Many veterans usually don’t like to air their struggles or setbacks. Those things stay bottled up — partly because of an unspoken, understood code of self-reliance — and a silence around mental illness that echoes 'Don’t ask, don’t tell.'

But meeting for a free cup of coffee through Buddy Check Coffee, a program of the newly-formed Lakes Region Veterans Coalition, could help change that pattern — especially when openness is critical. For a few, it might open floodgates.

It’s a universal problem across rural America: Veterans scattered in hard-to-reach places are more isolated than ever because of the pandemic and the drought of social interaction it created — which has had tremendous fallout for mental health. Even before COVID-19 nixed opportunities for social life, suicide rates for veterans in rural areas significantly outpaced their urban counterparts. 

In New Hampshire, rural Belknap, Carroll, Carroll and Sullivan counties have the state’s highest suicide rates, including for veterans. In rural areas, life is spread out and the likelihood of finding a military peer to share experiences and advice can be slim. For veterans in the Lakes Region, an offer to get together for coffee on a regular basis may take on new meaning and urgency.

“Just having somebody to talk to who understands them. It’s so important for the overall health and wellbeing of this population,” said Kimbly Wade, substance misuse and suicide prevention manager for the Partnership for Public Health, and a board member of LRVC. “We want to create a network for veterans to have a sense of community within a community. People that have shared experiences that support one another.”

It can be a life-changing match. When veterans gather with other veterans, a frequent remark is, “Wow, it’s so great to be with other veterans I can talk to, people who understand me,” said Kurt Webber of Gilford, president of the Patriot Resilient Leader Institute and a co-founder of LRVC. “Because of what they’ve experienced in their lives and done in the military, they’re more likely to have those issues than the general public,” said Webber, a retired Army lieutenant colonel who also founded Camp Resilience, a therapeutic outdoor adventure program for veterans and first responders who battle post-traumatic stress disorder, depression and other mental illnesses. “A feeling of isolation is a major factor to anyone committing suicide and it’s definitely an issue for veterans.”

Perhaps Buddy Check will reduce that risk. Veteran suicide is projected to spike in rural areas nationwide because of the lingering isolation COVID has spawned. During the pandemic, homegrown efforts to bring veterans together have cropped up in rural pockets. A veterans coalition in northwest Montana, the state with the nation’s highest adult suicide rate, including for veterans, started buddy checks by knocking on doors, making phone calls, and delivering care packages of hand sanitizer, face masks and flyers about veterans services as well as stress balls and puzzles. The Veterans Coalition of Northwest Montana did something else to break ground. The group coached 26 members to become master trainers in suicide prevention, and they trained over 400 people in two years. Service to others has been found to boost resilience by giving veterans a new meaning and an important mission.

Buddy Check Coffee, unique in New Hampshire and the Lakes Region, provides participating veterans with a $5 gift card for coffee at Dunkin' or $10 if they don’t already know each other. Participants register online and are matched. It may be the nation’s first local veterans outreach to harness the healing powers of meeting one-on-one for coffee – in person or online. It’s a natural forum for veterans to reminisce, trade stories or military jokes, and establish connections that could become critical during personal difficulties and periods of stress. The goal is to provide sincere companionship — as well as way to relax — and get to know someone who may turn into a friend and an ally who reaches out on a regular basis, who can help link you to help.

“That Veteran-to-Veteran connection is something really powerful,” said Nathaniel Mohatt, national director of the Together With Veterans rural suicide prevention program for the U.S. Office of Veterans Affairs, which is jumpstarting rural community coalitions across the country. The local coalitions come up with individual strategies to increase suicide awareness, tactics to bring veterans together, and non-confrontational ways to connect them with mental health counseling if needed.

“These buddy checks are super, super important to helping people engage each other and mitigate the social isolation we’re all experiencing this year,” said Mohatt.

Being with peers who understand is far more satisfying than trying to explain military culture, combat experience, or complications adapting to civilian life to someone who has never walked that path. Some mental challenges are unique to veterans and first responders; others are more prevalent among them. National and regional data show veterans, especially females, have much higher rates of suicide than non-Veteran adult females. Trauma is common in military life, and sexual harassment and assault have become problems for both sexes, especially for women. For many veterans, the military code has encouraged valuable character traits such as inner toughness and a stoic, go-it-alone attitude that can be counterproductive when it insists on independence and a zipped upper lip in times of personal crisis.

“So much emphasis is placed on being a rough, tough shoulder. I’m sure that plays into people not admitting they have a problem and need help,” Webber said.

“They can feel isolated when they’re surrounded by people. It’s an internal feeling,” said Wade.

There are good reasons for starting Buddy Check Coffee now. Shannon Libby, a social worker at the Veterans Administration clinic in Tilton, says many veterans who come for primary care say they wish they just had someone to talk to. “There’s been a theme since I’ve been here. Veterans just want to be connected with one another,” and have an opportunity to explain their struggles, frustrations and successes, she said. “So many things that are unique to the military. If you were not there, you don’t really understand.” That includes integrating back into society and their community. In the Lakes Region’s small towns and outlying areas, many veterans have no easy way or a reason to gather, or ready access to care that is pertinent to them — dilemmas exacerbated by COVID.

