VA Secretaries and Congress have made tackling veteran suicide a priority, but the number of deaths has kept rising.
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Randy McDonald once oversaw the manufacturing of precision-guided munitions and cluster bombs at Minot Air Force Base, sometimes working alongside some of the highest-ranking airmen. Now in his mid-40s, he had to make sure 10,000 items sat where they should on sprawling shelves at Home Depot: tools, thermostats, humidifiers, duct tape — you name it. He missed the camaraderie and brotherhood that had defined the first half of his life. Now, it felt like his sole goal was unloading enough retail from semi trucks to earn a bonus check.
He felt like a burden. He thought about ending his life and leaving behind his two daughters and his wife. Leaving behind the three-bedroom stucco house where they lived in Minot, North Dakota, and its brick-lined, arched front door. He came up with a plan. He knew the date, the time and the place, and how he was going to die by suicide. But then, a small deviation in his well-oiled journey snapped him out of his funk. “What the hell are you doing?” he thought.
He realized how close to the abyss he was teetering, and this realization set him out on a new journey. What if he could reach out to other veterans before it was too late, he wondered, even those in the far reaches of North Dakota?
He knew he was hardly the first veteran to think about suicide. Across remote areas of the country, from Pennsylvania to Montana, from Wyoming to Nevada, thousands are going through the same trepidations. They face a fragmented social fabric, a byzantine path to receiving health care and a pervasive stigma surrounding mental health. This, combined with a dearth of community resources, at-times crippling isolation and a gun-friendly culture, makes rural veterans 20% more likely to die by suicide than veterans as a whole. These former servicemen die by suicide at such a high rate, in fact, that they’re driving overall self-inflicted deaths in rural counties.
Deep in the Intermountain West, mental health researchers have developed a program they say could help stem this tide of veteran suicides. It hinges on a radical shift of paradigm: What if people like McDonald — not just mental health experts — were the first line of defense against suicide? What if it took a veteran to save a veteran?
Twenty-two. The numerals appear in white font on black rubber band bracelets worn by veterans — the estimated number of veterans who die by suicide every day. That figure has fluctuated over the years and now probably stands at around 17. But this issue has afflicted the U.S. military at least since the 19th century.
Rural veterans are 20% more likely to die by suicide than veterans as a whole.
While suicide was deemed morally repugnant at the time, many Civil War veterans traumatized by the war still took their own lives. Some of the soldiers who’d survived World War I didn’t live much longer after the conflict ended: In 1921, a former colonel in the Army’s Medical Corps testified in front of a Senate committee that 400 veterans had taken their lives in New York state just the previous year. And about 9,000 Vietnam War veterans are estimated to have died by suicide from the time of discharge through the 1980s.
The trauma associated with combat exposure has long been blamed for veteran suicide. It was once referred to as “nostalgia,” then as “shell shock” during World War I, and as PTSD after Vietnam.
By the time James Peake, an Army doctor who’d served in Vietnam, was appointed as the U.S. Army Surgeon General in 2000, the crisis was well documented. That’s why when the U.S. invaded Iraq, Peake made sure to send mental health experts to the front lines to “drive mental health (treatment) deeper into the units,” he says.
Researchers think veterans could hold the key to preventing suicides among their peers.
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The experts found that not much had changed since the Civil War. A number of soldiers who went to Iraq and Afghanistan were diagnosed with Post-traumatic stress disorder and reported heavy drinking, among other stresses and disorders. What was different was the avalanche of deaths the post 9/11 era ushered in.
One Boston University study found that 30,177 active-duty personnel and veterans have died by suicide on American soil since the Twin Towers fell, compared to 7,057 service members killed in war theaters. There’s no one explanation for that escalation. Experts point to the growing military-civilian divide, society’s scorn for interventions in the Middle East and the military’s failure to adequately prepare its members for civilian life. Some suggest that armed forces now attract a certain profile of people more likely to have experienced psychological trauma before. And then there’s the trauma many experience while serving, whether deployed or not, including sexual assaults and physical abuses.
