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Image © iStock/ Mariia Vitkovska
June 2, 2026
By Marcus Henry
VA Research Communications
“Veterans helping one another is the antidote to being suicidal. We’re recreating units for people.” — Dr. Marianne Goodman, James J. Peters VA Medical Center
He is wearing the same shirt he had on three days ago.
That detail matters because it tells you where he is: not just standing on a bridge in New York, contemplating jumping, but in the kind of depression where changing clothes is already too much to ask. Where time has stopped meaning anything. Where the distance between yesterday and today isn’t measured at all.
He reaches into his breast pocket — the way you do when you’re looking for something you forgot you had — and pulls out a folded piece of paper. It’s the safety plan a clinician handed him at discharge. He had stuffed it in his pocket when he left the hospital and hadn’t thought about it since.
He unfolds it. At the top, in his own handwriting, are the words he had written before the weight of everything came back: The one thing I have to live for is my kids.
He walks back from the bridge.
He calls his doctor.
That phone call reaches his clinician, Dr. Marianne Goodman, a psychiatrist at the James J. Peters VA Medical Center in the Bronx. It stops her cold. Not because the crisis has passed, but because of what it reveals: a man in the worst moment of his life had reached into his pocket and found a reason to stay.
The safety plan worked. The Veteran had written something true on it, something that mattered enough to pull him back.
“That is the moment that I said, ‘Holy … If I make these safety plans powerful, meaningful, accessible, I can save a life.’ — Dr. Marianne Goodman” —
That was more than a decade ago. Dr. Goodman said she didn’t know the first thing about safety plans at the time, but she went on a mission to find out.
What she has since built from that phone call is Project Life Force (PLF), a group-based safety planning intervention for Veterans at the highest risk of suicide, supported in part through VA’s Office of Suicide Prevention-funded center for advancing community-based suicide prevention research.
In 2023, 6,398 Veterans died by suicide — roughly 17.5 per day. According to VA’s 2025 National Veteran Suicide Prevention Annual Report, the suicide rate among Veterans is at its highest point since 2018. Among all Veterans who died by suicide that year, 61% had no recent VA care. They were outside the system entirely in the final year of their lives.
The emergency room visit, or the inpatient discharge, is one of the few moments where a clinician has direct contact with those Veterans most at risk. Federal policy requires clinicians to complete a safety plan at that moment. The intention is sound, but Goodman will tell you plainly that the execution often isn’t.
“They don’t do it necessarily very well. It became like a check-the-box kind of thing. Sometimes it’s done in 10 minutes.” — Dr. Goodman
A piece of paper handed to someone in crisis, and then the door closes.
That is what Project Life Force set out to fix.
Project Life Force is a 10-session structured group intervention. Veterans enter at the point of highest risk, coming off an inpatient unit or out of an acute outpatient crisis. The group is rolling admission, which means Veterans who are further along in their recovery are already there when someone new walks in. That is not by accident.
“There are people who have been in this group for a longer period of time, who are further along in their recovery process. It’s helpful to kind of look ahead and see people who are doing better but who understand how hard it is.” — Dr. Goodman
Each session covers one step of the safety plan. Warning signs. Coping strategies. How to identify people to put on the plan, how to ask them, how to word it. Veterans role-play the conversation. They practice calling 988, and as homework they actually call the number. They come back the following week and report what happened.
The curriculum is procedure-driven and specific. What it is not is clinical in the sterile sense. Veterans are asked to disclose suicidal symptoms out loud, in a room with other Veterans who are doing the same. It’s not something pushed to the side. It is the subject. One session is devoted entirely to listing out reasons for living.
Goodman said she got the interventions wrong her first time, starting with large goals like reconnecting with estranged family members or rebuilding careers. The Veterans pushed back. “Are you kidding?” one told her. “I can’t even get a bed.”
So she went back to the research. She found a Canadian website cataloging a thousand reasons for living, small ones, specific ones. Chocolate chip cookies in the oven. The first snow. Stomping in leaves. She reads them aloud with the group now. People start reflecting. The therapists write down what they hear. At the end of the session, those reasons get stapled to the safety plan.
It is not just a document anymore. It is something they built together.
