Families' moral distress when supporting military Veteran and public safety personnel mental health: Conceptual model

Families offer vital mental health and well-being support to Veterans and public safety personnel. This study offers a model of how families can experience moral distress from service cultures that exclude them, leaving families stuck, exacerbating a sense of moral distress resulting from perceived organizational betrayal felt in the context of families' help-seeking experiences. The model was informed by in-depth interviews conducted in Australia with 25 family members with experience seeking help and providing support to a family member who is a Veteran or public safety personnel. The interviews provided a detailed description of how embedded and aligned families were to a member's service role, and their profound sense of betrayal and distress when attempts to support family members' mental health were thwarted. Families may experience moral distress from identifying the problem and potential support solutions, but having nowhere to go to realize those supports for their family member. The implications for Veteran and public safety organizations as well as health professionals to promote more meaningful involvement of families is discussed. Introduction: Families are vital in supporting the mental health and well-being of military Veterans and public safety personnel (PSP; e.g., police, ambulance, fire, and emergency services), yet they can feel that services exclude them. The objective of this study was to describe families' experiences of supporting Veterans/PSP seeking help for mental health concerns and formulate a conceptual model to illustrate the impacts of these experiences on families. Methods: The conceptual model was informed by thematic analyses of in-depth semi-structured interviews conducted in Australia with 25 family members of Veterans/PSP. Results: Families were deeply embedded and aligned to their family member's role in the community, with significant empathy for sense of duty, and a profound sense of betrayal and distress when attempts to support family members were perceived as blocked or challenged. The conceptual model demonstrates families' help-seeking processes and how they may vicariously experience moral distress from being caught in a liminal space in which they can see the problem and potential support solutions but have no options to realize timely supports for family members. Discussion: This study offers a detailed model of how moral distress can arise for families of Veterans/PSP who experience mental health concerns. It demonstrates how organizational culture at Departments of Defence, Veterans' Affairs, and public safety groups exclude families, exacerbating a sense of moral distress. Implications and recommendations for Veteran/PSP organizations and health professionals to promote more meaningful involvement and consideration of families is discussed. Introduction : Les familles sont essentielles au soutien de la sant & eacute; mentale et du bien-& ecirc;tre des v & eacute;t & eacute;ran(e)s militaires et du personnel de la s & eacute;curit & eacute; publique (PSP; p. ex., services policiers, services ambulanciers, services d'incendie et services d'urgence), mais peuvent avoir l'impression que les services les excluent. Cette & eacute;tude visait & agrave; d & eacute;crire les exp & eacute;riences des familles qui soutenaient des v & eacute;t & eacute;ran(e)s ou des PSP & agrave; la recherche d'aide en sant & eacute; mentale et & agrave; proposer un mod & egrave;le conceptuel pour d & eacute;montrer les effets de ces exp & eacute;riences sur les familles. M & eacute;thodologie : Le mod & egrave;le conceptuel & eacute;tait & eacute;clair & eacute; par l'analyse th & eacute;matique d'entrevues semi-structur & eacute;es approfondies, r & eacute;alis & eacute;es en Australie aupr & egrave;s de 25 membres de familles de v & eacute;t & eacute;ran(e)s ou de PSP. R & eacute;sultats : Les familles adh & eacute;raient fonci & egrave;rement au r & ocirc;le du (de la) membre de leur famille dans la communaut & eacute; et ressentaient une grande empathie envers leur sentiment de devoir, mais & eacute;prouvaient un profond sentiment de trahison et de d & eacute;tresse devant l'impression que leurs tentatives pour soutenir le (la) membre de leur famille & eacute;taient bloqu & eacute;es ou remises en question. Le mod & egrave;le conceptuel d & eacute;montrait les processus de recherche d'aide des familles et la d & eacute;tresse morale qu'elles pouvaient & eacute;prouver indirectement en raison du point de vue et des solutions potentielles de soutien restreints dans lequel elles & eacute;taient maintenues, sans possibilit & eacute; d'apporter un soutien opportun aux membres de la famille. Discussion : Cette & eacute;tude propose un mod & egrave;le d & eacute;taill & eacute; de la d & eacute;tresse morale possible chez les familles de v & eacute;t & eacute;ran(e)s ou de PSP qui ont des probl & egrave;mes de sant & eacute; mentale. Elle d & eacute;montre que la culture organisationnelle des minist & egrave;res de la D & eacute;fense, des Anciens Combattants et des groupes de s & eacute;curit & eacute; publique exclut les familles et exacerbe l'impression de d & eacute;tresse morale. Les r & eacute;percussions de cette situation sur les v & eacute;t & eacute;ran(e)s, les PSP et les professionnel(le)s de la sant & eacute; et les recommandations de promouvoir une implication plus significative et une meilleure prise en compte des familles sont discut & eacute;s.