2). VHA’s suicide prevention media outreach campaign is just one of its  initiatives intended to reduce veteran suicide. For example, in 2007, VHA  established the Veteran’s Crisis Line (VCL), a national toll-free hotline  that supports veterans in emotional crisis. Since 2010, VHA has used  a contractor to develop suicide prevention media outreach content and  monitor its effectiveness. The primary focus of the  outreach campaign since 2010 has been to raise awareness of the  services available through the VCL. Website. VHA’s Suicide Prevention Media Outreach Activities Declined in Recent Years Due to Leadership Turnover and Reorganization VHA’s Suicide Prevention Media Outreach Activities Declined in Fiscal Years 2017 and 2018

VHA’s suicide prevention media outreach activities declined in fiscal  years 2017 and 2018 compared to earlier years of the campaign. The amount of social media content developed by  VHA’s contractor decreased in 2017 and 2018, after increasing in  each of the prior four years. Suicide Prevention Month. VHA officials  said that this was because they did not begin preparing early  enough. VHA officials that  worked on the campaign told us they did not have leadership available to  make decisions about the suicide prevention campaign during this time. By not assigning key leadership responsibilities and clear lines of  reporting, VHA’s ability to oversee the suicide prevention media outreach  activities was hindered and these outreach activities decreased. As a  result, VHA may not have exposed as many people in the community,  such as veterans at risk for suicide, or their families and friends, to its  suicide prevention outreach content. VHA Monitors Metrics for Its Suicide Prevention Media Outreach Campaign, but Has Not Established Targets against Which to Evaluate the Campaign’s Effectiveness VHA Monitors Metrics for Its Suicide Prevention Media Outreach Campaign

VHA works with its contractor to create and monitor metrics to help gauge  the effectiveness of its suicide prevention media outreach campaign in  raising awareness among veterans and others about VHA services, such  as the VCL. VHA Lacks Metric Targets to Evaluate the Effectiveness of Its Suicide Prevention Media Outreach Campaign

VHA has not established targets for the majority of the metrics it uses to  help gauge the effectiveness of its suicide prevention media outreach  campaign. Further, creating  targets for these additional metrics need not be arbitrary, because VHA  could use information about how its metrics performed in the past to  develop reasonable and meaningful targets for future performance. To  do so, VHA collects and monitors data on campaign metrics to help  gauge the effectiveness of its suicide prevention media outreach  campaign in raising such awareness, but has not established targets for  the majority of these metrics because officials reported that there are no  meaningful, industry-wide targets for them. 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. (Recommendation 1)  2.
Why GAO Did This Study

Veterans suffer a disproportionately higher rate of suicide than the civilian population. VA has estimated that an average of 20 veterans die by suicide per day, and in 2018, VA identified suicide prevention as its highest clinical priority. VHA's suicide prevention media outreach campaign—its collective suicide prevention outreach activities—helps raise awareness among veterans and others in the community about suicide prevention resources. VHA has contracted with an outside vendor to develop suicide prevention media outreach content.
GAO was asked to examine VHA's suicide prevention media outreach campaign. This report examines the extent to which VHA (1) conducts activities for its suicide prevention media outreach campaign, and (2) evaluates the effectiveness of its campaign. GAO reviewed relevant VHA documents and data on the amount, type, and cost of suicide prevention outreach activities since fiscal year 2013. GAO also reviewed VHA's contract for developing suicide prevention outreach content and interviewed VA and VHA officials.

What GAO Found

The Department of Veterans Affairs' (VA) Veterans Health Administration (VHA) conducts national suicide prevention media outreach on various platforms to raise awareness about VHA's suicide prevention resources. The primary focus of this campaign since 2010 has been to raise awareness of the Veterans Crisis Line (VCL), VHA's national hotline established in 2007 to provide support to veterans in emotional crisis. GAO found that VHA's suicide prevention media outreach activities declined in recent years due to leadership turnover and reorganization. For example, the amount of suicide prevention content developed by VHA's contractor for social media decreased in fiscal years 2017 and the first 10 months of 2018 after increasing in each of the 4 prior years.
VHA officials reported not having leadership available for a period of time to make decisions about the suicide prevention media outreach campaign. GAO found that VHA did not assign key leadership responsibilities or establish clear lines of reporting, and as a result, its ability to oversee the outreach campaign was hindered. Consequently, VHA may not be maximizing its reach with suicide prevention media content to veterans, especially those who are at-risk.
VHA evaluates the effectiveness of its suicide prevention media outreach campaign by collecting data on metrics, such as the number of people that visit the VCL website. However, VHA has not established targets for the majority of these metrics. Officials said they have not established targets because, apart from one industry-wide target they use, they lack meaningful targets for evaluating the campaign. However, VHA could use information about how its metrics performed in the past to develop reasonable and meaningful targets for future performance. Without established targets for its metrics, VHA is missing an opportunity to better evaluate the effectiveness of its suicide prevention media outreach campaign.

What GAO Recommends

VHA should (1) establish an approach to oversee its suicide prevention media outreach campaign that includes clear delineation of roles and responsibilities, and (2) establish targets for its metrics to improve evaluation efforts. VA concurred with GAO's recommendations and described steps it will take to implement them.