Former military personnel with mental health issues face the biggest battle of all: coming to terms with their condition. But help is at hand in a series of pilots, writes Andrew Mickel
The mental resilience instilled by military training has one unwelcome by-product: a reluctance to seek help when times are tough. The Ministry of Defence estimates that it can take 10 years after mental health symptoms present themselves for armed forces veterans to ask for support.
With this in mind, the MoD teamed up with all four UK health administrations and several NHS trusts to create six pilot projects offering community mental health care for veterans. The project in South Staffordshire is run by veterans mental health nurse Rob Heath, who, as a major in the Territorial Army and a registered nurse in mental health, describes himself as the “linchpin” connecting the two worlds.
“I will help the clinician through that military side of the maze, helping them do what they need to, and I’ll take the patient through the NHS side of the maze, acting as a sort-of advocate for the veterans with the clinical teams,” he says.
David*, a 25-year-old former member of the Parachute Regiment, is one who has benefited from the project. After nearly six years’ service, he calmly refers to the devastating roadside bombs encountered during his two tours of Iraq as “not the best of times”.
Absent without leave
But the events took a toll on David’s mental health, and he started going absent without leave before he left the army. “I had trouble adjusting when I got back from my second tour,” he says. “It’s hard to explain, but when I got back I just wasn’t myself. I just didn’t feel at home at all.”
Experiencing aggression, anxiety and trouble reintegrating into civilian life, David was referred by a GP earlier this year to the South Staffordshire community mental health team, which contacted Heath.
Team nurse Charlotte Potter-Walker, who has one-to-one sessions with David, says: “The one thing you need with a patient is engagement. When you can’t directly relate to their experience, it gives them a lot more confidence with someone there who knows what they’re talking about.”
Heath can also help veterans access other services – such as the Royal British Legion and ex-services charity Combat Stress – and is helping David file a claim for injuries received in Iraq.
David says the approach has worked. “At the first appointment with Charlotte, I learned so much about myself it was unbelievable. Rob joined after two sessions, which made things a lot easier because he was in the military. It’s a great combination.”
Since it started in September 2007, the project has worked with about 60 veterans, from former prisoners of war taken by the Japanese in World War Two to those returning from the frontline today. Heath says the issues for veterans reflect those of the general population, such as anxiety, depression and substance misuse, with a handful referred on for psychological help. Despite his broad workload, he says there is the capacity so long as “I can call on the 3,000 professionals within the trust. I don’t have to replicate the work of other people”.
Although the initial pilot period and money has ended, the work continues to be run by the NHS trust.
David’s sessions with Potter-Walker and Heath are continuing but he feels more in control of his life and his aggression and anxiety have subsided.
But he knows of many veterans who could benefit from the services.
“All the army training is about not being weak, so it’s hard to come forward,” he says. “It’s not just in my regiment. I’d hate to see soldiers who have served their country come back and take their own lives.”
* Name has been changed
What the other pilots offer
The University of Sheffield is evaluating the four pilots below. They will be compared with each other, as well as with the services they are replacing and three existing services.
Because the pilots started at different times, the report is not due to be published until early next year.
In its New Horizons mental health strategy, published last month, the government said the pilots would inform wider roll-out of community mental health services for military veterans.
The other pilots are:
Camden and Islington Mental Health and Social Care Trust
● Comprehensive mental health assessment and specialist trauma unit
● 110 referrals in 2008-9
Cornwall Partnership NHS Trust
● Integrated model with signposting, assessments, and some treatments
● 100 referrals since August 2008
Tees, Esk and Wear Valleys NHS Foundation Trust
● Virtual network across trust of 105 people trained in awareness of veterans, plus a virtual trauma network
● 41 veterans registered since July 2009
Cardiff and Vale NHS Trust
● Assessment, treatment, case management and signposting
● 155 referrals since March 2008
NHS Lothian, Edinburgh
● Drop-in centre providing complete psychosocial care, including health, employment and housing
● 175 referrals since March 2009
➔ More from New Horizons. Scroll to page 64
This article is published in the 14 January 2010 edition of Community Care under the headline “Forces of support”