In small-town Nebraska, with suicide rates high, one family delivers hope for thousands

Rural mental health struggles are real, as is the lack of mental health providers in small-town Nebraska.
But the Koch family, and many others, are working to help.

Content warning: This story discusses suicide. Call the 988 Suicide and Crisis Lifeline if you or a loved one needs help.

Twilight hung over the snow-crusted fields and stubbly cornstalks. Jeremy Koch drove down the long country road past center pivots stretching to a distant horizon as he took his 14-year-old son to 5:30 a.m. basketball practice. Then he saw it: a burgundy Dodge Ram pickup in the snow on the shoulder, its engine revving and 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 window and tapped on the glass. 

The man inside didn’t move. Koch opened the door. The man stayed slumped in his seat, a pistol in his hand and his foot on the gas.

Koch called 911. Then he called his wife, Bailey, back home 4 miles down the road.

“Why does this keep happening?” he wondered.

Koch had the same question for 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. And now another family’s story would be altered as news of what he’d found would spread through central Nebraska.

Koch knows what the experts say. It’s harder to see a therapist here and talk about mental illness as small-town Nebraska suicide rates continue accelerating past those in the state’s cities. But he also believes people here, including him, can author their own solutions.

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In 2014, Koch, an artist, landscaper and greenhouse owner, 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, asked for help or offered support through a grassroots network that now reaches 10,000 followers. 

Jeremy Koch waters plants in one of Natural Escapes’ two greenhouses. The Cozad business sells trees and garden, tropical and flowering plants. In winter months, customers can paint their own pottery. Photo by Lori Potter for the Flatwater Free Press

Meanwhile, state and federally funded programs have grown the rural mental health workforce, given thousands of Nebraskans free therapy and created new networks meant to help grieving families.

Nebraska’s rural suicide rate is above the national average but has stayed lower than rural rates in neighboring states. But that figure didn’t offer comfort on Jan. 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 nearly 4,000 people, and Bailey a few miles down the road in Eustis, a village of about 400. Each has deep family roots here.

A photo of Bailey’s great-grandfather, wearing a cowboy hat and riding a horse, hangs above a plaque honoring him as a member of the Dawson County Cattlemen’s Hall of Fame. Jeremy’s grandpa was the superintendent of Cozad Public Schools for 27 years. His parents taught there too. The Koch kids were baptized in the same church Jeremy was baptized in – the same church his dad grew up in and where his parents got married.

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 got there, 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 and made a shushing sound. 

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?’”

The Koch family. From left: Hudson, 17, Jeremy, 41, Asher, 14 and Bailey, 39. The family, posing for a portrait outside their home near Eustis on Jan. 26, 2024, has long struggled with mental health issues. The family has found healing by sharing their story online through a Facebook page it created in 2014. Since then, Anchoring Hope for Mental Health has added more than 10,000 followers who routinely share their own stories of mental health. Photo by Chris Bowling/Flatwater Free Press

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 especially worry that asking for help makes them look weak in places that prize self-sufficiency. 

“Oftentimes they’re not getting diagnosed for depression or seeking out their provider,” he said. “They’re suffering in silence until things get to an extreme breaking point.”

No one knew Jeremy worried he wasn’t good enough, that he 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 Ram truck toward a semi-truck hauling a combine on Feb. 16, 2012. 

Jeremy, alone in the car, remembers bowing his head in prayer before he clipped the semi’s wheel. 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 to save him. People fundraised money for his recovery, delivered meals and sent flowers. 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.

“I’ve followed your story since my diagnosis over 5 years ago,” reads another from one of their more than 10,000 followers. “Thank you for sharing your unfiltered truth for so many of us.”

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 grew up nearby in Lexington where she now works as a therapist, one of the few in the area. Jeremy’s been her client for 15 years.

Her clients often don’t seek help until things have gotten really bad – domestic violence, substance abuse, suicide attempts. 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 at all, according to numbers from the University of Nebraska Medical Center. More than half a million residents, 30% of the state’s population, 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 as far as Dallas where he got an advanced brain scan. With his medication dialed in, the suicidal thoughts faded and eventually disappeared.

Nebraska’s mental health workforce shortage is not unique. About half of Americans live in counties with too few providers, according to the National Institute for Health Care Management.

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, mentorships and training programs. Satellite offices in Kearney, Wayne and the Panhandle tailor programing to better suit their coverage areas.

Since 2010 the state’s behavioral health workforce has grown 22%, but only a small fraction of those workers are outside Douglas, Sarpy or Lancaster counties.

“The truth is that there will never be enough,” said program director Dr. Marley Doyle. “We will never, ever be able to say all of our counties have enough behavioral health providers.”

To do better, Doyle thinks, Nebraska needs to hunt for 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. 

Kids come here to talk and Neal gives them her full attention. Her blue eyes don’t waver behind her glasses. 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 but necessary 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.”

