During the few hours it takes for this historic hearing to conclude, another veteran will commit suicide. Most likely it will be a veteran of the Guard or Reserves, “who have fought in Iraq and Afghanistan [and] make up more than half of veterans who committed suicide after returning home from those wars.” (The Associated Press, February, 2008)  There will be at least seven family members left to deal with the adjustment, loss, anger, and grief.  Because their loved one was a citizen soldier, they will do so alone.  They will be forced to live with the pain of their preventable loss for the rest of their lives, without the formal and informal mental health services and support available to active duty military families. Just as they did during all phases of their loved ones’ deployment.

I am the author of “When the War Came Home: The Inside Story of Reservists and the Families They Leave Behind.  "Continuum Publishing, 2006)  I am currently separated from my husband, a National Guard soldier who served one year in Iraq in 2004-05.  Just as we are beginning to find our way back together, we are starting the countdown for a possible second deployment.  Two of my cousins by marriage have also served in Iraq, one with the MN Guard, a deployment that lasted 22 months, longer than any other ground combat unit. My other cousin, active duty, was killed in action. 

My family members have spent more time fighting one war - the war in Iraq - than my grandfather and uncles did in WWII and Korea, combined.  When the home front costs and burdens fall repeatedly on the same shoulders, the anticipatory grief and trauma – secondary, intergenerational and betrayal - is exponential and increasingly acute. Nowhere is that more obvious than in Guard and Reserve households.

Our loved ones perform the same duties as regular active troops when they are in theatre, but they do it with abbreviated training and, all-too-often, insufficient protection and aging equipment.  It was a National Guardsman who asked then-Secretary of Defense Donald Rumsfeld what he and the Army were doing "to address shortages and antiquated equipment" National Guard soldiers heading to Iraq were struggling with.

Guard families experience the same stressors as active duty families before, during, and after deployment, although we do not have anywhere near the same level of support, nor do our loved ones when they come home.  Many Guard members and their families report being shunned by the active duty mental health system.  Army National Guard Specialist and Iraq War veteran Brandon Jones said that when he and his wife sought post-deployment counseling, they were “made to feel we were taking up a resource meant for active duty soldiers from the base.”  One Guardsman’s wife was told that “active duty families were given preference” when seeking services for herself and her daughters while her husband was in Iraq. 

The nearly three million immediate family members directly impacted by Guard/Reserve deployments struggle with issues that active duty families do not.  The Guard is a unique branch of the Armed Services that straddles the civilian and military sectors, serves both the community and the country.  The Guard has never before been deployed in such numbers for so long.  Most never expected to go to war.  During Vietnam, some people actually joined the Guard in order to dodge the draft and avoid combat.  Today’s National Guard and Reservists are serving with honor and bravery, each and every time they’re called.  But when the Governor of Puerto Rico called for a US withdrawal from Iraq at the annual National Guard conference, more than 4,000 National Guardsmen gave him a standing ovation. (“Troops cheer call for Iraq withdrawal.” The Associated Press, August 26, 2007)

These factors are crucial to understanding the mental health impacts of the war in Iraq on the families of Guard/Reserve veterans, and tailoring programs and services to support them.

Several weeks after my husband got the call he was mobilized.  There was very little time to transition from a civilian lifestyle and employment to full-time active duty.  The Guard didn’t have regular family group meetings, and I couldn’t go next door to talk to another wife who was going through the same things I was, or who had already been there, done that.  Most Guard/Reservists live miles away from a base or Armory, many are in rural communities.  We are isolated and alone. 

At least 20% of us experience a significant drop in household income when our loved one is mobilized.  This financial pressure is an added stressor.  The majority of citizen soldiers work for small businesses or are self-employed.  Some have lost their jobs or livelihoods as a direct result of deployment.  The possibility of a second or third tour makes it difficult to secure another one.  Guard members have reported being put on probation or having their hours cut within a few days of being put on alert status for deployment.  Some of us have to re-locate.  Some of us go to food shelves.  Where we once had shared parenting responsibilities, the spouse left behind is now the sole caregiver, without the benefit of an on-base child care center.

