPG, Assessment and Management of Patients at Risk for Suicide, Provider Summary, 2024, PDF p. 7 ↗47For how long after hospitalization related to suicide risk does the CPG suggest periodic caring communications, and how should they relate to usual care?
For 12 months, in addition to usual care. The CPG suggests periodic communications such as postal mail or text messages to reduce suicide attempts.
VERIFIED AGAINST THE SOURCE
“We suggest sending patients periodic caring communications (e.g., postal mail, text messages), in addition to usual care, for 12 months following hospitalization related to suicide risk to reduce the risk of suicide attempts.”
— VA/DoD CPG, Assessment and Management of Patients at Risk for Suicide, Provider Summary, 2024, PDF p. 7 ↗48What type of self-guided digital intervention does the CPG suggest for short-term reduction in suicidal ideation?
An app or web intervention that includes cognitive behavioral–based therapeutic content. The suggested content may also include other components.
VERIFIED AGAINST THE SOURCE
“We suggest the use of self -guided digital interventions (app or web) that include , but are not limited to, cognitive behavioral –based therapeutic content for short -term reduction in suicidal ideation.”
— VA/DoD CPG, Assessment and Management of Patients at Risk for Suicide, Provider Summary, 2024, PDF p. 7 ↗49What access-related intervention does the CPG suggest to reduce suicide by firearms, jumping, or medication overdose?
Reducing access to lethal means. The CPG suggests this intervention to reduce suicide through these mechanisms.
VERIFIED AGAINST THE SOURCE
“We suggest reducing access to lethal means to reduce the risk of suicide by firearms, jumping, or medication overdose.”
— VA/DoD CPG, Assessment and Management of Patients at Risk for Suicide, Provider Summary, 2024, PDF p. 8 ↗50What examples of preparation for suicide and lethal-means-related warning signs appear in the pocket guide?
Giving items away, seeking access to lethal means, and recent use of lethal means. The pocket guide identifies giving items away as an example of preparation for suicide.
VERIFIED AGAINST THE SOURCE
“Preparation for suicide (e.g., giving items away); Seeking access or recent use of lethal means”
— VA/DoD CPG, Assessment and Management of Patients at Risk for Suicide, Pocket Card, 2024, PDF p. 1 ↗51Which protective factors should a clinician consider during a suicide risk assessment according to the pocket guide?
Access to mental or behavioral health care, connectedness, problem-solving skills, spirituality, mission or purpose, physical health, employment, and social and emotional wellbeing. The pocket guide suggests including these protective factors.
VERIFIED AGAINST THE SOURCE
“We also suggest including protective factors, such as the following. •Access to mental/behavioral health care; Sense of connectedness; Problem - solving skills; Sense of spirituality; Mission or purpose; Physical health; Employment; Social and emotional wellbeing”
— VA/DoD CPG, Assessment and Management of Patients at Risk for Suicide, Pocket Card, 2024, PDF p. 1 ↗52What two core features characterize high acute suicide risk in the pocket guide?
Suicidal ideation with intent to die and inability to maintain safety independently without external help or support. Both features appear in the high acute risk criteria.
VERIFIED AGAINST THE SOURCE
“HIGH ACUTE RISK for suicide (see Sidebar 3a )? Core Features* -Suicidal ideation with intent to die by suicide AND -Inability to maintain safety independently without external help or support”
— VA/DoD CPG, Assessment and Management of Patients at Risk for Suicide, Pocket Card, 2024, PDF p. 1 ↗53What distinguishes intermediate acute suicide risk from a similar presentation at high acute risk in the pocket guide?
Lack of intent to act on suicidal ideation and ability to maintain safety independently. Patients at intermediate acute risk may otherwise present similarly to those at high acute risk.
VERIFIED AGAINST THE SOURCE
“INTERMEDIATE ACUTE RISK for suicide (see Sidebar 3a) ? Core Features* -May present similarly to those at high acute risk, but lack intent to act on suicidal ideation and have the ability to maintain safety independently”
— VA/DoD CPG, Assessment and Management of Patients at Risk for Suicide, Pocket Card, 2024, PDF p. 1 ↗54During direct observation of a patient at high acute suicide risk, what environmental restriction does the pocket guide specify?
Limited access to lethal means. Examples include keeping the patient away from sharps, cords or tubing, and toxic substances.
VERIFIED AGAINST THE SOURCE
“Directly observe patients and keep them in an environment with limited access to lethal means (e.g., keep away from sharps, cords or tubing, toxic substances)”
— VA/DoD CPG, Assessment and Management of Patients at Risk for Suicide, Pocket Card, 2024, PDF p. 2 ↗55What four components should enhanced care management include according to the pocket guide?
Frequent contact, reassessment of risk, development or updating of a safety plan, and lethal means safety counseling. The pocket guide includes all four in enhanced care management.
VERIFIED AGAINST THE SOURCE
“Provide enhanced care management, which should include: •Frequent contact, •Re-assessment of risk (See Sidebar 3b) •Development or update of safety plan, and •Lethal means safety counseling”
— VA/DoD CPG, Assessment and Management of Patients at Risk for Suicide, Pocket Card, 2024, PDF p. 2 ↗56What term describes another person's suicidal act influencing someone to consider or attempt suicide?
Contagion. Knowledge of another person's suicidal act influences others to think about or attempt suicide.
VERIFIED AGAINST THE SOURCE
“contagion. A situation where knowledge of another person’s suicidal act influences others to think about or attempt suicide.”
— DoDI 6490.16, Defense Suicide Prevention Program, Change 3 (2 Feb 2023), p. 35 ↗57Who is the intended recipient of a postvention activity?
