In 2025, more than 48,000 people in the US died by suicide—more than twice the number who died by homicide. US Military personnel are disproportionately affected, especially in the National Guard (NG) where suicide rates (27.6/100,000) are the highest of all the Armed Forces and twice those of similar-aged individuals in the US population.
As suicide rates also rise among military family members, University of Michigan Injury Prevention Center researcher Mark Ilgen, Ph.D. — a clinical psychologist and investigator with the VA Center for Clinical Management Research (CCMR) at the VA Ann Arbor Healthcare System — and his team undertook a new collaboration with the Michigan Army National Guard aimed at empowering military service members with tools they need to address their own crises and help others in need.
Although crisis lines (including the Military & Veterans Crisis Line and the 988 Suicide and Crisis Lifeline) are widely available, many service members do not know how to use them or what to expect when they call. This study tested a brief, group-based intervention called Crisis Line Facilitation (CLF) to increase awareness, confidence, and willingness to use crisis line services among Michigan Army National Guard (MIARNG) soldiers.
By testing and refining Crisis Line Facilitation in diverse units, we developed a ready-to-use implementation toolkit, including:
- Participant Workbook (revised for private engagement and future reference)
- Comprehensive Facilitator Manual (step-by-step group guidance)
- Training Outlines (in-person or train-the-trainer formats)
- Fidelity and Process Tools
- Implementation Guidance aligned with military settings
The materials are designed to function as stand-alone resources that can be distributed widely.
We connected with Dr. Ilgen for a short Q&A exploring this IPC core research project.
Suicide rates among Active-Duty Military and Veterans remain elevated relative to the general US population, with National Guard service members consistently being a particularly high-risk group. Concerningly, suicide rates among military family members, including spouses and children, have also risen over the past decade, underscoring the broader impact of this issue beyond the individual service member. While many prevention efforts focus on intervening during acute crises, fewer approaches take a universal, upstream strategy that equips all service members with the knowledge and tools to support others in distress. In particular, there is a gap in awareness and understanding of accessible resources such as crisis lines, which can be critical in moments of need. To address this, we developed and implemented Crisis Line Facilitation (CLF), a brief, group-based intervention designed to increase awareness of and comfort with using the 988 Military and Veterans Crisis Line. This approach aims to empower service members not only to seek help for themselves, but also to effectively support peers and family members during times of crisis.
We collaborated closely with the MIARNG throughout the study, beginning with a partnership with a key liaison from the Integrated Primary Prevention Workforce who was instrumental in building support among senior leadership and helping to secure approval from The Adjutant General (TAG) for the project. Commanders from participating units played an active role during drill weekends by facilitating study activities and providing valuable feedback on both the intervention materials and their relevance to their units. In addition, members of the Integrated Primary Prevention Workforce contributed critical input on the Crisis Line Facilitation materials, offering practical recommendations to enhance feasibility and support future integration into Guard training initiatives.
Crisis Line Facilitation was well-received by MIARNG service members and led to meaningful improvements in comfort and confidence in using crisis line services, even after a single brief group session. Baseline awareness and prior use of the 988 Military and Veterans Crisis Line were relatively low, despite widely available messaging, highlighting a critical gap that CLF and similar interventions are well-positioned to address. While the intervention improved attitudes and intentions, actual crisis line utilization remained low over follow-up, underscoring the need for ongoing engagement and reinforcement strategies to translate intention into behavior.
In the short term, we were able to increase awareness, acceptability, and confidence in using crisis line services among MIARNG service members through delivery of the group-based Crisis Line Facilitation intervention. We hope that by providing this information to MIARNG units, the increase in knowledge will be passed on to others who may benefit in the future.
In the longer term, we hope to support sustainable, large-scale implementation of CLF within the National Guard by equipping leadership, behavioral health specialists, and/or chaplains with scalable training resources. Ultimately, the goal is to increase actual utilization of crisis line services and enhance peer support behaviors, thereby contributing to reductions in suicide risk among service members.