VHA Suicide Prevention Media Outreach Is Falling Short—But Not for Lack of Money

The VHA’s suicide prevention media outreach activities—including social media postings, public service announcements, paid media, and Suicide Prevention Month activities—shrank markedly in fiscal years 2017 and 2018, according to the Government Accountability Office (GAO).

Since 2010, the primary focus of the outreach campaign has been to raise awareness of the Veterans Crisis Line (VCL), with output falling into 2 main categories: unpaid (eg, social media, public service announcements [PSAs], website) and paid (digital media, such as online keyword searches, and “out-of-home” media, such as billboards).

But between 2016 and the first 10 months of 2018, social media content dropped from 339 pieces to only 47. VHA also had not aired a suicide prevention PSA in more than 1 year, the first time there has been a gap of more than 1 month since June 2012.

In 2015, with a budget of > $4 million, VHA ran 58 advertisements on Google, Bing, and Facebook; 30 billboards; 180 bus advertisements; > 19,000 radio advertisements; 252 print advertisements; and 39 movie theater placements across the US. Fiscal years 2013, 2014, and 2016 were similarly productive.

Meanwhile, in FY 2017, the VHA spent < 10% of its approximately $1.7 million on paid ads on Google and Bing. And as of September 2018, VHA said it had spent only $57,000 of its $6.2 million paid media budget.

The waning outreach is “inconsistent with VA’s strategic goals,” the GAO says, which identify suicide prevention as the agency’s top clinical priority for FY 2018 through 2024.

VHA officials said they had not spent all the available funds due to changes in leadership and organizational realignment of the suicide prevention program. The position of National Director for Suicide Prevention position, for example, was vacant from July 2017 to April 2018. It was filled temporarily for 6 months; the interim director was then hired permanently in April 2018.

Since 2016, the VHA says, the plan has been to have a national strategy for preventing veteran suicides—an average of 20 per day, according to the VA—using a public health approach, focusing less on raising awareness of the VCL and more on reaching veterans before the point of crisis. However, in May 2018, VHA officials told the GAO that they “were just beginning to conceptualize what the suicide prevention outreach campaign should look like moving forward.”

One problem, the GAO says, is that the VHA has not established targets for the majority of the metrics it uses to help gauge the effectiveness of the outreach campaign. As a result, the VHA does not have the information it needs for a full evaluation. The only target the VHA has set is for each PSA to rank in the top 10% of the Nielsen ratings because, it says, that is the only meaningful target available that is accepted industry-wide. (The GAO notes, however: “VHA could use information about how its metrics performed in the past to develop reasonable and meaningful targets for future performance.”)

The GAO has made 2 recommendations to the VA based on its audit:

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.”
2. Officials within the Office of Mental Health and Suicide Prevention (OMHSP) must establish targets for the metrics used to evaluate the campaign’s effectiveness.

In written comments, the VA concurred with the GAO recommendations and provided a time line for addressing them. VA said OMHSP has made organizational improvements, including creating a new organizational structure. It also has plans to work with communications experts to develop metrics, targets, and an evaluation strategy, expected to be completed by April 2019.

The VHA’s suicide prevention media outreach activities—including social media postings, public service announcements, paid media, and Suicide Prevention Month activities—shrank markedly in fiscal years 2017 and 2018, according to the Government Accountability Office (GAO).

Since 2010, the primary focus of the outreach campaign has been to raise awareness of the Veterans Crisis Line (VCL), with output falling into 2 main categories: unpaid (eg, social media, public service announcements [PSAs], website) and paid (digital media, such as online keyword searches, and “out-of-home” media, such as billboards).

But between 2016 and the first 10 months of 2018, social media content dropped from 339 pieces to only 47. VHA also had not aired a suicide prevention PSA in more than 1 year, the first time there has been a gap of more than 1 month since June 2012.

In 2015, with a budget of > $4 million, VHA ran 58 advertisements on Google, Bing, and Facebook; 30 billboards; 180 bus advertisements; > 19,000 radio advertisements; 252 print advertisements; and 39 movie theater placements across the US. Fiscal years 2013, 2014, and 2016 were similarly productive.

Meanwhile, in FY 2017, the VHA spent < 10% of its approximately $1.7 million on paid ads on Google and Bing. And as of September 2018, VHA said it had spent only $57,000 of its $6.2 million paid media budget.

The waning outreach is “inconsistent with VA’s strategic goals,” the GAO says, which identify suicide prevention as the agency’s top clinical priority for FY 2018 through 2024.