During deployment, we withdraw and do the best we can to survive.  Anxious, depressed, and alone, we may attempt to cope by drinking more, eating less, taking Xanax or Prozac to make it through.  We close the curtains so we can’t see the black sedan with government plates pulling into our drive.  We cautiously circle the block when we come home, our personal perimeter check to make sure there are no Casualty Notification Officers around.  Every time the phone rings, our hearts skip a beat.  Our kids may act out or withdraw, get into fights, detach or deteriorate, socially, emotionally, and academically.  There are no organic mental health services for the children of National Guard and Reservists, even though they are more likely to be married with children than active duty troops.

There are a growing number of military families with what psychologists are beginning to recognize as Secondary Traumatic Stress Disorder. Secondary Trauma may occur when a person has an indirect exposure to risk or trauma, resulting in many of the same symptoms as a full-blown diagnosis of PTSD. These symptoms can include depression, suicidal thoughts and feelings, substance abuse, feelings of alienation and isolation, feelings of mistrust and betrayal, anger and irritability, or severe impairment in daily functioning. (“Walking On Eggshells.” Mary Tendall and Jan Fishler, Vietnow Magazine.)

One woman wrote, “My husband is a Reservist and, foolishly or not, we did not expect him to be activated and sent to Iraq. During my husband's deployment I had anxiety, depression, loss of appetite, difficulty sleeping, and hair loss from the stress. I had to cut back on my work hours because I couldn't concentrate.”

When our soldiers come home, they are given a perfunctory set of questions about their mental health status, and then they are given back to us.  50% of Guard/Reservists who have served in Iraq suffer post-combat mental health issues, and the government has known for decades that Reservists are at significantly higher risk.

Numerous studies conducted in the 1980’s and 90’s on the impact of combat deployments in citizen soldiers found that “Being a reservist, having low enlisted rank, and belonging to a support unit increased the risk for psychiatric breakdown. [And] Loss of unit support [post-deployment] was considered a potential major factor for PTSD…In a study of National Guard reservists …nearly all subjects reported one or more PTSD-specific symptoms 1 and 6 months after returning from the Persian Gulf area.” (Possibilities for Unexplained Chronic Illnesses Among Reserve Units Deployed in Operation Desert Shield/Desert Storm. Southern Medical Journal, December 1996.)

The VA has done nothing about it.  I question the practice of commissioning reports and conducting studies if you’re not going to apply what you’ve learned. Perhaps rather than forking out another $5-10 million for another study to define a problem that somehow never fully gets defined, much less treated, you could use that same amount of money to fund community-based centers providing our military families and veterans three years of the free services that they are begging for – individual, high touch, weekend and evening, experiential, off-post – but aren’t currently available.

Perhaps in addition to soliciting the fee-for-service advice of people with Ph.D.’s in Psychology, you could commission the people with Doctorates in Deployment, the military families and veterans who have lived with it, worked with it and walked through it.  They know what’s needed, what helps, and what the emerging issues are.  I knew the suicide rates of citizen soldiers who served in Iraq were going to be off the charts when I started hearing from their family members more than two years ago. 

Although it stands to reason that the branch of service with the highest rates of PTSD would be the same one with the highest rates of suicide, it seems that the Department of Veterans Affairs had to do a formal analysis in order to determine that citizen soldiers are more likely to kill themselves as war veterans. A Military Citizens Advisory Panel could likely have saved lives, dollars and years of pain.

“How Do You Mourn for Someone Who Isn’t Dead?”

After our loved ones return from deployments that have all the precursors for post-combat mental health issues, (civilian casualties, longer than six months, significant combat exposure, enlisted rank, citizen soldier, loss of unit support post-combat, etc.) we’re given a pamphlet and told to “give it time.” While we’re reading and waiting, we’re losing our veterans, our marriages, and our families. One former spouse said:

This war cost me my family. When my husband returned from Iraq it quickly became apparent he was suffering from PTSD. He became increasingly verbally and mentally abusive to not only my daughter and I, but many of his subordinates at work who either quit or he had fired. He refused to admit he had a problem, and since the military does no mental status follow-up [for Reservists] he hasn't received any treatment for his condition. As a consequence, my family is destroyed. My son isn't being raised by his dad and my daughter lost the only father she knew. I know a divorce isn't as bad as losing my husband to death, but I can honestly say the man I married died in Iraq.

