Supportive Services for Veteran Families

Ali Habashi: Alright, so starting at the top, why was Give an Hour founded?

Dr. Trina Clayeux: So, 20 years ago, because we are actually in our 20th year anniversary, Give an Hour was founded in direct response to 9/11. And so our entire model of mental health care has been around servicing military veterans and their loved ones. For the first 12 years or so it was really about clinical care matching.

Before we were having the kind of mental health conversations we're having now, it was really challenging in the military veteran environment to talk about mental health, and certainly to flag that you may be struggling or may feel a certain level of distress.

So it was highly stigmatized, there weren't a lot of systems in place, and we certainly weren't in a position where we were having the same types of conversations we are having now. And so I would consider us an option or an alternative option for those service members, veterans, and loved ones that need to access to clinical care.

What our founder built was an entire network across the country of licensed mental health professionals who “give an hour” of that no-cost, low-barrier mental health care. Since that time, we have evolved where we continue to work with mental health professionals from across the country, but we also understand that clinical care isn't the solution.

We wanted to give them additional opportunities to seek care, so we've expanded to also include peer support. We do nonclinical work, which we could talk a little deeper about because I think we have an incredibly interesting model.

We also do education and training. And so that is how we're set up now: clinical care matching, non-clinical peer support, education, and training.

Ali: Can we talk about the different values of each of those, where maybe they come in and where there's a barrier with some of them?

Dr. Clayeux: Absolutely. I don't think it'd be a surprise to anybody that stigma around mental health continues to be, I would say, probably one of the largest, if not the largest, barrier to care. While it's different now, I feel like it's just morphed into a different type of stigma. And so while we have more awareness and we're having different conversations.

We find that really, on that personal level, that people have a lot of apprehension about seeking care, about raising their hand and being recognized as someone that might have a care need. And so the jump to clinical care for a lot of people is too far, and that's why having options is an empowering strategy for people to be empowered to make decisions about their mental health journey.

But it also provides a lot of autonomy for people to make a choice about what type of help they want and where they seek it. For people who want to go right into clinical care, we try to make that pathway available and we know that there's multiple ways of getting to the kind of care that you need.

We really trust lived experience as a highly valuable, very legitimate, very powerful pathway for people to get care. Making sure that people have access to that nonclinical support, which is all about community, we can learn a lot from them about how they build community and how they maintain it.

It's a really important way for people to also have pathways into an elevated level of care if that's something that they want and need.

Ali: With the peer support, I'm a huge advocate for that. I think it's really important. And I know when I've gone through things in the past and I felt like I needed to talk to somebody about it, I didn't necessarily want to talk to a therapist. Because I wanted to talk to somebody who had been through what I was going through and could actually tell me the realities of the situation and some of their own coping mechanisms and things to watch out for. And hope, to give me hope.

I did end up connecting with a peer, a few peers actually, and it helped so much. That support helped an enormous amount. When it comes to peer support for veterans and honestly for their caregivers as well, what have you seen in your experience, and where is peer support now and where do you see it going?

Dr. Clayeux: That is such a great question. I'll start with like where we are with peer support. We offer a number of peer support groups. We have several that are for that military veteran experience. We have one that we just started recently that is specific for female veteran and military members.

We have two for caregivers or veteran caregivers. And then a spouses group, which we're already fielding more inquiries about, and adding more groups there, especially given kind of the state of affairs that we are in right now.

What we're finding is that this access to this community and this network is so important. It's so imperative. It is a stabilizing force in so many people's lives. And they show up just like you would expect for military veterans and their loved ones. They show up for other people as well. So they come motivated by a need that they have, but they stay because they're so connected to being there for people to the left and to the right.

And so we find that this is, again, very powerful. But we also design with purpose. And so we hire, on contract, veterans to actually facilitate the peer groups because to your point, it makes a big difference to have somebody who gets it, who has a similar shared experience. May not be the exact one, but there's enough there that people feel very connected.

