veteran in army camoflauge

This research clarifies that, where needs exist amongst the veteran population, these are often multifaceted across both health and social care domains. 

It is evident that some veterans do not smoothly transition into civilian life and therefore, may struggle to cope with the demands of day-to-day functioning. 

From this research we recognised three overall themes around unmet needs: Accessibility, Being understood and Mistrust.


Accessibility

Whether this is related to benefits, transport, services, appointments or information available, we recognise that veterans may need additional support or adaptations to enable access.

Being understood

There is clear pattern of veterans not feeling that they are able to relate to, or that their unique experiences can be recognised by, civilians or civilian-led services. 

Mistrust

Veterans have often experienced trauma and may have been let down by the armed forces or by services. A concerted effort must be made to support them to rebuild this trust in local services.


The results of this study were discussed with Veteran stakeholders in October 2022 and an initial proposal for a NEL Veterans alliance was substantially supported.

The Alliance would promote the following:

  • An active, monitored advocacy role to support veterans with the goal to reduce stigma and any barriers to accessing services and support. 
  • Promote awareness and understanding of what local services exist through establishing links with key persons, and thus improve signposting and monitoring of agreed outcomes. The network of key persons would also ensure service support is easily accessible and with a minimum of difficulty. 

Access to services and feedback on a veteran-specific platform could be devised, which can improve veterans’ direct 
accessibility of the appropriate service. 

Removing the various processes that currently exist across organisations and providing a bespoke process would be more efficient. Stakeholders could also audit referral and signposting processes to ensure optimal delivery and impact. This could be based on the Veterans Gateway.

The employment of individual advocates for veterans, who provide a dedicated role to signposting, liaising with stakeholders to ensure appropriate referral pathways are followed may be a significant measure to improve service access and support for the unmet needs defined by this project. 

The advocate role could suit an “Expert by Experience” veteran, who will receive or have knowledge of local services and an expansive understanding of the challenged faced by veterans accessing these. 

Furthermore, the idea of a peer (veteran specific) support network or charity has been suggested by participant veterans throughout this research, which could be developed as part of this role. There are a number of veterans which expressed a desire to volunteer in a supporting role that is veteran specific. 

A copy of the final report will be forwarded to the Ministry of Defence (MoD), detailing findings and recommendations for a more comprehensive and tailored transition into civilian life and outlining the preventative approach to accessing services and identified need areas. 

The NEL Alliance is to be tasked with devising a local Veterans Hub where stakeholder services meet (regularity to be determined by demand) with any ex-military personnel, to access support and build social networks. The hub can be run by a combination of professionals and Experts by Experience. 

Veterans felt the development of a ‘New Veterans Hub’ would be appropriate to address gaps in provision and areas of need. Such a hub could be piloted to test its potential to meet this purpose. A similar scheme is in operation as proposed by veterans in this research.

The lack of support for family members of veterans places a significant responsibility on them. Accessing information on the support needs for this group of relatives and carers will be an important future objective. 

A peer support group for relatives and carers may facilitate the understanding of this issue, as research suggests there is often a perceived responsibility placed on the close network of veterans and this can have an impact on the carer’s wellbeing. 

The findings have evidenced that veterans can experience anger towards civilians and that may be an impact of military service. At present, no anger management service exists in North East Lincolnshire for this frequently cited need. 

Whilst it is known that services such as Navigo have provided support to veterans for anger management, this is not a veteran specific anger management group, which may be more appropriate considering the frequency of this need. 

As part of training and continued professional development, it may be useful for organizations to incorporate ‘promoting military awareness and 
understanding’ as a part of employee understanding. This will help to address the frequently cited barrier for veterans accessing civilian support services and work towards building trust and understanding in helping relationships. 

In accordance with the proposal by the Royal British Legion (2022), it is recommended that the local authority include loneliness and social isolation in their Joint Strategic Needs Assessment (JSNA), or equivalent, for veterans. 