We are also given the option of five free sessions with a civilian provider.  Here’s what one Guard wife wrote about that:

When my husband returned from Iraq, we were offered five free “helping” sessions- they were careful to stress that it was not counseling or therapy- after which, we were on our own. In our first session, my husband talked about the nightmares, the sounds that would trigger a flashback or a rush of fear. Our “helper” chose to focus that particular session on….our financial situation. She was a civilian, and was thoroughly unfamiliar with any of the issues facing military families, much less returning vets.

And so, my husband entered private therapy, at a cost of $85.00 a week which we often didn’t have. I was no longer a part of this process. The impact of his deployments on our family was no longer addressed. We were simply supposed to continue on as if nothing had changed. But we had been changed. Rob came back hardened, angry. I was angry myself, bitter and resentful. We both experienced PTSD.

Any reminder of his deployment, such as hearing about a group deploying or returning from Iraq, would send me into sobbing panic attacks. I experience what I called “home-front flashbacks”, sudden overwhelming feelings of isolation, fear, depression, helplessness, triggered by commercials, news stories, or a particular song on the radio. What use were these “helping sessions” when our “helper” had no concept of what life was like for a military family?

This is what life is like for another military family living with a combat veteran:

Back in May, Kyle suffered a PTSD dis-associative state of mind [and] held me at knife point [and] wouldn't let me leave; he had me and our family sitting on the
floor and was speaking to us in Arabic. This ordeal lasted about an hour and a half. He calmed down with the help of a Vietnam veteran friend [on] the phone… I took the kids next door and … the police showed up, woke my husband and arrested him.

The veteran’s unresolved traumatic re-enactment resulting in domestic violence – which is at least three to five times more prevalent in households with combat veterans - is the nucleus of intergenerational trauma, which the children and grandchildren of these veterans will live with for the rest of their lives. There are countless military family members suffering in silence all across America.  The wife of one profoundly injured Marine with polytrauma asked, “How do you mourn for someone who isn’t dead?” The physical, financial, emotional and psychological challenges faced by these caregivers are immense, and they have little – if any – support from the system. (“How the US is failing its war veterans.” Don Ephron and Sarah Childress, Newsweek, March 5, 2007.)

The greatest grief is borne by the Gold Star families, and often the parents and siblings have little, if any, support.  If the parents are divorced, one inevitably gets pushed aside.  This was the case for a grieving mother who contacted me, desperate for help for herself and her surviving sons, she told me, “I will spend the rest of my life in a mild state of depression.”  Another Gold Star mom wrote:

My son, Spec Jeremy W. McHalffey served in the Army National Guard and was killed in Iraq, January 4, 2005.  Jeremy's older brother Michael will never get over losing his brother. Jeremy owned a home in Little Rock, Arkansas and I planned to retire there in 5 years to live near both my sons. I don't want to retire to a grave site. We plan a family vacation to the shore each year. We have spent 3 years without Jeremy and it never gets any better.

But, “the military health system lacks the fiscal resources and the fully trained personnel to fulfill its mission to support psychological health” of the troops and their families, according to a Department of Defense mental health task force report released in June of 2007. 

When I went to the VA, I spoke with a program officer, who said, “It’s the wife’s responsibility to set the tone for the whole household.” A veteran’s advocate asked me, “Why don’t you take care of him?” The VA’s mental health professionals preach to the wives about resilience, but they aren’t the ones being woken up at three in the morning because their husband has shot the dog, or is holding a gun to your head, or a knife at your throat. 

