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.
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.
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?’”
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?”
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.
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.”
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.
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.”