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VA » Health Care » MIRECC / CoE » Rocky Mountain MIRECC » Together With Veterans Research

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Together With Veterans Research

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Together With Veterans

Publications

Rural community members' experiences and perceptions regarding lethal means safety in the context of suicide and accidental death rates - January 2026

Together with Veterans (TWV) is a suicide prevention program designed specifically for rural communities across the United States. It works by helping local community members create and carry out action plans that are grounded in evidence and tailored to their unique local strengths and needs. To better understand how people in these areas think about and talk about lethal means safety (LMS)—like safe storage of firearms and medications—data were collected from three diverse TWV communities in Mississippi (MS), New Mexico (NM), and Oregon (OR). Researchers gathered community-level data from national sources like the American Community Survey and the CDC’s WONDER database. They also conducted a large survey using a random sample of 45,000 rural households, primarily reaching out by mail. The three communities showed clear differences in suicide death rates: MS had an average annual suicide rate of 11.8 per 100,000 people, while NM’s rate was much higher at 33.0, and OR’s was 28.0. A total of 3,846 people completed the survey. Most were at least somewhat open to discussing firearm access at home with doctors or mental health providers. However, very few—only 3.8% to 10.8%—said a provider had ever brought it up with them. Conversations about medication safety were also limited, with only 14.1% to 21.7% reporting that a healthcare provider had discussed how to store medications safely. Furthermore, a significant number of people—between 16.9% and 23.5%—did not believe that using gun locks or safes can lower the risk of suicide. These findings show a clear need for more education and outreach about how safely storing guns and medications can help prevent suicide. Community-specific strategies are essential to ensure that prevention efforts are relevant and effective in rural areas.

The "tyranny of distance": community-based Veteran suicide prevention in Guam - July 2025

The population of Guam is comprised of a high proportion of Asian and/or Pacific Islander individuals, many of whom have served in the military. Minoritized community membership, as well as military service, have been associated with increased suicide risk. This mixed-methods study was conducted to increase understanding regarding the community context, factors associated with suicide risk among Guamanians, and implementation barriers and facilitators for a community-based suicide prevention program, Together with Veterans (TWV). This is a convergent parallel mixed-methods study. In 2022, qualitative and quantitative (i.e., communal mastery, collective efficacy, TWV implementation) data were collected from twelve individuals, including Guam TWV team and other community members. Qualitative data were analyzed via a rapid analysis approach. Themes were organized using a socio-ecological model framework, then integrated with quantitative data. Emergent themes by socio-ecological levels included: intrapersonal (e.g., identities, mental health stigma); social-interpersonal (e.g., perceptions of Veterans); social community (e.g., access to care); social organizational (e.g., hope for raising awareness); social public policy (e.g., part of, yet isolated from the mainland); and, chronosystem (i.e., geopolitical history). Quantitative data yielded convergent and divergent findings. Findings highlighted unique facilitators (e.g., cultural value of interconnectedness, beliefs regarding the capacity of the Guamanian community to achieve specific goals) and challenges (e.g., stigma related in part to colonial history) faced by those living in Guam, as well as the utility of structured community-based suicide prevention strategies to facilitate change among those living in island communities that are geographically distant from the mainland.

Visual Abstracts

TWV- VA National Strategy Alignment

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Implement Coomunity Based Suicide Prevention

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Menu if Options for Rural Veterans

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Last Updated 16 June 2026