According to 2017 data from Together With Veterans, a Veterans Administration program, male veterans ages 18 to 34 have the highest rates of suicide, but males veterans age 55 and older account for the most. The suicide rate for females who have served is more than twice the rate for female non-veterans. Firearms are involved in 69 percent of veteran suicides. According to 2018 data from the VA, New Hampshire’s Veteran suicide rate was twice the national suicide rate for all adults that year. “Veteran suicide is at a rate that is very disturbing," said Webber. According to the most recent average, 17 to 18 U.S. veterans die by suicide each day.

Global health studies indicate that suicide rates are significantly higher in almost all rural areas than in urban ones. During the last 15 years, U.S. suicide rates have grown fastest in rural regions. The most recent numbers suggest that veterans living in rural locations have a 20 percent higher risk of taking their own lives than their urban-dwelling counterparts, who benefit from easier access to health care and counseling and a broader array of Veteran-specific services.

Keith Gray retired in 2019 as superintendent of Belknap County Department of Corrections, and now serves on the board of LRVC. It’s well documented that many veterans become homeless, he said, and the divorce rate is higher for veterans than for the general public. Problems with depression, alcohol and drug abuse translate to higher suicide rates.

“A lot of veterans don’t reach reach out to one another, and it’s difficult for them to interact with other people who have not been in the military,” said Gray. “They get lost in a world of their own. Some people serve and when they get out, they just want to get away from it all.”

Gray, who served 20 years on active duty in the Navy, including as a chief petty officer and a gunner’s mate, stays in touch with his military peers through Facebook pages created for each ship he served on, and went to a reunion several years ago. Gray and others hope LRVC and Buddy Check Coffee will become new places where local veterans can reliably seek help and find companionship and empathy.

The problem of unconnected veterans remains a huge one. In New Hampshire, Hillsborough County veterans make up 22.5 percent of the state’s total VA enrollment, while Belknap County veterans comprise 8.9 percent, according to data from the Manchester VA. Nationally, the Veterans Administration sees fewer than 50 percent of all military service veterans, and VA benefits go only to those who were honorably discharged – which leaves a vulnerable population untapped. Shame and guilt can plague service members who left in cloudy circumstances. Veterans who are not connected to VHA healthcare have higher suicide rates, according to the VA.

Today, a compendium of factors increase suicide risk, including prior suicide attempts, access to lethal means (which is greater in rural areas), and stressful life events such as divorce, job loss or relationship difficulties (which can plague all veterans returning to civilian life). Homelessness, food insecurity, and death of a loved one are serious issues for veterans and civilians. Social isolation further ratchets up the risk, especially for veterans who suffer from major depression, anxiety, bipolar disorder, schizophrenia or PTSD.

“In a rural community, you can be really tight-knit, or break away and become really socially isolated,” said Mohatt, of Together With Veterans. Surveys show rural veterans are less likely to see a mental health specialist or primary care provider trained in Veteran health issues or suicide prevention. In rural counties and military culture, prejudices against seeking mental health treatment are a persistent barrier, seen as a sign of weakness considered less real or justifiable than having a physical ailment. Then there’s the rugged individualist mindset. Veterans are pre-programmed to think, “I can take care of this myself and suffer through this,” Mohatt said.

Although COVID-related data won’t be available for another two years, Mohatt said mental health providers who treat rural veterans are bracing for a rise in suicides post-pandemic. History shows that following natural disasters and wars — which unite people against a common threat — suicides increase after the crisis resolves. Veterans and non-veterans feel less bound together against an external foe, and those who were struggling with mental illness and suicidal thoughts beforehand drop back to feeling perpetually alone. “Briefly you thought you were together with your community. Then you return to square one after the crisis,” said Mohatt. “Afterward, you’re isolated with your pain again.” 

This makes Buddy Check programs potent medicine for the present, and for moving forward. Mental health research shows human connections have healing powers beyond medications or external rewards, and even group connections that are formally orchestrated can help.

“It doesn’t make you less of a man or a woman if you need to reach out for assistance,” said Gray, who remembers the values and pitfalls of military culture, which can create inertia or a “damned if you do, damned if you don’t” perspective on getting help. “There’s a certain type of machoism” in the military, Gray said. It’s almost a sign of frailty or inadequacy to admit vulnerability, much less an addiction or an inner sense of despair, and that prejudice against seeking mental health treatment is something the coalition is striving to remove.

“We can help them overcome what they’re dealing with. We could be an option,” said Gray.

For more information, to join LRVC or to sign up for Buddy Check Coffee, go to lrvcnh.org.

The Manchester VA is running a virtual coffee hour open to all veterans, a chance to meet with other veterans and talk and learn over coffee. While social in nature, meetings can also include education and resources. They are held Wednesdays from 9 to 10 a.m.

You can join the group by copying and pasting in a web browser: https://tinyurl.com/NHVetsCoffeeSocial

To join by phone: 872-701-0185  Pin: 431220211#

For veterans, crises can be heightened by their experiences during military service. If you’re a Veteran or service member and in crisis or are thinking about hurting yourself – or know a Veteran who is — you can get help right away, because you are not alone. Connect with the Veterans Crisis Line by calling 800-273-8255 and press 1. Anyone can receive support when experiencing a crisis or when struggling with thoughts of suicide by reaching out to the National Suicide Prevention Lifeline at 800-273-TALK (8255), as well as by texting TALK to 741741.

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