Content warning: This story discusses suicide. Call the 988 Suicide and Crisis Lifeline if you or a loved one needs help.
This story was originally published by Flatwater Free Press.
Jeremy Koch drove down a country road in the darkness, carting his 14-year-old son to 5:30 a.m. basketball practice. He glimpsed a Dodge Ram pickup on the shoulder, its engine revving, exhaust billowing from the tailpipe into the January morning.
“Maybe he’s stuck,” Koch, 41, thought as he pulled up, walked to the driver’s side and tapped on the window.
The man inside didn’t move. Koch opened the door. The man stayed slumped, a pistol in his hand, his foot on the gas.
Koch called 911. Then he called his wife, Bailey, back home 4 miles away.
“Why does this keep happening?” he wondered.
It was the question he asked himself when he woke up from the last of his five suicide attempts. When his teenage son attempted to do the same. When his father died by suicide in 2019. Now another family’s story would be altered.
Koch knows what the experts say. It’s harder to see a therapist here. That’s why small-town Nebraska suicide rates continue accelerating past those in the state’s cities. But he also believes people here can author their own solutions.
In 2014, Koch, a landscaper, and his wife Bailey, a special education teacher at Holdrege Middle School, started a Facebook page to catalog their struggles and successes. Others shared their own stories and offered support through a network that now reaches 10,000 followers.
Meanwhile, state and federally funded programs have given thousands free therapy and tried to grow the rural mental health workforce.
Nebraska’s rural suicide rate is above the national average but has stayed lower than rural rates in neighboring states. That didn’t offer comfort on January 19 as Bailey, 39, climbed into her yellow Ford Bronco, the one with the family’s mental health Facebook page’s logo plastered on the back windshield.
How would her 14-year-old son handle this? Would her husband be OK? How much grief can her community take?
“I remember thinking we were going to change the world, and it was going to end all suicides,” Bailey said. “You get humbled real fast.”
‘Don’t Tell Anybody’
Bailey and Jeremy Koch grew up in central Nebraska — Jeremy in Cozad, a town of 3,900 people, and Bailey a few miles away in Eustis, a village of 400. Each has deep family roots.
Here, in central Nebraska, Bailey and Jeremy Koch learned to talk – or to keep quiet – about mental health.
Bailey remembers being 12, terrified in the backseat as her mother raced toward her father’s feedlot. Between cigarettes she told Bailey she was going to kill him, then herself. When they arrived, her mother crumpled to the ground and sobbed. Let’s get her help, Bailey remembers her dad saying.
“I grew up with it being a discussion. There wasn’t any shame in mom needing help, mom needing medication or anything like that.”
“And he,” Bailey said, looking at Jeremy sitting next to her at their dining room table, “grew up the complete opposite.”
Jeremy remembers being 10 years old, crowded among family in his grandparents’ house. Grandma was back from the hospital in North Platte where she was treated for depression, Jeremy remembers his uncle saying before he put his finger over his lips. “Shush.”
Jeremy understood: don’t talk about it.
“I can see where that was affecting me when I was diagnosed in 2009,” Jeremy said. “Because my first thought was, ‘Don’t tell anybody. Who’s gonna hire the crazy landscaper?’”
Stigma keeps many from seeking help, said Quinn Lewandowski who develops behavioral health strategies through the University of Nebraska Public Policy Center. In a small town, everyone can spot your car outside the therapist’s office. Men worry that asking for help makes them look weak.
“They’re suffering in silence until things get to an extreme breaking point,” he said.
No one knew Jeremy had convinced himself he couldn’t provide for his family. Few knew he’d attempted suicide multiple times or that it wasn’t an accident when he steered his truck toward a semi-truck hauling a combine on February 16, 2012.
Jeremy remembers bowing his head in prayer before he clipped the semi. He spun into a second truck that flattened his kids’ car seats in the backseat. Emergency responders ripped open his half-ton pickup like the top of a soup can. People delivered meals and fundraised for his recovery. They wouldn’t have been as supportive had they known the truth, Jeremy thought then.
The hiding became unbearable to Bailey. That changed the night the couple ran into Jeremy’s business mentor in a Menards parking lot.
“So Rocky, just this big boisterous guy, says, ‘What are you guys doing in Kearney on a Monday night?’” Jeremy remembered. “And I was getting ready to lie.”
“You could see it on his face,” Bailey said. “I literally stepped in between him and Rocky and I said, ‘Oh, we’re going to a mental health support group. Jeremy has depression.’”
Jeremy’s face flushed. He thought he might pass out.
