Military Veteran Psychological Health and Social Care

Contemporary Issues

Jamie Hacker Hughes

• Publisher: Routledge
• Year: 2017
• Print ISBN: 9781138949492
• eBook ISBN: 9781351763073
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

When servicewomen and men leave the armed forces, their care transfers to the statutory and third sector where the quality and provision of services can vary enormously. This edited book, encompassing a range of perspectives, from service user to professional, provides a comprehensive overview of services available. Each chapter, in turn, examines the policy underpinnings of systems and services covering the psychological health and social care of military veterans and then focuses on the needs of a discrete number of types of military veterans including early service leavers, veterans in the criminal justice system, older veterans and reservists, together with the needs of the children of veterans' families.

This is the first UK book to examine the whole spectrum of contemporary approaches to the psychological health and social care of military veterans both in the United Kingdom and overseas. The book is edited by Professor Jamie Hacker Hughes, a former head of healthcare psychology within the UK Ministry of Defence and all contributors are experts in policy, service provision and academic research in this area. It will be of special interest to those designing and planning, commissioning, managing and delivering mental health and social care to military veterans and their families

PART I

The British Veteran

1

INTRODUCTION

Walter Busuttil, Jamie Hacker Hughes and Neil Kitchiner

The British military in the twentieth century

Following the Second World War, the North Atlantic Treaty Organisation (NATO) was formed in 1949, with its remit of collective defence in response to an attack by an outside aggressor (Isby and Kamps, 1985). Britain and its military capability has been involved in various NATO missions including defending its territories from attack, peace-keeping duties and, more recently, as a member of the multi-national coalition forces in Iraq (NATO Training Assistance Implementation Mission) and Afghanistan (International Security Assistance Force).

It could be argued that Britain has been at peace since the end of the Second World War in 1945, yet between then and the time of writing, only in 1968 has a serviceman or woman not been killed in action somewhere in the world (Higham, 1972). Serving in the Armed Forces was a common occurrence for men of conscription age, particularly following the end of the Second World War in 1945, despite compulsory National Service ending briefly. In 1947, National Service was re-imposed by the UK Government in an attempt to boost Armed Forces numbers. National Service had a duration of 18 months initially but this was later extended to 2 years. This policy finally ceased in 1960, with the last National Serviceman demobilised in May 1963 (Ruhl, 2003).

On 1 November 2011, the manning levels for the whole of the three British armed services were officially set at 176,680 (the actual number in post was 173,830) providing a deficit of 2,850 individuals (Ministry of Defence, 2010). These numbers represented a dramatic decline in the number of individuals exposed to a period of military service since the end of National Service. This, in turn, has resulted in the vast majority of the UK population having no experience of serving in the military.

Current aims and strategic objectives of the MOD

The following will briefly describe the role, function and current focus of the Ministry of Defence (MOD) in its deployment of equipment and personnel.

Defence aim

The defence aim is ‘to deliver security to people in the UK and the Overseas Territories by defending them, including against terrorism; and to act as a force for good strengthening international peace and stability’.

This ambitious aim is a challenge to deliver in a world in which security threats are less ambiguous and more rapidly changing than in previous decades. To achieve this aim requires the Armed Forces to be able to undertake expeditionary operations around the world, in a flexible and operationally agile manner (Ministry of Defence, 2011). In 2009 to 2010, defence was estimated to be the fourth highest area of government expenditure behind education, health, work and pensions. In addition, Britain was the fourth highest-spending country on military expenditure in the world, spending 58.3 billion US dollars (Ministry of Defence, 2010).

Life in the modern British Armed Forces

Choosing to follow a career in the Armed Forces has many positive and negative aspects. For instance, many recruits join as young adults when they are beginning to shape their own values, beliefs and attitudes about themselves, the world and others. The Armed Forces’ powerful culture laden with its own values and standards socialises these young adults, leading them to adopt military values and ideals as their own, which they may well carry with them for the rest of their lives (SAMH, 2009).

Military life has been described as a great leveller (Humber Foundation NHS Trust, 2010), particularly for those from disadvantaged backgrounds, often allowing them to enjoy a more productive and fulfilling life. Many service personnel and veterans develop close relationships and bonds with colleagues, in order that they can rely on each other in times of crisis. Military basic training also promotes strict conformity to high standards of behaviour, in terms of discipline, punctuality, orderliness, cleanliness and obedience. Other social and economic reasons for joining the Armed Forces include personal improvement through learning new skills. This may include a trade, for example, electrical engineering, with job security and full-time employment. It also allows for extensive travel opportunities to experience life in different parts of the world and the opportunity to do something different with their life (SAMH, 2009).

There is, however, a downside to the military lifestyle which brings with it many unique concerns challenges and pitfalls. Major issues include the adjustment to an often highly mobile lifestyle in foreign lands where there may be considerable differences in language and culture, as well as isolation from the civilian community and extended family support. In addition, there is likely to be adjustment to military rules, regulations and frequent family separations. Other factors may compound these stressors such as the difficulties experienced by the spouses or partners and children of service personnel. Spouses may have difficulty gaining employment in the area local to the military placement. They may also be responsible for bringing up children single handed for extended periods during deployments as well as managing the varied household duties (Black, 1993).

