Abstract: OBJECTIVE: This mixed-methods study evaluated a pilot peer specialist intervention designed to reduce suicide risk in high-risk veterans with severe psychiatric disabilities. METHOD: Veterans with high-risk flags for suicide (n = 12) were recruited, and peer specialists (PSs, n = 5) were trained for a feasibility study of peers for valued living, a 3-month semistructured suicide prevention intervention delivered by PSs. The Reliable Change Index was used to calculate whether veterans achieved reliable changes on standardized baseline-to-posttest assessments of personal recovery, depression, suicide ideation, perceived burden and thwarted belongingness, suicide cognitions, and hopefulness. Qualitative interviews with veterans as well as PSs and their supervisors were analyzed using rapid qualitative analysis. RESULTS: Most veterans (n = 10, 83.3%) improved on at least one measure, and five veterans (41.7%) deteriorated in at least one area. Reliable improvements were most common in suicide cognitions (n = 5, 41.7%) and suicidal ideation (n = 4, 33.3%). Qualitative analyses indicated that veterans uniformly described positive experiences with peers for valued living. PSs and supervisors were initially uneasy about openly discussing suicide and struggled to adopt the semistructured discussion framework. But with time, they felt more confident and skilled in engaging with high-risk veterans. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This mixed-methods pilot study establishes the feasibility and preliminary effects of a peer-delivered suicide prevention intervention with veterans with high-risk flags for suicide. Reliable positive changes were observed in suicidal ideation and other suicide cognitions. Qualitative interviews identified a range of important factors that are critical to efforts to employ PSs more directly in suicide prevention roles.