Together With Veterans Rural Suicide Prevention Program
Need: Suicide among veterans has been steadily increasing, and rural veterans have an 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: Data collection is ongoing.
Veterans who live in rural America are more likely to die
by suicide than urban veterans.
The Together With Veterans Suicide Prevention Strategies
are implemented using a five-phase process to support
rural communities in developing a local veteran suicide
prevention action plan. Six evidence-based suicide
prevention strategies (Provide Suicide Prevention
Training, Enhance Primary Care Suicide Prevention,
Promote Connectedness and Help Seeking, Improving
Communication Across Veteran Serving Programs, Enhance
Behavioral Health Suicide Prevention, Promote Lethal
Means Safety) are used by TWV to support local planning
efforts. These strategies are designed for community-wide
implementation to increase awareness and knowledge about
veteran suicide and improve community response to the
needs of local veterans.
The following groups served as pilot sites for TWV and
have helped with the development of a TWV online toolkit:
For more information regarding TWV, see the program's
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 many rural veterans through direct
contact at meetings, regional events, or local
Kreisel, C. J., Wilson, L. K., Schneider, A. L.,
Mohatt, N. V., & Spark, T. L. (2020). Reducing rural
veteran suicides: Navigating geospatial and community
contexts for scaling up a national Veterans Affairs
program. Suicide & life-threatening behavior,
51(2), 51(2), 344-351.
Mohatt, N. V., Billera, M., Demers, N., Monteith, L.
L., & Bahraini, N. H. (2018). A menu of options:
Resources for preventing veteran suicide in rural
communities. Psychological Services, 15(3),
Mohatt, N. V., & Helm, S. (2017). Brief Report:
Stigma as a Barrier to Community Readiness for Suicide
Prevention among Rural Veterans. The Community
Psychologist Rural Interest Group.
Monteith, L. L., Holliday, R., Brown, T. L., Brenner,
L. A., & Mohatt, N. V. (2021). Preventing Suicide in
Rural Communities During the COVID-19 Pandemic. The
Journal of Rural Health, 37(1), 179-184.
Mohatt, N. V., Kreisel, C. J., Hoffberg, A. S.,
Wendleton, L., & Beehler, S. J. (2020). A Systematic
Review of Factors Impacting Suicide Risk Among Rural
Adults in the United States. The Journal of Rural
Health, 37(3), 565-575.
Monteith, L.L., Wendleton, L., Bahraini, N.H.,
Matarazzo, B.B., Brimner, G., & Mohatt, N.V. (2020).
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. (2019).
"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.
In rural communities, desire for privacy and general wariness of mental healthcare may get in the way of one's willingness to get help. Stigma may come from structures within the community or the general public.
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
Veterans may associate having mental health struggles with negative consequences.
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.