Combat Veterans and First Responders

Mental Health & Suicide Awareness

You carried others. You do not have to carry this alone.

An information guide from Stronger Mental Health (SMH) Counseling Services  •  September 2026

• 

IF YOU ARE IN CRISIS RIGHT NOW

Call or text 988  •  Chat at 988lifeline.org

Veterans, service members, and their families: Dial 988, then press 1  •  Text 838255  •  VeteransCrisisLine.net

If there is immediate danger, call 911. You do not have to be enrolled in VA care to use the Veterans Crisis Line.

This guide is written for combat veterans, active-duty service members, law enforcement, firefighters, EMS, dispatchers, corrections professionals, and the families who love them. It is also written for the partners, supervisors, chaplains, and friends who want to know how to help without making it worse.

At Stronger Mental Health (SMH) Counseling Services in Jasper, Alabama, we believe asking for help is not a weakness. It is a tactical decision. Roma Aaron, EdS, LPC, NCC, CTAPSB, EMDR—owner of SMH and a combat Army Veteran—built this practice so people who have seen the hard things have a confidential place to put them down.

Why This Conversation Matters

Combat and first-responder work trains people to stay functional under pressure. That same training can hide injury. Repeated exposure to death, moral injury, sleep loss, public scrutiny, and the expectation to “suck it up” stacks over years. Suicide risk rises when pain outruns connection, when alcohol or pills become the only off-switch, and when a person starts believing the team would be better off without them.

The data below is not meant to scare anyone. It is meant to name the problem so it can be treated like any other occupational hazard: with training, gear, and backup.

The Numbers: Veterans and Combat Service

The U.S. Department of Veterans Affairs 2025 National Veteran Suicide Prevention Annual Report (covering deaths through 2023, released in 2026) is the most current comprehensive federal picture.

•         6,398 Veterans died by suicide in 2023 — 44 fewer than in 2022, and lower than 14 of the previous 15 years. Progress is real. The work is not finished.

•         About 17.5 Veteran suicides per day in 2023 (down slightly from 17.6 in 2022).

•         61% of Veterans who died by suicide in 2023 were not receiving VA health care in the last year of their life. Connection to care matters.

•         Age-adjusted rates rose slightly from 2022 to 2023: 37.3 to 37.8 per 100,000 for male Veterans, and 13.7 to 13.9 for female Veterans.

•         Younger Veterans (ages 18–34) remain a high-risk group. Transition out of service, relationship strain, pain, TBI, homelessness, and unsecured firearms are frequently identified risk factors.

•         Firearms were involved in about 73% of Veteran suicides in 2023, compared with about 53% of non-Veteran adult suicides. Temporary, voluntary secure storage during a high-risk window can save a life.

•         PTSD is common after combat deployments. VA research has long reported that nearly 1 in 4 Veterans who served in Iraq or Afghanistan and use VA care experience PTSD. Recent national survey work has also found high and, in some cohorts, rising rates of PTSD, generalized anxiety, and suicidal ideation among combat-era Veterans.

Active-duty military suicides fell in 2024 (471 deaths, an 11% drop from the prior year, according to the Department of Defense), but the long-term active-duty rate has still trended upward since 2011. Most service members who died by suicide were enlisted men under 30. Relationship problems, workplace strain, and mental health or substance diagnoses were common in the records.

The Numbers: First Responders

First-responder suicide is undercounted. Many deaths are not flagged as occupational. Still, the picture is consistent: police, fire, EMS, and dispatch live with trauma loads far above the civilian average, and stigma inside the job still keeps too many people silent.

•         SAMHSA estimates about 30% of first responders are affected by PTSD and/or depression because of the work; about 20% of those also struggle with a substance use disorder.

•         First H.E.L.P. documented 163 first-responder suicides in 2024 and 145 in 2025, with 148 reported in one 2025 organizational tally. These are confirmed reports, not a complete census.

•         U.S. Fire Administration research has placed suicide rates near 17 per 100,000 for police and 18 per 100,000 for firefighters, versus about 13.5 per 100,000 in the general public.

•         In many years, more officers and firefighters die by suicide than in the line of duty. That finding, first widely publicized by the Ruderman Family Foundation, continues to hold in later tracking.

•         Firefighter Behavioral Health Alliance data have shown more than 100 confirmed firefighter and EMS suicides in recent years; the Alliance estimates the true number may be roughly 40% higher because of underreporting. About 20% of confirmed 2024 firefighter/EMS suicides were retired members. The job does not end when the uniform comes off.