“I struggled with depression,” Rocky’s wife said. “What do you do that helps?”
“Wait, what?” Jeremy remembers thinking. “She wants to keep talking to me?”
‘Never Enough’
The first posts read like diary entries: Bailey’s joy when Jeremy traded his rifles for bows during hunting season in 2014; her pride when her then 8-year-old son told his friends to be nice to people with disabilities, even ones they can’t see like his dad’s depression. Over time more people paid attention to Anchoring Hope for Mental Health, the Facebook page Bailey and Jeremy started to be more open about their lives.
“Your story helped me to keep going,” a comment on a January 2024 post reads.
Another: “I started following you after I had gone through a crisis myself — and after a lot of counseling I have come to the conclusion if we don’t talk no one knows and nothing will change.”
Stacey Cahill knows how badly this community needs to talk. She’s a therapist in nearby Lexington, one of the few in the area. Jeremy’s been her client for 15 years.
Her waiting list for new appointments is two months long.
The problem is worse elsewhere in the state. About 100,000 Nebraskans live in counties with no mental health workers, according to the University of Nebraska Medical Center. Nearly one-third of the state’s residents live in a county with less than five providers.
Seeing a therapist can mean an hour’s drive. Telehealth is a solution, though unreliable internet and preferences for in-person therapy can be an obstacle. For speciality care Jeremy had to go to Dallas. With his medication dialed in, the suicidal thoughts faded then disappeared.
Since 2009 Nebraska has funded a workforce development program meant to boost its number of mental health providers, including those in small towns. The UNMC-run Behavioral Health Education Center of Nebraska offers scholarships and training out of satellite offices in Kearney, Wayne and the Panhandle.
Since 2010 the state’s behavioral health workforce has grown 22%. But only a fraction of those workers are outside metro counties.
“The truth is that there will never be enough,” said program director Dr. Marley Doyle.
To do better, Doyle thinks, Nebraska needs to seek different ways to deliver care.
Connecting Communities
A short walk from Bailey Koch’s classroom at Holdrege Middle School, past the shoulder-high lockers and linoleum-floored cafeteria, Stefanie Neal sits in her office and listens.
Kids come here to talk. A blue Bic pen tucked in her bun of blond hair seems poised to jot a quick note. She’s Holdrege Public Schools first mental health practitioner, a rare job in rural Nebraska, she said, where kids need to learn not to hide from their emotions.
“If you do that, you won’t know yourself very well,” Neal said, “and you won’t be able to really connect with others.”
That’s the guiding force behind all of Nebraska’s suicide prevention work, said Dave Miers, who cofounded the Nebraska State Suicide Prevention Coalition in 1999. That can mean training primary care physicians to spot suicidal thoughts, putting more mental health workers like Neal in schools or launching peer-led teams to support families after a suicide.
Since the early 2000s, Nebraskans have also been able to call the state’s Rural Response Hotline to request free therapy vouchers. In the past decade, the hotline has delivered 36,000 vouchers. The goal of all this work: Connection.
That’s gotten harder in recent years as towns shrink, businesses close and schools consolidate. A 2023 University of Nebraska-Lincoln poll found the percentage of rural residents’ who think life is getting worse is increasing.
Neal’s watching a local solution to this widespread problem be built in real time.
Holdrege’s children and teenagers are coming to her. Then coming back.
Students who see her come to school more, Neal said. They get better grades.
The counselor almost daily visits the classrooms of teachers like Bailey. Together, they brainstorm ways to help students and families.
“(We say) ‘Let’s do a prayer request. Let’s do meals. How can we help?’” Neal said. “Then all of a sudden, it’s all taken care of.”
The Next Generation
Jeremy sits at the Koch family’s long dining room table, nodding his head as Bailey says sometimes she feels like a failure. He thinks about the last time he offered to get his dad special mental health treatment.
“No, I’m OK,” his father said. He died by suicide not long after.
Jeremy raised his son Hudson to talk about his feelings. The now 17-year-old attempted suicide three times before he found stability.
It took a while to learn: There will be steps back after steps forward. It’s a disease, like cancer. There’s no quick fix.
But the more the family embraces their story, the more it feels like they’re getting somewhere new. Somewhere better.
“We can help our children … turn it into something beautiful, and a way to help people. And as much as I hate how much our kids have had to go through … I think that they are so far ahead of where we were,” Bailey said through tears. “They get it. They’re incredible.”
She puts an arm around Hudson as Jeremy smiles. “My aunt always says our kids win,” he said. “The next generation is the one that’s benefiting from the hard work of the generations before.”