America Is Fighting a Shadow War Against Military Suicide. New Programs Could Help.

WHEN A RECRUIT enlists in the military, he knows there’s a chance he could lose his life. But maybe not in the way he assumes. Suicide is the leading cause of death among active-duty soldiers, and the second-leading cause of death among veterans younger than 45. They’re more likely to die by their own doing than during combat.

Roughly 500 active-duty service members and around 6,000 veterans die by suicide each year. These statistics hadn’t really changed in almost 20 years, until 2019 and 2020, when suicide among veterans briefly dipped. But the numbers increased again in 2021, especially among high-risk populations such as homeless and lower-income veterans. Yet—with the worst of the pandemic over and new federal and local initiatives—there’s rekindled hope.

A New VA Approach

SOME OF THAT hope comes from a leadership change at the U.S. Department of Veterans Affairs (VA). Matthew Miller, M.P.H., P.h.D., a clinical psychologist and Air Force veteran, became executive director of suicide prevention there in March 2020.

The pandemic accelerated a paradigm shift: VA leadership was finally recognizing suicide prevention as a public health issue rather than a private matter, Miller says. And with that recognition came a cascade of federal funding and research that helped fund several new initiatives:

• In 2022, the VA launched the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant program, which has since awarded $52.5 million to local groups and service providers who work with veterans on suicide prevention.
• In January 2023, the VA expanded access to free emergency care for veterans in crisis. Nearly 50,000 vets used the service in its first year.
• The Governor’s Challenge, in which governor-appointed teams across the country create city-specific suicide prevention plans for veterans, expanded into all 50 states by 2024.

Constructing Prevention Plans

The ultimate goal is to help veterans and military members well before suicidal ideation mounts. But planning for those crisis moments has to happen during calmer times, much like you might have a safety plan at home in the case of a fire. That way, in a period of heightened distress, everyone knows what to do.

A suicide prevention plan might also look like identifying who to call in a moment of crisis or brainstorming distracting activities that help in the moment, like taking the dog for a walk, says Katherine A. Dondanville, PsyD, chief scientific advisor at the veteran suicide prevention organization Face the Fight, and a clinical psychologist and associate professor at the University of Texas Health Science Center at San Antonio.

A Focus on Gun Storage

The VA also prioritized messaging about securely storing firearms. When someone in the military community takes their life, it’s almost always with a gun. A veteran dies by suicide using a gun about every two hours. One active-duty service member dies by suicide using a gun each day. Which means secure storage—keeping guns locked and unloaded—can be life-saving.

The time between thinking about suicide and taking action is often minutes, maybe hours, Miller says. “If they reach for their loaded firearm that’s unsecured, then there is no time for the desire to subside or be interrupted,” says Jayna Moceri-Brooks, Ph.D., R.N., clinical assistant professor at NYU Rory Meyers College of Nursing and former postdoctoral fellow at the NJ Gun Violence Research Center at Rutgers University.

In the context of guns, “the trusted person in the home would be able to restrict access to the firearm even further, according to their prearranged plan,” Moceri-Brooks says.

A More Rapid Response

The VA’s campaign for September’s Suicide Prevention Month, “Don’t Wait, Reach Out,” normalizes asking for help before reaching a breaking point.

Change happens slowly, especially when it involves long-standing traditions like the loyalty and respect demanded by the military. Men remain more likely to die by suicide than women, regardless of military involvement. “Men have a tendency to isolate,” Miller says. “We find ourselves thinking others in our life would be better off without us.”

“The deeply embedded culture of selfless service can dissuade them from seeking care because they do not want to be perceived as ‘weak,’” Moceri-Brooks says. But there’s an opportunity to reframe that belief. “Asking for help and connecting—that is strength,” Dr. Dondanville says. “Weakness is ignoring or denying your struggles.” The new campaign reminds veterans of the avenues they have for connection, and that they don’t have to solve all of life’s challenges on their own.

Help From the Private Sector

ALONGSIDE FEDERAL FUNDING and support, more private corporations and non-profits have focused on suicide prevention in recent years, Miller says. For example, the financial services company USAA launched Face the Fight in 2023, which funds veteran suicide prevention efforts such as safety and crisis response training for bystanders.

The American Foundation for Suicide Prevention (AFSP) fosters connection through community events, says Christine Yu Moutier, M.D., the AFSP’s chief medical officer, but also supports policy change: The AFSP is currently supporting a bill moving through the Senate that would devote more support and funding to “assist service members transitioning out of active duty in their first year of transition,” Dr. Yu Moutier says, when veterans are at the highest risk of dying by suicide.

All this feels like progress to Miller. “You’re seeing a coming together in a public health approach across private corporations, federal agencies, and veteran service organizations to advance suicide prevention overall,” he says.

Transitioning into life as a veteran is like pulling onto a busy highway. “You can feel like you’re merging as a solo car amidst a lot of other cars who have already been on this road,” Miller says. But with continued dedication from the organizations above, more vets can simply step on the gas.

Can You Help Prevent Someone’s Suicide?

THERE ARE ENOUGH of these stories that you’ve probably heard one: A therapist, a spouse, a buddy just saw their patient, husband, friend the day before he took his own life and didn’t suspect anything was wrong.

No bystander wants to feel like they could have done something differently. Even if you don’t notice any red flags, here’s how you can intervene.

Start a conversation about suicide.

“You’re not going to introduce a thought of suicide by asking, ‘Are you thinking about dying and death?’” Miller says. “Those questions actually open the door for conversation.”

Make time to catch up.

Suggest getting a coffee, a beer, or whatever feels natural to your relationship with a friend or family member you’re concerned about. It lets them know they’re not alone, Dr. Dondanville says.

Stay present.

If you learn someone is thinking about suicide, you don’t need to be trained in mental health care to help. “Staying with them and keeping them safe is not insignificant,” Dr. Yu Moutier says, even if you’re sitting in silence.

Call for backup.

If they need more support, dial 988, the suicide and crisis lifeline, then press 1 for help for veterans. You don’t have to be the person in crisis to make the call. You can also chat online at VeteransCrisisLine.net/Chat or text 838255 to reach a responder.