This would allow for services to consider how additional initiatives could be targeted at members of the Armed Forces Community. It is also proposed that psychological distress and welfare are considered for inclusion in the JSNA. 

In the first instance, Navigo Health and Social Care CIC will employ a dedicated engagement officer to lead on progressing the action plan from this report in conjunction with the local armed forces covenant. 
 

Armour, C., Spikol, E., McGlinchey, E., Gribble, R., Fear, N. T., & Murphy, D. (2022). Identifying psychological outcomes in families of Five Eyes alliance armed forces Veterans: A systematic review. Journal of Military, Veteran and Family Health, 8(1), 7-27.

Barkham, M., Gilbert, N., Connell, J., Marshall, C., & Twigg, E. (2005). Suitability and utility of the CORE–OM and CORE–A for assessing severity of presenting problems in psychological therapy services based in primary and secondary care settings. The British Journal of Psychiatry, 186(3), 239-246.

Bergman, B. P., Mackay, D. F., Smith, D. J., & Pell, J. P. (2019). Non-fatal self-harm in Scottish military veterans: a retrospective cohort study of 57,000 veterans and 173,000 matched non-veterans. Social psychiatry and psychiatric epidemiology, 54, 81-87.

Bowes, M. A., Ferreira, N., & Henderson, M. (2018). The influence of psychosocial factors in veteran adjustment to civilian life. Clinical Psychology & Psychotherapy, 25(4), 583-600.

Bray, R. M., Marsden, M. E., & Peterson, M. R. (1991). Standardized comparisons of the use of alcohol, drugs, and cigarettes among military personnel and civilians. American Journal of Public Health, 81(7), 865-869.

Evans, C., Connell, J., Barkham, M., Margison, F., McGrath, G., Mellor-Clark, J., & Audin, K. (2002). Towards a standardised brief outcome measure: Psychometric properties and utility of the CORE–OM. The British Journal of Psychiatry, 180(1), 51-60.

Fear, N. T., Jones, M., Murphy, D., Hull, L., Iversen, A. C., Coker, B., ... & Wessely, S. (2010). What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study. The Lancet, 375(9728), 1783-1797.

Fossey, M., Cooper, L., & Raid, K. (2019). The transition of military veterans from active service to civilian life: Impact of transition on families and the role of the family, support, and recognition. In Military veteran reintegration (pp. 185-213). Academic Press.

Garcia, H. A., Finley, E. P., Ketchum, N., Jakupcak, M., Dassori, A., & Reyes, S. C. (2014). A survey of perceived barriers and attitudes toward mental health care among OEF/OIF veterans at VA outpatient mental health clinics. Military medicine, 179(3), 273-278.

Goodwin, L., Wessely, S., Hotopf, M., Jones, M., Greenberg, N., Rona, R. J., ... & Fear, N. T. (2015). Are common mental disorders more prevalent in the UK serving military compared to the general working population?. Psychological medicine, 45(9), 1881-1891.

Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., & Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England journal of medicine, 351(1), 13-22.

Iqbal, Z., Airey, N. D., Brown, S. R., Wright, N. M., Miklova, D., Nielsen, V., ... & Sajjad, A. (2021). Waiting list eradication in secondary care psychology: Addressing a National Health Service blind spot. Clinical Psychology & Psychotherapy, 28(4), 969-977.

Iversen, A. C., & Greenberg, N. (2009). Mental health of regular and reserve military veterans. Advances in psychiatric treatment, 15(2), 100-106.

Jacobson, I. G., Ryan, M. A., Hooper, T. I., Smith, T. C., Amoroso, P. J., Boyko, E. J., ... & Bell, N. S. (2008). Alcohol use and alcohol-related problems before and after military combat deployment. Jama, 300(6), 663-675.

Jakupcak, M., Tull, M. T., McDermott, M. J., Kaysen, D., Hunt, S., & Simpson, T. (2010). PTSD symptom clusters in relationship to alcohol misuse among Iraq and Afghanistan war veterans seeking post-deployment VA health care. Addictive behaviors, 35(9), 840-843.

