Terry Gerton There is some good news coming out of VA. They recently reported record high suicide risk screening and follow-up rates. Given all of the focus on veteran suicides, that does sound like it’s great progress. What has changed operationally to make this possible?

Steven Dobscha Well, a number of things have happened over the last several years. First, preventing veteran suicide remains VA’s highest clinical priority. And so our recent positive results reflect years of a sustained investment in building one of the most comprehensive suicide prevention systems in the nation. So we began implementing our new suicide risk identification strategy, otherwise known as Risk ID, beginning in about 2018, and over the last eight years, Risk ID has become really one of the nation’s largest universal suicide risk screening and evaluation programs. So, our success has really been driven by implementing standardized screening processes across multiple clinical settings. We’ve expanded staff training, we’ve refined that, strengthened performance monitoring, and really all in an effort to ensure veterans, who are identified at being at higher risk, are rapidly connected to care, as indicated.

Terry Gerton These improvements come after an Office of Inspector General review that found gaps in the screening and follow-up processes. How important were those recommendations in how VA approached designing this multi-pronged outreach strategy?

Steven Dobscha They were very important. They were quite helpful to us, and we really tried to view those recommendations as an opportunity to strengthen our already robust system. So we did a number of things in response. First, suicide risk screening and evaluation training is now required for clinical staff responsible for those activities, and a lot of our training efforts have been ongoing. There are periodic updates, which help. We’ve also established clear national performance benchmarks to ensure that people are screening and evaluating compliant with our protocols and policies. We have developed new monitoring systems to help us assess performance in particular areas such as inpatient mental health stays and facilities have been required to develop standardized operating procedures to define staff responsibilities and workflows. So as a result, we’ve addressed all of those recommendations and improvements are in place across the system. And I’ll just add that one of the most important lessons learned is that suicide prevention requires continuous evaluation, refinement, and accountability. And we have found it quite helpful to use data and feedback to improve our performance and ensure that veterans receive consistent. And high quality care.

Terry Gerton Well, speaking of data, one of the headline numbers here is that 96% of at-risk veterans now receive a comprehensive evaluation within 24 hours. That’s a really tight window. What has to happen on the ground to actually deliver that kind of response?

Steven Dobscha Yes, it’s a great question. So when a veteran screens positive for suicide risk, and that’s a pretty limited number of questions initially, the process doesn’t stop there. So that if someone has a positive screen that immediately triggers a more comprehensive evaluation that’s conducted by a qualified clinician. So in most outpatient settings, those evaluations occur the same day. In in-patient, residential and emergency room settings, veterans receive an immediate risk assessment and appropriate intervention. And the evaluation really helps determine the level of risk. It’s really a tool for the clinician and the patient to work together to figure out what is that level of risk and what makes most sense as a next step. And that might be safety planning, it might be more direct crisis intervention, might be hospitalization in some cases, or referral to outpatient service.

Terry Gerton What are the biggest challenges of meeting that 24 hour window? Is it availability of the folks who do the next step?

Steven Dobscha Not usually. There are usually qualified clinicians who are available. I think it does take time. As I mentioned before, we’ve done a lot of work to develop workflows so that we’re able to find the clinicians. So in some cases, like in primary care settings, we may call in mental health specialists who are on site in those settings to come do the care. In other settings, the primary care clinician may start with that initial evaluation and then refer on as needed.

Terry Gerton Dr. Steven Dobscha is the acting executive director of the Office of Suicide Prevention at the Department of Veterans Affairs. Dr. Dobscha, at the same time, the VA’s data shows that many veterans who die by suicide weren’t actually enrolled in VA care. How does that shape your approach to suicide prevention?

Steven Dobscha It’s had a lot of impact and increasingly a focus for our service. So one of the most important findings we have found in the last few annual suicide reports that our office puts out is that many veterans, almost two-thirds who die by suicide, aren’t connected to VA health care at the time of death. And so we’ve made significant efforts to expand outreach beyond our facilities and into communities where veterans live and work and are looking for resources. And so during the first half of this year, VA has done a lot of work around messaging and communications. So we’ve delivered more than 1.4 million text messages and 11 million emails to veterans nationwide, promoting healthcare enrollment as well as suicide prevention resources. And those efforts have contributed to more than 124,000 new enrollments into VA health care as of June of 2026. We’ve also expanded partnerships with veteran service organizations. We’re doing more work with faith-based organizations, community coalitions, state governments, peer networks, and local providers to reach veterans who may never walk into the doors of a VA facility.

