When Everyone Is Helping and Veterans Are Still Dying

By David Campisano

We have spent years trying to prevent veteran suicide. We have crisis lines, screening tools, clinicians, peer networks, community organizations, public campaigns, and families doing everything they can to keep the people they love alive.

And veterans continue to die by suicide.

The Department of Veterans Affairs (VA) reports that 6,398 veterans died by suicide in 2023. Sixty-one percent had not received Veterans Health Administration (VHA) care in the year of their death or the preceding year (VA, 2026). That figure does not mean they had received no help elsewhere, or that VHA care alone would have prevented their deaths. It does remind us that a prevention strategy centered only on the people visible to one health system cannot reach everyone. The report also notes that the veteran suicide rate rose from 34.7 per 100,000 in 2022 to 35.2 in 2023, even as the number of deaths fell slightly.

The question is larger than whether any one intervention works: How can people and organizations respond competently to what they see while a veteran’s overall life continues to deteriorate?

Suicide has no single cause. Systems thinking does not assign blame to the VA, clinicians, nonprofits, families, or veterans. It asks us to examine how their separate efforts connect, where information is lost, and what happens between contacts.

Everyone sees a piece

Donella Meadows described systems as interconnected elements whose relationships produce patterns over time. Her framework directs attention to feedback, delays, information flows, and the goals of the system (Meadows, 2008).

Her account of bounded rationality is especially useful here. People act with limited time, incomplete information, and a view shaped by their own role. A clinician, benefits specialist, employer, spouse, and peer can each make a reasonable decision based on the piece of a veteran’s life available to them (Meadows, 2008; Simon, 1957).

Imagine a veteran who has stopped sleeping well and gradually stops attending a weekly peer group. He tells his physician about his sleep but says little about his growing isolation. The group assumes he is busy. A friend checks in, and he replies, “I’m good.”

No single interaction necessarily signals an acute suicidal crisis.

Every person may be acting with care and skill. Yet no one may see the whole trajectory. Everyone can be doing their job while nobody sees how the pieces are changing together.

Three ways a system can lose the trajectory

These are proposed feedback loops, not universal accounts of why veterans die by suicide. They are questions we should investigate in actual programs and communities.

Self-reliance. Military service can cultivate the ability to function under adversity. That ability can remain a strength. But when distress grows, relying solely on oneself may reduce disclosure; less disclosure can mean fewer opportunities for others to respond. Isolation may then deepen the original distress. A strategy that helped someone through one environment can have different consequences in another.

Navigation. The services a veteran needs may multiply just as pain, poor sleep, financial pressure, or depression make forms, appointments, phone calls, and referrals harder to manage. A missed appointment can leave a need unresolved. The unresolved need can make the next step harder still. Good services may exist, while the route through them exceeds the person’s capacity at that moment.

Fragmentation. One organization treats pain, another handles housing, another addresses employment, and another offers peer connection. Each can deliver what it promised without knowing whether the veteran’s circumstances are stabilizing. A referral made is not the same as a referral completed. A service completed is not the same as a life moving in a safer direction.

Research on military-to-civilian transition gives this problem a human shape. In interviews with ten recently discharged veterans who had experienced suicidal thoughts, urges, or behaviors, Edwards and colleagues (2026) identified a theme they called “transition whiplash”: unpreparedness, economic vulnerability, identity disruption, and social alienation. The study offers qualitative insight into those participants’ experiences; it does not establish how common that pattern is among all veterans. Participants also recommended a primary contact to help them navigate transition and more accessible peer support.

A person’s changing circumstances may be visible only in pieces.

The connection to suicide theory

Thomas Joiner’s interpersonal theory provides one way to understand why these trajectories might matter. It proposes that thwarted belongingness and perceived burdensomeness can contribute to suicidal desire, while the capability for a lethal act is a distinct part of the theory (Joiner, 2005; Van Orden et al., 2008). This is a theoretical lens, not a formula for predicting an individual’s death.

Loss of military community may weaken belonging. Relationship strain and isolation may deepen it. Unemployment or financial dependence may shape how a person sees their contribution to others. Chronic pain can make daily functioning harder. None of these experiences alone establishes suicide risk, and no one should assume that a veteran with them is suicidal.

Together, however, the systems lens and suicide theory pose a useful question: What happens when several conditions that support connection, purpose, and stability deteriorate at the same time?

