Veterans

Veterans include anyone who has served for at least one day in the Armed Forces (Regular or Reserve), as well as Merchant Navy seafarers and fishermen who have served in a vessel that was operated to facilitate military operations by the Armed Forces.

Around 18,000 Service people move back into civilian life every year, including around 2000 who leave the Services on medical grounds. Veterans may prefer to use other terms to describe themselves, such as ‘ex-Serviceman’

Veterans may face particular issues when leaving the armed forces and re-entering civilian life. They may face challenges in securing housing and employment. They may also have particular health problems, including mental health.

While meeting healthcare needs of serving personnel is the responsibility of the Armed Forces, following discharge from the Forces, the duty of care for a veteran lies with the NHS.

What do we know?

Service in the Armed Forces is different from other occupations. Apart from the obvious uncertainties and dangers, Service people relinquish some of their own civil liberties and put themselves in harm’s way to protect others.

As an illustration, the risk of death (occupational attributable mortality) for the Army overall is currently around one in 1000 per year, or about 150 times greater than for the general working population. Risk of serious injury (for example loss of limbs, eyes or other body parts) is substantially increased.

(Source: Meeting the Healthcare Needs of Veterans RCGP)

The UKs ex-service population (including veterans and their dependents) is elderly and declining in size. Nearly half of the ex-service community are over the age of 75. Large numbers in this age group are experiencing problems with mobility and self-care.

The younger population make up 6% of the ex-service community. Veterans aged 16 to 64 in particular are more likely than the general population to report a long term illness. This includes depression, mobility issues and sensory impairment. They are also less likely to be in employment, and more likely to suffer from financial difficulties and have caring responsibilities.

(Source: Royal British Legion)

Mental Health

Conditions of military service can affect veterans’ mental health. The most common disorders post-deployment are depression, alcohol misuse, and anxiety disorders (serving personnel). Post-Traumatic Stress Disorder (PTSD) remains the most common reason for referral to our service (SCVS)

Risk factors for health concerns

  • Deployment to Iraq or Afghanistan significantly associated with the report of alcohol misuse on return from theatre, particularly if in combat role.
  • Those leaving the Armed Forces within 4 years of joining are identified as particularly vulnerable and have higher incidence of mental health problems
  • Higher rates of mental health difficulties and rates of PTSD in reservists

Barriers to seeking help

 

  • stigma
  • perception of ‘civvies’ (you won’t understand what I have been through)
  • confidentiality concerns
  • previous negative experiences with NHS
  • mental health professionals don’t ask about military experiences
Research shows that veterans tend to present to mental health services approximately 10-15 years after first experiencing psychological difficulties

Facts, figures, trends

Very little local data is available to estimate the health needs of veterans in Slough.

There are currently 210 veterans in receipt of an Armed Forces pension living in Slough. Approximately 50 referrals per year are made to the South Central Veterans Service from Berkshire-based veterans. The exact number from Slough is not known.

National and local strategies (current best practices)

Armed Forces Covenant

The Armed Forces Covenant (introduced in 2000) states that veterans should face no disadvantage compared to other citizens in the provision of public and commercial services.

In 1997 it was recognised that veterans in receipt of a war pension should be given priority treatment by the NHS. In 2008 this was extended to include all veterans. Therefore, all veterans with health conditions (physical or psychological) that are related to military service should be afforded priority treatment, subject to clinical need.

Local Policy and Services

Local areas are encouraged to develop community covenants and a Slough covenant was signed in March 2013. An action plan has been developed to support the local covenant.

The Localism Act 2011 placed a duty on local authorities to prioritise veterans in terms of obtaining social housing and this is reflected in the council’s practice and new housing allocation policy.

South Central Veterans Service (SCVS)

This service offers primarily a mental health assessment and signposting service for veterans. Additionally, PTSD treatment is provided for veterans able to attend our hub in Reading . Other aspects of the service include liaison with community and charitable services, and teaching, training and consultation

What is this telling us?

  • The transition out of the Armed Forces can be a difficult period of time
  • It’s anticipated that service-related psychological difficulties will remain a common presenting issue for veterans
  • Currently, SCVS figures show a growing demand for psychological assessment and treatment for veterans who have experienced multiple service-related traumatic events and present with symptoms consistent with Post-Traumatic Stress Disorder. Though Talking Therapies work well with single-incident traumas, cases involving multiple traumas require more intensive specialist input
  • SCVS Teaching/training to NHS services/community services/charitable organisations has gained positive feedback

Recommendations for consideration by other key organisations:

  • Clinical Commissioning Groups (CCGs) and GPs to review whether health needs of veterans needs to be addressed in a collective way
  • When a veteran leaves the forces a summary health record is returned to their GP which the Department of Health note should be recorded with the Read code ‘History Relating to Military Service’: Ensuring this is done will help identify needs in future. Guidance for GPs is available from the Royal College of General Practitioners.

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