Major John Ruocco came back from Iraq in 2004, joining his wife, Kim, and their two sons in their new house near the New Hampshire border.

Then 40 years old, Ruocco was a covert pilot in the U.S. Marine Corps and had flown 75 combat missions.

Weeks after returning stateside, he was dead. Like an alarming number of veterans, John Ruocco died by suicide.

More than 6,100 veterans in the U.S. killed themselves in 2017, and the rate at which veterans die from suicide has been going up for years as the population of veterans in the U.S. goes down. In 2017, 27.7 per 100,000 veterans died by suicide, up from 18.8 in 2007, according to a study by the U.S. Department of Veterans Affairs released in September. In those years, more than 67,000 veterans died by suicide nationwide.

And that doesn’t include those, like Ruocco, who were still on active duty when they died.

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The growing suicide rate among American veterans has prompted a massive effort – from the high school auditoriums of the South Shore and the halls of the White House and beyond – to get help for veterans in need before it’s too late. The push comes not just out of a recognition of veterans’ service for the country but because the suicide rate among them is 1.5 times higher than that of the rest of the U.S. population, which has also seen an increase in suicide rates.

The VA’s annual suicide report, started two years ago, is part of a push by the agency to tackle what it has called its top clinical priority. President Donald Trump signed an executive order in March meant to help stem the growing suicide rate by creating a Cabinet-level task force and encouraging more outreach through grants to community programs.

But experts say identifying veterans who are at risk is difficult — though not impossible — because every veteran has a different story.

“Every single suicide kind of has its different factors that lead up to (it),” said Kim Ruocco, now an executive at the nonprofit Tragedy Assistance Program for Survivors, which helps families after a veteran suicide and other service member deaths. “So that’s been one of the biggest challenges with suicide … figuring out how exactly do we identify those at risk and get them the right care in a timely manner.”The VA said in its report that a variety of factors contribute to suicide rates in general, included economic disparity, homelessness, unemployment, level of military service, disability status, community connection and personal health and well-being. Only about half of veterans use services or benefits provided by the VA, according to the department.

Suicide rates are particularly high among women and young veterans, who are also more likely to struggle with substance abuse, according to the VA report.

The latest numbers show that female veterans are 2.2 times more likely to die by suicide than their civilian counterparts, and that the highest rate of suicide among veterans in 2017 was for veterans ages 18 to 34.

Dr. Matt Miller, a veteran of the U.S. Air Force now serving as acting director of the suicide prevention program in the office of mental health and suicide prevention at the VA, said substance abuse among younger veterans, which is more severe than that of their civilian counterparts, can also be a suicide risk factor. And among younger veterans who died by suicide, almost half had a significant “relationship disruption” or other issue immediately prior to their death.

Though much of his work takes place at the highest levels of the VA, Miller says the key to suicide prevention will come from the communities where veterans live. He said community support, coupled with clinical support, is what works.

“You need those community-based interventions to support those clinically based interventions,” Miller said. “We’re also trying to demonstrate that suicide prevention is everyone’s business. It’s not something that’s resorted to the clinical psychiatrist or psychologist.” Miller pointed to the VA’s “Be There” campaign, launched in March, aimed at raising awareness about veteran suicide and getting conversations started about mental health. Community outreach for veterans in need is well underway in Massachusetts, where an average of 66 veterans died by suicide each year from 2005 to 2017, according to the VA.

Jennie Babcock, chairwoman of the Plymouth County Suicide Prevention Coalition, fears that number could be even higher because the lingering stigma around suicide means some deaths go unreported.

Babcock said outreach, education and increased awareness are key to helping veterans start getting the help they need. “When we ask veterans, ‘Are you OK?’ or ‘Are you thinking of suicide?’ we’re basically giving them permission to talk, because in the military they’re taught they need to ask permission for anything,” Babcock said. “Give them that opportunity to talk to us, then they’ll talk to us.”Gregg Brasso, the host of a veterans-focused talk show called “Veterans’ Voice” on Marshfield-based radio station WATD, has made it a mission to foster frank conversations about suicide among veterans. He said that chief among the factors that lead to suicide is lack of connection. “The suicide arena is really, I think it’s about loneliness. It’s about a disconnection from their troop brothers and sisters,” Brasso said.

Ruocco said military culture makes it more difficult for veterans to seek help. Service members are often trained to be tough and soldier on, Ruocco said, which can lead them to suffer in silence.She said she would like to see mental health training and awareness be incorporated into earlier stages of a service member’s training. She said prevention is important because suicide often follows a long period of trouble. “If you compare it to a physical ailment, if somebody has cancer and they are hiding it for 10 years and then you’re telling them to come forward when they can’t function, then you’re trying to then fix a problem that has been now eating away at that person for a really long time,” Ruocco said. “And in the case of veterans and service members, that erosion time can look like addiction problems or loss of job, criminal issues, relationship breakup and other things that just keep adding up, with the core of it being either a mental health injury or illness that is untreated.”Ruocco offered advice to all families: Start a conversation about mental health early. “I look back with my husband and it’s almost as if I watched him suffer with a long-term disease. And then when he was literally dying was the first time I realized he needed help,” Ruocco said. “So I would encourage people to have a conversation about mental health in your own families. Talk about it openly.” If you or someone you know is in crisis, call National Suicide Prevention Hotline at 800-273-8255. For veterans, press 1.

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