Recognising and responding to suicide risk in Australian veterans: a guide for GPs

Suicide among veterans is a national crisis. The Royal Commission into Defence and Veteran Suicide confirmed what many general practitioners (GPs) already know - that veterans face a disproportionate risk of suicide, and too often, those at risk slip through the cracks¹.

General practitioners are trusted by veterans, so with insight, compassion and structured tools, you are uniquely placed to identify suicide risk and intervene.

This article outlines evidence-based frameworks endorsed in Australia and practical strategies to support you in suicide risk assessment and intervention with veteran patients.

Why veterans are at increased risk

Veterans face a unique set of risk factors for suicide, including:

• cumulative or chronic trauma exposure from combat, training accidents or moral injury

• mental illness, including post-traumatic stress disorder (PTSD), depression and anxiety

• increased prevalence of substance abuse, gambling, and polypharmacy (especially combined opiates, benzodiazepines, antipsychotics, and potentially prescribed cannabis products)

• relationship breakdowns and social isolation 

• loss of identity and purpose following discharge

• physical pain and disability

• difficulty navigating civilian systems, including employment and healthcare

According to the Australian Institute of Health and Welfare, male ex-serving veterans are 27% more likely to die by suicide than civilians. For women, the rate is more than double². Risk is highest in the years following the transition out of service—especially following medical discharge³.

Key principles in veteran suicide risk assessment

GPs need to create a safe, structured space to explore suicide risk as veterans may not readily disclose suicidal thoughts. This may be because they fear judgement or stigma or repercussions for their ongoing careers 

A comprehensive suicide risk assessment should be grounded in the following principles:

1. Use a biopsychosocial approach

National guidance recommends assessing suicide risk in three domains:

• biological: mental illness, chronic pain, substance use

• psychological: hopelessness, helplessness, trauma, intrusive thoughts

• social: disconnection, recent significant life stressors, role loss, lack of support⁴

2. Ask directly and empathetically

Use open, respectful language to explore suicidal thoughts, plans and protective factors. Avoid euphemisms, as clear, direct questions build trust.

3. Do not rely on screening tools alone

Tools such as the PHQ-9⁵ or K10 can support broader mental health screening but are not sufficient for suicide risk assessment. Use clinical judgement, supported by structured models like the SafeSide CARE framework⁴.

4. Document clearly

Record the presence or absence of suicidal ideation, risk factors, protective factors, your clinical formulation, and the agreed plan of care.

5. Follow up and plan collaboratively

Suicide risk is dynamic. Safety planning and regular review are essential to reduce risk and maintain engagement. Involve the patient’s support network where possible (with consent).

6. Mitigate anniversary reactions

Some traumatised veterans will be triggered by certain events and anniversaries. For instance, ANZAC day, Remembrance Day, Lon Tan day or days they lost comrades. Long holidays and traditional times for families to come together (Easter, Christmas etc) may also be times of increased risk for socially isolated veterans. Asking patients “what times of year do you struggle with” can easily identify times of increased vulnerability, allowing pragmatic risk mitigations.

Structured frameworks endorsed in Australia

1. Department of Veterans’ Affairs (DVA) Veteran Health Check

The DVA-funded Veteran Health Check includes psychological screening using the Kessler-10 (K10), PHQ-9 and PTSD tools⁷ such as the PCL. A K10 score ≥17 should prompt further assessment and follow-up.

2. SafeSide CARE framework

This four-step model is used nationally by Defence clinicians and is endorsed by Open Arms⁴:

• Connect – Establish rapport and assess immediate safety

• Assess – Ask about suicidal thoughts, plans, intent and means

• Respond – Reduce risk, implement a safety plan and involve support

• Extend – Arrange follow-up and link to care

Rather than predicting suicide, this model focuses on practical steps to increase safety.

3. Safety planning and the Beyond Now app

Open Arms recommends collaborative safety planning for any patient at risk⁶. The Beyond Now app (developed by Beyond Blue) allows veterans to document:

• warning signs

• coping strategies

• reasons for living

• emergency contacts

Safety planning can be completed together in the consultation and revisited regularly⁶.

Use the VETERANS lens to guide your consultations

The VETERANS’ lens is a practical tool for guiding conversations about service history and related risk if the veteran is not well known to you.

