Managing Care for Soldiers at High Risk for Suicide

April 27, 2012

News Type:  Weekly Spark Research

The High Interest Program (HIP) at the Fort Campbell, Kentucky Army installation may prove an effective model for the care of patients at high risk for suicide in both military and civilian settings. The program was developed in response to a number of suicides at Fort Campbell in 2009. The High Interest Program provides care and coordinates transitions for soldiers recently discharged from inpatient psychiatric care.

In contrast to a traditional model of care, in which high-risk patients are assigned to individual mental health care providers, patients in HIP are assigned to the HIP team. This team includes a psychologist, psychiatrist, psychiatric technicians, case managers, and therapists. The case manager begins to track patient progress while patients are hospitalized and helps with discharge planning. The HIP psychiatric technician conducts a safety-focused interview on the day a patient is released from inpatient care, assigns an HIP team doctor to the case, and—unless the patient presents an imminent danger to self or others—releases the patient to a regular command. The technician also recommends any safety precautions that might be warranted (such as restrictions on access to weapons or a referral to the Army’s substance abuse program). During the first week after release from inpatient care, the soldier is also seen by the team’s psychologist, therapist, and psychiatrist (if the patient has been prescribed medications). After the first week, the patient continues to have weekly meetings with his or her team therapist. If the patient is on any medications, he or she also meets with the psychiatrist at least once a month.

At their daily meeting, HIP staff members discuss new, problematic and complicated cases, as well as patients who are leaving the program. Patients remain in HIP until the consensus of the team is that the soldier can return to treatment by traditional Army mental health providers or transfer to the Warrior Transition Unit (which has its own behavioral health providers), or until the soldier is assigned to a different post or is discharged from the Army. The High Interest Program coordinates support for soldiers during any of these transitions.

In first year, HIP averaged 150 enrolled patients at any given time. The patients spent an average of four weeks in the program. Only one soldier enrolled in HIP died by suicide. Although this track record seems to indicate that the program is effective, the authors warn that HIP requires more resources than standard clinical care, including mental health practitioners with both the skills and emotional resiliency to work with soldiers who are at high risk for suicide.

Waits, W., & Wise, J. (2011). The Fort Campbell High Interest Program. Military Medicine, 176 (4), 359.