•         Law enforcement analyses have found suicide rates around 21 per 100,000 officers (2016–2022) and elevated risk compared with other working adults. Firearms are the predominant method.

•         Lifetime suicidal ideation among firefighters has been reported as high as nearly 47% in some studies. EMS personnel have been found in multiple reviews to carry substantially elevated suicide risk compared with civilians.

In Alabama, community reporting in 2026 noted more than 100 first-responder suicides nationally in 2025 and highlighted local peer-support work through groups such as the Alabama Law Enforcement Alliance for Peer Support (ALLEAPS). First responders here are not invisible. Support exists. It is underused.

What the Injury Often Looks Like

PTSD is not the only wound. Combat veterans and first responders commonly carry a mix of:

•         Hypervigilance that will not turn off at home

•         Irritability, rage, or emotional numbness

•         Nightmares, poor sleep, or using alcohol to force sleep

•         Avoidance of crowds, certain calls, or anything that smells like “that day”

•         Guilt for surviving, or guilt for not saving someone

•         Moral injury — the sense that a line was crossed, or that the system failed people you were supposed to protect

•         Depression, anxiety, panic, and a shortened fuse with family

•         Substance use that started as “taking the edge off”

•         Relationship strain, isolation, and the belief that nobody who was not there could understand

•         Suicidal thoughts that come and go, then stay longer

None of this means a person is broken or unfit. It means the nervous system did its job in a high-threat environment and has not yet been given a safe way to stand down.

Warning Signs — In Yourself or Someone You Serve With

Watch for change from that person’s baseline, not a Hollywood checklist.

•         Talking about being a burden, being trapped, or having no reason to keep going

•         Giving away gear, weapons, or things that used to matter

•         Sudden calm after a long stretch of agitation (sometimes a decision has been made)

•         Increased drinking, pills, or risk-taking

•         Withdrawal from the crew, family, church, or hobbies

•         Rage, reckless driving, or looking for a fight

•         Sleep collapse or not sleeping at all

•         Talking about death as a relief, or researching ways to die

•         Saying goodbye in a way that does not match the moment

If you see several of these, treat it like a mayday. Do not wait for certainty.

How to Help — Without Making It Worse

You do not need perfect words. You need presence, directness, and a plan.

1.       Ask the question out loud. “Are you thinking about killing yourself?” Asking does not plant the idea. It opens the door. Soft language (“Are you okay?”) is easy to dodge.

2.       Listen more than you fix. Do not argue them out of their pain. Do not say “You’ve got so much to live for” as a rebuttal. Say: “I’m here. I’m not leaving. We are getting help.”

3.       Reduce lethal means for a window of time. Most suicide attempts that become deaths happen in a short spike of despair. Temporary, voluntary firearm storage with a trusted person, a department locker, or an Alabama S.A.F.E.R. Together partner FFL can buy time. Remove or lock excess medication. This is not confiscation. It is covering someone’s six.

4.       Stay with them and make the call together. 988 or 988-then-1. Do not drop them a number and walk away. Offer to drive. Offer to sit in the waiting room.

5.       Protect their career when you can, and do not lie about safety. Fear of losing a badge, security clearance, or custody keeps people silent. Confidential peer lines and private counseling exist for a reason. If someone is in imminent danger, safety comes first.

6.       Follow up after the crisis. The week after a close call is when people feel ashamed and drop out of care. A text that says “Still with you” matters.

What not to do: do not swear them to secrecy if they are unsafe. Do not mock “being soft.” Do not leave them alone with a loaded firearm during a crisis. Do not make their pain about your discomfort.

Coping Skills That Work in This Culture

Skills have to fit the job. Ten minutes of incense and a gratitude journal will not survive a 24-hour shift. These do.

In the moment (60 seconds to 5 minutes)

•         Physiological sigh: two inhales through the nose (second one on top of the first), long exhale through the mouth. Repeat 3–5 times. This is a fast downshift for a keyed-up nervous system.

•         5-4-3-2-1 grounding: name 5 things you see, 4 you can touch, 3 you hear, 2 you smell, 1 you taste. Pulls you out of a flashback or spiral without anyone noticing.

•         Box breathing (used by special operations and tactical teams): inhale 4, hold 4, exhale 4, hold 4. Run it before you walk into the house so the family does not get the leftover adrenaline.