Here’s something else that changed. For a long time veterans bore the responsibility for suicide, which was seen as a sign of moral weakness. But the onus is now on the government for failing to care for its veterans. When Peake, then VA secretary, was called in to testify before the House Committee on Veterans’ Affairs in 2008, lawmakers made clear something needed to be done. “We should all be angry at what has gone on here,” one admonished him. Veteran suicide has since become one of the few nonpartisan issues on Capitol Hill. The last three VA secretaries all made it their top clinical priority, and Congress in recent years considered at least five bills or initiatives aiming to tackle suicides.
And yet, a rising number of veterans took their lives during the past decade, with the exception of a small dip between 2018 and 2019. Despite making up only 8.3% of adults, veterans today represent 14.3% of all suicides, according to the VA.
North Dakota hasn’t been immune to this national trend. Veterans now make up less than 6% of the state’s population but accounted for 17% of suicides in 2020. McDonald came perilously close to being one of them.
A burly man with kind eyes and a light brown beard, McDonald grew up in the college town of Morgantown, West Virginia, a Rust Belt community nestled in the Appalachian foothills, and the home of West Virginia University. It stands a few miles from the Pittsburgh coal seam and, at the height of the coal mining boom, men waiting to board buses for one of the 60 coal mines outside of town were a common sight. McDonald saw firsthand what mining will do to you. When his uncle died at 76, his lungs had soaked up about as much coal dust as tar from the three packs of cigarettes he smoked a day.
McDonald wasn’t interested in suffering the same fate. He wasn’t much interested in college, either, he says from a bakery in downtown Minot. He’s brought lunch — a couple of turkey sandwiches and a bag of onion chips — but he barely touches it.
He says he did what many young men in rural areas do when faced with limited options. He walked into a military recruiting office and joined the Air Force. After training in San Antonio, he was put on the maintenance career track and was sent to Minot Air Force Base for three years. Now married, he was deployed to Spangdahlem Air Base in Germany, where his first daughter was born. He went on to Virginia to work in a bomb shop at Langley Air Force Base, before spending a few more years in Minot, this time supervising one. With his wife, he bought a house a few blocks from the Souris River, which flows through Minot. After stints in Guam and Turkey, he retired from the Air Force in 2013. He’d seen the world and had had a rich career serving with men he admired. What else could he ask for?
He got a job at Nash Finch, a wholesale food distributor. It was an uneasy transition from manufacturing bombs, to say the least. He’d been managing 70 people in Minot Air Force base, having in effect the power of “life and death” over people in far-flung countries like Iraq and Afghanistan, often the bombs’ final destinations. Now, he had to make sure grocery stores got their extra case of soda, or that the ice cream wasn’t too soft. He grew agitated, seemingly unable to hold on to a job for more than a year or two.
None gave him the same pride and satisfaction he’d felt as an airman. He hit a new low when he found himself working the night shift at a Home Depot, missing out on evenings with friends. The long winters only compounded a growing sense of isolation. He all but gave up painting, a long-held passion, instead spending his days watching TV or reading books. “Those are the times where you really start sinking down into your negative thoughts,” McDonald says.
One memory especially sticks out. He sees himself walking down the street outside of Incirlik Air Base in southern Turkey, where he’s been stationed for a few months. It’s 1999 and Albanian refugees have been pouring from war-torn Kosovo. A group of children materializes, swarming McDonald and other airmen, looking to thumb-wrestle for a soda or peddle $1 pieces of gum. Suddenly, a Turkish teenager watching from a distance pounces on an Albanian child. Airmen aren’t allowed to intervene, and McDonald, about 24 at the time, watches powerless as the teenager beats the child, dragging him behind a corner.
He enters the rabbit hole. What happened to the kid? Did he lose his vision? Did he have broken bones? Sometimes positive thoughts put up a fight against the bad ones. Perhaps a church person or a doctor found the child and treated him? But more often than not, the good thoughts lose.
Due to the Air Force base, there’s no shortage of veterans in Minot, where they make up nearly a tenth of the city’s about 48,000 residents. The American Legion, Veterans of Foreign Wars, Disabled American Veterans and AMVETS all have chapters in town. But this doesn’t necessarily translate into a tight-knit, multigenerational veteran community.
At Charlie’s Main Street Cafe, you might see airmen in camouflage uniforms seated at one of the green upholstered booths, digging into a blueberry pie or wolfing down a hot beef sandwich. Veterans, on the other hand, don’t wear uniforms, and many won’t make their military history known.
