Integrating families into Veteran care: A call to action for holistic support systems

Abstract: The Veteran Affairs (VA) mission statement is, "To fulfill President Lincoln's promise to care for those who have served in our nation's military and for their families, caregivers, and survivors." However, the current inclusion of Veteran families, caregivers, and survivors into VA care is nuanced, limited, and inconsistent. A hallmark of modern military life is that service members who have enrolled since 2001 (called "post 9/11 Veterans") include a higher percentage of women, dual-military member households (married couples in which both members serve), and families with children. This is in large part because of the extensive support provided by the Department of Defense (DOD) for service members, including housing, childcare, healthcare, and other forms of social and physical support, such as services for dependents with disabilities. However, when a service member transitions out of the military, little to no DOD services transfer with them. Moreover, post-military services are less comprehensive and designed to meet the needs of Veterans, rather than provide holistic support for family members and dependents. This lack of services for family during the transition process may contribute to what has been recognized as a large social and financial support gap that can last up to 3 years post service, or in some cases, longer. This is when Veterans are at high risk for a variety of complications, including suicide because of emerging physical and mental health challenges that can be exacerbated by other support needs. Moreover, when a Veteran seeks services through the VA or community care for various military-related injuries, providers do not typically inquire about the services needed during transition for the Veteran's family, and do not include family members in the Veteran mental or physical health treatments. This could contribute to a Veteran's feeling of isolation or lack of continuity of care for themselves and other family members. This critical and often overlooked aspect of the transition process is the impetus for this call to action. As family-based researchers, we recognize that the role of familial involvement could be especially important for those with critical conditions that contribute to functional and mental health decline, such as traumatic brain injury, post-traumatic stress disorder, and others. Here, we present evidence that (1) including family members in psychosocial support improves Veterans' mental health outcomes; (2) family member resources for long-term disability support are available but underutilized; and (3) recognition of children and nontraditional family member caregivers (other than the spouse) as critical components of the VA health care system is needed. All 3 areas contribute to the overall health and well-being of Veterans and their families.