Jose Perez, left, walks with his son Joseph Perez, 17. (Michael Todd for The Washington Post)

The military has never been a particularly family-friendly career. (Thus the old saying that if Uncle Sam had wanted you to have a family, he’d have issued you one.) Yet 44 percent of military personnel have children, and families serve, too.

In recognition of the rigors of service, every branch of the military runs programs to support the psychological health of military families. But a report released in 2013 by the Institute of Medicine concluded that these efforts are falling short in many areas.

Even relatively smooth deployments can strain families, says psychologist David Riggs. The person who comes back from war is not the same person who left, but the family that stays behind changes, too. “It’s not like the service member comes back” and family life just returns to normal, says Riggs, executive director of the Center for Deployment Psychology in Bethesda, Md., which trains behavioral health professionals to work with military personnel and their families.

Studies show that partners and children may develop anxiety, depression and other mental health problems while a family member is deployed, Riggs says, and these problems can persist after their loved one has come home.

The departments of Defense and Veterans Affairs have invested billions of dollars to expand their capacity to support veterans and their families, but it’s not clear that those dollars are translating into better results, says Terri Tanielian, a senior research analyst at the Rand Corp. in Arlington. “When people get care, are they getting the right care? Are they getting better, and if they’re not, is the system able to identify that and adjust accordingly?” Those questions remain unanswered, she says.

Jose Perez watches his son John during a hike near Chino, Calif. Perez left the Army in 2007 after being wounded in Iraq. (Michael Todd for The Washington Post)

The IOM analysis found that, too often, programs for military personnel and their families are implemented without evidence that they’re effective, and few programs are monitored to track whether they’re making a real difference, says Kenneth Warner, the University of Michigan professor of public health who led the assessment. He and his colleagues recommended that efforts to prevent psychological disorders in service members and their families include outcome measurements to ensure that they’re getting the intended results.

Stigma barrier

Stigma remains a major barrier to care. “Members of the military are notoriously stoic,” Riggs says. “Even when they’re in a great deal of psychological pain, they’re not likely to show it.” Often, someone with mental health needs will seek help for a physical pain instead, so health-care providers need training to identify underlying mental health issues.

“The number one complaint that brings people in for care is sleep disturbances,” Riggs says. Instead of telling a doctor that they’re having flashbacks, they’ll say that they can’t sleep, he says. “People worry that ‘if I go see a psychiatrist, my career is over.’ Yet we know that’s not the case most of the time,” Riggs says. As an example of how stigma can be fought, he points to the Real Warriors program, a campaign by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury to encourage service members and their families to get help treating invisible wounds.

Once people make the decision to get help, they need to find it accessible. “One comment that we hear from family members is that it is sometimes difficult to find the recourse they need at the time they need it,” Riggs says. In many cases these resources exist, but people don’t know how to find them when they’re in the middle of a crisis, he says.

When Alyssa Mansfield, a VA epidemiologist in Honolulu, surveyed spouses of Vietnam-era veterans who were receiving treatment for post-traumatic stress disorder about their own needs, the response was overwhelming. “They wanted their own support groups,” she says. “The veterans had their groups, and the spouses wanted support, too.”

Defining families

Because of the narrow focus on traditional families — a service member, spouse and child — others are shut out of support programs, the IOM report found. To remedy this, the definition of families must include unmarried partners, same-sex partners, stepparents, parents and siblings. “We often think about the kids in schools who have a parent deployed. But what if I’m 12 and my 19-year-old sister is deployed?” Riggs says. Parents and unmarried partners of military members are also too often overlooked, he says.

While elected officials and military leaders clearly took note of the IOM report, it’s too early to tell how much impact it will have, says Shelley MacDermid Wadsworth, who helped write the analysis. In August, President Obama announced 19 executive actions aimed at improving services for military members, veterans and their families, and these included a promise to provide better care and access to mental health care.

A program for veterans has helped Perez connect better with his children. (Michael Todd/For The Washington Post)

Given what many military members and their families have been through, such support is crucial, says Wadsworth, who is director of the Military Family Research Institute at Purdue University. “These people have voluntarily subjected themselves to a series of potentially traumatic experiences, because they wanted to serve their country,” she says. “The country made a commitment to take care of them, and if we want to see better outcomes than we had for previous wars, this is the time to get it right.”

Aschwanden, a regular contributor to the Post’s AnyBODY wellness column, was a 2014 Rosalynn Carter Fellow for Mental Health Journalism.