In rural areas, 1 in 3 veterans isn’t enrolled in VA health care, making it less likely they will be screened for depression as part of a routine checkup.
This means that former servicemen like McDonald can feel utterly isolated, even in a military town. The VA, of course, provides robust mental health services, including at the local clinic, a one-story building next door to a Little Caesars. But in rural areas, more than a third of all veterans aren’t enrolled in VA health care, making it less likely they will be screened for depression as part of a routine checkup. For many who, like McDonald, suffered no service-related physical disabilities or injuries upon being discharged, receiving care through the VA isn’t always the first option, especially if they have good private insurance.
“Once a service member leaves the service, there is nothing that overtly compels them to have contact with the VA,” says Jeffrey Smith, an associate professor of history at the University of Hawaii Hilo who has studied military suicides. This makes it challenging for the VA to flag veterans who may be at risk. People sometimes think that “there’s some kind of magic list with all the veterans, and that if we called all of them they wouldn’t kill themselves,” says Carl LoFaro, a suicide prevention social worker at the VA. “That’s not really, unfortunately, how it works.”
Historically, veterans clubs played a key role in suicide prevention, albeit not an explicitly defined one. Men sitting at the bar counter would suddenly spill out their guts in booze-fueled catharses, sharing harrowing war stories for the first time. But these days, mostly aging Vietnam veterans meet at vets clubs, a TV sometimes playing a black-and-white movie in the background. It can be hard for younger vets to feel welcome.
“We’re having trouble recruiting new members,” says Tammy VanWinkle, the head of the American Veterans’ Minot chapter. This means that younger veterans, who research shows are more likely to commit suicide than older cohorts, aren’t receiving the same informal peer support as their elders.
In this context, intervening before it’s too late is akin to a crapshoot, especially in rural areas. Some groups like Forward Flag, a veteran nonprofit in New Mexico (it also has operations in Tennessee), have developed their own methods to ferret out former military members. There, volunteers drive a rusty Bluebird Wanderlodge bus deep into remote locales like the Jicarilla Apache Indian Reservation, and, once there, set up on well-trafficked parking lots. If they’re lucky, a veteran’s inquisitive grandmother or aunt will stop by and, later on, return with the veteran, opening up the possibility volunteers may identify signs of depression and direct them to mental health services.
In Minot, McDonald couldn’t find the kind of peer support that would pull him out of the rabbit hole. A call with the ND Cares Coalition in Bismarck, a state-sponsored initiative that seeks to improve veteran-related services, finally brought him fresh answers. Someone, it turns out, was working on developing the sort of help he desperately needed.
Nathaniel Mohatt, a research psychologist, stood in a conference room in front of a dozen veterans in Kalispell, Montana. It was early 2018 and he’d just flown with a team of experts from the Western Interstate Commission for Higher Education, an interstate agency based in Boulder, Colorado. They had one goal: persuade the men to become the first line of defense against veteran suicide in northwest Montana.
The VA has been trying something new to make a dent in veteran suicide — make veterans themselves the first line of defense.
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Mohatt, a soft-spoken man with well-kept hair and tortoiseshell-rimmed glasses, knew a thing or two about rural veterans. In the 2010s, he’d worked on a mental health initiative targeting National Guardsmen in Kansas, and he’d studied ways rural primary care could better address suicide risks. In his years in the field, he’d noticed there weren’t any structured, comprehensive programs in rural America. Rather, existing initiatives tended to be one-off, often led by counties’ public health departments or by community behavioral health centers.
This observation led him and his colleagues at the VA-affiliated Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention to develop a new approach. What if veterans were the ones doing suicide prevention, as opposed to experts in lab coats? After all, it’d long been documented that veterans were more likely to open up to one of their own.
But to get the VA to fund the new initiative, called Together With Veterans, he would need to ground it in solid evidence. So, Mohatt set out to find successful programs for inspiration. After rummaging through the academic literature, he found three. The first one was in Arizona, where the White Mountain Apache Tribe trained law enforcement, EMTs and community leaders to recognize warning signs of suicide, put together awareness campaigns and taught coping skills to at-risk youths. It managed to cut suicide rates by more than 38%. Then there was the Air Force, which worked to normalize help-seeking and reduce stigma around suicide.
