Connecting the Dots: Does Military Sexual Trauma Exacerbate Women Veterans’ Experience of Homelessness?
Housing Instability Seems to Remain an Issue for Survivors, Despite Access to VA Healthcare and Compensation
In my reading recently on women veterans and homelessness from the research literature — don’t worry, it’s fascinating — I came across a very interesting recent study by Ann Elizabeth Montgomery, Ph.D. et al., on a sample of veterans, both male and female, who were enrolled in VA Health Care services. Now, enrollment for veterans of any gender in VA is not a given, but particularly so for women veterans.
“Back in the day,” before the current era, women who served in the military either assumed or were actually, wrongfully told when they left the military that they were not veterans, or were not eligible for VA services — or both. (Sadly, in many cases it has taken women veterans decades to figure out that they are VA-qualified, often through a chance conversation with a younger serving family member, friend or neighbor. Women veterans separating from the military now do know, and have enrolled at VA in increasing numbers. But for many older women veterans, there may have been a lengthy gap in service in which they neither felt acknowledged for their service to their country or realized they were eligible for VA services.)
In my current survey of almost 3,000 women veterans from every era (WWII to the present), for example, four in 10 said they were not told they were eligible. (More than a third of those women are still not enrolled with VA for health care — although technically VA has many other services to offer, including claims, home loans, education, even burial benefits.
In Dr. Montgomery’s study, all the women involved — more than 100,000 — are enrolled in VA for healthcare. This isn’t representative of all the women veterans in the U.S., nor does she imply that it is — it’s merely a characteristic of the specific dataset she had to work with. Mine is a little different, because — as an outsider — I was reaching out to women veterans who are positioned both inside and outside the VA system. Our results should vary somewhat, but it might be telling to see how, and begin to uncover why. (To recap, all of her women veterans in the study realized they were eligible and later enrolled. In mine, only a portion were told, and a subset of those enrolled.)
Her general findings were that women in a middle-aged age bracket — not young (below 35) or older (above 65) were particularly at risk for homelessness; also if they were Black, or unmarried (this is just the women). And if they’re receiving VA healthcare, they’re less at risk.
I have some very different findings, and it might be interesting to speculate why. In my study, like hers, women veterans 65 years and older have much less chance than any other group of having experienced homelessness (about 1/4 the risk). But, I didn’t see a lower risk below age 35. The women veterans in my study tend to be younger, and many (30 percent) have fought in OEF/OIF conflicts, have seen combat (an exact one-third), or both (27 percent).
In my study, like hers, the risk for Black women veterans is higher (as other research traditionally indicates.)
But — in a major difference — the women veterans in my study who were enrolled in VA healthcare were actually doing worse re: homelessness. In other words, enrollment in VA healthcare did not seem protective for them against experiencing homelessness. Comparing just these factors, whether women were told they were eligible for VA and whether they are enrolled in VA health care, the largest percentage of women veterans in my study who had experienced homelessness were those who were not told they were eligible for VA services, of whom almost six in 10 experienced homelessness. The next highest group was those who were enrolled in VA healthcare, where 55 percent reported experiencing housing instability.
Now this sounds extraordinary and counter-intuitive — why would more access to services be associated with a worse experience? Perhaps unless you factor in at least one other dimension that wasn’t looked in the scope of Dr. Montgomery’s study. (Of course, research never looks at everything possible; but progressively investigates slices of what to look at next, determined to be potentially important.)
More connecting of dots
Here are some items where the connection might be worth pursuing. How about having a PTSD diagnosis, or being told by a healthcare practitioner that you have experienced military sexual trauma (MST) during your service? (Technically, MST isn’t its own diagnosis, like PTSD, although it frequently leads to PTSD. So my survey asked women veterans if a healthcare provider had ever told them they’d experienced MST — versus relying on their own impression. Not that women veterans wouldn’t know, but to make it more “official” that someone else in a therapeutic role had told them that. Additionally, it’s not uncommon at all for women veterans to have both PTSD and an experience of — or multiple experiences of — MST.
When I went back and checked my data for women veterans who were enrolled with VA healthcare and had received a diagnosis of PTSD, fully two-thirds (65.4 percent) had experienced homelessness. It was even higher for women veterans in VA who had been told they’d experienced MST: More than seven in 10 (70.9 percent) had experienced homelessness.
Military sexual trauma often feels like the unwelcome elephant in the room. It’s certainly far too common in women (and men) veterans’ experiences in the military, and it’s been shown by Emily Brignone, Ph.D., et al. in an article published in JAMA Psychiatry to be “independently associated” with a greater risk for homelessness in veterans at every interval they studied — 30 days, one year, five years out.
Now, for a long time in veterans homelessness research — not just with women but with men as well — it’s been hard to understand why, generally speaking, veterans experience trouble with homelessness to the degree that they have, given their access to a world-class system of health care and benefits that’s also free (seen as paid for by their service). So there’s been some concern that this development can’t be understood at face value — access to services should improve outcomes, overall — and the phenomenon appears to need further research.
Another difference Dr. Montgomery and I find in our studies is that in her group, women veterans who are what’s known as “service-connected” for a disability and are consequently receiving compensation from VA, but from a “different side of the house” (claims) are doing better re: homelessness. This would make complete sense as to why that would be. Women veterans who were service-connected in her study were at a lower risk for homelessness, so she finds it to be protective. (And just as a point of reference, about 4.5 million veterans in the U.S. have service-connected disabilities, numerically about half as many veterans as are enrolled in VA healthcare, according to recent VA data.)
But when I look at my data, I find the polar opposite outcome. How it is possible we could both be right? By introducing another element into the mix and seeing if that changes anything. Let’s take a look.
In my survey, the more compensation women veterans were receiving from VA for service-connected disabilities, the higher their experiences of homelessness were(!) But again, taking a look at PTSD and/or MST could provide the explanation. (In my group of respondents, almost half had PTSD diagnoses, about four in 10 had had a healthcare provider tell them they’d experienced MST, and more than one third of the respondents qualified as having both PTSD and MST. When it came to whether women veterans with both PTSD and MST had also suffered housing instability, more than one in five (22.5 percent) had.
Service-connected disabilities and compensation
In my study, if women veterans said they were service-connected, more than half (52.8 percent) had still experienced homelessness. In fact, the numbers were higher for those who were rated 50 percent and above than for those below that rating(!). Worst of all were the rates for the women respondents who were still waiting for VA to approve their claim (more than two-thirds of whom had experienced homelessness) or who had their claims denied (almost two-thirds had experienced homelessness) (It should be mentioned that these were small groups; overall VA seems to have greatly improved the claims experience for veterans, with individual exceptions as always.) Rosie Palfy’s case comes to mind, a former Marine and MST survivor who waited eight years for her claim to be resolved, during which time she became homeless despite the fact she was working. (I wrote about Rosie’s story here.)
I asked women veterans in my study who were service-connected if they were receiving payments from VA, from social security, or both (both being a possibility that seems infrequently explored). Oddly, the higher the level of compensation, the higher also their chances for having experienced homelessness. Seven in 10 women veteran respondents who were receiving both VA and SSDI compensation had experienced homelessness. Paradoxically, this may also just imply that these women veterans are more disabled and less likely to be able to secure or maintain gainful employment, which cascades into ability to maintain secure housing. But it also begs the question, are payment levels actually set too low to make a substantial enough difference in quality of life — especially when it comes to housing?