The VA already describes suicide prevention as a public-health effort involving clinical care, community partners, and risk and protective factors. The task is to make that broad approach work across the points where a veteran’s life and our organizations intersect.

What we count, and what we miss

We can count screenings, appointments, calls answered, referrals, trainings, and event attendance. Those measures tell us whether work happened. They do not always tell us whether circumstances improved.

We should also ask: Who would notice if this veteran stopped showing up? Did a referral become a real connection? Is the veteran’s sense of belonging strengthening or fading?

These questions call for conversation and continuity, with the veteran’s consent and control over what is shared. They are not a new diagnostic checklist or a reason to treat ordinary struggles as proof of impending suicide. Nor can a dashboard reliably infer an individual’s intentions from a few data points.

They can, however, help us test whether our measures reflect the outcomes we claim to pursue.

“Call me if you need anything”

That sentence is usually sincere. It also asks the person who may be struggling to recognize a need, decide it is serious enough, overcome reluctance, choose whom to tell, and start a difficult conversation.

We can lower that burden. A friend can offer a specific invitation and follow up. A program can make it easier to return after someone misses an event. A transition navigator can stay with a veteran through a handoff. Two organizations can confirm, with permission, whether a referral actually resulted in contact.

None of these steps replaces treatment or crisis response. They make support easier to enter before someone has to announce a crisis.

Connection often begins with someone following up.

From a single moment to a changing life

“Is this veteran suicidal?” remains a necessary question when safety is at stake. It is not the only question. We can also ask, “What direction is this person’s life moving, and what could help change it?”

A large cohort study found that suicide rates after military separation were time dependent, generally peaking six to twelve months after separation. Risk varied by demographic and service characteristics; the study did not show that the stresses of transition caused any particular death (Ravindran et al., 2020). It does give us a reason to take continuity after separation seriously.

In practice, a systems approach would examine where contact breaks down and where a completed referral is mistaken for a resolved problem. It could then test a named point of contact, a warm handoff, or a simpler way to return after disengaging.

Meadows called places where changes can alter a system’s behavior leverage points. Better information flow is one possible point. But it must serve the veteran: useful information, shared appropriately, with consent, clear responsibility, and a real person able to act on it. More data without better relationships and follow-through will not solve the problem.

A veteran can encounter compassionate clinicians, effective programs, and a supportive family while gaps still emerge between them. The most useful question is not simply, “Who failed?” It is: Where did we lose the trajectory, and what would have made it easier to see and change earlier?

No single organization can answer that question alone. If everyone is helping, our next task is to make sure the help connects.

References

Edwards, E. R., Smith-Isabell, N., Epshteyn, G., Greene, A. L., Gorman, D., Hubay, D., Losieniecki, R., Appelt, C., Osterberg, T., Walker, M., Geraci, J., & Goodman, M. (2026). Veteran suicide thoughts and attempts during the transition from military service to civilian life: Qualitative insights. Death Studies, 50(1), 116–128. https://doi.org/10.1080/07481187.2024.2414283

Joiner, T. E. (2005). Why people die by suicide. Harvard University Press.

Meadows, D. H. (2008). Thinking in systems: A primer (D. Wright, Ed.). Chelsea Green Publishing.

Ravindran, C., Morley, S. W., Stephens, B. M., Stanley, I. H., & Reger, M. A. (2020). Association of suicide risk with transition to civilian life among US military service members. JAMA Network Open, 3(9), e2016261. https://doi.org/10.1001/jamanetworkopen.2020.16261

Simon, H. A. (1957). Models of man: Social and rational. Wiley.

U.S. Department of Veterans Affairs. (2026). 2025 National Veteran Suicide Prevention Annual Report: Part 1—Overview. Office of Suicide Prevention. https://www.mentalhealth.va.gov/docs/data-sheets/2025/2025_Annual_Report_Part_1_508.pdf

Van Orden, K. A., Witte, T. K., Gordon, K. H., Bender, T. W., & Joiner, T. E., Jr. (2008). Suicidal desire and the capability for suicide: Tests of the interpersonal-psychological theory of suicidal behavior among adults. Journal of Consulting and Clinical Psychology, 76(1), 72–83. https://doi.org/10.1037/0022-006X.76.1.72