The British Government in a recent cross-party agreement entitled ‘The Nation’s Commitment to the Armed Forces Community’, aimed to stop any disadvantage that being in the Armed Forces might bring to serving personnel and their families (HMSO, 2008). For instance, service personnel have often complained about barriers to obtaining services and facilities that most people take for granted, such as obtaining a mortgage, opening a bank account, finding a dentist, accessing benefits, applying for social housing or applying for residency or citizenship for themselves or their dependents.

These issues have now been highlighted and policies are being developed to minimise the likelihood of future disadvantage for service personnel (Ministry of Defence, 2010) with a pledge from the previous British Prime Minister, David Cameron, that the mutual obligations between the nation and its Armed Forces, named the military covenant, will be enshrined in UK law (Ministry of Defence, 2010).

Who makes up the military?

There is a lack of demographic data and official statistics to definitively describe where recruits to the Armed Forces hail from originally, although many army regiments have historically recruited more often from specific regions. These are often situated within areas of economic and social deprivation such as the north east of England and Scotland, as well as the larger UK cities, Northern Ireland and the South Wales Valleys. The Armed Forces offer potential recruits many prospects such as a large variety of highly to semi-skilled trades and the opportunity of foreign travel that may not have been available to them if they were to remain in their local communities (Fossey, 2010).

Childhood factors and early adversity

In general, the Armed Forces recruits individuals who are young and physically fit and from a wide variety of backgrounds, regardless of marital status, race, ethnic origin, religious belief or sexual orientation (Ministry of Defence, 2009). Individuals with poor health are largely excluded from joining the Armed Forces following a comprehensive medical assessment, meaning serving personnel are on the whole physically healthier than the rest of the population. At present, there are no policies and practices in place to detect potentially vulnerable individuals who may develop mental health problems in the future, although this may change following further research into its effectiveness.

There is a commonly held view that some new recruits to the Armed Forces, particularly the army, may come from dysfunctional family backgrounds and/or poor employment opportunities, and use the Armed Forces as a means of escape from such social environments (Johnstone, 1978). Weich et al.’s (2009) systematic review of family relationships in childhood and their association with anxiety and depressive disorders in adult life, demonstrated that abusive relationships predicted these disorders and post-traumatic stress disorder (PTSD). Maternal emotional unavailability in early life also predicted suicide attempts in adolescence.

Woodhead et al. (2011) compared the health outcomes and treatment seeking of 257 post-National Service veterans aged 16 to 64 years and 504 matched non-veterans living in the community in England. Male veterans reported more childhood adversity and were more likely to have experienced a major trauma in adulthood than non-veterans. Those veterans who had left service early (less than four years’ service) were more likely to be heavy drinkers, experience suicidal thoughts and to have self-harmed than longer serving veterans.

A recent UK study of 4,762 (61 per cent) randomly selected Armed Forces personnel who had been deployed to Iraq since 2003, investigated the relative contribution of demographic variables (including: the nature of exposure to traumatic events during deployment; appraisal of these experiences; home-coming experiences; and childhood adversity) in relation to the prevalence of PTSD. The presence of PTSD symptoms was associated with lower rank, being unmarried, lower educational attainment and a history of childhood adversity (Iversen et al., 2008).

Data from a US Marines cohort of 8,391 individuals, who completed a survey during initial training, identified several risk factors for the subsequent development of PTSD, including adverse childhood experiences prior to being deployed to either Iraq or Afghanistan 2001–2004. A review of patient medical records several years later highlighted that that those who reported physical neglect in childhood were more likely to be diagnosed with post-deployment PTSD (Leardmann et al., 2010).

Iversen et al. (2007) examined the association between self-reported childhood vulnerability and later health outcomes in a large randomly selected British male military cohort. Data was collected from the first stage of an ongoing cohort study comparing Iraq veterans and non-deployed British military personnel. Male regular Armed Forces participants (n = 7,937) completed a detailed questionnaire. The results highlighted pre-enlistment vulnerability was associated with being in the army, a low educational achievement, coming from the lower ranks and being unmarried. Pre-enlistment vulnerability such as a ‘family relationships’ factor reflecting the home environment and an ‘externalising behaviour’ factor reflecting behavioural disturbance, was associated with a variety of negative health outcomes (Iversen et al., 2007).

Brewin et al. (2012) compared a cross-sectional sample of UK veterans; 43 had developed PTSD after discharge from service, 35 controls were receiving war pensions for a physical disorder and 48 had developed PTSD in service. The delayed PTSD group described significantly more disciplinary offences, including absence without leave, disobedience and dishonesty compared with the no-PTSD group; these differences were present before any exposure to trauma. These data supports the link for externalising disorder and vulnerability to PT...

Table of contents

• Cover-Page
• Half-Title
• Title
• Copyright
• Dedication
• Contents
• List of Figures
• List of Tables
• Preface
• List of Abbreviations
• List of Contributors
• Part I The British Veteran
• Part II Models of Service Provision
• Index