VA Health Care: Improvements Needed in Suicide Prevention Media Outreach Campaign Oversight and Evaluation
Preventing veteran suicide is one of the Department of Veterans Affairs' highest priorities. VA reports that an average of 20 veterans die by suicide each day. Since 2010, VA has conducted national outreach to raise awareness about suicide prevention resources for veterans.
However, we found that VA's outreach activities dropped off in 2017 and 2018, and the office responsible for these activities lacked consistent leadership. We also found that VA did not have clear goals for evaluating the effectiveness of its outreach activities.
We recommended VA improve its oversight and evaluation of its suicide prevention outreach activities.
This VA Suicide Prevention Billboard Advertisement is an example of VA's outreach activities.
This is a photo of a billboard that shows photo of a veteran with his arms crossed, and says, "24/7 Confidential Crisis Support."
What GAO Found
The Department of Veterans Affairs' (VA) Veterans Health Administration (VHA) conducts national suicide prevention media outreach on various platforms to raise awareness about VHA's suicide prevention resources. The primary focus of this campaign since 2010 has been to raise awareness of the Veterans Crisis Line (VCL), VHA's national hotline established in 2007 to provide support to veterans in emotional crisis. GAO found that VHA's suicide prevention media outreach activities declined in recent years due to leadership turnover and reorganization. For example, the amount of suicide prevention content developed by VHA's contractor for social media decreased in fiscal years 2017 and the first 10 months of 2018 after increasing in each of the 4 prior years.
Suicide Prevention Outreach Content for Social Media, since Fiscal Year 2013
VHA officials reported not having leadership available for a period of time to make decisions about the suicide prevention media outreach campaign. GAO found that VHA did not assign key leadership responsibilities or establish clear lines of reporting, and as a result, its ability to oversee the outreach campaign was hindered. Consequently, VHA may not be maximizing its reach with suicide prevention media content to veterans, especially those who are at-risk.
VHA evaluates the effectiveness of its suicide prevention media outreach campaign by collecting data on metrics, such as the number of people that visit the VCL website. However, VHA has not established targets for the majority of these metrics. Officials said they have not established targets because, apart from one industry-wide target they use, they lack meaningful targets for evaluating the campaign. However, VHA could use information about how its metrics performed in the past to develop reasonable and meaningful targets for future performance. Without established targets for its metrics, VHA is missing an opportunity to better evaluate the effectiveness of its suicide prevention media outreach campaign.
Why GAO Did This Study
Veterans suffer a disproportionately higher rate of suicide than the civilian population. VA has estimated that an average of 20 veterans die by suicide per day, and in 2018, VA identified suicide prevention as its highest clinical priority. VHA's suicide prevention media outreach campaign—its collective suicide prevention outreach activities—helps raise awareness among veterans and others in the community about suicide prevention resources. VHA has contracted with an outside vendor to develop suicide prevention media outreach content.
GAO was asked to examine VHA's suicide prevention media outreach campaign. This report examines the extent to which VHA (1) conducts activities for its suicide prevention media outreach campaign, and (2) evaluates the effectiveness of its campaign. GAO reviewed relevant VHA documents and data on the amount, type, and cost of suicide prevention outreach activities since fiscal year 2013. GAO also reviewed VHA's contract for developing suicide prevention outreach content and interviewed VA and VHA officials.
Recommendations
VHA should (1) establish an approach to oversee its suicide prevention media outreach campaign that includes clear delineation of roles and responsibilities, and (2) establish targets for its metrics to improve evaluation efforts. VA concurred with GAO's recommendations and described steps it will take to implement them.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Veterans Affairs | 1. The Under Secretary for Health should establish an approach for overseeing its suicide prevention media outreach efforts that includes clear delineation of roles and responsibilities for those in leadership and contract oversight roles, including during periods of staff turnover or program changes. (Recommendation 1) |
VA concurred with this recommendation. In April 2019, VA provided a new oversight plan for its suicide prevention media outreach campaign that includes clearly delineated leadership and contract oversight roles. The plan specifies the reporting structure and identifies positions that can serve in acting capacities during periods of turnover.
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| Department of Veterans Affairs | 2. The Under Secretary for Health should require officials within the Office of Suicide Prevention and Mental Health to establish targets for the metrics the office uses to evaluate the effectiveness of its suicide prevention media outreach campaign. (Recommendation 2) |
As of August 2019, VHA has established metrics related to awareness, education, and engagement to evaluate the effectiveness of its suicide prevention media outreach campaign. Additionally, VHA has established targets to assess the campaign's performance against these metrics.
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