Fear of Involuntary Hospitalization Impacts Veteran Responses to Suicide Screening: Veteran and Staff Perspectives.

OBJECTIVES: Veterans generally accept the rationale for suicide risk screening; however, the screening process can be affected by barriers to disclosure. The objective of this analysis was to describe veteran and staff perspectives on fears of involuntary hospitalization related to screening and how staff can help alleviate these concerns to facilitate disclosure. METHODS: We used semi-structured interviews to collect qualitative data and applied thematic analysis to transcripts using a conventional/directed hybrid approach. The sample comprised 90 veterans recently screened for suicidal ideation and 53 Veterans Health Administration (VHA) clinical staff members in primary care, mental health, and emergency department settings. RESULTS: Veterans consistently reported fear of involuntary hospitalization as a barrier to disclosing suicidal thoughts and behaviors, and staff reported experiences with veterans who expressed fear of hospitalization as a concern during suicide risk screening. Training to adequately assess suicide risk, building a trusting relationship between patients and staff, and transparent communication were considered paramount in addressing fears of hospitalization. CONCLUSION: Veteran and staff participants reported that fear of hospitalization was present for veterans during screening and evaluation for suicidal thoughts. Veterans and staff recognize that fear of hospitalization impacts how veterans engage with the suicide risk screening and can be affected by the staff's level of training and experience. These findings support a patient-centered approach to screening, which includes facilitating an honest conversation and involving veterans in decision-making.