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Then Ketchum learned one other family member was there so that his mother could go back to work. Ketchum also thought increasingly that he was becoming a burden to his girlfriend, therapist Kirby wrote in his notes.During April and May, Ketchum began missing group and individual therapy sessions.

Nichols did decide to contact the VA several days later, urging that someone be appointed to handle Ketchum's personal finances.Late on the night of June 14, he called the VA suicide hotline and said he was thinking about ending his life.He showed up for counseling the next day complaining about a deep depression. A VA case manager called Ketchum on June 24 to check in.The veteran admitted he was having severe heroin cravings and was severely depressed."Patient stated he is in a really dark place right now," the case manager wrote.

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By February, he had gone almost a year without using heroin, and in March, he graduated from intensive outpatient therapy for substance abuse.

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