Inside Mission Daybreak: VA’s effort to support innovative suicide prevention

Although the Department of Veterans Affairs has been working to enhance its suicide prevention initiatives in recent years, including through the use of some artificial intelligence tools and predictive models to identify retired servicemembers at high risk of self-harm, these efforts have primarily focused on veterans engaged with the department.

But in statistics provided to Nextgov/FCW, VA Press Secretary Pete Kasperowicz noted that approximately 60% of retired servicemembers who have died by suicide did not receive any care from VA’s health care arm, the Veterans Health Administration, “at any point in the two years prior to their death.”

To better assist veterans in crisis outside its network, VA has been working to engage with and support outside organizations developing innovative mental health solutions. 

This article — the third in a series of pieces about VA’s support for and adoption of AI tools to help prevent veteran suicides — is based on documents obtained through Freedom of Information Act requests and interviews with almost two dozen current and former VA officials and employees, researchers, veterans and veteran advocates over the past year.

Creating Mission Daybreak

VA has struggled to bring down the overall veteran suicide rate, with the number of retired servicemembers who have died by suicide remaining largely unchanged since 2008: roughly 6,500 veterans each year, or more than 17 each day. 

Over roughly the same time period, research has also shown a growing disparity in mental health care outcomes for veterans who do not engage with the VHA, as compared with those who do.

A May 2022 study published in the Community Mental Health Journal noted that “since 2001, suicide rates among veterans who did not receive care from the U.S. Department of Veterans Affairs (VA) increased by a rate of more than four times of those connected to VA care.” The report further estimated that only approximately 35.5% of veterans experiencing suicidal ideation are receiving mental health care, with those in VA’s network much more likely to obtain those services.

To better support outside organizations working with at-risk veterans, VA launched the Mission Daybreak grand challenge in 2022 to award $20 million to groups pursuing innovative solutions to the veteran suicide crisis. 

Dr. Amanda Lienau, director of data and analytics innovation for VA, told Nextgov/FCW that the challenge evolved out of the work of the President's Roadmap to Empower Veterans and End a National Tragedy of Suicide — or PREVENTS — Task Force, which was created by President Donald Trump in 2019 to take a “a holistic, all-hands-on-deck approach” to suicide prevention.

“Mission Daybreak came out of everyone's clear directive and deep feeling that suicide prevention is the clinical priority of the VA,” Lienau said. “And while there's incredible clinical practice guidelines, care guidelines — the work the VA is doing is amazing — there's always more opportunity to bring even more players into the field to be part of the solution to prevent veteran suicide.”

The challenge received more than 1,371 submissions, with 10 organizations named grand challenge winners.

Mission Daybreak’s finalists

One of Mission Daybreak’s first-place grand challenge winners, Stop Soldier Suicide, was awarded $3 million for its Black Box project, which uses AI to extract and analyze data from the devices of veterans who died by suicide to better identify retired servicemembers who may be at at high risk of self-harm.

Austin Grimes, Stop Soldier Suicide’s chief product officer and an Army veteran, said the organization’s effort is about challenging the status quo when it comes to assisting retired servicemembers in crisis.

“Despite decades of research and billions of dollars poured into this problem, the numbers are exactly the same every single year, and so you're left with really two choices: One is to accept that for all the work we're doing, this is the best it's ever going to be, and we've reached a functional zero; or you've got to acknowledge that we've got to try some different things,” Grimes said.

He noted that a majority of veterans who have died by suicide did not outwardly express any signs of suicidal ideation, and having a better understanding of how these individuals used their digital devices would provide unique data that could then be used to enhance future mental health interventions.

Stop Soldier Suicide released a report in August that detailed its findings to date, including identifying disparities in the ways that veterans who died by suicide electronically communicated with others and their digital behaviors.

“Late-night device activity nearly doubled in the final months of life, jumping from 30% to 53% with a critical inflection point at 10 weeks before death,” the report found, in part. The pattern was seen across individuals, and “may serve as a universal early warning signal that transcends individual coping styles and could trigger timely interventions weeks before traditional clinical indicators emerge.”

Grimes said Stop Soldier Suicide also prioritizes privacy and depersonalization of the data from the voluntarily loaned devices, which are subsequently returned back to the families.

While Mission Daybreak is focused on supporting innovative suicide prevention approaches, it does not only support organizations utilizing next-generation capabilities. 

“Mission Daybreak is looking for what is the right solution for the ways that we want to optimize care, and sometimes that's technology, and sometimes it isn't,” Lienau said.

Health technology company Televeda was also a first-place winner of Mission Daybreak’s grand prize challenge for its Project Hózhó, a web application for American Indian and Alaska Native veterans that uses traditional healing practices to combat loneliness and support mental health. 

Mayank Mishra, Televeda’s co-founder, said the project — now known as Hero’s Story — connects Native veterans with one another by employing digital talking circles and storytelling through the platform. The company has already partnered with the Navajo Nation Veterans Administration on the project.