But even more promising was the third initiative, which targeted a broad slice of the population, and not just subsets. In Germany, the Nuremberg Alliance Against Depression had taught 2,000 priests, teachers, pharmacists, policemen and other community facilitators how to identify people with depression. It’d achieved a 24% reduction in suicide attempts and completed suicides, and inspired the European Alliance Against Depression, an international nonprofit that brought the model to Chile and Australia.
“It’s worked with native populations, it’s worked in Europe, it’s worked with the Air Force,” Mohatt thought. What if rural veterans could be trained to deliver the same kind of intervention in their communities?
The suicide prevention center contracted with the Western Interstate Commission to design a program drawing on these efforts. Now, the researchers needed to test out their idea. After scouring suicide and population data, Mohatt’s team identified four communities to try it on. One of them was in the Kalispell region, whose high concentration of veterans and high suicide rates made it an ideal candidate.
But the veterans gathered in the conference room in northwest Montana weren’t biting. They sat squarely in their chairs, their arms crossed as a lunch of sandwiches, chips and cookies arranged on a table laid untouched. “It was like talking to a silent room,” says Mohatt.
At the end of a 40-minute presentation, the team asked a simple question. “Do you want this in your community?” Suddenly, the atmosphere in the room changed. The veterans had been given a choice — this program wouldn’t be imposed on them unless they wanted to participate. Slowly, the veterans started weighing in on Mohatt’s idea. “They started eating our food,” he says.
For a year, Western Interstate Commission representatives flew in from Denver to craft a plan alongside the veterans. “While we were rolling the wheel down the road, we were inventing it,” says L.D. Gross, a veteran involved in the effort. They set the main goals for the grassroots organization: reduce the stigma attached to seeking help; promote gun safety; provide suicide prevention training — including to primary care providers; and link veterans to suicide hotlines and mental health centers. Now named the Veterans Coalition of Northwest Montana, the group would receive a $100,000 grant from the VA spread over three years. It would be on its own after that.
Once organized, the veterans moved fast. They put up two big billboards on either end of Kalispell, showing a casket draped with an American flag, the words “NO MORE SUICIDE” superimposed on it, as well as the phone number to a crisis helpline. They got trained to teach “Question, Persuade, and Refer,” a program focused on discerning warning signs of suicide. Invariably wearing military baseball caps, they became fixtures at local gun shows, giving away gun locks — firearms are the method of choice for veterans committing suicide — and leaflets.
It’s too early to say whether these actions have made a dent in suicides, Mohatt says, in part because it takes two years for statistics on suicide deaths to trickle down to national databases. But there have been encouraging signs. Since 2019, the coalition has delivered QPR training to 432 people, including in vets homes and farming communities. It had 10,000 people attend its events and, crucially, helped 731 veterans access housing, receive food assistance or get health care. This is an important metric because veterans enrolled in the VA are less likely to commit suicide.
Some benefits might not be easily measured but feel equally important. After Gross and two other veterans finished teaching a QPR course at an American Legion post on the Flathead Indian Reservation, two old farmers in overalls stood up to speak. They’d lost five family members to suicide, all veterans, they said, tears streaming down their faces. “You can run into some pretty emotional stuff,” Gross says. Soon after, the veterans got a call from the post. Could they organize another class?
Back in Minot, McDonald hopped on a phone call in late 2020 with a consultant for Together With Veterans. The program was expanding to dozens of communities across the country. Maybe McDonald could start the first chapter in North Dakota?
The model made sense to McDonald. “I’ve always noticed that veterans can talk to veterans easier than they can talk to anyone else,” he says. So, in January last year, he started reaching out to local veteran groups and nonprofits, hoping to recruit volunteers to help him set up the nonprofit.
But things didn’t go as planned. His efforts got little traction, which he chalks up in part to a perceived lack of legitimacy. “I failed miserably,” McDonald says. In the summer, however, he gave it another try, reaching out again. He’d quit his job at Home Depot and started a new position as an outreach specialist for disabled veterans, in addition to studying for a master’s degree in mental health counseling. This time, he received positive feedback.
He joined forces with a female veteran who agreed to take on the paperwork, and in the fall, the chapter held its first meeting at the local post of Veteran of Foreign Wars. After reading about the event in the Minot Daily News, about 15 people showed up, most having no idea what the meeting was really about, McDonald remembers. “That brought out a mixed crowd.” One participant had lost her brother, a veteran, to suicide in another state two days before and couldn’t immediately be with her family. The group was the only source of healing she could find at the time.
