Over 1.85 million people in the United Kingdom (UK) reported in the 2021 census that they had previously served in the UK Armed Forces (Office for National Statistics, 2022) and there are estimates that the ex-service personnel community (ex-military and dependents) is in excess of five million people (Royal British Legion, 2014).
For some individuals, military service can lead to mental health difficulties, including Post-Traumatic Stress Disorder (PTSD), depression, alcohol misuse and anxiety disorders (Iversen & Greenberg, 2009).
While PTSD is anecdotally considered as the primary mental health need for veterans, research would suggest that there is a much higher prevalence of common mental disorders (CMD): between 22% and 27% in military personnel (Iversen et al., 2009; Stevelink et al., 2018), comparative to 17% in the general population (McManus et al., 2016) and the odds of CMD development is double for military personnel (Goodwin et al., 2015).
Nonetheless, deployment presents a high risk for experiencing traumatic events (Hoge et al., 2004). As such, PTSD is a relevant risk and has been associated with holding a combat role (Rona et al., 2009; Fear et al., 2010).
While it is reported that the prevalence in serving Armed Forces personnel is low (MoD, 2021), it is estimated that 6.2% of veterans have probable PTSD (Stevelink et al., 2018).
Indeed deployment to Iraq or Afghanistan were associated with poorer mental health outcomes (Murphy & Busuttil, 2015). Further challenges occur beyond trauma from service, including the transition back to civilian life (Bowes et al., 2018), for which experiential avoidance, mental health and cognitive reappraisal were predictors for adjustment difficulties.
Many military personnel use substances to cope following deployment as opposed to talking about their trauma (Jacobsen et al., 2008).
Veterans with depression or PTSD are twice as likely to report alcohol misuse compared to those without these mental health difficulties (Jakupcak et al., 2010). This strategy may be engrained from early in their Armed Forces career, given alcohol’s use as a bonding tool or distress relief in the military culture (Keats, 2010).
In addition, constant relocation, working overseas and separation from family can compound alcohol and substance misuse (Bray et al., 1991).
The return and readjustment to civilian life puts veterans at a greater risk of substance misuse (Thomspon et al., 2011). It is estimated that 11% of veterans misuse alcohol compared to 6% of non-veterans (Rhead et al., 2022).
In the UK, veterans can access standard mental health care through normal general population pathways (e.g. primary care, crisis services, substance misuse services) and veteran-specific pathways (e.g., Veterans Mental Health Transition, Intervention and Liaison Service, Combat Stress), see Osborne et al. (2021) for a comprehensive report of pathways.
Waiting lists are a barrier to accessing this care, as they are prominent in NHS mental health services (Iqbal et al., 2021) and also veteran specific services (Murphy & Busuttil, 2015).
Moreover, internalised stigma that seeking help is ‘weak’ (Randles & Finnegan, 2021) and norms of stoic military attitudes to coping (Garcia et al., 2014) can lead to veterans not accessing support until crisis point (Rafferty et al., 2019).
Indeed the challenges faced by veterans can lead to increased risk of harm to self. Veterans who left service early were found to be more likely to engage in non-fatal self-harm (Bergman et al., 2019).
The suicide rate for veterans is not dissimilar to that of the general population but risk factors for increased suicide risk have been identified as being male, serving in the Army, discharge between the ages of 16 and 34, being untrained on discharge and length of service under 10 years
(Rodway et al., 2023).
There has been a commitment to improving care by the UK government: the Armed Forces Covenant states that veterans should be given priority within services (health and mental health care) should their difficulties be related to their service (MoD, 2011).
Yet further social challenges exist in the adjustment to civilian life: commonplace difficulties such as waiting lists in healthcare and necessities to pay utility bills and taxes are less present in the military system and may be additional, unexpected stressors (Fossey et al., 2019).
This is notwithstanding the impact on a veteran’s family system, who themselves may require additional support for their own mental health (Armour et al., 2022).
While there is ongoing changes to nationwide services (Ministry of Defence, 2023), termed as ‘Operations’ including Op COURAGE (i.e., mental health support), Op COMMUNITY (i.e., point of contact for the Armed Forces community to offer support and guidance as they navigate NHS services), and Op RESTORE (i.e., veterans’ physical health and wellbeing service), we wanted to understand what we could offer as a local organisation to fulfil unmet needs.