We do the same with caregivers. Our peer groups are facilitated by veteran caregivers. Who understands that journey better than that person? And those individuals self-identify and say, “Hey, I've gone through this process. I would like to facilitate my own group.” They understand that it also is very reciprocal.

There's a lot of healing that comes from facilitating groups, and being there to help bring resources and to help create spaces and to help connect people. We then pair each of those facilitators with a licensed mental health professional who they do consultations with at least once a month.

It can be more. And then if we have any kind of challenges or things that we need additional consultation on, those mental health professionals are on retainer, and so they can step into these spaces with us. They can help support both as a facilitator, but also if we need an additional level of care, we need maybe an intervention or a safety plan, it's right there built into our system.

And so I’m absolutely a huge champion, as you are, for peer support, but I also think there's a design element to it that has to be there. And so we design for belonging. We design for connectedness. We measure for these things as well.

We're really looking at how people are feeling empowered, how they are feeling transformed by this experience, and why they keep coming back. So those are things that we can push into. Those are the things we want to keep designing for. So it's incredibly powerful.

As you said, there can be times when somebody is looking for a clinical match or clinical care. But having somebody get it without all the explanation is really, really important. And especially now when there's one mental health professional for every 340 people in need. Half of our country is in a mental health professional shortage, and so we just don't have the amount of mental health professionals to go around.

So we have to keep adding to this, and healing belongs in community, and we deeply believe that.

Ali: I think that's very true. And I think you're filling this niche that needs to be filled. I'd like to zoom out a little bit and discuss just the state of veteran care and especially mental health when it comes to veteran care.

I think we often hear about the mental health challenges that plague veterans and their caregivers, but we don't often talk about the help that is available and where that support tends to fall short. What are some of the support gaps that you've seen for this group just in larger America?

Dr. Clayeux: There is a playing field to work with, so there is a backbone to the mental health care for this population. It is fragmented. It is hard to navigate. and my experience is that it's not designed for how people actually seek support.

And the limitations that come with it are not how most populations would engage in either peer or clinical support. And I could give an example: if your insurance or a system allows you 10 sessions per episode, per stressor, per incident. I would say a veteran will take nine of them before they're ever going to start trusting enough to start to disclose what was driving them to come in the first place.

I would say caregivers who have a very enduring, and layered stresses because of their role within that community. They're often in multiple caregiving roles. There's a sense of isolation. Like I'm not telling you or your audience anything you don't know. Most of the questions that they're getting is about the caregiving itself and they forget that there is a person outside of the caregiving experience.

The system isn't built for that. Our mental health professionals, unless they have chosen this, have not been trained in these lived experiences. And so that's why for us, lived experience is such an important element of what we do, and what we listen to, and then how we use that to inform our services and support.

Yes, there's a system and for the people the system works for, they're very satisfied. I will say there's a segment of the population that the system does not work for, and that's where people like us and many VSOs, veteran service organizations across the country, step into those gaps.

Ali: That just reminds me so much of our own Care Guides. As you said, when it comes to caregivers, sometimes they're not just taking care of one person. Especially with sandwich generation caregivers who have children and aging parents and maybe a spouse who is a veteran or active military.

It just adds up so fast. And not only that, but caregiving also is just not linear. It's something that can start and stop over time. And that's what we've seen quite a bit with our caregivers. They will have an episode of care and then it will end, and then they'll come back six months later because something else has happened and they need somebody who's there because their ten sessions haven't run out, you know?

And they can return when they need to.

Dr. Clayeux: Yes, the systems engagement is just so complex on top of people who are already dealing with so many layers of complexity. And that is again why we try to make it as barrier free as possible. We do a low-barrier intake form. We try to do a lot of high-tech, high-touch, where we absorb some of the load.

I always say it's not about the paperwork. We don't want a piece of paper to interfere with our ability to help someone and to connect with them. So the fact that we have people to reach out and if a person doesn’t ask to be called, we don't call them.

