Helpful Tips When Working With Military Families

The following useful tips and insights were shared by a few PHA providers that work with military families.  These important themes and resources are important to consider as we continue our goal of providing well informed and appropriate care to those suffering with PMADs, in this case, the military families that make huge sacrifices in the service of our country. PHA is grateful to the service providers that contributed to this blog:

Gretchen Mallios LCSW, (619)265-5263  www.gretchenmallios.com

Danielle Michaelis Castillo LMFT, Modern Counseling San Diego (619)549-3994  www.moderncounselingsandiego.com

Ashley Clark MD, Alison Reminick MD, and Theresea Nguyen NP, UCSD Women’s Reproductive Mental Health Program  (619)534-7792 

1) What are some common themes when working with military families and PMAD?

As in most cases of PMADs, the parents often begin by lacking an understanding of what is happening for the person suffering from. This leads to a lot of self blame on their part and isolation from their spouse or partner. While this is extremely common in the course of a family navigating a mental illness, what seems to be unique about the military families, is that one person is already sacrificing a lot through their career service. That sacrifice could be in the form of current or past deployment, a very demanding and difficult training station or being stationed out in a war arena.  Even if they haven’t ever been in combat, the general hardship of making their way through the demanding rigor of military rank and service may be enough to challenge the family. Regardless of the post or deployment experience, a career in the military comes with a culture that expects sacrifice from service members and their families. Therefore, for the spouse that is suffering from a PMAD, it is that much more challenging to disclose and acknowledge they are having a hard time or may need help. It seems that doing so would feel like an even greater burden on an already burdened family system or burdening to a spouse whose already making great sacrifices in their career. Consequently, this can lead to even stronger tendencies for a partner struggling to deny his/her own treatment needs and feel guilt for ‘having any problems’. The result of this can be a lower likelihood of accessing care or engaging in and maintaining treatment because the time and financial resources it takes from the family feels like ‘too much’.  Also the person suffering from PMAD worries how they will affect their family’s military career.

In addition, stressors on the marital relationship can often arise merely from the disruption that deployment and separation associated with active duty. Add to it the confusion and burden of a mental illness at a time when all myths say ‘everything should be great’ and it can lead to a very distressed family system. This can sometimes lead to breakdowns in the system that can be very difficult to repair.

Lack of social support is also a common theme.  Many families are new to San Diego and are away from their own families and personal support systems.  Some may have a sense of “why invest in friendships if I know I am leaving in a year?”.

2) What are barriers to getting your client’s needs met for medication, support, etc?

While Tricare can be a very generous health benefit when families have a PPO, it can also be confusing to navigate and find a qualified provider.  In the case of a Tricare Prime HMO, families do not need to prior authorization for seeing a therapist who is a Tricare Prime provider.  They can see them for up to 6-8 sessions before an authorization is needed.  It is important for the provider and person receiving treatment to know when the appropriate authorization is necessary as to not disrupt care and progress.

If the person who needs care is active duty, this is the greatest barrier because they inherently have Tricare Prime which is an HMO and often will require that they see a provider within the military health system.  Often, this option does not appeal to those in the service who don’t want their health and mental health records potentially associated with their career employer and confidentiality is at risk.  For military service members, there is so much at stake in their rank, class, and professional achievements. If their health or mental health record should become a negative point on their profile, it could cost them greatly in their potential for advancement or even earnings and assignment to certain posts.  Often service members would rather ‘grin and bear it’ when it comes to mental health, rather than put their career potential at risk.

Additional barriers are: frequent relocations making it difficult to establish long term care, frequent deployments, demanding and dangerous jobs, lack of predictability or regularity in active duty, and many parents ultimately feel isolated as if they are single parents.  As mentioned earlier, the knowledge that families will be moving soon may create ambivalence about initiating new friendships and creating support systems.

3) What are useful resources for military families?

It is important to have good PCPs who help families navigate the barriers mentioned above.  Comprehensive health systems that include specialists and high quality care within the same network are vital because they lower the barriers of accessing the necessary providers.  Also, the ability to bring children/baby to appointments can be useful, having a supportive command, and getting in for intake quickly can all be important factors for families.

Additional resources include:

Armed Services YMCA New Parent Support Program (858) 751-5755

• In home or office counseling for junior enlisted active duty service members and their families.

Family Forces https://www.mhsinc.org/listing/family-forces-2/

• Mental Health Systems Family Forces provides mental health and drug and alcohol recovery services.

Fleet and Family Support Center (FFSC) 619-556-8809

Provides a wide range of confidential and no-cost counseling and assistance, to include:

• Individual counseling
• Child counseling
• Family counseling, including blended families
• Marriage/couple’s counseling
• Domestic Abuse Victim Advocates
• Family Advocacy Program (FAP) Services

Counseling could be for: adjusting to military life, anger management, communication and conflict resolution, deployment reintegration, divorce, grief & loss, infidelity, parenting skills, relationship challenges or anything else affecting your life.

Other services include:

• Individualized Consultations & Resource Referrals
• Navy New Parent Support Home Visitor Support
• Support Groups
• Workshops

FOCUS Program  http://www.focusproject.org/

• FOCUS (Families OverComing Under Stress) provides resilience training to military children, families, and couples. It teaches practical skills to help families and couples overcome common challenges related to a military life. It helps build on current strengths and teach new strategies to enhance communication and problem solving, goal setting and creating a shared family story.

Military & Family Life Counselors MFLC (for Marines) (619)524-0465

• Offer short term counseling services and support

Military One Source (MOS) 800-342-9647

• Telephonic and in person EAP counseling for military members and their dependents. Military One Source can also be used for individual, couples or family counseling. Active duty as well as dependents can utilize the resources
• Assistance finding childcare http://www.militaryonesource.m il/web/mos/-/child-care-the-es sentials?inheritRedirect=true& redirect=%2Fweb%2Fmos%2Fchildc are
• Support through the New Parent Support Program http://www.militaryonesource.m il/-/the-new-parent-support-pr ogram
• Other help such as financial and legal

Naval Medical Center SD Perinatal Loss Support Group

4) Any additional comments, or useful tips?

It is so important when serving military families to see them in the context of their career affiliation. Military service isn’t a job. It can, for many, be a large portion of one’s identity, it can create a sense of security and pride for many in the service. So working with those factors and others that are unique to military life is important so that family’s entire identity is held in context of the treatment. If treatment resistance or barriers seem to arise, get curious about what pressures and forces may be at play that would impact them and be prepared to see if you can help them navigate those in a way that helps them both access care and retain whatever security or comfort they need in relationship to their military ties.

This is a very challenging, but rewarding population to work with. They are often young, new parents, and without the social support that most families have. So to be able to provide care to them in their time of need is really a privilege, especially considering everything that they are sacrificing to serve our country.

Dependents (spouses, children) can use their Tricare insurance to get counseling (off-base) with practitioners in the community. This is often a good option as providers are in the community and often closer to the family’s residence.