Issues Facing Today's Female Veterans — 'Feeling Invisible and Disconnected'
By Valerie L. Dripchak, PhD, LCSW
Social Work Today
Vol. 18 No. 6 P. 24

Female veterans have myriad underaddressed, gender-related concerns from their time in the military that follow them after discharge.

Women comprise a growing minority of veterans as more are entering the military, serving their country, and being honorably discharged. While the restriction of women being assigned to combat units has been only recently lifted, women always have served in this predominantly male arena, but their roles have expanded over time. The VA now considers women to be the fastest growing group of veterans, but their issues are not discussed as often.

Sexual Assault During Active Duty
While the Department of Defense (DOD) acknowledges that sexual assault exists in the military and is committed to zero tolerance, it continues to be an underreported crime. In fact, the DOD's Annual Report (FY 2016) suggested that about two-thirds of female service members did not report their sexual assault. Some of the reasons given included that women wanted to forget about it and move on, did not want more people to know about it, and experienced shame or embarrassment.

The report also indicated that there were growing percentages of women who did not report military sexual trauma (MST) because they feared reprisals from their coworkers and were concerned that their accusations would not be believed.

There have been movements by female veterans, such as #NotInvisible, to draw attention to the rampant problem of MST. Nevertheless, their plight is underaddressed. Organizations such as Service Women's Action Network released information from their survey that MST is the most prevalent factor affecting women's mental health. Its 2017 survey indicated that female veterans have higher rates of depression and PTSD than civilian women. The report demonstrated that even after leaving the military, as women attempt to access veteran health services, they reported being stressed.

To further compound the issues of MST, a report issued by Yale Law School's Veterans Legal Services focused on the health consequences that survivors of MST face as they adjust to civilian life. It was noted that claims for veteran benefits for women due to PTSD are more often related to MST as compared with rates of combat-related PTSD that men seek. However, women were awarded veteran benefits at lower rates.

Bias Against Mothers
The military offers many opportunities for women such as good pay, excellent benefits, and career advancement. At the same time, there are significant challenges. Women who have served in the military face the same difficulties that confront many of today's working mothers—the delicate balance between work and family is no easy task. However, for female veterans, there may be an even more unforgiving reality for them when they return to civilian life.

The gaps in time of not being with one's family while being deployed are more fully realized when they try to reintegrate into family life. There may be personal crises with guilt, and these women also may be confronted with additional social biases. Even today, societal norms seem to be more accepting of fathers than mothers being away from their families due to deployments.

There is even a greater degree of complexity when single mothers are deployed. While the Army requires a family care plan that outlines the arrangements service members have made for their children during deployments, it is not legally binding. It leaves deployed mothers open to legal notices for increases in child support, custody changes, and caregivers who can no longer continue with childcare responsibilities, etc.

There are some military resources in place that may help to support deployment for women, such as family readiness groups and behavioral health services. However, not all of them provide for the multidimensional needs that are required, and some of these services are more focused on males who were deployed. More resources are necessary for veteran mothers, who are reentering civilian lives faced with handling the many changes that have occurred to their children, not only developmentally but also behaviorally and socially. Their supports must include specialized needs assessment and the inclusion of psychoeducational and therapeutic interventions.

Health Concerns
Women veterans have unique health care requirements compared with their male counterparts. In order to understand firsthand the similarities and differences, a group of eight women veterans volunteered to discuss this issue with Social Work Today. Their chief complaint was that their battle equipment was usually ill fitted. They indicated that their gear was designed to fit men, resulting in injuries to their necks, backs, and hips that continue to cause them pain even years later.

While one woman, who was more recently discharged from the military, explained that this situation was "getting better," there remain a number for whom this was not the case.

Another concern raised by this group of female veterans was the prevalence of chronic urinary tract infections. During their deployments, they encountered such issues as a lack of privacy, unsanitary conditions, harsh climates, and insects that made it difficult to urinate. While their male counterparts faced the same environments, anatomic differences required females to remove their equipment and clothing when they needed to urinate. In order to reduce urination, some women restricted their intake of fluids. Others discussed the unsanitary measures that were needed in order to urinate while still others used layers of padding to absorb urine.

All of these methods were breeding grounds for health issues that these veterans continue to encounter after leaving the military.

While health concerns of female veterans reportedly remain their primary issue, the VA hospitals were often unprepared to treat these unique medical concerns. However, this may be improving for newer veterans. In 2010, the VA published updated guidelines for women's health care that included privacy requirements, as well as training to providers on such topics as contraception, cervical cancer screening, and sexually transmitted infections. In order for the guidelines to be fully realized, however, it is important for more of these specialized services for women veterans to be made available.

Homeless Female Veterans
The VA estimates that female veterans are at least twice as likely to be homeless as nonveteran women. At the same time, other individuals suggest that the figure is much higher. While it appears to be a challenge to quantify, there is agreement that it is a growing concern.

In addition, women veterans are more apt to be single parents, with other issues associated with homelessness that may include unemployment, poor mental and/or physical health, and substance use disorders.

