National Review of Mental Health Integration and Suicide Risk Identification in Audiology Clinic Settings

The VA Office of Inspector General (OIG) conducted a national review of the Veterans Health Administration’s (VHA’s) suicide risk and intervention training, suicide risk screening practices, and implementation of progressive tinnitus management (PTM) in audiology settings from October 2023 through September 2024. Audiology services are key access points to VHA, with over 447,000 new patient appointments annually. Tinnitus, the most common service-connected disability, is associated with mental health conditions such as depression and anxiety, underscoring the need for integrated care.

The OIG found that Office of Suicide Prevention (OSP) leaders did not identify audiologists as clinical staff for suicide risk and intervention training purposes, which led to incorrect training assignments. Most audiologists (80 percent) completed nonclinical training instead of the required training for clinical staff. 

Adherence to VHA’s required annual suicide risk screening in audiology services was 22 and 39 percent in fiscal years 2023 and 2024, respectively. During the same period, 15 facilities did not complete any screenings when due, representing 24,000 missed screenings. An Office of Audiology and Speech Pathology Services leader stated that audiologists receive limited training in suicide risk screening, and shared a perception that adherence improves with increased education. 

While most facilities implemented PTM, facility audiology contacts identified limited scheduling, lack of collaboration, and absence of co-located services as barriers to mental health integration. Neither the Office of Audiology and Speech Pathology Services nor OSP provide oversight of PTM mental health integration.

The OIG made five recommendations to the Under Secretary for Health, including clarifying training requirements and delineating responsibility for completion, evaluating training assignment accuracy, improving screening adherence, and evaluating mental health integration oversight responsibilities. VHA concurred with the recommendations, highlighted a new performance metric, and indicated a plan to implement a directive that will include training requirements, definitions, and oversight responsibilities.