“I’ve always noticed that veterans can talk to veterans easier than they can talk to anyone else.”
McDonald felt unsure about the initiative. How, for instance, would he go about reaching veterans removed from society, those who elect to live on farms surrounded by dirt roads, dozens of miles away from the nearest city? His plan was for the group to team up with a San Diego-based nonprofit to build bunk beds for kids. Perhaps a carpenter living in a rural area would hear about the workshops and get Bob, his veteran neighbor, to lend a hand and nail a few planks. Bob would show up and find a community ready to welcome him with open arms. Perhaps the dark thoughts would go away then. Perhaps his life would be saved.
Still, McDonald had mixed feelings about being the face of this effort. How could he talk about saving veterans when he’d come so close to losing himself? “This is my first time admitting this publicly,” he wrote on the group’s Facebook page in September 2021. “I’ve kinda felt like a fraud putting together a non-profit that focuses on rural veteran suicide, knowing how close I was just a year ago.” But, he continued, “This organization matters to me, veterans’ matter to me, YOUR LIFE MATTERS TO ME!!!!!”
A dozen people emerge from the biting cold and file into a spacious conference room inside the Ward County Administration Building in Minot, a rotund edifice with sleek glass panels. The emblems for the five military branches hang on a black wall, bathed in white light. The Minot chapter of Together With Veterans has been scrupulously following a 187-page toolkit developed by the VA for local groups. This evening, they’re tackling phase two of a five-step plan: a SWOT analysis — the acronym stands for Strengths, Weaknesses, Opportunities and Threats — of their community.
Ten fresh boxes of Papa John’s pizza are stacked on a filing cabinet. The smell of hot, melted cheese fills the room. “Through this process, you guys are helping shape what this organization looks like,” McDonald, wearing a cornflower blue polo shirt and a beige baseball cap, tells participants in a pep talk. They’re mostly men, veterans ranging in age from mid-30s to late 70s. Some, sporting druid-like gray beards, resolutely prop up their elbows on one of four tables arranged in a rectangle. Others sit at a distance, coats still on. Some won’t open their mouth once during the two-hour meeting, as though worried they may break a vow of silence.
Soon, among those willing to talk, the comments pour in. There are the long, depressing winters, says one. Surely that’s a weakness. Old veterans have a hard time going grocery shopping, says another. A sexagenarian with a well-trimmed beard chimes in. “Does everybody in the community know that there is a veteran suicide issue?” An Iraq vet in a black hoodie emblazoned with an American flag holds up his smartphone and notes that there’s no dedicated website for Together With Veterans. How is that for brand recognition? And by the way, how do we reach younger vets who don’t read the local paper?
A man in a green sports jacket and brown boots notes another hurdle: How do we reach veterans with PTSD, who may steer away from big events? How about we do it in an open space, suggests someone. Green Jacket remarks drily that this leaves the group a 60-day window in the summer to organize meets, referring to the interminable North Dakota winters.
By the time the meeting is over, it’s apparent the chapter has a lot on its plate. The group isn’t even sure about the scale of the issue. When I point out to McDonald that only one veteran committed suicide in the county last year, according to provisional data provided by the North Dakota Health Department, he smirks. This number, he says “seems very, very low.” But perhaps it doesn’t matter if only one veteran in the whole county is saved. At the very least, veterans who didn’t know each other six months ago have banded together, their eyes set on a larger goal than themselves, the despair they may experience at times receding in the depths.
McDonald knows what he’s talking about. In the past months he has started meeting with a counselor, talking about his PTSD. Things are finally looking up. The sense of meaning that had eluded him all these years is slowly coming back, in no small part thanks to his involvement with the chapter. “It’s a little self-serving, building this nonprofit itself,” he says. “I get to accomplish what I need to accomplish for myself.” Perhaps he’s saved a life already.
Where to get help:
The Department of Veterans Affairs maintains a hotline for veterans in crisis that operates 24 hours a day.
Call 1-800-273-8255 and press 1. Online, visit veteranscrisisline.net/get-help/chat, or send a text message to 838255.
This story appears in the May issue of Deseret Magazine. Learn more about how to subscribe.