Collateral Damage

Four years ago, combat veteran James Christian Paquette lost his battle with Post Traumatic Stress and shot himself in the head. This summer, his son Alex, wearing dog tags with his dad's picture, followed in his father's footsteps. His mother found a note in his room that read in part, "I'm going to see dad in heaven."

Alex was 13 years old.

The American public hears stories about the devastating impact that mental wounds of war can have on a combat veteran, and how far too often, the Department of Veterans Affairs is failing them.

But there's an untold story behind these tragic deaths that no one is talking about, an invisible population of veterans' children whose entire lives have been shaped by a war that has come home. An estimated 22 veterans die by suicide every day in this country, leaving shattered families behind -- collateral damage from wars that have all but left the headlines.

We now have an entire generation of military families who know nothing but war. An estimated 30-35% of the 2.7 million troops who have deployed since 9/11 are struggling with Post Traumatic Stress (PTS), Traumatic Brain Injury (TBI) and/or substance abuse. These are conditions known to affect entire families, and can derail the mental health and development of the over two million children who have had a parent deployed over the past 14 years.

A growing body of evidence indicates that some children of military families -- especially those living in PTS/TBI households -- have been negatively affected by their parent's deployments. Research conducted by the University of Southern California found that military connected adolescents have a higher rate of suicidal thoughts than their civilian counterparts, and other studies indicate that military spouses -- particularly those serving as caregivers to support their wounded veterans -- are more at risk to suffer mental health problems.

To make matters worse, in most cases spouses and children of the over 60% of post 9/11 troops who have left active duty, are not eligible for healthcare from the Department of Veterans Affairs. No one federal agency is held accountable, and there is no coordinated system to respond to the needs of these families. In fact, for the most part they are invisible to the systems that could be providing them services. While the Department of Defense has been directed by Congress to start tracking suicides among active duty family members, the VA has no such mandate to track family members once they leave active duty.

We, as a nation, are failing these families, many of whom feel abandoned by the country their loved ones fought to protect. Helping these families isn't just a moral imperative, it's a public health concern. RAND estimates that the lost productivity among post 9/11 caregivers (mostly young wives) will confer a societal cost of almost 6 billion dollars. And the National Center for Child Traumatic Stress reports that poverty, addiction and mental illness are just some of the conditions that have their roots in untreated childhood traumatic stress.

What can be done?

Children and Family Futures, a California based advocacy organization, recommends the Departments of Defense, Veterans Affairs and Health and Human Services expand their research program to better assess the behavioral health needs of veteran children. Currently, the bulk of research focuses on active duty families, who have far better access to care. In addition, mental health conditions related to wartime service sometimes take years to manifest, which means hundreds of thousands of veteran family members are at risk of falling through the cracks.

Second, an estimated 350,000 veteran families lack health insurance. This requires a targeted outreach campaign -- at both the federal and local levels -- to educate and enroll these families in health coverage under the Affordable Care Act.

Third, the VA must do more to identify and help these families. Currently, there are no screening or assessment protocols used to determine the service needs of veteran caregivers or children. The VA is struggling to keep up with the growing demand in mental health services for veterans, and does not have the capacity (or congressional authority) to provide behavioral health support for family members. But, they can certainly do a far better job of ensuring warm hand-offs to community based mental health agencies.

The fact is, the majority of veteran families in need of behavioral health care will be seen by community based organizations. These agencies will require the funding, cultural competency and education in evidence based practices to expand their capacity and effectively serve veteran families in crisis. The VA's Supportive Services for Veteran Families (SSVF) program, which grants $300 million dollars a year to community based organizations, has been widely credited for helping to drastically reduce veteran homelessness. This same model can be used to support community based behavioral health care for veterans and their families.

The yellow ribbons have faded and the welcome home parades are a distant memory. But there's a price to pay for outsourcing our national defense to less than one percent of the population over 14 years of war. This isn't a military problem. It belongs to all of us.

Alex's mom, Jami, and her remaining son are now getting the counseling they need through a local veterans center. As painful as it is for her to speak openly about her tragic losses, she is committed to raising awareness. It's too late for Alex, but we can still save hundreds of thousands of families damaged by war, and give them a chance to become whole again.