“One person actually said, ‘Every time I look at that safety plan, it reminds me of the other people in the group. It becomes something much more meaningful than the piece of paper you’re given as you leave the hospital.’” — Dr. Goodman
The program now runs across multiple VA settings, including the Suicide Prevention 2.0 clinical resource hubs serving the highest-risk Veterans in the country. It operates in person, virtually, and in hybrid formats. There are sites in New York, Michigan, Houston, and southern New Jersey. Each one has adapted the model to fit its Veterans without losing the core of what the model is.
In southern New Jersey, a peer suicide prevention program had made Project Life Force the core of what it does. Veterans come in, go bowling, go fishing, build something together. PLF is the spine of it all. Peer specialists with lived experience co-facilitate the groups. They model what it looks like to use a safety plan — not explain it, use it — in front of everyone.
In Michigan, the team drives two and a half hours, picks up Veterans one by one, and brings them to breakfast at the end of each cycle. A van full of people who spent 10 weeks keeping each other alive.
“Veterans helping one another is the antidote to being suicidal. You can’t really be suicidal if you’re helping somebody else, because you’re caring about that connection. And to be cared for means you matter. We’re recreating units for people.” — Dr. Goodman
Ian Brady did 20 years in the Marine Corps. He joined in 1997, served as military police, was a drill instructor twice, shot competitively, deployed to Iraq, and retired in January 2017 as a gunnery sergeant. He had a plan.
That plan did not include what happened in the last year of his service.
Brady had been struggling for years. Deployments to Iraq, then straight to Okinawa with no transition, no downtime. Sleep was bad. Anxiety was bad. He started seeking help as far back as 2010 but spent years fighting the stigma of being a staff non-commissioned officer (NCO) with problems. When a provider finally recommended him for Wounded Warrior, he fought it for two and a half years. Then he accepted it.
Then his commanding officer told him no. Brady said he was told, “You have two arms, two legs. Just suck it up.”
Brady left that office and went to the armory. He had a match-grade competition 1911. He knew exactly how much trigger pressure it took to fire. He put the weapon in his mouth.
What stopped him was a single image. Every day when he came home, his young son would run to him and want to go to the park across the street. As Brady’s finger was on the trigger, one thought arrived: who’s going to take him to the park today?
He was so afraid pulling the weapon out that he thought touching his tooth might set it off. He put it down, checked it back in, and called someone. That person called 911. His own military police came to get him. He talked his way out of inpatient care that day. His oldest son, then about 17, came to pick him up from the hospital.
They told his wife Amanda it was an anxiety attack. She didn’t learn what had actually happened until nine years later.
Brady is now a peer specialist at the Wilmington VA in Atlantic County, New Jersey, working on the same team as supervisory peer specialist Patrick Carney. When Brady joined the VA, Carney and their licensed clinical social worker (LCSW) coordinator Matt Jacobs approached him about building a Veteran peer suicide prevention program. They wanted his input specifically because of his history. He was in immediately.
“I wanted to bring to this program everything that I needed but no one offered me, or I was too proud to ask for.” — Ian Brady
He came to PLF as a co-facilitator alongside Carney, not as a patient. In the first session, he discovered he could not have told anyone what was on his own safety plan — he had no idea what it said.
“I think all too often, the first time people are doing their safety plan, they’re in crisis. ‘I don’t care. I’m going to say whatever you want me to say to get out of this office because I’m not in a good headspace right now.’” — Ian Brady
What changed through PLF was not his knowledge of the plan, it was his relationship to it. He has since revised his safety plan with every single cycle he has facilitated. A tweak here, a name updated there. He knows every item on it now without looking.
It was Dr. Goodman who finally told him he needed to tell Amanda the full truth before he told it to a room of strangers. He had been scheduled to speak at a Veterans event, prepared to walk 200 people he had never met through the details of that day. Amanda might be in the audience.
He went home, waited until she was reading in bed, and told her. She smacked him, kissed him, hugged him, and cried.
Eight years in the Army as an infantry staff sergeant, Patrick Carney had a plan to do 20 years and retire. The Army had a different plan.
After multiple surgeries and a medical board, his shoulders were held together with pins, and he couldn’t carry a rucksack anymore. In 2013, they showed him the door. There was no handbook for what came next.