VHA officials said they had not spent all the available funds due to changes in leadership and organizational realignment of the suicide prevention program. The position of National Director for Suicide Prevention position, for example, was vacant from July 2017 to April 2018. It was filled temporarily for 6 months; the interim director was then hired permanently in April 2018.

Since 2016, the VHA says, the plan has been to have a national strategy for preventing veteran suicides—an average of 20 per day, according to the VA—using a public health approach, focusing less on raising awareness of the VCL and more on reaching veterans before the point of crisis. However, in May 2018, VHA officials told the GAO that they “were just beginning to conceptualize what the suicide prevention outreach campaign should look like moving forward.”

One problem, the GAO says, is that the VHA has not established targets for the majority of the metrics it uses to help gauge the effectiveness of the outreach campaign. As a result, the VHA does not have the information it needs for a full evaluation. The only target the VHA has set is for each PSA to rank in the top 10% of the Nielsen ratings because, it says, that is the only meaningful target available that is accepted industry-wide. (The GAO notes, however: “VHA could use information about how its metrics performed in the past to develop reasonable and meaningful targets for future performance.”)

The GAO has made 2 recommendations to the VA based on its audit:

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.”
2. Officials within the Office of Mental Health and Suicide Prevention (OMHSP) must establish targets for the metrics used to evaluate the campaign’s effectiveness.

In written comments, the VA concurred with the GAO recommendations and provided a time line for addressing them. VA said OMHSP has made organizational improvements, including creating a new organizational structure. It also has plans to work with communications experts to develop metrics, targets, and an evaluation strategy, expected to be completed by April 2019.

The VHA’s suicide prevention media outreach activities—including social media postings, public service announcements, paid media, and Suicide Prevention Month activities—shrank markedly in fiscal years 2017 and 2018, according to the Government Accountability Office (GAO).

Since 2010, the primary focus of the outreach campaign has been to raise awareness of the Veterans Crisis Line (VCL), with output falling into 2 main categories: unpaid (eg, social media, public service announcements [PSAs], website) and paid (digital media, such as online keyword searches, and “out-of-home” media, such as billboards).

But between 2016 and the first 10 months of 2018, social media content dropped from 339 pieces to only 47. VHA also had not aired a suicide prevention PSA in more than 1 year, the first time there has been a gap of more than 1 month since June 2012.

In 2015, with a budget of > $4 million, VHA ran 58 advertisements on Google, Bing, and Facebook; 30 billboards; 180 bus advertisements; > 19,000 radio advertisements; 252 print advertisements; and 39 movie theater placements across the US. Fiscal years 2013, 2014, and 2016 were similarly productive.

Meanwhile, in FY 2017, the VHA spent < 10% of its approximately $1.7 million on paid ads on Google and Bing. And as of September 2018, VHA said it had spent only $57,000 of its $6.2 million paid media budget.

The waning outreach is “inconsistent with VA’s strategic goals,” the GAO says, which identify suicide prevention as the agency’s top clinical priority for FY 2018 through 2024.

VHA officials said they had not spent all the available funds due to changes in leadership and organizational realignment of the suicide prevention program. The position of National Director for Suicide Prevention position, for example, was vacant from July 2017 to April 2018. It was filled temporarily for 6 months; the interim director was then hired permanently in April 2018.

Since 2016, the VHA says, the plan has been to have a national strategy for preventing veteran suicides—an average of 20 per day, according to the VA—using a public health approach, focusing less on raising awareness of the VCL and more on reaching veterans before the point of crisis. However, in May 2018, VHA officials told the GAO that they “were just beginning to conceptualize what the suicide prevention outreach campaign should look like moving forward.”

One problem, the GAO says, is that the VHA has not established targets for the majority of the metrics it uses to help gauge the effectiveness of the outreach campaign. As a result, the VHA does not have the information it needs for a full evaluation. The only target the VHA has set is for each PSA to rank in the top 10% of the Nielsen ratings because, it says, that is the only meaningful target available that is accepted industry-wide. (The GAO notes, however: “VHA could use information about how its metrics performed in the past to develop reasonable and meaningful targets for future performance.”)

The GAO has made 2 recommendations to the VA based on its audit:

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.”
2. Officials within the Office of Mental Health and Suicide Prevention (OMHSP) must establish targets for the metrics used to evaluate the campaign’s effectiveness.

In written comments, the VA concurred with the GAO recommendations and provided a time line for addressing them. VA said OMHSP has made organizational improvements, including creating a new organizational structure. It also has plans to work with communications experts to develop metrics, targets, and an evaluation strategy, expected to be completed by April 2019.