Transition from service to civvy street: the needs of armed forces veterans and their families in the UK

Abstract

Aims:

Although many veterans make the transition from military to civilian life without difficulty, a small proportion struggle due to an impact on mental and physical wellbeing. Stigma and a reluctance to seek help further exacerbate this problem. The Armed Forces Covenant outlines the importance of ensuring that public services are aware of the specific needs of veterans; however, evidence suggests that knowledge among professional staff may be limited.

Methods:

This exploratory study included three phases. Phase 1 (questionnaires) explored the needs of veterans and their families in Warwickshire (UK) regarding information about their health and wellbeing and the barriers and facilitators to accessing local public health services. Also in Phase 1, health and public services staff knowledge of veterans’ needs and the Covenant is explored. In Phase 2, both samples attended a related focus group for a more in-depth exploration of the issues identified in Phase 1; in order to inform a Phase 3 workshop to co-develop an intervention.

Results:

Veterans, their families and friends, wanted more information about what services do, how and when to access them and what to expect. Confusion over when to seek help for mental health ‘symptoms’ was highlighted. More support for families was identified, alongside a need for health and social care staff to have a better understanding of the unique experiences and needs of veterans. Only 35% of staff reported a good understanding of the Armed Forces Covenant and their responsibilities to uphold it.

Conclusions:

Public health teams within UK local authorities are well placed to ensure veterans have more knowledge about and access to public services. Interventions to address stigma and veterans’ reluctance to seek help were needed. To this end, interventions for local veterans, their loved ones and staff in public services, designed in co-creation with these groups, is discussed.

Keywords

military medicine mental health health services military veterans inequalities patient care

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References

Ahern

Worthen

Masters

et al . The challenges of Afghanistan and Iraq veterans’ transition from military to civilian life and approaches to reconnection. PLoS ONE 2015; 10(7): e0128599.

Hoge

Castro

Messer

et al . Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med 2004; 351(1): 13–22.

Kim

Thomas

Wilk

et al . Stigma, barriers to care, and use of mental health services among active duty and National Guard soldiers after combat. Psychiatr Serv 2010; 61(6): 582–8.

Iversen

van Staden

Hacker Hughes

. Help-seeking and receipt of treatment among UK service personnel. Br J Psychiatry 2010; 197: 149–55.

Iverson

van Staden

Hacker Hughes

et al . The stigma of mental health problems and other barriers to care in the UK Armed Forces. BMC Health Serv Res 2011; 11: 31.

Murrison

. Fighting Fit. A Mental Health Plan for Servicemen and Veterans. London: HM Government. Available online at: https://www.gov.uk/government/publications/fighting-fit-a-mental-health-plan-for-servicemen-and-veterans-2 (2010, last accessed April 2015).

Hotopf

Hull

Fear

et al . The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study. Lancet 2006; 36: 1731–41.

Goodwin

Wessely

Hotopf

et al . Are common mental disorders more prevalent in the UK serving military compared to the general working population? Psychol Med 2014; 45(9): 1881–91.

Fear

Iversen

Meltzer

et al . Patterns of drinking in the UK Armed Forces. Addiction 2007; 102: 1749–59.

10.

MacManus

Wesseley

. Veteran’s mental health services in the UK: are we heading in the right direction. J Ment Health 2013; 22(4): 301–5.

11.

Iverson

Greenberg

. Mental health of regular and reserve military veterans. Adv Psych Treat 2009; 15: 100–6.

12.

Murphy

Palmer

Westwood

et al . Do alcohol misuse, service utilisation, and demographic characteristics differ between UK veterans and members of the general public attending an NHS General Hospital? J Clin Med 2016; 5(11): 95.

13.

Ministry of Defence. The armed forces covenant. London: Ministry of Defence; 2011. Available online at: https://www.gov.uk/government/policies/armed-forces-covenant (last accessed January 2017).

14.

Burdett

Woodhead

Iverson

et al . ‘Are you a veteran?’ Understanding of the term ‘Veteran’ among UK ex-service personnel: a research note. Armed Forces Soc 2012; 39: 751–9.

15.

Royal College of General Practitioners. Meeting the Healthcare Needs of Veterans: A Guide for General Practitioners. Available online at: http://www.rcgp.org.uk/policy/rcgp-policy-areas/veterans-healthcare-needs.aspx (2011, last accessed July 2017).

16.

Simpson

Leach

. The General Practitioner and the military veteran. J Roy Army Med Corps 2015; 161: 106–8.

17.

Dent-Brown

Ashworth

Barkham

et al . An evaluation of six community mental health pilots for veterans of the armed forces. A Report for the Ministry of Defence CTLBC-405. Sheffield: University of Sheffield, 2010. Available online at: https://www.mentalhealth.org.uk/sites/default/files/the-mental-health-of-serving-and-ex-service-personnel.pdf 2010 (last accessed 26 June 2018).

18.

Ministry of Defence. The Armed Forces Covenant for Communities. Available online at: https://www.gov.uk/government/publications/armed-forces-community-covenant/armed-forces-community-covenant (2011, last accessed 14 August 2017).

19.

Shannon-Baker

. Making paradigms meaningful in mixed methods research. J Mix Method Res 2015; 10(4): 319–34.

20.

Braun

Clarke

. Using thematic analysis in psychology. Qual Res Psych 2006; 3(2): 77–101.

21.

Coulthard

Farrell

Singleton

et al . Tobacco, alcohol and drug use and mental health. London: TSO; 2002.

22.

Du Preez

Sundin

Wessely

et al . Unit cohesion and mental health in the UK armed forces. Occup Med 2012; 62: 47–53.

23.

Jones

Fear

. Alcohol use and misuse within the military: a review. Int Rev Psychiatry 2011; 23: 166–72.

24.

White

de Burgh

Fear

et al . The impact of deployment to Iraq or Afghanistan on military children: a review of the literature. Int Rev Psychiatry 2011; 23(2): 210–17.

25.

De Burgh

White

Fear

et al . The impact of deployment to Iraq or Afghanistan on partners and wives of military personnel. Int Rev Psychiatry 2011; 23: 192–200.

26.

Keeling

Wessely

Dandeker

et al . Relationship difficulties among UK military personnel: impact of sociodemographic, military, and deployment-related factors. Marriage Fam Rev 2015; 51(3): 275–303.

27.

Warwickshire County Council. Service to Civvy Street: A Booklet to Help Service Veterans Navigate Healthcare, Employment, Housing, Education and Other Support. Available online at: https://apps.warwickshire.gov.uk/api/documents/WCCC-630-318 2015 (last accessed 26 June 2018).

28.

Warwickshire County Council. Service to Civvy Street: A Booklet to Help Partners/Spouses Families Navigate Healthcare, Employment, Housing, Education and Other Support. Available online at: https://apps.warwickshire.gov.uk/api/documents/WCCC-966-985 2015 (Last accessed 26 June 2018).