•         Cold water on face or wrists, or a cold shower after a bad call. Temperature is a circuit breaker.

•         Name it without judging it: “That’s the after-action dump. It will pass.” Labeling reduces the sense that you are losing control.

After the shift

•         Debrief with someone who gets it — a peer, chaplain, or counselor — not only with alcohol.

•         Protect sleep like equipment. Dark room, same window when possible, no news in bed. Sleep loss is a suicide risk factor, not a badge of honor.

•         Move your body. A walk, a lift session, or yard work discharges what talk has not reached yet.

•         Limit the “second shift” of scrolling crash videos and department rumor. Your brain does not know that is not another call.

•         Keep one civilian ritual that is not about the job: fishing, church, cooking, a kid’s ballgame.

Over the long haul

•         Build a written safety plan: warning signs, people to call, reasons to stay, and who holds spare keys or stores a firearm during a bad stretch.

•         Treat pain, TBI, and sleep apnea. Physical injury drives a large share of Veteran suicide risk.

•         Get substance use help early. First-responder and Veteran programs exist that keep you with peers, not in a mixed civilian group that does not speak your language.

•         Let family have their own support. Spouses and kids absorb secondary trauma. Couples work is not a luxury.

•         If talk therapy has stalled, ask about trauma-focused care: EMDR, Cognitive Processing Therapy, Prolonged Exposure, CPT, DBT skills, or somatic work. Different nervous systems need different tools.

Point of Contact: Who to Call

National crisis lines (24/7, confidential)

Resource	How to reach them
988 Suicide & Crisis Lifeline	Call or text 988  •  988lifeline.org
Veterans Crisis Line	988, then press 1  •  Text 838255  •  VeteransCrisisLine.net  (no VA enrollment required)
Crisis Text Line (first responders)	Text BADGE to 741741
COPLINE (law enforcement peers)	1-800-267-5463  •  copline.org
Safe Call Now (first responders & families)	(206) 459-3020
IAFF Share the Load (fire/EMS)	888-731-FIRE (3473)  •  iaff.org
Fire/EMS crisis support	Firestrong: (844) 525-3473
Vets4Warriors (Veteran peers)	855-838-8255

Alabama and local contacts

Resource	How to reach them
ALLEAPS / ALEA peer support	833-219-2461 (24/7 dispatch for LE, fire, EMS, dispatch, families)  •  alleaps.org
Alabama 988 / ADMH crisis system	988  •  Connect Alabama app for local treatment search  •  mh.alabama.gov
Crisis Center (central Alabama)	(205) 323-7777
Birmingham VA / Veterans Response Team	Veterans Crisis Line 988-1  •  Birmingham VA ED (205) 933-4518  •  East Clinic (205) 957-5300
Birmingham Vet Center	400 Emery Drive, Suite 200, Hoover, AL  •  (205) 212-3122  (confidential, no-cost counseling for Veterans, service members, families)
S.A.F.E.R. Together Alabama	safertogetheral.org — voluntary, confidential temporary firearm storage for military, Veterans, and first responders
Wings Across Alabama Veteran peer line	1-844-999-4647  •  wingsacrossal.org
Northwest Alabama Mental Health (Walker Co.)	After-hours: (205) 302-9000
Bradford Health first-responder program	24-hour line: (205) 547-2727 (peer-group substance use treatment)

Also useful: Code Green Campaign (first-responder mental health education), Give an Hour (free counseling for post-9/11 Veterans and families), and the VA’s PTSD Coach app.

What SMH Counseling Provides

Stronger Mental Health Counseling Services is a private practice in Jasper, Alabama, founded and led by Romalyn “Roma” Aaron, EdS, LPC, NCC, CTAPSB, EMDR. Roma is a combat Army Veteran. That is not a marketing line. It is the reason the room is built the way it is: direct, confidential, trauma-informed, and free of the civilian instinct to flinch when you tell the truth about a call or a deployment.

Who we serve

•         Combat veterans, Veterans of all eras, and military families

•         Law enforcement, fire, EMS, dispatch, corrections, and other first responders

•         Spouses, partners, and children carrying secondary trauma

•         Adults, teens, children, and older adults

•         People facing PTSD, moral injury, suicidal ideation, depression, anxiety, grief, anger, substance use, dual diagnosis, relationship strain, and the quiet erosion that happens after years on the job

How we work

SMH uses a client-centered, culturally respectful approach. You keep your dignity. You are not asked to perform “brokenness” to get care. Treatment is matched to the person, not a one-size protocol.

