Suicide Prevention After Community Care Discharge

NCT ID: NCT06596044

Last Updated: 2025-12-03

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 120 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-10-01
• Study Completion Date: 2028-09-30

Brief Summary

The study is of high importance to Veterans' health because it will study a suicide prevention intervention in a Veteran population that is at high risk of suicide but has not been a specific focus of the Veteran Affairs' (VA's) suicide prevention efforts. Specifically, a growing number of Veterans are now receiving acute mental health treatment in VA-purchased settings (commonly referred to as Community Care). While these Veterans are at high risk of suicide after discharge, very little is known about how to prevent suicide in these Veterans. This study will directly address this problem by looking at whether a promising suicide prevention strategy called the VA Brief Intervention and Contact Program (VA BIC) can decrease the risk of suicide in Veterans after they are discharged from a non-VA mental health treatment setting. The proposed research is highly pertinent to the VA's top clinical priority-to prevent suicide in Veterans.

Detailed Description

Background: Suicide is a chief concern in Veterans. An increasing number of Veterans are accessing acute psychiatric treatment in non-VA settings. There is little knowledge about effective strategies to mitigate suicide risk in this population. A promising suicide prevention strategy, called the VA Brief Intervention and Contact Program (BIC), has been developed. VA BIC is designed to meet the unique needs of Veterans. Pilot studies of VA BIC in VA settings have suggested that VA BIC may address key factors related to suicide risk during care transitions including social connectedness and treatment engagement. Based on these promising results and given the critical gaps in suicide prevention care in Veterans who receive acute psychiatric treatment in non-VA settings, it is essential to determine whether VA BIC can reduce suicide risk in this high-risk population.

Objectives: This project aims to 1) Identify the effect of VA BIC on suicidal ideation after a non-VA mental health discharge, compared to standard care alone; 2) Identify the effect of VA BIC on engagement in mental health care after a non-VA mental health discharge, compared to standard care alone; 3) Identify the effect of VA BIC on social connectedness after a non-VA mental health discharge, compared to standard care alone; and 4) Compare the effect of VA BIC on suicidal behavior after a non-VA mental health discharge, compared to standard care alone.

Methods: This is an assessor-blinded, randomized control trial of VA BIC plus standard care compared to standard care alone. The trial will enroll up to 120 participants aged 18 years and older who are Veterans eligible to receive VA services and have received acute psychiatric treatment in non-VA settings affiliated with VA in Northern New England. Participants will be randomized to either the VA BIC intervention plus standard care or standard care alone. Suicidal ideation, engagement in mental health care, social connectedness and suicidal behavior will be measured at baseline and three, six , and nine months follow-up.

Hypothesis: Veterans receiving the VA BIC intervention plus standard care will report reductions in suicidal thoughts at follow-up assessments compared to Veterans receiving standard care alone. Veterans receiving the VA BIC intervention plus standard care will experience an increase in engagement in mental health care and social connectedness at follow-up assessments compared to Veterans receiving standard care alone

Conditions

Suicide Prevention

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: PREVENTION
• Blinding Strategy: SINGLE

Study Groups

VA BIC

Patients randomized to VA BIC will receive the VA BIC intervention plus standard care

Group Type: EXPERIMENTAL

VA BIC

Intervention Type: BEHAVIORAL

VA BIC is a suicide prevention strategy that is designed to meet the needs of Veterans who receive acute psychiatric treatment. VA BIC can be delivered by a trained mental health provider (e.g., mental health nurse, social worker, psychologist, psychiatrist). VA BIC includes two synergistic elements to support the patient after a mental health discharge. The elements include a brief educational session, where the patient receives a one-on-one, one-hour, personalized educational session on suicide prevention. The session incorporates aspects of motivational interviewing. The patient then receives 7 regular follow-up contacts that are conducted by the interventionist. Here the interventionist monitors symptoms, assesses treatment adherence, reviews the safety plan, and assists the patient with engaging in steps to promote their well-being. The sessions incorporate aspects of motivational interviewing. Of note patients in this arm will also receive standard care.

Standard Care

Intervention Type: OTHER

Regardless of study assignment, all patients will have access to standard care provided upon mental health discharge in non-VA settings. VA staff will also follow standard procedures for mitigating risk including placing Veterans on high risk list when clinically appropriate.

Standard Care

Patients randomized to the control arm will receive standard care alone.

Group Type: OTHER

Standard Care

Intervention Type: OTHER

Regardless of study assignment, all patients will have access to standard care provided upon mental health discharge in non-VA settings. VA staff will also follow standard procedures for mitigating risk including placing Veterans on high risk list when clinically appropriate.

Interventions

VA BIC

VA BIC is a suicide prevention strategy that is designed to meet the needs of Veterans who receive acute psychiatric treatment. VA BIC can be delivered by a trained mental health provider (e.g., mental health nurse, social worker, psychologist, psychiatrist). VA BIC includes two synergistic elements to support the patient after a mental health discharge. The elements include a brief educational session, where the patient receives a one-on-one, one-hour, personalized educational session on suicide prevention. The session incorporates aspects of motivational interviewing. The patient then receives 7 regular follow-up contacts that are conducted by the interventionist. Here the interventionist monitors symptoms, assesses treatment adherence, reviews the safety plan, and assists the patient with engaging in steps to promote their well-being. The sessions incorporate aspects of motivational interviewing. Of note patients in this arm will also receive standard care.

Intervention Type: BEHAVIORAL

Standard Care

Regardless of study assignment, all patients will have access to standard care provided upon mental health discharge in non-VA settings. VA staff will also follow standard procedures for mitigating risk including placing Veterans on high risk list when clinically appropriate.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Veteran who is eligible to receive VA services;
• 18 years or older;
• able to speak English;
• received acute psychiatric treatment in a non-VA setting affiliated with VA in Northern New England;
• endorse recent suicidal ideation (score 2+ on Beck Scale for Suicidal Ideation).

Exclusion Criteria

• Unable to provide informed consent;
• Currently receiving assertive community treatment;
• Potentially vulnerable populations including prisoners, institutionalized patients, or patients currently admitted on involuntary commitment status;
• Study physician deems the patient is not clinically appropriate because of clinical status such as presence of active psychosis or dementia.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

White River Junction Veterans Affairs Medical Center

FED

Sponsor Role: collaborator

VA Office of Research and Development

FED

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Natalie Riblet, MD MPH

Role: PRINCIPAL_INVESTIGATOR

White River Junction VA Medical Center, White River Junction, VT

Locations

White River Junction VA Medical Center, White River Junction, VT

White River Junction, Vermont, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

Natalie Riblet, MD MPH

Role: CONTACT

Natalie.Riblet@va.gov

(802) 295-9363 ext. 5893

Bradley V Watts, MD MPH

Role: CONTACT

Bradley.Watts@va.gov

(802) 295-9363 ext. 5235

Facility Contacts

Brian Shiner, MD MPH

Role: primary

Brian.Shiner@va.gov

802-295-9363 ext. 6036

Cory E Gaudette, AA

Role: backup

cory.gaudette@va.gov

(802) 295-9363 ext. 6880

Other Identifiers

101CX002797

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

MHBC-003-24S

Identifier Type: -

Identifier Source: org_study_id