Thank you, Chair, and thank you for the invitation.
My comments reflect our clinical work with serving and retired military members, along with some of my research at Mount Saint Vincent University.
I served in the navy for about nine years, then as a psychologist at the military base in Halifax for another 10, and then headed off to lead a clinic of five psychologists for 18 years. During that time we assessed and treated several thousand members and veterans for OSI— primarily operational PTSD and substance abuse. About 40% could be classed as highly invested in treatment and recovery, did their best to stay connected with their families; the remaining 60% were more ambivalent about the need for treatment, and about one-third of those were primarily men who were intensely angry with the military and Veterans Affairs, and were not invested in treatment.
When it comes to veteran caregivers, they're primarily women spouses and partners, in our experience. I think understanding their needs requires a re-examination of our veteran-centric approaches that focus on symptoms and trauma triggers that position family members as passive participants. Their primary role is to attend to the mental and emotional needs of injured veterans. Caregiver spouses are expected to reduce stress and manage potential triggers, primarily dealing with Veterans Affairs Canada, or keeping children quiet in the home, which is a continuation, on some level, of the strength behind the uniform promoted in the military, and as a belief, held among many male veterans, that is premised on taking for granted women's role to manage the home front.
Most of these caregivers are stoic women. Canadian military family researchers have catalogued the extraordinary efforts they expend in seeking out formal and informal supports. They seek out treatment options for their partners while often working outside the home, cleaning, managing bills, cooking and caring for children. Among those we saw, sleep disturbances, anxiety and physical and emotional exhaustion were quite common. They often placed their own needs second.
In our clinic, we routinely asked to interview veteran caregivers during assessment and treatment planning, and sometimes met them privately. Despite fears of creating issues for veteran claims, we heard often about veterans withholding information about their volatility, or spending their days drinking or being disengaged from family life and responsibilities. These caregivers were often quite frustrated with treatment approaches that excluded them and their families. We also received many phone calls from distressed partners whose partners were not clients of Veterans Affairs, so they were left out, despite their obvious needs.
Military veterans are under continual scrutiny, yet we lack a parallel framework to assess the consequences of military OSIs on family members, including vicarious and secondary trauma. In my view, the standing model of “veteran as casualty” excludes the entire family system, which can be a casualty of military service. Veterans' partners receive little direct, practical help in managing their day-to-day lives with former military men with mental health problems. A persistent fear among many of these partners centres around veteran self-harm should they decide to leave the relationship, or even leave the home for errands or to attend work. At other times, veterans would simply leave the home for days following conflicts or disagreements to be alone, to visit buddies, and then show up again unannounced, often throwing families into disarray. This lack of predictability is a formula for all kinds of mental health issues.
In considering the supports needed for veteran caregivers, it is important to acknowledge that spouses, mothers and adult daughters are often given de facto responsibility to manage veterans in between scheduled mental health appointments. In our experience, this vigilance and monitoring role is also handed to adolescents and older children as well, yet none of these people have a say in treatment decisions. They are the ones who call authorities or military buddies to help manage crises. They talk down veterans from nightmares, they contend with drunken tirades and they're expected to be on guard for suicidal indicators. Many partners describe having an additional child at home in terms of reminding their partners to eat, to bathe, to take medications or to organize their days.
Despite our public statements to the contrary, veteran families are often invisible linchpins to veteran recovery status. As noted by military family researcher Deborah Norris, veteran and family well-being is a dynamic, bi-directional process. Family members have a central role in veteran well-being, and vice versa, that far exceeds the effects of medication and individually focused therapies. In sum, no matter the specific individual veteran-centric treatment, it is the social and family context that matters most to veteran welfare and progress.
In Canada we have not explored this intersection of family mental health and family involvement investment in treatment as requisites of veteran health.
It is my view that entire families are often casualties in military service, especially in the case of service-related mental health problems. In keeping with the recent veterans ombudsman's report, families, not just veterans, require assessment of needs and ongoing case management supports.
Thank you, Chair.