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Make Every VA Vet Center Accountable for Veteran Suicide Prevention
Final signature count: 64
64 signatures toward our 30,000 goal
Sponsor: The Veterans Site
Veterans in crisis cannot afford delayed suicide reviews, unreliable high-risk tracking, or lessons that never reach the next Vet Center.
VA Vet Centers provide confidential, community-based counseling to veterans, service members, and eligible family members. Their staff may work with people who face combat trauma, military sexual trauma, grief, readjustment problems, and suicide risk. The VA Office of Inspector General has repeatedly found gaps in the processes designed to identify and protect clients at high risk.6
In testimony that covered inspections across all five Readjustment Counseling Service districts, the OIG described frequent noncompliance with required suicide-risk assessment and documentation procedures. It also identified weak oversight, unclear policies, and problems with the systems staff use to track care.6
Suicide Reviews Have Been Late or Incomplete
A 2026 inspection of North Atlantic District 1 found that leaders did not complete every required morbidity and mortality review within 120 days after a client suicide, did not properly report delays, and failed to distribute lessons learned nationally.2 WV News reported that three of five reviews involving active clients who died by suicide missed the required deadline.1
Other districts have faced related problems. Midwest District 3 completed three reviewed cases on time, but required panel members were missing and one review lacked a required component. Inspectors also found failures to document high-risk client contacts and outcomes within five business days.3
Pacific District 5 had untimely mortality reviews, and inspectors could not complete a planned review of the High Risk Suicide Flag system because of data-accuracy concerns.4 Southeast District 2 also had delayed reviews, high-risk documentation failures, concerns about flag-system accuracy, and safety-plan deficiencies.5
High Risk Flags Must Work When Veterans Need Them
The High Risk Suicide Flag process exists so Vet Center staff can identify clients who require follow-up. Yet OIG testimony documented staff confusion about the system, difficulty using it, and inaccurate data.6 The latest North Atlantic inspection again found concerns about accuracy and functionality, along with noncompliance in high-risk documentation.2
These failures can prevent one Vet Center from learning from another and can weaken safeguards meant to keep high-risk veterans connected to care.
A National Standard Can Close the Gaps
We are calling on Veterans Health Administration and Readjustment Counseling Service leaders to require timely and complete mortality reviews after Vet Center client suicides, distribute lessons learned across the national system, and ensure high-risk suicide tracking tools are accurate, functional, and consistently used.
Sign the petition and demand reliable suicide-prevention safeguards at every VA Vet Center.