Stefanie Neal sits in front of her desk at Holdrege Middle School on Jan. 26, 2024. Neal started the 2023-2024 school year as Holdrege Public Schools’ first mental health practitioner, providing counseling and emergency assistance to students in the central Nebraska town. Photo by Chris Bowling/Flatwater Free Press

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 more primary care physicians to spot and treat suicidal thoughts or putting more mental health workers like Neal in schools. It means launching peer-led teams to support families after a suicide and strengthening relationships between law enforcement, health providers and nonprofits in the Nebraska Panhandle to help people before their needs become crises. 

Since the early 2000s, Nebraskans have also been able to call the state’s Rural Response Hotline (1-800-464-0258) to request free therapy vouchers. In the past decade, the hotline, currently run by Legal Aid of Nebraska, has delivered 36,000 vouchers, nearly all of which were cashed.

“Thank you and thank the Lord for your services to our family and others,” reads anonymous feedback from one recipient. “Counseling is hard to find in rural areas and small towns. Thank you for being one way people get help they need.”

The goal of all this work: Connection.

“The more connected our communities are, the less suicide that we have,” said Miers, also the senior director of behavioral health services at Bryan Medical Center in Lincoln. 

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. 

But Nebraska may be more apt to address those issues given its long history in suicide prevention, said Shawna Hite-Jones, who helps states increase suicide prevention through the Education Development Center. After 25 years, she thinks the Nebraska coalition has found a way to get everyone working together while still allowing localized solutions.

Neal’s watching that happen in real time. 

She’s successfully getting Holdrege’s students, from elementary to high school, to come to her, and then come back again, and again, for sessions. 

And once they see her, those students come to school more, Neal said.

They get better grades. 

The counselor almost daily exits her office and walks past the shoulder-length lockers into the classrooms of teachers like Bailey, or the school’s coaches. Together, they brainstorm ways, big and often small, to help students and their 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. And you don’t even know how.”

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. 

Hudson Koch, a Cozad High School junior, trims a dwarf jade plant. Photo by Lori Potter for the Flatwater Free Press

It took a while to learn: There will be steps back after steps forward. Mental illness is a sickness, like cancer. There’s no quick fix. 

But the more the family embraces their story – the good and the bad – 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 in order to get to that, 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 starts to smile. “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.”

By Chris Bowling

Chris Bowling is an investigative reporter for Flatwater Free Press. Prior to joining Flatwater Free Press Chris was an investigative reporter and editor for The Reader, Omaha's alternative monthly newspaper where he focused on issues like climate change, housing, health, criminal justice and social issues. A native of Cincinnati, Bowling graduated from the University of Nebraska-Lincoln in 2018.

10 Comments

Outstanding article, Chris Bowling! You took a complicated and misunderstood health condition (mental illness of all types, including depression and suicide ideation) and dispelled the taboos by shining a light on this beautiful family- The Kochs- and how their transparency and sharing has helped others to overcome obstacles as well.

I live in a small town with a population of less than 600. 24 years ago, I had a brain scan in Omaha. As interpretation of that exam was in its infancy at the time? I was misdiagnosed, resulting in a barrage of deprecating small-town gossip. Thankfully, medical science has progressed since 1990. Now? The M.D.’s have updated my diagnosis to multiple sclerosis. Yet? The calumny refuses to die. Bless the Koch family for doing all they can to (hopefully) reduce the stigma of “mental illness”. My M.D. has repeatedly commented, after what I have been through, that he “can’t believe (I’m) not suicidal”. (Perhaps, it is because I grew-up in Lincoln and Omaha.)

This is a great article!! I have been a licensed mental health practitioner in Nebraska for over 20 years. I worked in Lincoln, Omaha and Norfolk in agencies and my own private practice. I’m happy to say, my favorite place to work has been back in my home town of Laurel where I’m blessed with an amazing school admin that prioritized mental health, as I have worked full time as a Mental health practitioner for LCC since 2019. Breaking down stigma and delivering hope and mental health education and support to students and families!! Things are changing and I’m so grateful! Thank you for writing and sharing this article!! I often ask families to follow Bailey and Jeremy on Facebook. They are real, rural, and so open to talk about mental health! They too have become apart of Nebraska’s journey to better Mental Health and breaking down the stigma for better care!

Loved the story!!! The Koch family are amazing for sharing their journey in hopes of helping others.

Surprised to see the ratio of health providers to residents in Fillmore
County. Why such a good ratio.

I am so grateful to the Koch family for raising awareness around mental health. What a blessing you are to your community. I grew up in Northeast Nebraska in a town with 230 people. The work that you are doing tugs at my heart strings because you are neighbors helping neighbors AND you are helping to raise a family where talking about mental health is not taboo. Incredible work and I thank you from the bottom of my heart for doing it!

I became a part of the Suicide Family in August 1985, when my mom (49) took her life. 💔 We are in Colorado where rates are very high …. yet, the pain is the same wherever you live. Loss is loss
As I learned about Suicide, I could understand it more. I no longer needed to hide from the truth. I am much more compassionate and open to listen closer than I had.
Easy…no . Still feel the pain when others are impacted by Suicide.
Thank you for sharing this information. If it reaches only one, it will be a blessing!

Thank you for highlighting the great need for mental Health practitioners in Rural Nebraska, the need is just as great in the metro area, especially for those families that don’t have the right insurance coverage.

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