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Improving access for veterans: Understanding why veterans are reluctant to access help for alcohol problems

Improving access for veterans: Understanding why veterans are reluctant to access help for alcohol problems

Executive Summary

Report

The aim of this project was to explore why veterans are reluctant to access help for alcohol problems and the extent to which they may be different from other substance misuse service users within the general population. Research was conducted through a sequential process over four phases. The initial three phases consisted of interviews and focus groups with service planners, commissioners, providers, substance misuse service users and veterans from the wider community. The fourth phase was a planned symposium where findings from the first three phases were presented to substance misuse service planners, commissioners and service providers with input from veterans and service users.

Findings from this project suggest that veterans with alcohol problems have unique difficulties that set them apart from other substance misuse service users within the general population. From both Phase Two and Phase Three, it was clear that there is a normalisation of excessive alcohol consumption during military service that often remains on discharge. Veterans in Phase Three provided further insight into the difficulties experienced on discharge through the transition to civilian life. It was noted that looking in from the outside, a successful transition appeared the norm, however the focus group participants suggested that transition experiences provided a further warrant for alcohol consumption and continuation of alcohol based coping mechanisms established during military service.

This normalisation of alcohol consumption was found to contribute to a delay in engagement with substance misuse service. A delayed engagement in accessing care lead to complex presentations where all aspects of the veterans’ lives (physical, psychological and social) were impacted. Consequently, when veterans did engage in substance misuse services, they were often referred for alcohol treatment through other services such as social housing, unemployment and mental health.

Service providers’ lack of understanding of the unique needs and experiences of veterans, was consistently identified as a main barrier to care in the first three phases. Focus Group participants expressed a certain degree of antipathy towards civilian life and civilian culture, further reinforcing this barrier. Complex care pathways and the lack of integrated health and social care was cited as contributing to a disengagement with care. Support for this was found in Phase Four where a diagram showed that the current care pathway for veterans with alcohol misuse was extensive and convoluted. This was in contrast to service commissioners, planners and providers limited and over-simplified view of the current provision. Successful engagement in care was associated with service providers who had veteran workers within their provision.

Phase Four facilitated the development of a model from which to evolve current services. Utilising findings from the first three phases, it was proposed that a ‘hub and spoke’ approach would be potentially the most cost effective and beneficial means of engaging veterans in healthcare services. Veterans will be assigned a multi-agency worker who will assist in accessing and engaging in relevant services. An initial assessment will ascertain the veteran’s status on physical health, mental health, social situation and substance misuse. Essentially, the hub and spoke model has the potential to reduce the number of veterans who disengage/disappear from services due to difficulties in navigating complex services.

 

Veterans Substance Misuse: Integration of Health and Social Care

The four phases have culminated in a conference as an opportunity to present our findings along with other academics and workers in the field.

Conference Programme

 


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The Royal British Legion

The Royal British Legion help members of the Royal Navy, British Army, Royal Air Force, Reservists, veterans and their families all year round. They also campaign to improve their lives, organise the Poppy Appeal and remember the fallen. The Royal British Legion provided funding for this project.
www.britishlegion.org.uk


NHS-Logo

Northumberland, Tyne and Wear NHS Foundation Trust

Northumberland, Tyne and Wear NHS Foundation Trust is one of the largest mental health and disability Trusts in England, working across Northumberland, Newcastle, North Tyneside, Gateshead, South Tyneside and Sunderland. NTW helped with initial participant recruitment.
www.ntw.nhs.uk


Changing-Lives-Logo

Changing Lives

Changing Lives is a national charity, providing specialist support services for vulnerable people and their families. Changing lives works with veterans who are experiencing homelessness, addiction and a range of other problems, offering specialist support services and employment opportunities. Changing Lives supported peer participant recruitment.
www.changing-lives.org.uk


Northern-Learning-Trust-logo

Northern Learning Trust

Northern Learning Trust is a North East of England based charity that works with vulnerable young people and adults. They have dedicated support workers in their Veteran Support Service, working with veterans who are ex-offenders. Northern Learning Trust aided participant recruitment for this project.
www.northernlearningtrust.org.uk


AF&V-Launchpad-logo

AF&V Launchpad

AF&V Launchpad is a charity with houses in Newcastle upon Tyne and Liverpool, providing homeless veterans with accommodation, aiming to get them into employment and permanent housing. Launchpad helped to facilitate peer participant recruitment for this project.
www.veteranslaunchpad.org.uk

Map of Need and the Veterans' Service Directory (VSD)

Map of Need and the Veterans' Service Directory (VSD)

Armed-Forces-Covenant-Grant-logo

The main purpose of this surveillance project is to provide an evidence base from which to inform MoD future funding strategies.

In March 2017, The Ministry of Defence Covenant Grants Team commissioned The Northern Hub for Military Veterans and Families Research to produce a map of UK Military Veterans and families’ needs for the totality of the UK. The Map of Need project is intended to provide a ‘Public Health Observatory’ function - providing the MoD with information, data and intelligence on the health and social care needs care of the 2.75 million UK military veterans and their families.

Traditional monitoring systems in public health e.g. typically for the surveillance of contagious diseases, rely upon public health networks that are expensive and often complex. The Map of Need project makes use of data generated by a GIS software application, which provides users with a free-to-access directory of (quality assured) veterans’ services.

The data generated by day-to-day use of the application will allow for continuous surveillance (and subsequent analysis) of veterans’ health, wellbeing and social care needs by location, volume, and patterns of help-seeking behaviours that can then be cross-referenced against demographic characteristics.