If they ask for a text, we're going to text them. You really have to think about who your customer is and how they want to experience you. And also remember that they're not going to get back to you in 20 minutes because they're not sitting on their phone all day and so you have to adapt to their rhythm.

I think that comes because you have to sit and listen to people, and really understand their experience. Don't expect that they have to bend to your system. Our system has enough predictability and flexibility that we can meet you in many of those spaces. And I'm heartened by that work.

I know that, again, big-scale systems, they're not built for that and that's totally understandable. We are. And that's the way that we want to continue to be.

Ali: Oh my gosh. It's amazing hearing you talk because it sounds like you're talking about Homethrive.

Dr. Clayeux: I thought that when we talked before

Ali: I was like, it's the same.

Dr. Clayeux: It's the same. Yeah, same approach. And it's the same values. Like I think that's where, where I knew that we aligned was that our value is that we are here to be in service, but we're in relationship.

Ali: Absolutely. And that sort of digital-first approach, but followed by that expert who can swoop in whenever you really need special hands-on care, who is just available for you and understands where you're coming from.

We have social workers who've worked in social work for a decade or plus. And it's wonderful to hear them, especially on webinars answering questions that people just have. And they have so many questions and, as you've said, veteran affairs too can get so complicated, so fast.

I'm sure most of our audience listening to this episode has been on the Veteran Benefits website and oh my God. Oh my God. It is tangled.

Dr. Clayeux: It is tangled. You're right, it is tangled. And to ask someone who's carrying so much to be an expert in that system, because that's what it feels like, you have to have a level of expertise. You can see why so often people give up or they leave, they leave benefits on the table, they don't pursue certain things or they just keep taking on because it honestly seems easier in the moment. We'll just do it ourselves, or we'll take pay out of pocket, which isn't what the system wants you to do.

Hopefully that's not true. But the system doesn't want you to do those things. And so I do think that there's more education. And again, we could learn so much if we listened to the caregivers and to the veterans about their experiences. We could learn a lot. I'll just give an example: we know that the VA eligibility, like disability eligibility, process is a high stressor.

We hear it in our caregiver group; we hear it in our veteran group. And so we sourced our lovely friend Kate, who is an attorney and has a lot of experience in this work, who actually comes and does seminars that are just about helping people understand the legal process.

Because that's what it is. It's a legal process for your VA benefits eligibility, and the amount of stress that's reduced for folks to even understand that this isn't a medical thing. This isn't just a paperwork, this is a legal process. You have to understand what you are doing in order to be best positioned for your benefits.

And those are the things that we love to do is as we hear caregivers and we hear veterans coming to groups and talking about different stressors, then we can go source trusted resources and bring them to you rather than having 10, 15, 20 people trying to source this and figure it out themselves.

I love that part of it as well.

Ali: That is, that's amazing. I love, again, I love any support that can be given. Especially this kind of support that just reduces that stress, which just builds up and builds up. And I think especially we see it with caregivers as they just take on everything.

They feel guilty if they're not constantly caring, and physically there. And they just forget about themselves on several levels: physically, mentally. And we have to pull them out to grab their hands and say, “You deserve a break.”

Dr. Clayeux: To shift it and just tell people to self-care their way out of this, you know, again, isn't helpful.

So the pragmatic part of it is how do you self-care out of caregiving, or an enduring caregiving responsibility? We really try to, again, listen to how people's days work. What is the rhythm? what is their caregiving responsibilities? What are they already doing?

We try to find out what brings them joy and then how to build some of those things into their day. And it might be while they’re driving to the school to go pick up kids and they’ve got 20 minutes and that's it where they’re in the car alone and what can you do in that 20 minutes?

So I think the pragmatic part of it, the reality is that this isn't a vacation, this isn't aromatherapy, you just can't self-carry your way out of this. It has to be really sustainable things that you can do.

Engaging when and understanding when you're hitting that compassion fatigue or that stress, which is different than burnout. There are different approaches to each of those. But part of it is identifying that in yourself and for so many it's hard to even understand what's going on with yourself. It just feels like overwhelm. What I love again about this is that once you start listening to people and they're explaining what's happening, you can help them get to a point of them understanding is this episodic? Is this a higher level of stress than what you normally have, or is this temporary?

