Beyond 988, With Help: The Peer Specialist Role

Dear Editor:

     As an LCSW working with veterans in mental health crises, I found Dr. Jenna Mehnert Baker’s January 2023 article, “Building a Mental Health Crisis System Beyond 988: Social Workers’ Ethical Obligation,” timely and poignant. In 2020, 6,146 veterans died by suicide (U.S. Department of Veterans Affairs, 2022). The new 988 crisis line is a positive step toward addressing crises in the community, but the community needs more support.

     Social workers must advocate for a broader range of services and innovative solutions for mental health needs. Precisely, we must follow the advice routinely given to our clients: ask for help. Certified Peer Specialists stand ready to provide that help. Before that can occur, as Dr. Baker posited, social workers are ethically obligated to advance mental health practice change. Veterans’ lives depend on it.

     One way to fulfill this obligation is to improve suicide prevention. Suicide, a complex and “wicked problem,” has no singular cause or solution (Bryan, 2021, p. 17). Mysteries around suicide include contributing factors and how to reliably identify those who may attempt suicide. Through the Veterans Health Administration (VHA), social workers and peer specialists (PS) serve veterans at increased risk for suicide. We work with veterans from all service eras, ranging from 21 to 94 years old. Some have a mental health diagnosis; some do not. All of them are in pain and desperate for a solution to their plights that have led them to consider suicide.

     When a veteran is at acute risk for suicide, often after they report suicidal ideations with a plan or a suicide attempt, a “high-risk flag” is placed in the veteran’s medical record to alert all providers to the veteran’s heightened risk, and veterans receive enhanced care. Our VA leadership requires that clinicians perform a risk assessment and review the veteran’s safety plan at each visit.

     Safety plans are an effective intervention in preventing future suicide attempts (Stanley et al., 2018). Unfortunately, safety plans are missing from many VHA medical records, and those present vary in quality (Gamarra et al., 2015; Stanley et al., 2018). Veterans receiving treatment in community hospitals are often discharged with no safety plan, increasing their risk for future suicidal behavior. As quality safety plans have been shown to reduce the risk of suicide, we must provide this service to all veterans in crisis. Only licensed independent providers are currently approved to perform safety plans within the VHA.

     Peer specialists can help increase safety plan completion. Peers are veterans who are in recovery from mental health or substance use disorders and have completed a certification program. In 2008, Congress included peer specialists in a mandate to improve mental health treatment for veterans (Veterans’ Mental Health and Other Care Improvements Act of 2008, 2008). Fifteen years later, peers continued to provide mental health and recovery services in the VHA. To advance mental health treatment and increase safety plan completion, peer specialists should be trained and approved to perform additional tasks, including completing safety plans with veterans at risk for suicide. Just as peers collaborate with veterans on “recovery plans,” peers can collaborate on safety plans. It is social workers’ ethical obligation to advocate for peers to fulfill their potential and help veterans in crisis.

     Social workers can advance mental health practice beyond the 988 crisis line, but we don’t have to do it alone. 

Jessica Cahill Hughes, LCSW

References

Bryan, C. (2021). Rethinking suicide: Why prevention fails, and how we can do better. Oxford University Press.

Gamarra, J. M., Luciano, M. T., Gradus, J. L., & Wiltsey Stirman, S. (2015). Assessing variability and implementation fidelity of suicide prevention safety planning in a regional VA healthcare system. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 36(6), 433–439. https://doi.org/10.1027/0227-5910/a000345

Stanley, B., Brown, G. K., Brenner, L. A., Galfalvy, H. C., Currier, G. W., Knox, K. L., Chaudhury, S. R., Bush, A. L., & Green, K. L. (2018). Comparison of the safety planning intervention with follow-up vs. usual care of suicidal patients treated in the emergency department. JAMA Psychiatry, 75(9), 894–900. https://doi.org/10.1001/jamapsychiatry.2018.1776 

U.S. Department of Veterans Affairs, Office of Mental Health and Suicide Prevention. (2022). 2022 National Veteran Suicide Prevention Annual Report. Retrieved {February 11, 2023} from https://www.mentalhealth.va.gov/suicide_prevention/data.asp

Veterans’ Mental Health and Other Care Improvements Act of 2008. (2008). https://www.govinfo.gov/content/pkg/PLAW-110publ387/html/PLAW-110publ387.htm

Jessica Cahill Hughes, LCSW, has experience working in mental health and crisis intervention, with a focus on military and veteran populations. She is earning a DSW degree from University of Kentucky and works in suicide prevention with the James H. Quillen VAMC in Tennessee.

The views expressed in this letter are those of the author and do not necessarily represent the views of the VHA.