Veterans in Crisis: A Social Worker’s Guide to Suicide Prevention

By Maren Dale

Every day, 17 veterans die by suicide.

The number is tragic. At the same time, it can get lost in the volume of data social workers interact with every day. It also can be hard to fully grasp the scope of what that figure means. So, consider this for a moment:

It’s evening in the city and you’re on a walk. You pass a tall apartment building, each window brightly lit, with roughly 120 units inside. The next evening, you pass by again and notice some of the lights have gone out. In fact, each evening, the lights dim in 17 of the units. By the end of the week, you face a stark sight: every light is out and the high-rise is pitch black.

Now, picture a cityscape filled with many similar buildings—and each week, one goes dark. A sobering reminder of the nearly 120 veterans who die by suicide each week.

The issue is complex; the reality heartbreaking. But there is hope, and it is a problem where social workers can indeed make a powerful impact.

Combat and Noncombat Veterans

As a social worker serving veterans—and the family and friends who surround them—a place to begin gaining a broader understanding of veterans’ trauma is by taking a look at the unique perspectives of individual veterans.

Combat veterans often are dealing with the effects of physical injuries related to their deployments, such as illnesses due to toxic exposures or traumatic brain injury. They also confront profound psychological challenges related to their direct exposure to violence and trauma. Keep in mind, too, that a veteran who served in a combat zone but was not on the front lines likely still experienced trauma from indirect threats, such as witnessing the aftermath of battle and war crimes, or from being in a state of continual heightened alert.

These combat-related experiences can cause or lead to post-traumatic stress disorder, characterized by persistent flashbacks, night terrors, and heightened anxiety. The psychological impact of such trauma can linger long after a veteran’s service ends, contributing to ongoing struggles ranging from difficulties in maintaining relationships to major depression and suicidal ideation.

Joshua S. Gillihan-Young, LMSW, not only is a social worker, but also a U.S. Air Force veteran who was deployed five times. After medically separating from the USAF due to service-related issues, he obtained an associate in arts degree, followed by a BSW and MSW. He’s currently pursuing a doctorate in education, with the goal of obtaining a role where he can serve veterans.

During Gillihan-Young’s undergraduate and graduate training, he was invited to serve as a health science specialist, which involved answering calls that came in to the Veterans Crisis Line at the Veterans Administration. He says although veterans who called often were dealing with issues related to finances, substance abuse and trust, the majority of callers were struggling with relationship issues.

“When you serve, especially in a deployed location, you get to know the people you serve with and they can get to be closer to you than your biological family. Then, add in a shared traumatic experience like combat and the ties that are formed are like no other,” he explains. “With the loss of one of your brothers/sister-in-arms, it is like losing a part of yourself, and it can leave you feeling empty. A veteran could have what appears to be ‘the perfect life,’ with a loving spouse and children and a nice home and a nice job, but inside they are hurting and reliving their trauma, and missing their combat buddy.”

Noncombat veterans face different yet still significant challenges. Their trauma often stems from the stress of adjusting to civilian life and reconciling their military experience with their new roles. For instance, a noncombat veteran might struggle with a loss of identity and purpose after leaving a highly structured military environment. This can lead to feelings of inadequacy or purposelessness, particularly if their service was marked by a perceived lack of impactful contribution compared with peers who faced combat. These identity struggles can linger, making the transition to civilian life particularly difficult and contributing to a heightened risk of suicide if not addressed.

Military-Related Stigma

Stigma can be particularly pronounced among veterans due to several unique factors, and can prove to be a hidden but significant cause of suicidal ideation. Here are some of the ways it plays out:

• Cultural and institutional norms: Military culture often emphasizes resilience, strength and self-reliance. Veterans may internalize these values to the extent that seeking help feels like a personal failure or weakness.
• Perception of military identity: Some veterans may feel that acknowledging their struggles undermines their identity as a soldier or veteran. There is a strong sense of pride associated with military service, and admitting to struggles could feel to some as if they are compromising that identity.
• Fear of judgment from peers: Some veterans may worry about being judged or perceived as less capable or reliable if they seek help.
• Impact on career and benefits: Some may wonder and worry about how seeking care might affect benefits that they or their family members rely upon.

Impact on Families

“There is so much focus on the veteran and keeping them safe, but there are also major burdens on family members,” says Shawn Moore, LMSW, director of support programs at the Elizabth Dole Foundation, where she oversees the development and implementation of strategies to support the financial well-being of military and veteran caregivers.

Moore knows firsthand what she’s talking about. A former Kansas City police officer for 15 years, she began pursuing her MSW soon after marrying her husband, Brian, a veteran. After multiple attempts to die by suicide—and significant, numerous interventions and efforts by Moore to prevent it from happening—Brian died by suicide in February 2024.