Programs such as the Maryland Center for Veterans Education and Training (MCVET), a 24-hour service and residential housing facility that began accommodating female veterans in 1997, can help. In addition to the service needs identified for men, the program also addresses intimate partner violence and MST for women veterans.

While programs such as MCVET are critical, there are not enough of them to fully serve all women veterans. Part of the dilemma may be that MCVET is a nonprofit organization supported in part through the federal government with the remainder funded through private donations. As a result, funding may vary from year to year or even disappear.

Female Veterans in the Criminal Justice System
In spite of the growing number of female veterans, there is little information available regarding their presence in the court system. The U.S. Department of Justice estimates that veterans comprise about 10% of prisoners in the state and federal prisons, and about 1% of them, approximately 1,400 veterans, are women. While this appears to be a relatively small number, the National Resource Center suggests that many more veterans in the criminal justice system are unidentified as veterans because the question is not asked of them.

A special report issued in December 2015 by the Department of Justice highlighted some important information about the incarcerated population of veterans: nearly one-half of all the veterans were informed by mental health professionals that they had a mental health condition, and more than three-quarters of incarcerated veterans received honorable discharges from their military service.

This report suggested that the number of veterans incarcerated in local jails and state and federal prisons has decreased. Some studies propose that this decrease may be due to jail diversion programs. The intent of these programs is to prevent inappropriate arrest and detention or remove individuals with behavioral health issues from the criminal justice system prior to arraignment or sentencing.

Initiated by the Substance Abuse Mental Health Services Administration in 2008, the Jail Diversion and Trauma Recovery Program supports 13 states to implement the program for veterans with PTSD and other trauma-related disorders. While not all of the programs are available to female veterans, some of the findings indicated that they had higher rates of mental health issues than their male counterparts.

Veterans' courts are a fairly recent development in the civilian legal system, and there are continued discussions as to how to refine them (e.g., the types of offenses to be included and the severity of the offenses). Veteran mentors are an important part of this program; they are volunteers who act as advocates but do not assume the role of attorneys or treatment providers. There are training programs for the mentors, but no curriculum has been universally established. Special efforts have begun to engage female veterans to volunteer to mentor other female veterans on legal issues. Such programs offer good beginnings toward a better understanding of the issues female veterans are confronting.

Suicide
One of the most critical issues facing women veterans, suicide can be associated with every other ongoing concern. According to figures released by the VA in 2017, the suicide rate among women who have served in the U.S. military is more than twice as high as that of adult civilian women. The report also indicated that the recent suicide rate among female veterans increased to a greater degree than the suicide rate among male veterans.

As more women are entering the military, these rates may show even further increases in the future. Many attribute these alarming statistics to MST, sexual harassment, homelessness, mental health concerns such as PTSD and depression, reintegration into their families, and general societal biases. Related factors such as hopelessness, powerlessness, isolation, and alienation are key indications known to contribute to depression and suicide.

Some of the women who were interviewed explained how they understood the "desperate" turn to suicide by their sister veterans as they recognized their own feelings of "being invisible while in the military" and "a lack of connection with the outside world" when they were trying to adjust to civilian life.

Social Workers' Role
Social workers who work directly with veterans in either the public or private sectors interviewed for this article articulated different views about the needs and services available to female veterans. One expressed concern that there are no differences in service needs between male and female veterans and "every individual is viewed with unique service needs."

While they indicated that there might be wait lists for some of the services for female veterans, such as housing and employment, there are no preferences between the genders in receiving services. Other social workers suggested that recognition of issues, such as health care, has "greatly improved" over the past several years. Still, some social workers who also are veterans believe the needs of women veterans and the frustrations they face in seeking services are not being properly addressed. In particular, there exist societal biases against women who report MST and who leave their families to serve in the military. Also, a lack of specialized counseling services remains troublesome.

While there were different insights offered, there also was a common denominator conveyed by these professionals that the number of female veterans they counsel is a lower figure than male veterans, which may account for the lack of specialized considerations. Another agreed-upon area is that they do not have specific assessment tools for female veterans in the areas of emotional, social, or health needs. Lastly, they all shared that the suicide rates are "disturbing" and recommended that every licensed clinician needs a competence level to assess for suicide.

While there may be some different points of view about the services needed by female veterans, as social workers we must take their plight seriously. While we should respect everyone who served our country, we also want to understand the growing concerns of those who are being underserved and make services available to them. The Preamble of the 2017 Code of Ethics states that our "primary mission" is to improve the well-being of others "with particular attention to the needs and empowerment of people who are vulnerable."

Where do we begin? As we know, for any significant change to be effective, it must occur at both the macro and micro levels. On the macro level, we first must become aware and educated about the unique areas that confront female veterans and then inform others—professionals, families of veterans, legislators, service providers, judges, etc. This is no easy task because cultural biases remain, both within and outside of the military, against women serving in the military, so their plight as veterans may make them disenfranchised as a group.

As we rally for the rights of any disenfranchised group, we must seek ways to organize, lobby, and demand ways to overcome the challenges confronting today's women veterans and make their difficulties visible.

— Valerie L. Dripchak, PhD, LCSW, provides services to veterans, active service members, and their families and facilitates workshops to community agencies in clinical practice areas.