Understanding the Health and Well-being of Canadian Armed Forces Veteran Families

1. NEW RESEARCH ON VETERAN FAMILIES: Qualitative Study on the Health and Well-being of Families of Canadian Armed Forces Veterans with Mental Health ProblemsJUNE 2018

2. Understanding the Needs of Veteran Families: Building an Evidence Base • Family Well-being Qualitative Study 2018 2016 2016 2015 2015 2007

3. What Did Prior Research Tell Us? • Family relationships are critical to the well-being and life satisfaction of both serving members and Veterans • Military families show strengths in areas such as: • resiliency • loyalty • resourcefulness • pride • Potential negative impacts of military service on families include: • divorce • financial insecurity • stress • lower life satisfaction • mental health problems • behavioural issues in children • career sacrifices for the spouse • lower spousal income

4. What Did Prior Research Tell Us? • Families of injured Veterans may be more likely to face: • Social isolation • Negative health impacts (e.g. caregiver burnout, stress, depression) • Lower incomes • Areas identified as opportunities to support families included: • information and engagement (outreach targeted at families) • education and support for informal caregiving role • help navigating systems and supports (e.g., CAF, VAC, provincial, NGO) • support during transition process • recognition for their support to Veterans and contributions as a military family • compensation for loss of labour market earnings/financial support while caregiving • Additional research required on families of Canadian Veterans

5. New Research: 2018 “Family Well-Being” Study • Qualitative study on the well-being of families of CAF Veterans with mental health problems: • Examined family impacts, well-being,whether they accessed supports (and if so, did they find these beneficial). • Contracted through Canadian Institute for Military and Veteran Health Research • 27 in-depth interviews and 3 focus groups across the country (both English and French) • Final report provided to VAC in February 2018

6. Study Strengths • Conducted by expert Canadian academic qualitative researchers independent of Veterans Affairs Canada. • Methodology minimized bias and used standard data analysis techniques. • Qualitative approach adds depth of understanding to the LASS quantitative population-level findings. • Canadian: Most qualitative Veteran family research has been done in other countries. • Veterans in the respondent families represented a variety of ranks, service environment and experiences during military to civilian transition. • These strengths indicate strong evidence and good certainty of conclusions.

7. Impacts of Veterans’ Mental Health Problem(s) on the Family • Changes in family structure, roles and functioning • Challenges to identity (giving up jobs, switching from spouse to caregiver, etc.) • Veteran not present as a spouse or parent; spouses/ children in caregiving roles; constant vigilance: “walking on eggshells” • Relationship issues • Lack of intimacy; extramarital affairs; Veteran not that same person • Financial tension and instability • Veteran and/or spouse may have to reduce or quit working. “…I’ve had to quit my job in order to take care of him.” • Feelings of isolation • “Overall, relationships outside the home were often hard to maintain.” • Spouses reported burnout, depression, anxiety (in themselves and children) • Some families developed stronger resiliency and reconnected to family priorities

8. How Family Life Impacts Veteran Well-being during MCT • Family support is critical and potentially lifesaving • “I think that we’ve been a positive thing for him. Because I don’t think that if we were not there, I don’t think he’d still be here. I think he would have taken his own life at some point.” • Veteran’s behavior impacts the family and vice versa • “(the Veteran) having a good day can also depend on whether you’re having a good day, and if your kids are having as a good day.” • Some Veterans experienced guilt about the impact of his mental health on the family • “Like, he feels a lot of guilt because he can’t be at the, the kids’ school plays or, or when they’re getting awards, or whatever. He, he can’t be around that.”

9. Families Accessed a Variety of Supports • Informal supports with positive experiences: • Social support from family or friends and other military spouses with shared identity • Social media, such as Facebook and online supportive networks and resources • Employers/co-workers • Pets • Exercise • Formal supports with positive experiences: • Individual counselling • Psychoeducation to help families understand what the Veteran is going through • Couples counseling • Peer support (Operational Stress Injury Social Support [OSISS], Military Family Resource Centres [MFRC]) • Service animals Advocacy groups • Financial benefits

10. Families Identified Barriers • Identity challenges (losing themselves, giving up jobs, being a caregiver and not a spouse) • Veteran in denial and families face stigma/fear of what others think • Supports target Veterans and there is a lack of information • Relying on the Veteran as their primary source of information “… my husband is the one who gets all the information, but he is the one that is sick. And when he is given information, he forgets.” • Navigation: What’s available and who is eligible; proving mental health problem is related to service; bureaucracy and paper work • Culture gaps (e.g. insufficient understanding by civilian service providers and friends): “It’s the loneliest thing, not having anyone to know what it’s like.” • Geographic isolation (rural/remote)

11. Suggestions from Family Members • Fill gaps in services/supports, such as services for children or targeted services in rural/remote areas • They want to be more involved in Veterans’ mental health care, such as having resources to better understand • They want to be more involved in the transition process and to see navigation simplified to access supports • They believe transition processes, systems and services could be improved, such as ensuring benefits are in place before release

12. What Do We Know Now? • This qualitative study confirmed previous thinking that families: • are important to Veteran well-being and adjustment to civilian life • experience stress and caregiver burnout • put jobs on hold or limit career progression • are resilient • can feel isolated and misunderstood by “civilian” society • are committed to family obligations • find it difficult to navigate the system to access support • are not aware of all of the supports available to them • prefer to receive information and support directly (not via the Veteran) • face barriers like stigma and geographic isolation

13. What Is New From This Study? • New evidence indicates that family members: • experience identity challenges • find that military-centric supports work best (shared identity) • are the first to recognize problems the Veteran is having and their mental health problems often started before release • are used to a culture that does not seek help • need to receive information prior to the Veteran’s release • can derive a sense of purpose from their role in caring for the Veteran • have developed positive coping mechanisms that may help other families • may need help with negative coping mechanisms, such as substance abuse • report benefits from counselling, therapy and other formal supports • prefer peer support (shared identity) and online interactions as informal supports

14. What Do These Findings Mean for VAC? • Budget 2017 programs will enhance family support via: • Caregiver Recognition Benefit • Veteran and Family Well-Being Fund- investing in innovative ways to support Veterans and their families • Expansion of the Veteran Family Program across all Military Family Resource Centres • Centre of Excellence on PTSD and related Mental Health conditions • Implementation of these programs and new program development should factor in the evidence including: • Direct outreach to families was cited as an area for improvement • Families found help via formal and informal peer support mechanisms • Assistance required to navigate system • Geographic isolation is a barrier • Families report benefits of online interactions • Information does not necessarily flow through the Veteran to the family