Expecting the wife or family member to treat the veteran violates the professional standard prohibiting family members from treating their own; places the burden of care on the family; creates a highly unfair and unethical expectation that we are trained mental health providers; discounts our reality; excuses the VA from fulfilling its responsibility to our veterans; and places an immoral burden upon the family member, who is likely already suffering undue mental health and financial consequences as the result of having their loved one deployed.

The legacy of guilt and self-blame this creates is profound.  Virtually every family member I have talked to who lost their veteran due to suicide or divorce has said, “I thought if I loved him enough, I could fix him.”  That the VA and the military continues to lay this on the wives and family members, in practice, if not in policy, is a gross moral and ethical violation and an abdication of responsibility.

It Is a Covenant, and It Has Been Betrayed.

After being denied care, having their symptoms dismissed, or put on waiting lists of up to half a year, dozens of Guard/Reserve veterans have committed suicide, including Jonathan Schulze, Jeffrey Lucey, Chris Dana, Tim Bowman, and Joshua Omvig.  Given the documented failure (CBS News, November 2007) of the Veteran’s Administration to track and disclose veteran’s suicide rates in a timely and forthright manner, and the fact that they don’t monitor Guard and Reserve, it is extremely likely that the actual number is in the hundreds, if not a thousand or more.

When the VA repeatedly proves to us that we cannot trust them to take care of our loved ones, we feel betrayed.  The 60% of military family members of a veteran who has served in Iraq or Afghanistan and say that the war in Iraq was not worth the cost feel betrayed. (Los Angeles Times/Bloomberg poll, December, 2007) When our loved ones are committing suicide after they are refused treatment by the VA, we feel betrayed.  When the Army’s mouthpiece, Col. Elspeth Ritchie, says, “People don’t tend to suicide as a direct result of combat…failed personal relationships are the primary cause,” then goes on to further blame the military families by stating, “Families are getting tired.  Therefore, they’re more irritable, sometimes they don’t take care of each other the way they should, are not as nurturing as they should be.” WE FEEL BETRAYED.

There is no dictionary large enough to describe what you feel when you learn that your loved one has fought, died, been wounded, is on the ground or on alert to return to fight in a war that was launched on 935 lies. (The Center for Public Integrity, and the Fund for Independence in Journalism.) 

According to the wife of an Ohio National Guardsman:

My husband served with his National Guard Unit on Victory Base during 2004. [He] was deployed six months after our wedding... Neither of us believed that this war was just … The rage and anger at the sacrifices being asked of military families, coupled with the severe emotional strain of worrying about my husband in Iraq pushed me to a breaking point. We were able to receive a hardship discharge for him to come home because [of] my severe depression and anxiety…The shadows of the war are omnipresent in our lives still. We both seek therapy.

Mental health experts refer to this as betrayal trauma, which occurs when “the people or institutions we depend on for survival violate us in some way.  Betrayal, as a form of deception, is the breaking or violation of a presumptive social contract (trust) that produces moral and psychological conflict within a relationship amongst individuals, between organizations or between individuals and organizations.” (Wikipedia)

When it is life and death and your loved one on the line, when your husband, father, mother, brother, daughter or son is fighting for country and Constitution, military service is no mere contract.  It is a covenant, and it has been betrayed.

The Guard and their families are keeping their promise to this country.  It’s time for this country, and the VA, to keep its promises to them.  Please provide our veterans and families the mental health care and services they deserve.

Closing Remarks:

One of the most critical elements in promoting the short- and long-term wellness of the combat veteran is the military family.  Yet, Guard and Reserve families are generally left to fend for themselves during and after deployments.  In order for the VA to genuinely care for America’s veterans, it must attend to the needs of the families who are left behind during combat deployments, enduring the stress, trauma, violence and grief of war, struggle with marriage and family cohesion and reintegration, and serve as the first line of support for the soldier during deployment and for the veteran upon his/her return. 

However, within the Veterans Administration, treatment benefits are tied to the veteran. Military spouses cannot access services at the VA until their soldier has acknowledged his/her trauma, registered with the appropriate agency, and provided paperwork/given permission for the spouse to receive assistance or attend a support group, which may or may not be available at that time. 

