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.
The four phases have culminated in a conference as an opportunity to present our findings along with other academics and workers in the field.
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
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 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 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 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
Project Aims
The main aims of this study were:
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.
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.
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
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
Evaluation of the Branch Community Support Programme – The Royal British Legion
This research project was designed in two parts:
Part one included an evaluation of the Branch Community Support Programme (BCS) Findings from the evaluation demonstrated that both customers and branch workers recognised social connection and social activities as being vital for physical and psychological health and well-being, and valued the services offered by Royal British Legion (RBL). A comprehensive project report was published in 2019 for funders and the RBL: Maintaining Independence: An Evaluation of The Royal British Legion’s Branch Community Support Programme for Aged Veterans, published October 2019 submitted as part of the Aged Veterans Fund reporting procedure.
In order to support RBL branches to deliver and develop BCS interventions effectively, the project was extended. Part Two of this research aimed to:
· Evaluate the successful implementation of the BCS programme from the perspective of RBL branch workers and RBL customers and develop case studies.
· Produce a ‘Good Practice’ guide to support the long-term organisation, reach and running of the BCS programme through the lens of tackling loneliness and social isolation.
A Summary Final Report and Good Practice Guide was published in 2002
Understanding Unique Factors of Social Isolation and Loneliness of Military Veterans: A Delphi Study
This Delphi Study set out to gather expert consensus relating to the cause, impact and ways to tackle social isolation and loneliness of military veterans. The study was based on evidence gathered by third-sector military organisations and highlights that military veterans can experience social isolation and loneliness in a ‘unique’ way. These unique factors are due to military-related intrinsic and extrinsic factors including number of transitions, military-related trauma such as limb loss, physical health and mobility, and losing touch with comrades.
SSOP Annual Camp: Narrative Evaluation
This project captures the voice of the military childed to understand the lived experience of what growing up in a military family is like; and to understand why they attend SSOP summer camp. Moreover, this project evaluates the psychosocial interventions provided by SSOP, a Danish charity which supports children and young people from military families whose parents have a service attributed mental health issue.
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