Call to support PTS families and ‘carers’

The partners of veterans and emergency services first responders need more emotional, social and organisational support, a new Flinders University study says.

Flinders Human Behaviour and Health Research Unit researchers have made a series of recommendations, including that the vicarious impact of Post-Traumatic Stress (PTS) on the partners be more formally recognised within organisational policies and procedures of the Department of Veterans’ Affairs (DVA) and Emergency Services First Responders (ESFR) services.

There’s also a call for clearer communication about the potential risk of PTS associated with their partner’s role in military or emergency services at the beginning of their career or as early as possible.

Funded by leading veterans and emergency services charity The Road Home, part of The Hospital Research Foundation Group, the study was conducted by Professor of Psychiatry Sharon Lawn and her Flinders University team of Dr Elaine Waddell, Dr Louise Fuller and Dr Julie Henderson.

“This particular project is about trying to help people understand the impact Post-Traumatic Stress has on partners and to recognise that they are in fact carers,” Professor Lawn says.

“Most people in that position do not link themselves with that term.

“Few studies in the past have examined the emotional health and wellbeing of partners of ESFRs.

“Even fewer studies have examined the broader lived experience of being an intimate partner of a contemporary veteran (those who undertook military service from 1989 onwards) or ESFR with PTS.

“Research on the wellbeing of partners of veterans has tended to focus on their psychological health by measuring the prevalence and nature of their psychological distress: the ‘secondary traumatisation’ or levels of perceived burden.

“They have tended to take a narrow clinical focus with recommendations limited to psychological treatment or therapy for the partner or couple,” Professor Lawn says.

Three major interrelated themes arose from this study: protecting the family unit; the need for support; and barriers to support.

Protecting the family unit was revealed as paramount with the focus being on ensuring the wellbeing of all members.

While other sub-themes arose in the study, it was obvious that underpinning all of them was an overriding sense of commitment that this group of participants expressed towards their partners.

Participants described many different impacts of their lived experience of being a partner of a veteran or ESFR with PTS.

Within these descriptions, the need for support was a central feature; so too were the considerable barriers to accessing the support.

“Barriers included a lack of recognition and understanding of the partner’s role and needs by organisations, mental health services and other support service providers, and self-stigma and organisational stigma,” Professor Lawn says.

“Navigating the complex health support systems for their family member with PTS as well as themselves was also seen by partners as a major barrier to seeking help,” she says.

Overall, findings strongly suggest that responding to the needs of the partner is critical in the recovery journey of the veteran or ESFR with PTS because of their key role in supporting their partner’s autonomy, identity and sense of purpose in life beyond the partner’s military service or role as an ESFR.

“They are the key navigators of the mental health system and advocates for the care of their partners with PTS, while striving to preserve their relationship and the wellbeing of the family unit as a whole, often at the suppression of their own needs.

“We must ensure better systems are put into place to help partners to better support their loved ones when experiencing a traumatic event in the course of their work,” Professor Lawn says.

Key Recommendations:

  1. More formal recognition of the vicarious impact of PTS on partners of veterans and ESFRs is needed within organisational policies and procedures for these populations, the DVA, and ESFR services.
  2. Any family support services developed to support people with PTS and their partners should acknowledge the potential differences between the experiences and needs of veterans and ESFRs and tailor their responses accordingly, in consultation with each individual, rather than assume that one size fits all.
  3. Partners’ understanding of mental health conditions and their impacts (i.e. partners’ health literacy) should not be assumed merely by providing them with generic information about what PTS is and how it manifests in a clinical or definitional sense. Education materials developed for families of veterans and ESFRs with PTS must also include more information about strategies for ‘living with’ the experience in everyday family life.
  4. Promoting PTS health literacy should commence early. Partners should also receive formal early communication about the potential risk associated with their partner’s role (e.g. military service, ESFR), and at various transition points in the partner’s career trajectory, given that they are likely aware of problems developing before others.
  5. Mechanisms for early intervention within primary care could be improved. GPs should be encouraged to ask about family life where they know that their patient is a veteran or ESFR, or a partner of a veteran or ESFR.
  6. Families must be included from the outset of an individual’s career, not only as an afterthought when problems arise in the performance of their professional role.
  7. More focus is needed on making explicit the value of family peer support groups in promoting wellbeing and resilience, and more work is needed to understand what they could and should look like. The Road Home’s Skills Training in Affective Interpersonal Regulation (STAIR) program is one potential model.
  8. One-to-one mentor support may be one option for filling the need created by significant role changes arising from the presence of PTS.
  9. PTS treatment and care providers must create therapeutic spaces for people with PTS and their partners to raise issues about intimacy, or initiate discussions about intimacy more centrally in their dialogues with veterans and ESFRs with PTS and their family members. Leaving intimacy issues ‘unspoken’ separates the person from important sources of identity and support, and overlooks key components of the problems that can perpetuate their PTS, and which can be associated with marital conflict, grief and loss.
  10. Children of veterans and ESFRs should not be overlooked in the design and promotion of mental health literacy for families. Strategies for supporting children should be designed to reflect the different issues associated with the parent’s occupational background and should not be limited to clinical counselling.
  11. With the increasing number of young families experiencing financial distress as result of medical discharge from the ADF, there is an urgent need to raise this issue with government services, including the Department of Defence and DVA.
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College of Medicine and Public Health Research