Moore has made it her life’s work to advocate for families of veterans who are either dealing with the challenges of living with a veteran who has suicidal tendencies, or are coping with the effects of a veteran who has died by suicide.

A lifeline for Moore and her family, both before and after Brian’s death, was the social worker at her youngest daughter Peyton’s school. Moore says she talked with the social worker about their situation and let her know that Peyton was significantly impacted. It was an enormous help for the whole family in making it through the situation, she said.

“The first thing I did [after Brian’s suicide] was to call her. I don’t know if Peyton could have made it without her. That social worker was her safe person,” Moore says. “She replaced me when I couldn’t be there.”

Moore stresses that suicide is still very stigmatized, and many veteran caregiver parents likely won’t speak up and ask for help like she did. She also points out that while intake forms often ask whether a child has a parent or guardian who is active duty in the military, these forms typically don’t ask if they have had a parent who has served in the past and is a veteran. “You need to ask families specifically, ‘Have you or a loved one ever served in the military?’”

Another practical way to help families, Moore says, is to encourage them to prepare for a time when the veteran no longer is there. For instance, having passwords and knowing where and how to access bank accounts, bills, wills and other important documents can help tremendously down the line—particularly since there will be even more paperwork to complete after a veteran has died.

Caregiver Resources

The VA’s Caregiver Support Program provides access to caregivers in one of two ways: through the Program of General Caregiver Support Services; or the Program of Comprehensive Assistance for Family Caregivers. There are specific eligibility requirements for each program.

“In general, a veteran must be enrolled in VA health care, need assistance with either an activity of daily living, supervision or protection, and agree to receive care from the caregiver in order for the caregiver to qualify for PGCSS,” explains Leah Christensen, LCSW, national program manager of the PGCSS. There is no formal application required to enroll in this program.

To qualify and participate in PCAFC, the veteran and caregivers(s) must submit a joint application and meet specific eligibility requirements, which are determined through an assessment process at the VA. For those found eligible for PCAFC, enhanced benefits are provided directly to the caregiver.

There are numerous other online resources available for caregivers, including a blog series written by caregivers called “Dear Fellow Caregiver,” which Christensen recommends.

Christensen says when considering family needs, keep in mind that caregivers have a holistic view of the veteran that can sometimes play a life-saving role.

“Caregivers may be the first to recognize changes in mood and behavior, such as expressions of anger, emotional pain, or increasing use of alcohol or drugs,” Christensen says. “They can play a vital role in supporting a veteran and preventing a crisis.”

Firearm Safety

No single solution can address the complex factors involved in suicide. However, one area of focus must be firearm access and safety. According to the 2023 National Veteran Suicide Prevention Annual Report, in 2021, firearms were used in 72% of veteran deaths compared with 52% for non-veterans.

Emily Resnik, LISW-S, has worked at the Cincinnati VA medical center for nine years and has been a suicide prevention case manager for more than three years. She also serves as co-chair of her facility’s suicide postvention team, which provides support to staff and loved ones following the death of a veteran or an employee by suicide.

She says safety planning offers an opportunity to take a person-centered approach by inviting veterans and their family and friends to take an active role in ensuring the plan is something the veteran is likely to use if needed.

“Sometimes that means removing firearms from the home, but other times it means putting them in a safe with the combination or lock managed by a third party—or even the VA providing a cable gun lock for the veteran to use,” Resnik says. “Being able to offer a menu of options for whatever lethal means a veteran has considered using gives them agency in a time when they may feel like they may not have many choices or have had new limitations imposed (e.g., hospitalization).”

Straight Talk

Resnik acknowledges that working with a veteran who may be suicidal can induce anxiety. She says laying the groundwork using a curious, person-centered approach is highly beneficial and can help social workers meet clients where they are.

“Having templated risk assessment forms can be incredibly helpful and necessary,” Resnik says, “but providers should also be able to conduct that assessment without the client feeling as if it is scripted or the provider is simply checking off boxes.”

Gillihan-Young agrees.

“For social workers who are not veterans, I would just encourage them to be honest, straightforward, and to not use clinical language when interacting with a veteran who is in crisis,” he says. “Most veterans were taught, and live by, the acronym KISS (Keep it Simple, Stupid), so being direct and using plain language is ideal, in my humble opinion. That is the way I have been since entering the social work profession, and I have always received positive feedback for doing so.”

Maren Dale is a writer based in Washington State and has written for NASW since 2009. She has interviewed more than 500 leaders and written for more than 100 organizations in 18 states.

Resources

NASW Practice-Military and Veterans

VA/DoD Clinical Practice Guidelines

VA Health Care Providers

VA Caregiver Support Program

VA PCAFC

VA PGCSS

Elizabeth Dole Foundation