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June 24, 2014

Ask Me Anything: Rajeev Ramchand on Military Caregivers

Photo by Alex Chernak/Fotolia

An estimated 5.5 million military caregivers—family members, friends, and acquaintances who provide a broad range of services to current or former military servicemembers—save the United States billions of dollars each year.

Unfortunately, caregiving comes with a cost. These individuals are at greater risk for health problems, as well as difficulties at home and in the workplace.

This spring, RAND released the most comprehensive study of America's military caregivers to date. It examines current policies and programs that support caregivers, identifies gaps and opportunities for improvement, and provides recommendations to ensure caregivers' short- and long-term well-being.

Policymakers are already taking notice. Shortly after the study was released, Senator Patty Murray introduced a bill to expand eligibility for benefits, particularly for servicemembers and veterans with mental health issues or those who've experienced a traumatic brain injury. The following day, First Lady Michelle Obama, Dr. Jill Biden, former First Lady Rosalyn Carter, and former Senator Elizabeth Dole, whose foundation commissioned the study, gathered at the White House to express their support. More recently, Representatives Jim Langevin, Mike Michaud, and Elizabeth Esty introduced companion legislation in the House.

With these “hidden heroes” quickly becoming a topic of national discussion, Rajeev Ramchand, the study's co-leader, hosted an “Ask Me Anything” session on Reddit last week, fielding a variety of questions about military caregivers and other issues concerning mental health and the U.S. military. Here's a selection:

What are the differences between mental health issues in pre- and post-9/11 servicemembers? What implications do these have for service providers and caregivers?

Ramchand: Many pre-9/11 servicemembers are dealing with ailments associated with aging, in addition to those associated with military service. In contrast, many more post-9/11 servicemembers are dealing with illnesses and injuries associated with service. In RAND's study of caregivers, many more post-9/11 caregivers reported caring for someone with behavioral health issues. We know that caring for someone with behavioral health issues increases caregivers' risk of meeting criteria for depression.

What happens when parents and spouses of veterans get old or divorced and can no longer act as caregivers?

Ramchand: Around 25 percent of those caring for ill, injured, and wounded post-9/11 veterans are parents, and more than 30 percent are spouses. We need to plan for the future, when parents are unable to care for their sons and daughters or when marriages dissolve. Individually, this means making care continuity plans. As a society, we should be thinking about the types of home-based and institutional care that these veterans may need. We project these needs will be great in as little as 15 years.

As the family member of a soldier who just came home from his third deployment, I worry a lot about his mental state, alcohol use, etc. How can family members best support the soldiers in their lives? Is it better to discourage their coping mechanisms (alcohol use, sleeping pills) or to be silently supportive?

Ramchand: First of all, thank you and your family member for your service. I think it's important to be aware of these issues and symptoms, but also not to treat everyone in the military as meeting criteria for mental health conditions. If you or other family members do notice a problem, your approach will be determined by your existing relationship with the family member. I think supporting your family member in the ways he needs support is important. If he has sleep problems, for example, I would encourage him to see a doctor who can advise him on various options, or to identify whether the sleep problems are indicative of an underlying illness or other condition.

For more insights about military caregivers, mental health and the U.S. military, and more, follow Ramchand @RRamchand. Look out for more AMAs with RAND experts in the future.

— Pete Wilmoth