What followed was, as Carney puts it plainly, a hell of a time. A first suicide attempt in the spring of 2014. A second not long after. He was in a wheelchair recovering from knee surgery, shoulders too damaged to use crutches, in school on a stipend while his wife Melissa worked full time.
The moment he describes most clearly happened on a highway. He had been running an errand for his father, picking up a part for a lawnmower. He was on his way home when the intrusive thought hit: ‘I’m just an errand boy. I don’t deserve to be here anymore.’
He pointed his truck at a tree.
His phone rang.
It was a man named Ed, calling to tell him a golf program had finally gotten off the ground and Carney was going to be the first one in. He hung up and called Melissa. He did not tell her how close it had been, he just called her and cried.
“She was the only person I could share any of my emotions with. Man, that was it. That was the moment.” — Patrick Carney
Carney is now Brady’s supervisor. They run Project Life Force together every Tuesday at 10 a.m. at the Wilmington VA. By design, nothing moves that appointment.
Fourteen of the men Carney served with have died by suicide. Brady has lost close friends to it as well. When the anniversaries come, when new news arrives, their thoughts go somewhere dark and they know it. They have learned not to wait it out alone.
No one who walks into their group on a Tuesday morning waits it out alone.
Veterans kept telling Goodman what Project Life Force was missing, so the program kept building. Veterans in rural Arkansas told her they had put their spouses on their safety plans, but the spouses didn’t know what that meant. They didn’t know what to say when something was wrong. They didn’t know what to do. Many had never even heard of 988.
So last summer Goodman convened an advisory board of Veterans, spouses, lived experience peers, and a parent whose son had been suicidal — the military had handed him his son at discharge with no instructions. They met seven times. They told her what family members needed to know and what the program had never given them. Together, they designed a five-session module for the spouses and family members identified on a Veteran’s safety plan.
Goodman began her first spouse and family member session just recently. They all had their materials. They all checked in on time. They all said they’re looking forward to coming back next time. One spouse said she felt like she’d been drowning.
The module is the latest iteration of something that has been expanding since the pandemic. Goodman had moved the groups to virtual when she realized she could reach Veterans in rural Arkansas, Veterans who weren’t in VA care at all, Veterans in places where a 10-minute safety plan at discharge was the only thing standing between a crisis and a firearm that wasn’t locked up. That had now led to something even greater.
“This thing keeps morphing to meet people where they’re at.” — Dr. Goodman
What Melissa Carney and Amanda Brady had to learn through painful experience, they had now helped build into a curriculum so others would not have to.
When things get serious now, Patrick Carney hands the keys to the gun safe to his wife.
“Just because I give you my keys doesn’t mean that everything needs to stop. It just means one of us is weaker in the moment than the other.” — Patrick Carney
“He’ll say, I’m giving this to you. Don’t tell me where it’s at. And then we get into talking, and he’ll let me know what’s going on.” — Melissa Carney
After that they might walk the dogs, or he plays a video game, or they just sit together until the weight shifts and he lets her know he is okay. He will not ask for the keys back until he is sure.
For the Bradys, it went a little differently. Last June Amanda and Ian had developed a contingency plan with Patrick. It proved to be a literal lifesaver.
On one October evening Amanda and Ian had argued. Things were said. Ian went upstairs. Amanda saw him come back down with a gun case. She did not panic. She picked up the phone and called Patrick Carney, who lives a few blocks away.
By the time Patrick answered, Ian was already pulling into his driveway. Amanda knew to call Patrick because of the family module. Four months of sessions had given her the one thing the military never provided: a plan for what to do when everything goes wrong.
“Before that, I would not have known what to do.” — Amanda Brady
The evidence behind Project Life Force has been building for a decade, one careful study at a time.
The first published trial appeared in the Archives of Suicide Research in 2020. It was a small open trial, just 31 Veterans at the James J. Peters VA in the Bronx, and it was never designed to prove anything definitively. It was designed to find out whether the program was feasible, whether Veterans would show up and stay, and whether the data pointed in the right direction.