Assessing suicide risk

In a suicide risk assessment, aim to explore:

• Suicidal thoughts – Are they fleeting or intrusive? Are they active (“I want to die”) vs passive (“It would be better if I was dead”)?

• Plans and intent – Is there a plan? Are means accessible?

• Protective factors – What or who keeps them safe, and why?

• Past attempts – What happened, and why? How recent?

• Support network – Who can they talk to? How well can they engage?

• Foreseeable changes – What may increase risk?

• Access to help – Are they linked to, and engaged with, Open Arms, Lifeline or DVA services?

Case studies in the VETs HeLP platform model these assessments in action.

How to determine the level of risk

Use clinical judgement informed by:

• intensity and frequency of suicidal thoughts

• existence of a plan and access to means

• availability of, and engagement with, protective factors such as social supports and other services

• current mental state and functional capacity

• reliability and potential changeability of the self-report

Distress does not need to lead to suicidal distress or a suicidal crisis.

Exploring motivations for suicide can help identify how the veteran can engage with services aimed at supporting problem solving rather than remaining helpless and hopeless. Asking directly if the veteran feels safe today can help determine their current level of risk and explore who they would tell if they didn’t feel safe in future, and what they would do about it if so. 

Risk can change quickly and often, if there is an acute situational or interpersonal crisis. For example, a veteran with persistent, intrusive thoughts and access to means-but who retains good engagement with protective factors-may be at moderate risk³. However, loss of those protective factors, say due to interpersonal conflict, would likely increase risk at that time. Always ask about foreseeable changes and plan accordingly and reassess often.

Suicide risk assessment in practice

Veterans at risk may present with:

• deteriorating mental health

• chronic pain or insomnia

• new or escalating substance use or gambling problems

• family conflict or breakdown, significant other life stressors, and or social withdrawal or isolation

Ask clearly and with empathy: “Sometimes people in your situation feel overwhelmed. Have you had thoughts that life is not worth living?”

Document key statements, risk level (low/moderate/high), and agreed next steps.

Responding to suicide risk

Low risk

• Create a collaborative safety plan (paper-based or using the Beyond Now app)

• Schedule regular follow-up

• Refer to Open Arms or a private psychologist

Moderate risk

• Refer to mental health services

• Involve a support person (with consent)

• Call Open Arms together during the consultation

High risk

• Contact emergency services or refer to hospital

• Ensure the patient is not left alone

• Engage crisis services such as:

• Open Arms: 1800 011 046

• Lifeline: 13 11 14

• Suicide Call Back Service: 1300 659 467

• Triple zero: 000

What services can veterans and families access?

Many GPs are not aware of the range of DVA-funded mental health supports:

• Non-liability mental health care (NLMHC): for veterans with NLMHC entitlement, DVA will fund treatment for all mental health conditions, whether accepted as service-related or not, by psychiatrists, psychologists, and for some treatment programs. 

• Open Arms counselling services: access to free counselling services for veterans and their families.

• Medication, hospital admission and inpatient care: fully covered under NLMHC

You can refer directly or help the veteran access support during the consultation. For example:

“Let’s call Open Arms together while you are here.”

Open Arms provides 24/7 support for veterans and clinicians: 1800 011 046.

Practical tips for GPs

• Normalise the conversation: make suicide screening a standard part of mental health care

• Use structured tools: K10, PHQ-9⁵ and Beyond Now⁶ can support the process

• Validate the patient: “It sounds like things have been overwhelming. Thank you for trusting me.”

• Identify strengths: What helps them cope? What do they look forward to?

• Encourage engagement: “Who could you see to help you with these problems? How can I help you do this?”

• Follow up quickly: Schedule a review within days. Risk can escalate rapidly.

You can save lives

Veterans are more likely to see their GP than a mental health provider—and often during a time of crisis. Asking about suicide may feel uncomfortable, but it can open the door to connection and safety.

With a structured, empathetic approach, you can help keep your veteran patients safe and supported.

Ask the question. Use your clinical tools. Take action. Every conversation could save a life.

Need help now?

• Veterans and families: Open Arms – 1800 011 046 (24/7)

• GPs: contact your local mental health triage service or Open Arms for clinical advice

For more training, tools and veteran-specific education, visit the Veterans’ Health Education Hub.