Keats, P. A. (2010). Soldiers working internationally: Impacts of masculinity, military culture, and operational stress on cross-cultural adaptation. International Journal for the Advancement of Counselling, 32, 290-303.

McManus S, Bebbington P, Jenkins R, Brugha T. (eds.) (2016) Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital.

Ministry of Defence. (2021). UK Armed Forces Mental Health: Annual Summary & Trends Over Time, 2007/08 to 2020/21. Accessed 02/02/2024: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/993208/20210617_MH_Annual_Report_2020-21.pdf

Ministry of Defence. (2023). Armed Forces Covenant and Veterans annual report 2023. Available online at: https://www.gov.uk/government/publications/armed-forces-covenant-and-veterans-annual-report-2023

Ministry of Defence. The armed forces covenant. London: Ministry of Defence; 2011. Available online at: https://www.gov.uk/government/policies/armed-forces-covenant

Murphy, D., & Busuttil, W. (2015). Exploring outcome predictors in UK veterans treated for PTSD. Psychology research, 5(8), 441-51.

Office for National Statistics (ONS). (2022). UK armed forces veterans, England and Wales: Census 2021.

Office for National Statistics (ONS). (2023). Characteristics of UK armed forces veterans, England and Wales: Census 2021.

Osborne, A., McGill, A., & Kiernan, M. D. (2021). Pathways into Mental Health Services for UK Veterans. Covenant Fund. Available online at: https://covenantfund. org. uk/wp-content/uploads/2021/04/2021-Pathways_into_Mental_Health_Services_ for_UK_Veterans. pdf (accessed 02/02/2024).

Phelan M, Slade M, Thornicroft G, Dunn G, Holloway F, Wykes T, Strathdee G, Loftus L, McCrone P & Hayward P (1995) The Camberwell Assessment of Need: the validity and reliability of an instrument to assess the needs of people with severe mental illness, British Journal of Psychiatry, 167, 589-95.

Rafferty, L. A., Wessely, S., Stevelink, S. A., & Greenberg, N. (2019). The journey to professional mental health support: a qualitative exploration of the barriers and facilitators impacting military veterans’ engagement with mental health treatment. European journal of psychotraumatology, 10(1), 1700613.

Randles, R., & Finnegan, A. (2021). Veteran help-seeking behaviour for mental health issues: a systematic review. BMJ Mil Health.

Rhead, R., MacManus, D., Jones, M., Greenberg, N., Fear, N. T., & Goodwin, L. (2022). Mental health disorders and alcohol misuse among UK military veterans and the general population: a comparison study. Psychological medicine, 52(2), 292-302.

Rodway, C., Ibrahim, S., Westhead, J., Bojanić, L., Turnbull, P., Appleby, L., ... & Kapur, N. (2023). Suicide after leaving the UK Armed Forces 1996–2018: A cohort study. PLoS Medicine, 20(8), e1004273.

Rona, R. J., Hooper, R., Jones, M., Iversen, A. C., Hull, L., Murphy, D., ... & Wessely, S. (2009). The contribution of prior psychological symptoms and combat exposure to post Iraq deployment mental health in the UK military. Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies, 22(1), 11-19.

Stevelink, S. A., Jones, M., Hull, L., Pernet, D., MacCrimmon, S., Goodwin, L., ... & Wessely, S. (2018). Mental health outcomes at the end of the British involvement in the Iraq and Afghanistan conflicts: a cohort study. The British Journal of Psychiatry, 213(6), 690-697.

The Royal British Legion. (2014). A UK Household Survey of the ex-Service Community.

Thompson, J. M., MacLean, M. B., Van Til, L., Sudom, K., Sweet, J., Poirier, A., & Pedlar, D. (2011). Survey on transition to civilian life: Report on regular force veterans. Research Directorate, Veterans Affairs Canada, Charlottetown, and Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, 4.