Mishra said the goal is to “help veterans reframe that, ‘We're not victims here, but we're on a challenging journey, and we're heroes here, and we're going to survive and contribute back to our communities.’”

Training Veteran Crisis Line reponders with AI

Beyond supporting outside programs, Mission Daybreak has also enabled VA to adopt new AI capabilities to strengthen its crisis interventions. 

One of the challenge’s second-place winners, ReflexAI, provides AI-driven crisis line training and simulated scenarios for responders, which VA onboarded to help support the work of Veteran Crisis Line responders.

VCL crisis responders have answered more than nine million calls, chats and texts to the lifeline, according to VA figures, with over one million veterans also receiving referrals to local suicide prevention coordinators. 

VA documents obtained through FOIA requests said ReflexAI provides crisis line responders a “low risk, high reward training program” that was refined in collaboration with VCL leaders “to reflect the diverse demographics and personal experiences of those reaching VCL.” 

Like VA’s other uses of emerging capabilities, these tools do not directly engage in any way with veterans in crisis who are calling, texting or chatting with the VCL. 

Sam Dorison, co-founder and chief executive officer at ReflexAI, said the training focuses on mirroring realistic situations and provides VCL responders with 14 different simulations to help give callers more detailed information about VA’s mental health services.

“You have a wide range of opportunities to explain the [suicide prevention coordinator] program to some veterans who might have been coming to the VA for years and had good experiences, some veterans who have only used the VA very sporadically and some who might have never used the VA before,” Dorison said. “VCL might be their first touch point with VHA, period. And depending on their background, you need to engage with them on this topic very differently.”

How solutions are working

Programs to intervene with veterans at risk of self harm outside the VA network are increasingly looking to use AI tools to enhance those intervention efforts.

A report released in April by the Rand Corporation, in coordination with nonprofit Face the Fight, reviewed 156 currently operating initiatives and an additional 226 proposed programs to determine the types of approaches that organizations were taking to support veterans in crisis. The analysis used, in part, Mission Daybreak applicants to identify proposed programs.

While the review found that 17% of current suicide prevention initiatives “explicitly stated they use AI in their veteran suicide prevention activities,” it said “among proposed programs, this percentage more than doubles” to 37%. This was cited as being a result of organizations shifting their focus toward “multifunctional digital health platforms, which frequently feature suicide risk identification and real-time monitoring, among proposed programs.”

VA officials have stressed that the use of AI tools to help prevent veteran suicides is only meant for training purposes and to augment clinician-led interventions. Veterans advocates have said that is how these tools should always be used. 

The Mission Daybreak initiative has since continued through a Broad Agency Announcement that allows VA to solicit concept papers, review proposals and co-design pilots with external innovators. The solicitation for the ongoing BAA is open until the end of September 2026.

“The purpose of a grand challenge is to award prizes for really great ideas,” Lienau said. “And so I'm really pleased that then, following this, there was enough leadership engagement and the enthusiasm around the thousands of people who involved themselves in the grand challenge to say, ‘Yes, let's continue by looking closely at a few targeted pilots of core, strong, mature solutions that would be ready to test and evaluate for impact for veterans.’”

In a September blog post, Lienau said VA is launching seven programs this year that have resulted from Mission Daybreak partnerships.

The path forward

VA administers other initiatives to support outside groups working to assist veterans in crisis, including the Staff Sergeant Parker Gordon Fox Suicide Prevention Grants Program. This effort was launched in 2022 and provides funding for community-based organizations supplying mental health resources and assistance to veterans in crisis.

The department said the Fox grants program has awarded over $157.5 million to 95 groups across 43 states, territories and tribal lands. VA announced in May that it was making another $52 million in grants available to outside groups. 

Kasperowicz, VA’s press secretary, said organizations that received Fox grants “have made more than 24,400 referrals for suicide prevention supports, including life-saving emergency service connections for 854 Veterans at high risk for suicide.”

But even as VA programs have helped to support outside groups working to provide mental health assistance to retired servicemembers, veteran suicide rates continue to remain stubbornly high.

VA Secretary Doug Collins has told lawmakers he is looking at pursuing “a fresh, new approach” to suicide prevention, noting that department funding of suicide prevention outreach has increased by more than 11,000% — from $4.4 million per year in 2008 to $522 million per year in 2022 — despite the fact that the number of veterans who have died by suicide remained flat over that same period. 

Kasperowicz said the department is taking steps to review the impact of its current programs, including measuring how many referrals its community coalitions and outside partners make to VA or community care providers “so we can see where our efforts are succeeding and adjust as necessary.”

If you are a veterans in crisis or are having thoughts of suicide, or if you know a veteran in crisis, you should call the Veterans Crisis Line for confidential crisis support. Dial 988 then Press 1, chat online at VeteransCrisisLine.net/Chat or send a text message to 838255. The line is available 24 hours a day, 365 days a year.