NYHealth Senior Program Officer Derek Coy submitted the following testimony to the October 29, 2024, New York City Council Committee on Veterans oversight hearing on supporting the families of veterans coping with PTSD:

Thank you for the opportunity to testify on behalf of the New York Health Foundation (NYHealth) regarding the urgent mental health needs of veterans and the essential role of family support. NYHealth is a private, independent, statewide foundation dedicated to improving the health of all New Yorkers—including more than 133,000 veterans who call New York City home. My name is Derek Coy; I’m a Senior Program Officer at NYHealth. I am also a proud veteran, having served as a Sergeant in the United States Marine Corps.

The Foundation has worked for more than 15 years on behalf of veterans by engaging in grantmaking, policy analysis, advocacy, and convenings to understand and support military veterans’ health needs. Our work has found gaps in services and helped develop effective, promising programs to address them. We have supported a range of community-based organizations, health care providers, and peer mentor programs to ensure New York’s veterans receive high-quality, culturally competent care and support that meets their health needs and preferences. NYHealth has supported the work of organizations like Military Family Clinics, the Headstrong Project, and partnerships with the Unified Behavioral Health Center because of their unique focus on serving veterans alongside their families and caregivers. By addressing the mental and behavioral health needs of those who support New York’s veterans, these programs help create a more resilient and capable network of support for those who have served.

Understanding the Mental Health Challenges Facing New York City’s Veteran Population
Recent research highlights the mental health challenges veterans face and the need for family-centered approaches to mental health care, especially for those dealing with post-traumatic stress disorder (PTSD). According to an NYHealth-commissioned study published by RAND in October of this year, 26% of New York State veterans who recently separated from the military have a probable PTSD diagnosis—a 60% increase since 2010. (One caveat: it is important to consider that factors like improved screenings, reduced stigma related to mental health, and greater access to care may have contributed to this increase.) Almost two-thirds of these veterans reported having a disability and 20% rate their health as “fair” or “poor”—meaning that veterans have more health problems than their civilian peers. Additionally, more than one in five veterans reported an unmet need for mental health care. For those with suicidal ideation in the past year, 43.4% had unmet mental health needs.[1]

The invisible wounds of war—PTSD, suicidal ideation, and substance use—contribute to poor outcomes for veterans. An NYHealth analysis found that New York City veterans had a 2.5 times higher rate of “deaths of despair” (suicide and alcohol- and drug-related deaths) than civilians in New York City from 2012–2021. Substantial disparities in deaths of despair exist across different demographic groups. For example, the Bronx reported the highest rates of any borough—nearly double the citywide average. Citywide, deaths of despair rates were highest among veterans ages 55–64, particularly among Black and Hispanic veterans.

Secondary Trauma: The Overlooked Mental Health Burden on Veterans’ Families
Mental health challenges often extend beyond veterans, to affect their families, who may experience “vicarious trauma” or secondary trauma, which mirrors PTSD symptoms and places families under significant strain.[2] Veterans’ families, especially caregivers, often bear additional emotional and mental burdens. U.S. Department of Veterans Affairs (VA) studies highlight that children of veterans with elevated PTSD symptoms show increased behavioral issues and emotional distress.[3] Children of combat veterans with PTSD can feel sadder and more anxious compared to children of non-combat veterans without PTSD.[4] Caregivers are also heavily affected: according to the Elizabeth Dole Foundation, nearly half of caregivers of veterans under age 60 meet the criteria for depression. One in three caregivers sought mental health care in the past year but could not access it; 78% of them cited time constraints as the main barrier to care.[5]

The Importance of Inclusive Research on Veteran and Family Needs
It is crucial that research on veterans’ mental health include diverse samples that reflect the veteran population. A 2012 review revealed that most studies focused on male veterans and their female partners, which may mask important differences in risk factors and outcomes by gender and sexual orientation.[6]

There is promising research on interventions to support veterans with PTSD and their families. Research on interventions for caregivers of veterans with PTSD—particularly those focused on coping strategies and managing PTSD-related concerns—found that, after the intervention, caregivers reported reduced burdens, lower levels of depression and anxiety, less stress, and decreased time spent providing care, among other outcomes.[7] Furthermore, having families involved in a veteran’s treatment can reduce their potential for dropping out of care.[8]

To support veterans with PTSD and their families, we offer the following recommendations:

  1. Expand and invest in integrated services for veterans and families. Programs that support both veterans and their families (such as Military Family Clinics, the Headstrong Project, and partnerships with Unified Behavioral Health Center) should be expanded and replicated. These models provide holistic mental health care that addresses the interconnected needs of veterans and their loved ones, reducing PTSD symptoms and alleviating family stress for improved household wellbeing.
  2. Increase awareness and outreach efforts. Recent national research indicates that a significant portion of veterans (25%) and their families (64%) are unaware of available mental health resources.[9] Family members often face additional barriers when navigating these resources. Targeted outreach and educational campaigns can bridge this gap, helping veterans and families understand and access available benefits and support.
  3. Expand peer support services for family members and caregivers. Peer support offers invaluable guidance for families, who benefit from shared experiences. Expanding peer support networks—including those funded through the New York City Department of Veterans’ Services Request for Proposals for the Joseph P. Dwyer Veterans’ Support Program initiatives, as well as networks specifically tailored for families and caregivers—could provide essential emotional support and practical resources to those affected by a loved one’s PTSD.

NYHealth remains dedicated to advancing these recommendations, and we believe New York City can play an important role in meeting the growing mental health needs of veterans and their families. By prioritizing family-centered care and awareness, we can help mitigate the effects of PTSD on veterans and create healthier, more resilient families. We invite you to look to the New York Health Foundation as a resource in this work. You can learn more about our veterans’ health initiatives by visiting our website, www.nyhealthfoundation.org.

 

[1] RAND. 2024. “Understanding Veterans in New York”. New York Health Foundation. New York, NY. Available at: https://nyhealthfoundation.org/wp-content/uploads/2024/10/RAND_Understanding-Veterans-in-New-York.pdf.

[2] Diehle, J. Brooks, S. K. Greenberg, N. 2016. “Veterans are not the only ones suffering from posttraumatic stress symptoms: what do we know about dependents’ secondary traumatic stress?” Social Psychiatry: Psychiatric Epidemiology. doi: 10.1007/s00127-016-1292-6

[3] Lambert, J. E. Holzer, J. Hasbun, A. 2014. “Association between parents’ PTSDD severity and children’s psychological distress: A meta-analysis.” Journal of Traumatic Stress 27(1). https://doi.org/10.1002/jts.21891

[4] U.S. Department of Veterans Affairs, “PTSDD: National Center for PTSDD. When a Child’s Parent has PTSDD,” https://www.PTSDd.va.gov/family/effect_parent_PTSDd.asp#:~:text=Some%20children%20of%20combat%20Veterans,nightmares%20about%20the%20parent’s%20trauma., accessed October 2024.

[5] Ramchand, R. Dalton, S. Dubowitz, T. Hyde, K. Malika, N. Morral, A.R. Ohana, E. Parks, V. Schell, T.L. Swabe. G. et al. 2024. “America’s Military and Veteran Caregivers. Hidden Heroes Emergency from the Shadows.” RAND. Available at: https://www.rand.org/pubs/research_reports/RRA3212-1.html.

[6] Lambert, J. E. Engh, R. Hasbun, A. Holzer, J. 2012. “Impact of posttraumatic stress disorder on the relationship quality and psychological distress of intimate partners: a meta-analytic review. Journal of Family Psychology. doi: 10.1037/a0029341.

[7] Martindale-Adams, J. L., Zuber, J., Graney, M. J., Burns, R., & Nichols, L. O. (2021). “Effect of a Behavioral Intervention on Outcomes for Caregivers of Veterans with PTSDD. Military Behavioral Health. doi: 10.1080/21635781.2021.1927916.

[8] Thompsons-Holland, J. Lee, D.J., Sloan, D. M. (2021). “The Use of a Brief Family Intervention to Reduce Dropout Among Veterans in Individual Trauma-Focused Treatment: A Randomized Controlled Trial.” Journal of Traumatic Stress 38:4. doi: 10.1002/jts.22680.

[9] Ramchand, R. Dalton, S. Dubowitz, T. Hyde, K. Malika, N. Morral, A.R. Ohana, E. Parks, V. Schell, T.L. Swabe. G. et al. 2024. “America’s Military and Veteran Caregivers. Hidden Heroes Emergency from the Shadows.” RAND. Available at: https://www.rand.org/pubs/research_reports/RRA3212-1.html.

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