Northern -hub _partnership -logos _ripple -namiThe software application chosen as the platform of this project has been developed by the US technology provider RippleNami Inc. and has previously been used extensively by the World Health Organisation, World Bank, Governments and Non-Governmental Organisations for a range of purposes. The platform is ‘device agnostic’ and is designed to work on any digital device including smartphones. The primary users will be frontline health and social care staff will use the ‘directory’ in their day-to-day encounters with military veterans and their family members.

Maintaining independence: A Study into the Health and Social Wellbeing of Older Limbless Veterans

Maintaining independence: A Study into the Health and Social Wellbeing of Older Limbless Veterans

Final Project Report

Key Findings Booklet

This project is funded by The Aged Veterans Fund using LIBOR funding. The Aged Veterans Fund was established in 2015 to assist organisations across the UK to address the health, wellbeing, and social care needs of older veterans.

Project Aims

The main aims of this study were: 

  1. To explore the physical, psychological and social wellbeing of older, limbless veterans across the life-course;
  2. To ascertain the factors that contribute to the ability of limbless veterans to maintain their independence at various stages in their lives.

Ultimately, this research aimed to produce recommendations for health and social care policy around the requirements of an ageing veteran population, inform future service design, and shape the interface between NHS and third sector organisations with responsibility to care for limbless veterans.

 

Methodology

The research used a peer-led approach to successfully identify and engage older limbless veterans. The research team conducted detailed life history interviews. The life histories of 32 limbless veterans, aged between 43 and 95 formed the data for the study. Each of the participants were involved in semistructured life history interviews.

 

Design

A multiple method convergent design was adopted for the study, encompassing Narrative Inquiry and Framework Analysis (Social Applied Policy Research). This enabled dual attention to 1) the narratives that shape how veterans reconstruct their lives and identities after limb-loss; and 2) policy and practice implications drawn from observations that some veterans may be more able to adjust and maintain independence than others.

 


The Aged Veterans Fund

This project is funded by The Aged Veterans Fund using LIBOR funding. The Aged Veterans Fund was established in 2015 to assist organisations across the UK to address the health, wellbeing, and social care needs of older veterans.


Northern -hub _partnership -logos _poppy

The Royal British Legion

The Royal British Legion help members of the Royal Navy, British Army, Royal Air Force, Reservists, veterans and their families all year round. They also campaign to improve their lives, organise the Poppy Appeal and remember the fallen.
www.britishlegion.org.uk


BLESMA

Recruitment to the study will be via contacts in BLESMA and the Veteran & Families Institute. BLESMA was founded in 1932 and is a national Armed Forces Charity that directly supports all Service men and women who have lost limbs and the use of limbs or the loss of eyesight in service of the country. They are a chief support agency for limbless veterans in the UK.
blesma.org

Maintaining Independence: A peer-led evaluation of the Royal British Legion's branch community support programme for aged veterans

Improving access to services: Hub & spoke model evaluation

Improving access to services: Hub & spoke model evaluation

Current pathways for veterans accessing help for alcohol problems appear to be variable at best, occasionally ineffective, and potentially damaging at worst.

Veterans typically describe experienced confusion, delays and multiple assessments and referrals, each one increasing the likelihood of disengagement from services.

It is important to acknowledge that the veteran must be motivated to engage with healthcare services as a first step towards accessing meaningful help. Any unwillingness to engage may increase the likelihood of re- referrals. Multiple re-referrals to primary and secondary healthcare as well as third sector organisations are likely to cost far more (in both financial and human terms) than a single successful referral. It is important to ascertain why veterans may be reluctant to engage in the first place before changes to current provision can take place.

In an attempt to combat the confusion and lack of continuity experienced by service users, the ‘hub and spoke’ approach to health and social care for veterans has been designed for implementation and evaluation in Sunderland.



Northern -hub _partnership -logos _poppy

The Royal British Legion

The Royal British Legion help members of the Royal Navy, British Army, Royal Air Force, Reservists, veterans and their families all year round. They also campaign to improve their lives, organise the Poppy Appeal and remember the fallen. The Royal British Legion provided funding for this project.
www.britishlegion.org.uk


Sunderland City Council logo

Sunderland City Council

The Director of Public Health and Lead Commissioner in Sunderland agreed support implementation of the model and to act as a pilot Local Authority area. In addition, a contribution from Sunderland Local Authority has been added to the overall grant award.

Veterans Awareness Training Masterclass Programme

Veterans Awareness Training Masterclass Programme

There is a need to recognise and address workforce training and awareness needs with a focus of improving understanding of armed forces/veterans culture.

The Masterclass session is designed to increase understanding of the issues faced by veterans accessing and utilising health and wellbeing services.

An evaluation of personal learning gained will be carried out (based on where individual understanding was, where it is now and where it might lead). The evaluation will help to show understanding of the knowledge gained and how this will can be applied in practice.

Knowledge and understanding gained during the Masterclass sessions aim to support the key learning outcomes below:

  • Identification of a veteran
  • Why are veterans different?
  • What are the risks?
  • How to identify, assess and address support needs
  • Knowledge of broader service provision

The half-day sessions will be supported by academic staff from Northumbria University and support staff who are veterans themselves.

For more information please contact:

Gill McGill

Tel: +44 (0)191 215 6062
Email: gill.mcgill@northumbria.ac.uk

Peer Research Training

Peer Research Training

The Peer Researcher Training Course for Veterans is a short course designed to help participants to gain the skills and knowledge needed to be able to take an active and meaningful part in research projects that concern military veterans and/or mental health service users.

For more information please contact:

Gill McGill

Tel: +44 (0)191 215 6062
Email: gill.mcgill@northumbria.ac.uk

Armed Forces E-learning Programme

An e-learning programme by NHS England has been launched to support healthcare professionals care for serving personnel, veterans & families.


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