•         EMDR to process stuck trauma so the body stops treating last year like it is still happening.

•         Trauma-focused and somatic work for people whose symptoms live in sleep, muscle, and startle response, not just in thoughts.

•         CBT and DBT skills for depression, panic, anger, and the urge to use substances as armor.

•         Motivational Interviewing when part of you wants change and part of you does not trust it yet.

•         Family and couples counseling because the people at home are part of the mission.

•         Substance use and dual-diagnosis support (Roma is also an Alcohol & Drug Counselor).

•         Crisis intervention and safety planning when suicidal thinking is present — including work around means safety, sleep, pain, and who is on your call list at 0200.

•         Psychological testing and evaluation when clarity about diagnosis or functioning would help.

Sessions are available in person and online, with flexible hours built around shift work. Two Jasper locations:

•         Stronger Mental Health Counseling Services — 310 AL-195, 2nd Floor (enter around the back of the building and come upstairs), Jasper, AL 35504

•         Mind Body Heart Wellness Center — 401 4th Avenue South, Jasper, AL 35501

Cost, insurance, and confidentiality

Individual sessions are $100. Couples sessions are $150. A sliding scale may be available. SMH is in-network or credentialed with a wide range of plans, including TRICARE, VA Community Care Network (CCN), TriWest, Blue Cross Blue Shield, Aetna, Cigna, UnitedHealthcare/Optum, Medicaid, Medicare, All Kids, BHS, Carelon, Anthem EAP, GEHA, and others. Self-pay is welcome.

Counseling here is confidential. Like every licensed clinician, Roma follows Alabama law and HIPAA. The limits of confidentiality — imminent danger to self or others, and legally required reporting — will be explained clearly at the start so there are no surprises. Fear of a fitness-for-duty hit is real in this community. That fear is discussed openly, not dismissed.

How to start

Call SMH Counseling at (205) 273-6848 or (205) 388-8197. Say you are a Veteran, a first responder, or a family member. You do not need the perfect speech. “I think I need to talk to someone” is enough.

A Direct Word to the Person Still White-Knuckling It

You have already done harder things than sitting in a chair and telling the truth. The job taught you to ignore pain until the mission was over. For a lot of people in this work, the mission never ends — it just changes zip codes.

Suicide is not a character failure. It is what happens when pain, isolation, sleeplessness, and access to lethal means line up at the same time. That lineup can be interrupted. People who were sure they would not make it through the night are still here because someone asked, someone stored a firearm for a week, someone sat in the truck and dialed 988 with them, or someone booked a first appointment.

If you are reading this for yourself: make the call before you “feel ready.” Readiness is a myth. If you are reading this for someone else: do not wait for them to come to you. Go to them.

Stronger together. That is not a slogan. It is the only way this work has ever been done.

STRONGER MENTAL HEALTH COUNSELING SERVICES

Romalyn “Roma” Aaron, EdS, LPC, NCC, CTAPSB, EMDR  •  Combat Army Veteran

310 AL-195, 2nd Floor, Jasper, AL 35504  •  401 4th Avenue South, Jasper, AL 35501

Phone: (205) 265-2226  •  (205) 757-9872  •  In person and telehealth

Crisis: 988  •  Veterans: 988, then 1  •  Text 838255

Sources and Notes

Statistics change as new reports are released. Figures in this guide are drawn from publicly reported data current as of 2026, including:

•         U.S. Department of Veterans Affairs, 2025 National Veteran Suicide Prevention Annual Report (2023 deaths; released 2026) and related VA Office of Suicide Prevention briefings.

•         U.S. Department of Defense annual suicide report covering calendar year 2024.

•         Substance Abuse and Mental Health Services Administration (SAMHSA) first-responder behavioral health estimates.

•         First H.E.L.P. / First H.E.L.P. published tracking of first-responder suicide deaths; Firefighter Behavioral Health Alliance confirmed-case reports; U.S. Fire Administration occupational suicide research.

•         Peer-reviewed and agency summaries on law-enforcement suicide mortality, firefighter ideation rates, and EMS risk.

•         Alabama Department of Mental Health crisis system, ALLEAPS, Birmingham VA Veterans Response Team, and Vet Center public listings.

This article is educational. It is not a substitute for emergency care, a fitness-for-duty evaluation, or an individual clinical assessment. If you are in danger, call 988 or 911.