Like maybe you're going in for surgery in a recovery period, which is different. Are you just in a compassion fatigue spiral? You're not able or haven't done anything replenishing in order for you to have to interrupt that and 99% of you is now caregiving and you're at the margins of everything.

And so what will it take to pull that in knowing that the caregiving responsibility is still there? I think this is like the fascinating part of this work, when you are working in relation with people, that you're not giving people off-the-shelf solutions or answers or recommendations. That you can hit best practices and really help people tailor to the life that they're living.

Ali: Yeah, I can see too when it comes to caregiving, it being a kind of frog in boiling water situation where it just keeps adding up, and you don't quite notice until you're completely overwhelmed. So what are some signs for caregivers to watch for that may mean it's time to find more help, either for themselves or for their loved one, their veteran, their military spouse?

When is it time to start looking for peer professional help?

Dr. Clayeux: Well again, one of the things that we had done years ago was really look at what are ways that everyday people don't need to see a therapist to have this be something that you can notice in yourself or others, what are the signs of distress?

And so you're thinking from their baseline, I should always say that, from what you know about someone. But are they more agitated or angry than the baseline? Are they more isolated or have withdrawn?

So you have somebody who likes to be social and suddenly they're not doing those same things, so that’s different from their baseline. Look at any hygiene or more physical manifestations–losing weight, gaining weight, not taking care of themselves. Those are great signs to watch for.

Certainly hopelessness, somebody who starts talking about feeling like a burden. And we hear this a lot in this community, if you feel like a burden to someone else that can be a sign of hopelessness. So really looking at what is different from baseline.

How do you approach that in yourself? It's identifying “Do I seem shorter and more agitated lately or am I just not taking care of myself? Am I going days without taking a shower or am I lying in bed for days at a time? Is this unusual for me?”

I think those are the signs that you want to take a look at and take note of and then start looking at what kind of plan can you have going forward? So is this time to reach out to a loved one? Do you have your ugly-cry friend that you can call? I always think like you have to have your circle of people.

On those days when you're going to be really busy, is there somebody that you rely on who can let your dog out? or do you have someone in the school where you can have somebody pick up your child if you aren't able to make it? Having those things in place, even though I know it feels like an upfront load, it can really help you at those times when you are taking on more and maybe are starting to feel those signs or recognizing those signs.

And then always, finding ways to approach it. I think one of the lowest barrier ways and the lowest threatening way is just to say, “I've just noticed that you don't seem like your energetic self anymore,” or “I've just noticed that you're not getting up before 10 o'clock and I'm concerned.”

You're really using language that doesn't feel judgmental, but it comes from a point of concern. And so being able to open those conversations, I know a lot of times we're afraid to say something. And how do we overcome that little bit of resistance that us people usually say, “Oh, I'm fine. It's good. Yeah, everything's fine,” right?

And so we teach a little about that gentle persistence. Like, “I know you're saying you're fine but this is what I've seen, or this is how it looks from my point of view, or this is how I'm experiencing this.” So again, just a little gentle persistence. You'll be surprised how many people be like, “Okay, you got me. Yeah, something's different.”

Ali: Yeah, and, I don't know if this is the right way to go about things, but I know with my friends, if I'm worried about them, I use humor to sort of cut in and say, “Hey, get up. You're coming with me. We're getting coffee.” And it’s just to get them out of the house or get someone moving. And it doesn't even need to be that I'm worried about them.

It can just be they're sitting in front of their office computer for too long, curled up in a ball.

Dr. Clayeux: And sometimes you're going into their space, maybe they aren't at a space where they can go out and you're like, I'm going to grab lunch and come to your house, so see you at noon.

And you know your people. And so that's what I love too, is that yes, humor can go a long way and it can break down a lot of barriers that people feel. It'll give you an opportunity to do it in a way that people are more receptive to.