Individuals who have lost a loved one or colleague to suicide. Postvention activities provide support to these individuals.
VERIFIED AGAINST THE SOURCE
“postvention activity. An intervention or efforts de signed to provide support to individuals who have lost a loved one or a colleague to suicide.”
— DoDI 6490.16, Defense Suicide Prevention Program, Change 3 (2 Feb 2023), p. 37 ↗58For which events must designated trained personnel complete a DoDSER entry?
All confirmed and suspected suicides and suicide attempts. Trained personnel must complete a DoDSER entry for these events.
VERIFIED AGAINST THE SOURCE
“D esignate trained personnel to complete a DoDSER entry for all confirmed and suspected suicides and suicide attempts.”
— DoDI 6490.16, Defense Suicide Prevention Program, Change 3 (2 Feb 2023), p. 21 ↗59What accuracy and submission requirements apply to DoDSER inputs overseen by the Chief, PHCoE?
Thorough accuracy checks and submission within USD(P&R) timelines. DoDSER data must be checked for accuracy and submitted according to those established timelines.
VERIFIED AGAINST THE SOURCE
“Oversees all DoDSER inputs and requires data to be thoroughly checked for accuracy and submitted in accordance with timelines establi shed by the USD(P&R)”
— DoDI 6490.16, Defense Suicide Prevention Program, Change 3 (2 Feb 2023), p. 12 ↗60At which stages must Military Departments provide suicide prevention training to uniformed behavioral health professionals?
Internship, residency, fellowship, and continuing medical education. Suicide prevention training must be included in these programs.
VERIFIED AGAINST THE SOURCE
“Ensures that the Military Departments provide uniformed behavioral health professionals suicide prevention training as part of internship, residency, fellowship , and continuing medical education programs .”
— DoDI 6490.16, Defense Suicide Prevention Program, Change 3 (2 Feb 2023), p. 11 ↗61What type of suicide prevention and clinical intervention programs must the Director, DHA integrate across the Military Health System?
Evidence-based programs and strategies. Their use must be integrated across the Military Health System.
VERIFIED AGAINST THE SOURCE
“Integrates the use of evidence- based programs and strategies related to suicide prevention and clinical intervention across the Military Health System.”
— DoDI 6490.16, Defense Suicide Prevention Program, Change 3 (2 Feb 2023), p. 11 ↗62What must the Director, DHA ensure is readily available to providers alongside distribution of the suicide risk clinical practice guideline?
Related clinical support tools and training. These resources must be readily available to providers.
VERIFIED AGAINST THE SOURCE
“for related clinical support tools and training to be readily available to providers.”
— DoDI 6490.16, Defense Suicide Prevention Program, Change 3 (2 Feb 2023), p. 11 ↗63According to the VA/DoD provider guide, in which two situations should lethal means counseling be used?
When patients currently have suicidal thoughts, and when patients in distress have attempted suicide in the past.
VERIFIED AGAINST THE SOURCE
“When should I use lethal means counseling? ■ When patients currently have suicidal thoughts. ■ When patients in distress have attempted suicide in the past.”
— VA/DoD, Lethal Means Safety Counseling for Providers, PDF p. 1 ↗64What home-storage information should a clinician assess when raising lethal means safety?
How firearms and medications are currently stored. The assessment should address storage of these lethal means at home.
VERIFIED AGAINST THE SOURCE
“Assess how lethal means such as firearms and medications are currently stored at home.”
— VA/DoD, Lethal Means Safety Counseling for Providers, PDF p. 1 ↗65What should follow-up confirm after a lethal means safety plan is developed?
That the safety plan was implemented. Follow-up must confirm implementation of the plan.
VERIFIED AGAINST THE SOURCE
“Confirm that the plan for safety was implemented.”
— VA/DoD, Lethal Means Safety Counseling for Providers, PDF p. 1 ↗66How should firearms be stored under the routine safe-storage recommendations?
Unloaded in a locked gun safe. This is a recommended routine firearm-storage practice.
VERIFIED AGAINST THE SOURCE
“Store firearms unloaded in a locked gun safe.”
— VA/DoD, Lethal Means Safety Counseling for Providers, PDF p. 1 ↗67What medication quantity and pharmacy guidance should a clinician recommend for lethal means safety?
Keep only small quantities and consult a pharmacist about safe dosing and safety packaging. Pharmacy consultation should address these practices as appropriate.
VERIFIED AGAINST THE SOURCE
“Keep only small quantities on hand. Consult a pharmacist for safe dosing practices and safety packaging as appropriate.”
— VA/DoD, Lethal Means Safety Counseling for Providers, PDF p. 1 ↗68What reassurance should accompany recommendations to temporarily restrict firearm access?
The restriction is temporary, not permanent removal. Patients should have the opportunity to get their firearms back.
VERIFIED AGAINST THE SOURCE
“These options should be considered temporary. Patients should be reassured that the purpose of restriction is not to remove firearms permanently. Patients should be afforded the opportunity to get firearms back.”
— VA/DoD, Lethal Means Safety Counseling for Providers, PDF p. 2 ↗69Which categories of firearm access should be assessed during suicide risk assessment and safety planning?
Both military-issued and privately owned firearms. Assessing access to both is a core component of risk assessment and safety planning.
VERIFIED AGAINST THE SOURCE
“Assess access to both military-issued and privately-owned firearms as a core component of risk assessment and safety planning.”
— VA/DoD, Lethal Means Safety Counseling for Providers, PDF p. 2 ↗Know questions we're missing?
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