Terry Gerton And as you press that outreach, what are you hearing from veterans? Is this the first time they’ve had contact with the VA? Are they responsive and enthusiastic?

Steven Dobscha They are. There are many who are now, for one thing, many of the veterans we’re reaching are getting enrolled in care. Now that’s a first step. Once you get enrolled, you need to make appointments and actually connect with care. So not everybody’s doing that. Just the fact that, at least to date, 124,000 new enrollments just this fiscal year is some evidence that people are interested in those services and would like to be engaged.

Terry Gerton And you just also mentioned about the number of organizations that you’re reaching to as well. Where has the integration across those programs been the most challenging, and where would you say it’s made the biggest difference?

Steven Dobscha It might be a little early to see where some of the biggest differences are. We’re working very effectively with the governor’s challenge, a 50 state challenge, and doing a lot of work around transitioning veterans, veterans who are in that first year after they leave the military. Turns out that’s a very high risk group. And so I just went to a meeting a few weeks ago where we met with representatives from five states to talk about their programs. The approaches are variable and involve reaching out, various efforts to reach out to veterans, different types of supports and community resources that are offered to the veterans and so forth. So there’s a lot of heterogeneity. I would say in general, veterans in the community are very welcoming. There’s a lot of people who really don’t know what we do in VA. We’re working very hard to get the messages out that we want to help and that we’re available.

Terry Gerton We just chatted with GAO recently about a report they did on DoD’s suicide prevention training program, basically finding that the training is not standard, it’s not measured, they don’t have good data on how it’s being completed. If DODs program was meeting GAO standards, how would you expect that suicide prevention awareness to carry over from active duty as folks leave and actually enter veteran status?

Steven Dobscha I think It would have impacts in a number of ways. Certainly, I think military service members who leave the service would be more aware of resources available to them. I think they would all have some basic skills in recognizing warning signs among their peers and maybe have some skills in being able to refer, help their peers get into care. I think ideally in a program you’d see spouses and supports engaged as well. And so, you know, within VA, we’ve done, we have something called SAVE training, which all veteran-facing staff participate with, which touches on all those skills. Now a lot, most of the majority of people that are trained in this aren’t experts in suicide prevention. And so a key piece of that is knowing when to refer and how to refer and what resources are available. So I think that an optimal training program would include all of those components.

Terry Gerton And as you look ahead at VA’s suicide prevention programs, what are the next priorities for you?

Steven Dobscha Well, I think one of the things that we want to do is focus more on what’s called a precision medicine approach. And that refers to making sure that you can offer the right or the best treatment at the right time for that particular person. So right now, because we know that no single intervention works for every veteran. And so we’re trying to tailor, tailor our approach, learn better ways to tailor our approaches to what does a veteran need at the particular time. And so one of the ways we do that is with predictive analytics. So we are working with data available in the medical record, for example, and with veterans themselves to identify what are key risk factors and can we identify subgroups of people that may be at especially high risk, but then we can develop programmatic changes. So that’s a big effort. It’s still early phases to some extent to figure out how to best do that. So we’re also working on better ways to enhance our care coordination. So helping with some of these handoffs and workflows to make them more efficient, make the communication stronger, especially with community providers between the VA and the community. We’re working on these partnerships in the community, We think that suicide is everybody’s business. And everybody needs to help, and we’re trying to develop more targeted intervention for these subpopulations that may be at especially high risk. We also have interest in strengthening protective factors for veterans, so that includes enhancing connections to care, family support, stable housing, financial well-being, helping people develop meaningful relationships and purpose.

Terry Gerton As we close here, let me give you the opportunity for a public service announcement. What do you most want veterans and their families who might be listening now to know about VA suicide prevention programs?

Steven Dobscha I think that we’re here. I think we have done a lot of work, especially in the last decade. I’ve been in the VA 31 years, but I’ve seen a lot of effort in the past 10 years to develop a real comprehensive suite of opportunities and interventions. And so I would invite people who are looking for help to reach out to us. And we also need your help. I think one of the biggest challenges, as we talked about, is reaching out to veterans who aren’t connected to VHA care. And so I think things that you can do within your communities to get involved are an important piece of the picture.