Ali: Yeah. And just them knowing that you're there and you care is huge.

Dr. Clayeux: A hundred percent.

Ali: So the caregivers that we often interact with, they are working full-time. And that's really hard because obviously caregiving itself is like a whole second job at this point. So how does Give an Hour help those who are working and caregiving full-time, or dealing with veteran trauma, or their own veteran trauma at work?

Dr. Clayeux: It's such a real issue because as you said, many caregivers are in these two or three roles. It's not even just, a dual role. And so they may be employers, and their partners, they may be parents. They also may take on advocacy roles, which I'm sure many of them are care coordinators and they’re building expertise in all of these different systems.

And so it can, and likely does, lead to a lot of chronic stress. When I think of our approach in general, we know and understand that people need flexible, layered support that is addressing or filling a need. That if they're going to spend their time in that they're going to need it to reach them. You know the phrase of “meet them where they are.”

When someone reaches out to us, I always think of peer support and again, it's not the right fit for everybody, but I do think the right fit for a lot of people is to get connected into one of our peer support groups. It is that immediate feeling like you're home. It's that immediate welcoming.

It's that immediate people dropping their phone numbers and saying, “Hey, I know you just got here. You are in the right place. Here's my phone number if you need something.” That is how these communities show up for each other and the importance of being validated just can't be understated. How important that support is for someone who feels alone, who feels isolated, who feels overwhelmed. And to have somewhere where you are recognized, that you are understood.

And that it doesn't always just have to be talking about caregiving. There's lots of other things that we could talk about. So we talk about books and movies and lots of other aspects of your life, and I think that's something else that these groups can bring. Is that they remember that you're a whole person because those people who are there are experiencing something very similar.

And then we're always looking at things that can help people increase their confidence around their mental health or supporting someone else. And it may be understanding boundaries and what does that mean when you're so enmeshed in the kind of work that you're doing when you're in these dual roles, and what does a boundary mean?

And a lot of times now, if you do social media boundaries, it's like a wall, putting up a wall. “Preserving my peace.” I hear that one a lot. And I was like, “It's kind of the opposite of what you want, right? You're not trying to make your world smaller and more protected. It's more like a fence where you have just enough, but you can still reach through it and there's people there.”

And so cutting yourself off is not a boundary. But understanding where your limit is and making it clear to other people, I think is a very empowering thing to be able to do. And so it might be that you have to do it at work or you're having to do it at home, and it's one of the harder things to practice and implement.

I would say by far, especially in caregiver roles, where there is a tacit expectation that you are everything to everybody but yourself.

Ali: I know that's true. And yeah, I know when we speak about boundary setting and stuff, we're often speaking to caregivers who have a larger family who don't quite understand their caregiving role, and they all have advice.

Dr. Clayeux: Oh, that's fun.

Ali: It's been wonderful to have you on the show today. Thank you. I just want to ask you one last thing which is what's your advice to someone in a veteran caregiver role who maybe is struggling right now to either take care of themselves or take care of their loved one?

Any final parting words for them?

Dr. Clayeux: Yeah, I always invite individuals to say, we don't have to hit a breaking point. Before support is visible or before we reach out or before we get into community. Oftentimes when it comes to your mental health, we think we must be just on the edge before we have earned the right to get help or care.

And I would highly challenge that. I would say do it soon. Do it now. It doesn't have to be as formal as peer support. Like you said. It could be your friends, it could be just creating a circle around you that is reliable, that accepts you, that is nonjudgmental. And if it is more, there are so many great networks, peer support is definitely one of them.

And then again, if it feels like something that is more elevated, that is, interfering with day-to-day functioning, I would then highly suggest seeking out a higher level of care. And it's all in community. So my final thing for healing is community. It's done locally, and I'll use air quotes, whatever local means to you, but it is definitely done in community.

Nobody's gotten better in isolation. So I would say the more that we can, the more we have to lead into each other. It is reciprocal. Other people benefit from being able to support you just like you benefit from supporting them.