Together With Veterans Rural Suicide Prevention Program
Need: Suicide among veterans has been steadily increasing, and rural veterans have a 20% increased risk of death by suicide compared to urban veterans.
Intervention: A program called Together With Veterans was formed to help rural communities address and prevent suicides among veterans. The initiative is veteran-led, collaborative, evidence-based, and community-centered.
Results: The program is currently in 6 states and reaches over 1,500 veterans every quarter while nurturing connections between agencies and community members.
Veterans who live in rural America are more likely to die
by suicide than urban veterans, and the statistics have
steadily rising since 2005.
Based in Colorado, Together
With Veterans (TWV) Rural Suicide Prevention Program
recruits, trains, and organizes veterans and supporting
organizations to lead evidence-informed veteran suicide
prevention strategies in their communities. TWV was
initially developed using a
community-based participatory research approach and
helps tailor these strategies to individual communities.
By emphasizing veteran leadership, TWV maximizes
opportunities to prevent suicide and encourage wellbeing
among rural veterans.
With input from the community, TWV starts a program by
forming a leadership team of veterans and key healthcare
stakeholders who have a vested interest in making a
difference in the lives of veterans and their families.
Leadership teams are comprised of at least 51% veterans
and may also include:
Crisis and support centers
Local firearms advocates
Clinics and hospitals
Veteran Service Officers
The following groups served as pilot sites for TWV and
have helped with the development of a TWV online toolkit:
TWV has identified 4 guiding principles that are at the
core of each community effort:
Veteran-driven – Veterans have agreed
to invite TWV to work in their communities and are a
part of the leadership team.
Collaborative – Community partners
actively support veterans, understand the ramifications
of veterans' mental health struggles, and are committed
to being a part of the education and strategy process.
Strategies vetted by TWV that have proved effective
in reducing suicide are adopted at the local level.
Leaders attend a Training Academy to learn the
strategies and how to use tools to inform their
decision making and aid in implementation.
Community-centered – Partners develop
and continually revise an action plan based on
TWV is implemented using 5 suicide prevention
Reduce stigma and promote help-seeking
Promote lethal means safety
Provide suicide prevention training
Enhance primary care suicide prevention
Improve access to quality care
The services provided by Together With Veterans are made
possible through the support of two leading agencies:
Supporting local communities using evidence based
implementation support including:
Training (TWV Training Academy)
Tools (implementation toolkit and web-portal)
Technical assistance (implementation
Quality improvement (supporting learning
communities across sites)
Together With Veterans is making a difference for the
veterans and partners who have participated. Every
quarter, TWV reaches 1,500 rural veterans through direct
contact at meetings, regional events, or local
Other noticeable effects of TWV programs for veterans:
After just one year in a community, veterans become
the local leading force for suicide prevention efforts.
After just two years, partnerships around suicide
prevention have been strengthened and better support
Veterans have found an avenue to
speak about mental health and an outlet in which to help
others through similar journeys.
The long-term goal is to evaluate the effect of TWV on
reducing suicide deaths in rural communities. TWV is
being rolled out nationally following a rolling-cohort
waitlist design, which will allow the research team to
rigorously evaluate the impact that TWV has on multiple
community outcomes. Because suicide death data is delayed
by 2 years and TWV is just beginning a larger rollout,
final results on suicide deaths will not be expected for
another 3-5 years.
TWV in Publications:
Monteith, L.L., Wendleton, L., Bahraini, N.H.,
Matarazzo, B.B., Brimner, G., & Mohatt, N.V.(in press).
Together With Veterans: VA National Strategy Alignment
and Lessons Learned from Community-Based Suicide
Prevention for Rural Veterans. Suicide &
Monteith, L.L., Smith, N.B., Holliday, R., Dorsey
Holliman, B.A., LoFaro, C.T., & Mohatt, N.V.(in press).
"We're Afraid to Say Suicide": Stigma as a Barrier to
Implementing a Community-Based Suicide Prevention Program
for Rural Veterans. The Journal of nervous and mental
Through community readiness assessments collected from
participating sites, the following challenges were
discovered to affect community readiness for implementing
suicide prevention programs:
Because suicide is a topic not often discussed among
community members or covered by local media outlets, a
general lack of community awareness and misconceptions
about the risk and reality of suicide among the veteran
population was noted.
Rural communities face a higher level of stigma.
Desire for privacy and general wariness of mental
healthcare often affect one's willingness to get help.
Stigma may come from structures within the community, the
general public, or is internalized among individuals
Lack of access to mental health services. Even when
services are available, veterans may be more likely to
seek help from trusted friends and family rather than
Because mental health diagnoses can affect acceptance
into the military or deployment orders, veterans can
associate admitting mental health struggles with negative
Process of initial connection:
Before TWV approaches a rural community about running a
program, coordinators go through the appropriate policy
channels at the state and local levels. For instance, TWV
chose to partner with states where the VA is rolling out
Governor's Challenge to Prevent Suicide among Service
Members, Veterans, and their Families. Next, TWV
gauges the interest of suicide prevention leaders on the
state level and discusses which rural communities would
be a good fit for a TWV initiative. A meeting is called
with local veterans and the TWV program is presented.
Agreement from the local veteran community and
identification of veteran leaders to champion the process
is required before moving forward.
5 Phases of Partnership:
Once a community commits to TWV, these 5
phases are rolled out. Although implemented in rural
communities, these steps can be replicated on a larger
Build your team
Inform veterans and community members about the
need for TWV.
Establish a team.
Within that team, establish a steering committee.
Learn about your community
Create a Community Readiness Assessment focus
group, interview key community members, and conduct a
SWOT Analysis to gauge the community's dynamics
and level of readiness to implement a program.
Teach your team
Equip individuals with suicide prevention skills
using evidence-based training.
Present multiple and use an agreed-upon strategy
to create an action plan.
Plan for action
Review results from analyses and focus groups to
understand community strengths and needs.
Identify available resources to support the
community-based suicide prevention strategies the
team agreed upon.
Develop an action plan for each strategy.
Follow your plan and measure your results
Track activity and results of each action items.
Revisit the strategies and
continually refine actions as needed.
Please contact the models and innovations contact directly for the most complete and current information
about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
community should consider whether a particular project or approach is a good match for their community’s
needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.