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Veteran Mental Health - What is next?- Written by Ed Parker

In my previous article, I noted that the diagnosis of mental health issues in veterans has doubled to 3 per cent in the past decade and I discussed the need to destigmatize veteran mental health. We must be careful about saying there is a problem, and not reacting to address this. In this article, I will explore what the veteran care pathway looks like and how it is being supported by military charities.

There are a number of military charities in the UK working to support veterans with their mental health as they leave the Armed Forces and transition to civilian life.  For example, Walking With The Wounded run a series of programmes such Head Start, providing one-to-one therapy for ex-service personnel with mild to moderate mental health difficulties such as depression, anxiety, PTSD and adjustment disorder. While charities provide a worthy service, I strongly believe the veteran care pathway should always start with the National Health Service (NHS), and principally GPs. Since its inception on July 5th 1948, the NHS has helped millions of UK citizens’ access vital mental health services. We must not lose sight of the fact that a veteran is also a citizen and should be able to access the same care as any other, precisely as the Armed Forces Covenant articulates. In order to fully understand the individual needs, it is crucial that healthcare providers ascertain ex-service personnel’s military service, and correctly diagnose the potential issues faced. The NHS has recently rolled-out a new scheme, the ‘National Heroes Service’, part of the NHS Long Term Plan. It has been designed to improve the primary care of those who served and their families. Through the scheme, GPs are sent comprehensive resource packages helping them to identify veterans and ensure that hospitals and staff recognise their military background. Subsequently, if specialist care is needed the patient can then be directed to specific referral pathways.

While GP services should always be the first point of contact for a veteran seeking mental health support, there are specialist veteran services that have been set up in order to address veteran’s needs. These services have a better understanding of the mitigating circumstances the individual may have faced because of their military service, and ensure greater engagement and empathy with the patient. The two principal services are the Transition Intervention and Liaison Service (TILS) and the Complex Treatment Service (CTS). These services are increasingly working in partnership with military charities in order to provide increased capacity and wider knowledge of the client group. Charities are also a rich source of knowledge and information and they can provide specialist engagement when needed. For example, WWTW’s Head Start programme has recently been commissioned in the Midlands and East of England to work in partnership with the NHS TILS service in that area. So far, the programme has supported 1181 referrals, and approved 947 veterans to receive therapy.  This type of programme demonstrates that the charity sector is an invaluable resource that can support and enhance the delivery of veteran services within the NHS. Nevertheless, military charities cannot replace the role of this service. By looking at the numbers this is evident. In 2018, it is estimated 36,000 veterans accessed mainstream NHS mental health services, a further 7,000 were supported by TILS and 800 by CTS. There is simply no chance that this level of care could be provided by the military charity sector, and with the NHS, there is no need. Charities should be seen as a resource that can be utilised to enhance the outcome for NHS service users.

In order to have the greatest impact to veterans, it is also important to look beyond clinical interventions and support the complete being through holistic care and social prescribing.  This means developing a pathway that not only addresses veteran mental health, but also one that encompasses social, economic and environmental needs. This could include volunteering, group learning, physical activity and employment. This last piece is crucial. WWTW is the only UK charity to offer veterans’ employment support through Individual Placement, and Support (IPS), a US protocol that assists veterans with mental health difficulties into employment. It involves intensive, individual support, a rapid job search followed by placement in paid employment, and time-unlimited in-work support for both the employee and the employer. Research has shown that IPS clients are twice as likely to gain employment compared to approaches that are more traditional.[1] In 2018, WWTW was named as an IPS Centre of Excellence for veterans by the Centre for Mental Health, the first veterans’ organisation to achieve this globally.

Although steps have been taken to simplify the veteran care pathway through care coordination, more can be done to enable veterans to gain easy access to the support they need. As a group of charities with the same beneficiary at stake, we must continue to strive for collaborative, ethical, informed outcomes that enable veterans to live independent of both State and Third Sector support.