The majority of the affected families/loved ones (parents, children, siblings, significant others, etc.) are beyond the scope and scale of mental health care and services provided by the military, the Veterans Administration, and Vet Centers.  Military ONE Source allows for a maximum of six visits, and Guard/Reserve families, extended family members, siblings and unmarried partners and significant others of the soldier’s family often do not have private insurance, cannot afford the co-pay or out-of-pocket expense, and are unable to find an adequate mental health provider. Few accept TRI-CARE (military medical plan); fewer still have the experience, training and awareness to address the particular needs of the military community during a time of war.  Such inadequacies put the health, well-being and future of military family members and their veterans at risk.

Gaps in Mental Health Services for Families of Guard/Reserve Veterans:

1. Mental health resources available for military family members are typically designated for active duty dependents.
2. Counseling/support is tied to the veteran, who may or may not be seeking services AND may or may not be willing to provide permission required in order for spouse to obtain care.
3. General disregard for veteran impact on family, reintegration issues, and effect of combat-trauma on family members during and after deployment.
4. DOD/VA subcontractors are often civilian providers with no previous experience with military families or therapeutic skill in counseling individuals struggling with the psychological stressors and strains of all phases of combat deployments.
5. No programs available for parents, extended family members, or gender-friendly events for male spouses/ partners of female Reservists.
6. No weekend or night sessions, when Guard/families are typically available.
7. Lack of ad hoc or informal support opportunities.
8. No exposure to wives/parents/military family members/veterans who have lived through combat deployments.
9. Virtually no services available in rural areas.
10. No regular phased follow-up i.e. 6, 12, 18, 24 months post-deployment.
11. Attempting to apply active duty models to citizen soldiers fails to recognize and address challenges and issues unique to families of citizen soldiers.

RECOMMENDATIONS (Annotated – Proposals Available Upon Request)

The Military Citizens Advisory Panel (MCAP):

Real support for citizen soldier veterans and their loved ones cannot be achieved without the perspectives of those who are directly affected by combat deployments.  It is critical that the expertise and experience of military citizens, i.e. family members from all branches of services, retired active duty and reserve, combat and non-combat veterans, etc., who are able to speak about the realities of being a veteran, the effects of combat deployments, and the battles that begin when the war comes home, is brought into the policy, program and oversight processes of the Veterans Affairs Committee. Because they are the people they represent, the Panel members primary concern is for service men and women, their families and communities, and the veterans of the Armed Forces. They know first – and most accurately – what is occurring with our veterans, the shortfalls in care and services, emerging issues, suggestions for improvement.

Peer-to-Peer Support Groups:   Peer counseling prior to/during/after deployment by wives of combat veterans/military families/parents/combat veterans.

Implement Adopt-A-Family program - Involve community members in taking a Guard/Reserve family under its wing throughout all phases of combat deployment.

Conduct Home Visits: Many Guard/Reserve families lack transportation or cannot easily travel to Guard Armories, and approximately 40% of veterans live in rural areas.

Fund Community-Based Weekend Retreats/Experiential Programs & Non-Clinical Services, including:

• Veteran Mentoring/Peer Counseling
• Family Group Counseling
• Off post readjustment/reintegration counseling for families of wounded warriors
• Grief Counseling for Gold Star families
• Developmentally-appropriate play therapy for children
• Respite & Bereavement Support: Taking care of the caregivers
• Outdoor/Experiential Programs

Develop & Implement Family-Systems Theory Programs/Services

By definition, a family system functions because it is a unit, and every family member plays a critical, if not unique, role in the system. As such, it is not possible that one member of the system can change without causing a ripple effect of change throughout the family system. (Source Unknown)  “The entire family suffers when a Veteran’s mental health needs are not acknowledged and resolved; it can strain even the strongest of marriages.  ...the longer the problem is not treated, the complicated the treatment becomes due to complications that arise from the lack of treatment.  As a result, our families suffer through crisis on a daily basis.” (LTC Carol Seger, WAARNG State Family Programs Director, August 20, 2007)

