Abstract: Objective: To evaluate whether the Veterans Crisis Line (VCL) Caring Letters (CL) intervention impacted outcomes among Veterans at elevated psychiatric risk. Study setting and design: This secondary analysis of a randomized clinical trial examined the association of CL, an evidence-based suicide prevention intervention, among Veterans who contacted the VCL from June 2020 to June 2021. Data sources and analytic sample: Data on Veterans was obtained from the Veterans Health Administration's (VHA) Corporate Data Warehouse (N = 186,514). Time-to-event models stratified by indicators of psychiatric risk were used to assess the association of CL with outcomes. Principal findings: Receipt of CL, regardless of psychiatric risk status, was associated with increased utilization of outpatient mental health services. Among those with no indicators of psychiatric risk, receipt of CL was associated with increased use of all-cause outpatient and inpatient services. The intervention did not have a significant impact on all-cause mortality among those with or without indicators of psychiatric risk. Conclusions: CL was associated with increased use of VHA services among those with and without indicators of psychiatric risk. Increased use of VHA services may represent appropriate use of high-value mental health services for Veterans who are experiencing crises.