They showed up. Seventy-seven percent of Veterans who completed a baseline assessment attended all 10 sessions. Those Veterans who made it through the first three sessions completed all 10. The data pointed where Goodman hoped: statistically significant decreases in suicidal ideation severity, depression, and hopelessness. The paper called for a larger, adequately powered randomized clinical trial (RCT).
That trial is now complete.
For over six years, VA-funded researchers compared Project Life Force, delivered as an adjunct to usual care, against usual care alone, in a study formally titled “Group (Project Life Force) versus Individual Suicide Safety Planning.” The primary outcome was time to suicidal behavior. The results have been submitted to a peer-reviewed journal; revisions have been requested, and resubmission is imminent.
The research also addressed a question that arose when the pandemic shut down in-person care in March 2020 and the trial shifted entirely to telehealth: would anything be lost? A published cost analysis found telehealth delivery cost about $690 less than in-person treatments per Veteran, with no difference in attendance between the two formats. A separate qualitative study of Veterans who participated in the telehealth version rated it highly acceptable, appropriate, and feasible, and reported that it enhanced their ability to manage suicidal urges and reduced loneliness. Nothing was lost. Something may have been gained.
In southern New Jersey, where Carney co-facilitates the Peer Mentoring, Camaraderie, and Support Program (PMCS), which uses PLF as its core, the results have already been published. A 2025 paper in the Patient Experience Journal documented a 77.8% reduction in suicidality among program participants, along with a 35.2% decrease in depression symptoms, a 23.6% decrease in post-traumatic stress disorder (PTSD) symptoms, and a 33.7% increase in perceived interpersonal support. The program’s name is a deliberate copy of a U.S. Army acronym, Preventative Maintenance Checks and Services, the tasks Soldiers complete to keep their equipment combat ready. The idea of readiness is the same, but now the focus is on the Veteran.
“Whatever branch you were, we always trained for the bad stuff with the hopes it wouldn’t happen. If you’ve done the drills, if you’ve done it before, if you know what’s on that information, it’s going to be that much easier.” — Ian Brady
Project Life Force is currently running in roughly 10 VA settings, but there are 18 Suicide Prevention 2.0 clinical resource hubs across the country, serving the highest-risk Veterans in the system. Goodman’s five-year goal is straightforward: she wants PLF in all of them.
Because it works.
In a randomized clinical trial of 207 high-risk suicidal Veterans, of those Veterans in the PLF group, 14.9 percent had an actual suicide attempt during the trial period. Among those in the comparison group, 26.4 percent did. Furthermore, those who received Project Life Force (PLF) in addition to their usual care took significantly longer to reach a first actual suicide attempt than those receiving usual care alone. If that rate continued into a nationwide implementation, it could save about 2,700 Veteran lives a year – a reduction in suicide of 40%.
But the most telling finding was not the rate. It was the direction. PLF shifted the trajectory of suicidal behavior away from actual attempts and toward aborted or interrupted behavior, meaning Veterans were stopping themselves. The program did not just delay the worst outcome. It changed what kind of outcome was possible.
Veterans in the PLF group also showed significant improvements in suicide-related coping at three and six months, including better use of outside supports, greater knowledge of emergency resources, and increased willingness to reach out to providers. By six months, internal coping had improved as well, including self-efficacy and the ability to manage crisis from the inside.
Those are the outcomes of a group built around a piece of paper.
The safety plan is still a piece of paper. That has not changed. What has changed is what happens to it, and to the person holding it.
The Veteran who brings it to a Tuesday morning meeting in southern New Jersey. Or riding in a van in Michigan on the way to breakfast. Or bonding with others across a screen in rural Arkansas.
Built up in a group, over 10 weeks, one step at a time. The safety plan gets the names of real people on it, people who have been asked and have said yes. It gets reasons for living stapled to the back of it, small ones, specific ones, things worth staying for. When a Veteran looks at it in a hard moment, they don’t see a check-the-box document a clinician handed them at discharge, they see the faces of the people who helped build it.
That is the intervention. Not the paper. The people.
Goodman has been at the James J. Peters VA for 27 years. She did not set out to build a suicide prevention program. She set out to answer a question a phone call forced her to ask: what would it take to make a safety plan matter enough to save a life?
The answer, it turns out, is other Veterans.
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