The US Department of Veterans Affairs (VA) implemented a fully virtual, enterprise-wide program providing evidence-based suicide prevention interventions to veterans with a recent history of suicidal self-directed violence. A recent study published in Frontiers in Psychiatry describes the implementation and reach of the program, Suicide Prevention 2.0 (SP 2.0) Clinical Telehealth, across the VA healthcare system. 

Scaling Evidence-Based Therapy for Suicide Prevention  

SP 2.0 Clinical Telehealth was developed to improve access to clinical interventions for suicide prevention, particularly in rural and medically underserved areas. The program implemented four evidence-based interventions through telehealth: Safety Planning Intervention, Problem-Solving Therapy for Suicide Prevention, Cognitive Behavior Therapy for Suicide Prevention, and Dialectical Behavior Therapy. 

The program builds on nearly two decades of system-wide dissemination and implementation of evidence-based psychotherapies using a training model that combines didactic and experiential learning with structured case consultation. Since 2006, the VA has trained more than 15,000 therapists in evidence-based interventions with demonstrated improvements in therapist competency and self-efficacy as well as symptom and quality-of-life improvements among the veterans they treat.

However, the authors note that therapist training is critical but not sufficient for sustained implementation. Organizational and system-level supports are needed to overcome barriers that are common in all healthcare settings, including staff turnover, workload, patient volume, scheduling, and competing demands. Implementation of SP 2.0 Clinical Telehealth was guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework.

By April 2023, services were available in all 18 VA regional Clinical Resource Hubs and all 139 VA health care systems nationwide. By the end of September 2024, the program had hired 137 therapists. All therapists had been trained in at least two evidence-based interventions for suicide prevention. SP 2.0 Clinical Telehealth is the first and only enterprise-wide fully virtual evidence-based treatment program for veterans at risk of suicide, and the program’s reach demonstrates its importance. The program had received 23,628 referrals by the end of September 2024.

A female military member hugs a young boy.

Commentary from Dr. Judith Beck

The findings highlight an important implementation question for mental health professionals, trainers, supervisors, and researchers: How can evidence-based suicide prevention treatments reach patients across a large and diverse healthcare system, while maintaining clinical effectiveness? The VA initiative demonstrates one proposed model, combining telehealth delivery with investment in infrastructure and therapist training.

“At Beck Institute, we have trained health and mental health professionals not only within the VA system, but in other large city, state, and federal systems and agencies,” said Beck Institute President Dr. Judith Beck. “We’ll be watching this program closely to see if future research can clarify clinical outcomes associated with delivering evidence-based interventions through a large-scale virtual model.”

Dr. Beck is hopeful that this model will be shown to be an effective approach to the important public health issue of military and veteran suicide, and that it may have implications for other populations and mental health concerns.

Reference: 

Landes, S. J., Walker, J. A., Bekman, N. M., Kumpula, M. J., Lhermitte, S. L., Hoff, R. A., … & Stacy, M. A. (2025). Implementation of a fully virtual enterprise-wide clinical evidence-based suicide prevention program in the US Department of Veterans Affairs: the suicide prevention 2.0 clinical telehealth initiative. Frontiers in Psychiatry, 16, 1668417.

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