If you or someone you know is in crisis, text “TALK” to 38255 or visit Colorado Crisis Services’ website.

Rural isolation, high gun ownership, and a sense of rugged individualism may contribute to higher rates of suicide among military veterans in Colorado and the Western States.

The United States Department of Veterans Affairs (VA) first state-by-state report on veteran suicide, released in September, examines 35 years of data through 2014. The findings reinforce known patterns—but also offer new insights into who is at risk, including veterans over age 50 and female veterans.

An average of 20 veterans a day died by suicide in 2014 nationwide, according to the data. And only 30 percent of those veterans were under VA care, increasing the weight on local communities to help fill the gap.

In Colorado, the 2014 suicide rate for veterans, at 47 deaths per 100,000 people, was nearly double the state’s overall rate of 25.5. To add perspective, Colorado consistently ranks as one of the ten states with the nation’s highest suicide rates.

There’s no single driver behind the West’s higher suicide rates, says Sarah Brummett, director of the Colorado Department of Public Health and Environment (CDPHE) Office of Suicide Prevention. The West has large rural areas with less access to mental health resources and more opportunities for social isolation, she says. Another factor is the Western mentality of pulling yourself up by your bootstraps when there’s a crisis: “You cowboy up and get through it,” says Brummett.

Veterans’ training and familiarity in the use of guns is also a worthy consideration. In 2014, about two-thirds of Veteran suicides involved firearms, compared to half of all suicides in Colorado, according to the VA data. “Firearms are such a highly lethal method of attempt that people don’t get that second chance at survival,” says Brummett. About 90 percent of people who survive a suicide attempt do not go on to die by suicide, she adds.

Public and private health professionals are clear that promoting firearm safety for veterans in crisis is not related to gun control. “It combines respect for the Second Amendment issues with recognition that firearms are a common means of suicide,” says Ira Katz, the VA’s senior consultant for mental health and suicide prevention program evaluation and an author of the report. The VA distributes gun locks through each of its medical centers without asking people to identify themselves, he adds.

Colorado’s ongoing Gun Shop Project is an innovative partnership between mental health professionals and gun shops, firing ranges, and safety instructors throughout the state to promote firearm safety and suicide prevention. “People inherently want to survive, and if you give them the information and the options they will generally make a decision to keep themselves safe,” says Carl LoFaro, manager of Veteran and Military Family Services at the Jefferson Center for Mental Health.

Another 18 percent of veteran suicides in Colorado in 2014 involved opioid or prescription drug overdoses—a growing crisis among veterans. One VA study found that veterans who were prescribed the highest dose of opioid painkillers were twice as likely to die by suicide as those who received the lowest doses.

In Colorado, men are also about four times more likely to die by suicide than women, according to the CDPHE. The VA data revealed that Colorado veterans follow a similar pattern: At least 95 percent of veteran suicides in 2014 were by men.

To better connect with men in crisis, the CDPHE launched Man Therapy, a free web site that uses a Ron Burgundy style approach to offering serious advice on how to deal with depression, anger, grief, and addiction. The site features a bacon-loving character named Dr. Rich Mahogany who cleans his desk with a leaf blower, reads chainsaw manuals and spreads the message: A mustache is no place to hide your emotions. The five-year-old site includes specific resources for military veterans.

The VA report also spotlights lesser-known risks: Nationally, about 65 percent of veteran suicides were by people age 50 or older, who are often harder to reach. Jefferson County trains gatekeepers in rural areas (think health workers, police officers, or the person in charge of the local Elks club) to educate community members about suicide prevention, LoFaro says.

The VA report also calls attention to a growing suicide risk that is 250 percent higher for female veterans than for non-veterans (and 19 percent higher for male veterans compared to civilians). As more women serve in the military, their suicide rate rose 62 percent over the past 15 years, said VA Secretary David Shulkin in public remarks last week.

Female veterans are more likely to be gun owners compared to civilians, VA officials say. And suicide rates are significantly higher among women veterans who report military sexual trauma, according to a 2016 study.

The positive news is that every Coloradan can help by reaching out to friends, neighbors and co-workers in crisis. The best thing to do if you’re concerned, says LoFaro, is tell the person your concerns and ask the question: Are you thinking about suicide? “Asking that question gives people the understanding that you’re a safe person to talk to,” he adds.

If a person is thinking about suicide, the next step is to contact a mental health professional, LoFaro adds. The VA suicide prevention crisis line number is 800-273-TALK. Help is also available online.

“Let’s get away from this idea that suicide is something that is shameful and stigmatized,” LoFaro says. “This is a public health issue in our community and the best way to address it is to get educated and be ready to assist.”