FAST FACTS: National Guard & Reserve Veterans and Their Families

1. Since the onset of military operations in Iraq and Afghanistan, more than 400,000 members of the National Guard and Reserve have served in the Middle East (counting each deployment as unique), and more than 600,000 have been mobilized since 2001. (Office of the Under Secretary of Defense, September 2007).
2. Assuming that each of those troops has seven immediate relatives–such as parents/step-parents, spouses/partners/significant others, siblings and children–the wars have closely affected more than 2,800,000 Guard/Reserve family members. (Formula adapted from “War’s Invisible Wounds.” Zak Stambor, APA Monitor on Psychology, Vol. 37, No.1, January 2006.)
3. Almost 50 percent of the Guard and Reserve who have served in Iraq are experiencing combat-related mental health problems, as are 38 percent of Soldiers, and 31 percent of Marines. (“An Achievable Vision: Report of the Department of Defense Task Force on Mental Health” June 2007, Defense Health Board, Falls Church , VA, p.6)
4. “National Guard and Reserve troops who have fought in Iraq and Afghanistan make up more than half of veterans who committed suicide after returning home from those wars.” (The Associated Press, February 2008).

5. “No U.S. forces have ever been compelled to stay in sustained combat conditions for as long as the Army units have in Iraq. In World War II, soldiers were considered combat-exhausted after about 180 days in the line.” (Lieutenant General William E. Odom, (Ret.) 05 July 2007)

Key Issues: Impacts of Combat Deployments on Military Families.

• The Journal of the American Medical Association (JAMA) released a study looking at families of enlisted Army troops with verified reports of child maltreatment.  The report revealed that among female civilian spouses, the rate of maltreatment during deployment was more than three times greater; the rate of child neglect was almost four times greater; and the rate of physical abuse was nearly twice as great.  (“Child Maltreatment in Enlisted Soldiers’ Families During Combat-Related Deployments”  Deborah A. Gibbs, MSPH; Sandra L. Martin, PhD; Lawrence L. Kupper, PhD; Ruby E. Johnson, MS. JAMA 2007; 298: 528-535; Vol. 298 No.5, August 1, 2007)
• School counselors, teachers, therapists and military family members report that a growing number of military kids are exhibiting social, emotional, and behavioral problems during and after deployments.  These problems are intensified if their soldier returns with a physical or psychological wound. (“Communication is Key for Children of Deploying Parents”  Bilyana Atova, Army News Service, August 15, 2007)
• Divorce and separation rates among returning Iraq war veterans are fast approaching double the rate of peacetime divorces. (“Deployments Stress Marriages.” Christine Metz, Lawrence Journal-World & News, October 8, 2007) The wife and child(ren) of the veteran suffer significant impacts of separation/divorce, including a major drop in household income, stress and expense of re-location, loss of friends, loss of sense of identity/connection to military, etc, in addition to the usual stressors associated with the dissolution of a marriage and the break-up of a family.
• According to the Miles Foundation (hometown.aol.com/milesfdn), domestic abuse in military households is already five times greater than the rate of civilian domestic abuse, and the numbers do not take into account assaults that occurred off-base, or involving domestic partnerships/common law spouses, etc.  It has been shown repeatedly that violence in the home and on military bases and installations increases during wartime, and spikes in the first year post-deployment, as evidenced in the spate of spousal murders at Ft. Bragg in the first months of redeployment from Afghanistan. 
• Preliminary research, self-reports and anecdotal information suggest that upwards of 30% of military family members are exhibiting war-related “secondary trauma,” which shares some of the same symptoms as a full-blown diagnosis of post traumatic stress disorder, including emotional withdrawal, increased anxiety, depression and poor anger management.
• With an unprecedented wound-to-kill ratio of nearly 16 to 1 and the prevalence of Traumatic Brain Injury (TBI) parents (particularly mothers), spouses, grandparents and siblings are becoming the primary caregiver of their grievously injured veteran and have scant support or services.