Prioritizing Veteran Social Well-Being

Abstract

The Department of Veteran Affairs (VA) has an increased interest in addressing the well-being and whole health of Veterans. In March of 2023, the VA convened a conference to discuss whole-person outcomes of relevance for Veterans in clinical, research, and population health areas. Based upon perceptions from conference participants who are Veteran community members, the aim of this manuscript is to offer a Veteran community perspective on the importance of prioritizing social well-being as part of VA Whole Health programming. Through the involvement of Veterans, their caregivers and their families, the VA can offer a more culturally relevant model of holistic care that promotes social belonging, connectedness, and support for all Veterans.

In March of 2023, the Veterans Health Administration hosted a 2-day State of the Art (SOTA) conference on “Measuring What Matters Most (M³): Whole Person Outcomes in Clinical Care, Research, and Population Health.” The objective of the conference was to consider how the measurement of well-being and whole-person outcomes can improve health and health care research. Insights were solicited from experts and thought leaders across various research institutions, government agencies, Veterans Service Organizations (VSOs), and Veterans themselves, along with their caregivers and families.

Social well-being was a topic of discussion during the conference and was identified as a top priority by the US Surgeon General during the same year.¹ For the purpose of this article, we define social well-being as the satisfaction of one’s relationships with others and their communities, including their social integration, connectedness with society, and potential for growth.² Prior research has shown Veterans report a loss of social well-being during the transition from military service to civilian life, with over half of Veterans reporting feeling socially isolated or lonely.³ Social well-being is critical for Veteran health considering Veterans with high levels of social connectedness are less likely to experience negative health disparities associated with exposure to trauma than those with fewer social connections.^4,5

Since social well-being encompasses many dimensions within Veteran Whole Health, we describe why the VA should build on their existing Circle of Health⁶ framework to explicitly address Veteran social well-being during the VA’s transformation to a Whole Health system of care.⁷ The aim of this manuscript is to offer a Veteran community perspective on the importance of prioritizing social well-being as part of Veteran Whole Health.

IMPORTANCE OF SOCIAL WELL-BEING IN VETERANS

The relationship between social connection and well-being within military and Veteran communities is not a new topic of discussion. During the Second World War, French civilians living in the newly annexed Alsace-Lorraine region were forcefully conscripted into the German Wehrmacht.⁸ Most spent years in Soviet prisoner-of-war camps and were treated as traitors and disavowed by French society after the war. Researchers found this group had high rates of post-traumatic stress disorder (PTSD) upon returning home and feeling estranged and psychologically isolated from society.⁸ Since this period, common significant periods of PTSD and other associated readjustment challenges have been identified in recent eras of US Veterans.^9,10 Postservice reintegration can be one of the most challenging periods in the lives of Veterans since many report loneliness, isolation, and a loss of a sense of belonging during this transition.³ This reduction in social well-being can have many negative physical and psycho-social effects, and has been linked to suicide events.³ Fortunately, participating in programs that increase social well-being, such as volunteering in one's community, have been shown to significantly improve Veteran’s health and well-being.¹¹ Specifically, Veteran participation in volunteering activities that bring together other Veterans and are geared toward civic service increases the likelihood of lasting positive outcomes for those Veterans with various mental health conditions.¹²

SOCIAL CONNECTION AND VA PROGRAMS

There are existing programs and services in place that promote social connection. The VA’s most public and well-known services are centered on Veterans’ health care,¹³ in addition to programs focused on improving Veterans' access to educational and employment attainment,^14,15 home ownership,¹⁶ and financial stability;^17–19 all which provide Veterans with the tools and training to integrate back into the civilian community. However, what may be less publicly known, are the various community initiatives and services that VA developed to address social isolation, a sense of belonging, and connection within the Veteran community. Supports like adaptive sports clinics,²⁰ peer support specialists,²¹ and VET Centers²² provide opportunities for Veterans to experience a similar sense of belonging and camaraderie associated with military service. In addition, there have been two key programs implemented in the last few years that encourage (re) connection in the military and Veteran communities. First, VA’s Buddy Check Week,²³ is a national campaign that aims to enhance peer-to-peer connections and increase access to VA resources, especially mental health services. Second, VA Solid Start (VASS) provides early and consistent contact to newly separated Veterans by proactively calling them 3 times during their first year after discharge from military service.²⁴ During these outreach calls, specially trained VA representatives address issues or challenges the Veteran mentions by connecting them to VA benefits and partner resources.²⁴ VASS engagements provide immediate, available resources within each Veteran’s local community to meet them where they are during a critical point in their reintegration after service. With programs at both national and local levels, VA strives to connect Veterans with other Veterans and allies to foster enhanced social connections. However, social well-being programming should be incorporated into VA’s Whole Health system of care given its focus on relationships and connecting for Whole Health.⁶

EXISTING OPPORTUNITIES FOR VETERAN ENGAGEMENT

With growing efforts to increase Veteran engagement as part of a learning health system at VA,²⁵ Veterans themselves should be involved in every element of integrating social connection and well-being into VA programs and services. As VA seeks to keep transitioning to a Whole Health system of care, given the documented benefits of social connectedness among the Veteran population, it is imperative that VA incorporate the voice of the Veteran community while defining Veteran Whole Health in a way that is culturally relevant and validated in a representative Veteran population. With the help of Veterans, in addition to their caregivers and families, VA can develop ways to measure Veteran social connectedness to further enhance use of existing and new interventions. VA could also encourage the widespread and consistent assessment of outcomes among organizations that aim to enhance social connectedness among Veterans, which could enhance their abilities to conduct internal evaluations and potentially compare results between organizations.²⁶

CONCLUSION

The Veteran community in attendance at the 2023 conference on “Measuring What Matters Most (M³): Whole Person Outcomes in Clinical Care, Research, and Population Health” underscores the importance of the social well-being of Veterans apart of Whole Health. Opportunities for new and existing programs focused on social connection can be integrated into VA’s Whole Health system of care to ensure that social well-being remains a fundamental priority for Veterans, especially those who are newly separated from military service. With the involvement of the Veteran communitythe VA can bolster a more culturally relevant model of holistic care that promotes social belonging, connectedness, and support for all Veterans.