Intermittent Separation: Exploring the psycho-social impact on dispersed military families

Name: Alison Osborne
Supervisors: Dr Gemma Wilson, Dr Matt Kiernan, Dr Michael Rodrigues
Funding: Armed Forces Covenant Fund Trust (through Map of Need Project)
Date: 2017-2020 (PT)

The perceived role and identity of the military family is shifting alongside new MOD and Government initiatives, increasing flexibility, and encouraging stability of family life.  Research has predominantly explored the psychological effects of operational deployments on military families; however, a gap remains in research pertaining to the impact of non-deployment related separations such as dispersal.  To explore the psycho-social impact of intermittent separation on geographically dispersed military families, research was carried out over two phases.  The purpose of the first phase was to provide an understanding on what is already known about dispersed military families and separation through a systematic narrative review and exploratory geospatial analysis of publicly available data.  Phase 2 provided primary research findings through semi-structured interviews with dispersed military families to understand their experiences of separation.

Upon the integration of these findings from Phase 1 and Phase 2, it was proposed that dispersed military families have a fluid identity that can change over the separation period, dependent upon the social situation (i.e., military vs. civilian community).  A disconnection with the military community and the separation from the military family member, caused dispersed military families to experience social and emotional loneliness.  It was reasoned that a fluctuation in emotional loneliness existed across separation.  Stability was consistently reported as a reason for dispersal, particularly as a result of the implementation of UK initiatives that encouraged stability and flexibility for military family life.  
Separation had an impact on the psychological well-being of dispersed military families.  Internal and external resources were found to be integral in determining good well-being and stressors associated with separation posed a challenge to this.  Resilience was highlighted as a buffer for the challenges experienced.  Specifically, resilient protective factors such as social support networks, a positive outlook and normalisation helped dispersed military families to cope with separation.

Women in the Military: A Narrative Study of the lives of women who have served in the British Military.

As a woman veteran, Christina is exploring the experiences of women veterans, who served in the Royal Navy, Army and Royal Air Force.  The women interviewed have served in the British military from World War Two to Afghanistan. Narrative interviews have enabled Christina to explore the experiences of women veterans, focusing on their lives before, during and after military service.

To explore the experiences of the intimate partner whose significant other has received treatment for a common mental health issue whilst still serving in the British Armed Forces

Name: Emma Senior
Supervisors: Professor Amanda Clarke, Dr Gemma Wilson, Dr Keith Ford
Date: 2016 -2021

Aims: The thesis will seek to explore the narratives of intimate partners when they have found themselves living alongside their UK serving partner during a common mental health illness and where treatment has been received.  A biographical approach using the life history narratives of the significant other has been implemented to understand their lives prior to, during and after referral and treatment for a mental health issue and understand its impact the relationship.   Moreover, the study aims to develop a deeper understanding of the challenges and enablers which help partners /significant others in their relationship with their UK serving military partner in the present circumstance.

Methodology: A qualitative methodology - Narrative Inquiry was used to understand the lived experience of being an intimate partner living alongside a serving partner.  Two in-depth interviews were conducted with each pf the nine participants’.

Data analysis:  It is important to me that the participant is not lost and broken down in the analysis. Lieblich et al’s (1998) work offered me a framework for analysis which encompasses both whole story analysis and thematic analysis. The framework categorises narrative analysis along two independent dimensions; “holistic versus categorical approaches” and “content versus form”. I have chosen to analyse the data using two of the approaches holistic and categorical/ This has enabled each individual story to be considered as a whole and with a further analysis which is primarily focused on abstracting phenomenon or themes from the individual stories but that are also shared across the group of participants.

Improving Access to Health and Social Care for Vulnerable Veterans

Name: Gill McGill
Supervisors: Dr Gemma Wilson, Professor Amanda Clarke
Date: 2021 (PhD by Published Papers)

The work submitted for this PhD by published work comprises seven papers published between 2018 and 2020.  The research that informed the published papers has identified key issues as well as the development and implementation of solutions to improve access for military veterans following transition from UK Armed Forces to civilian life.  This submission provides academic and policy relevant contributions to the field of military veteran studies and the papers make specific contributions to discrete areas involving access to health and social care.  The central premise and the overarching theme of this collection of research is that it is essential that health providers understand the characteristics of the veteran population and strives to enhance veteran-specific knowledge for clinicians will serve to improve care for diverse veteran populations.

Central to the research is the inclusion of experts by experience who support investigation of a community defined as ‘hard to reach’, from conceptualisation to dissemination.  In addition, narrative inquiry and applied social policy methodology provide insight via life histories and lived experiences shared by participants.  This has helped to place their struggles to transition and integrate into civilian life into context, allowing identification of key factors for further research.

The proposed ‘collection’ of research aims to validate a valuable contribution to knowledge in the field, presented as a coherent area of work that has undergone rigour, is original and significant. It champions change and benefits to policy, practice and, ultimately, service users and seeks to impact on improving access to health and social care services and identifying pathways to provision.   Furthermore, by focusing on applied policy research, it aims to strengthen recommendations for health and social care policy, inform future service design and shape the interface between serving in the armed forces to transition into civilian life.

Care of the ageing veteran population: Developing an evidence base for the Royal Hospital Chelsea model of care

Name: Helen Cullen
Supervisors: Dr Gemma Wilson, Dr Matt Kiernan, Professor Deborah Sturdy OBE
Funding: Collaborative PhD studentship (Royal Hospital Chelsea/Northumbria University).
Date: 2020-2023 (FT)

The Royal Hospital Chelsea (RHC) has provided a sheltered housing environment alongside integrated health and social care and comradeship for British Army veterans since 1692. Today approximately 300 In-Pensioners, known globally as ‘Chelsea Pensioners’ live at the Royal Hospital in London.

This research presents a unique opportunity to evaluate the Royal Hospital’s current service provision, inform future direction and address the gap in evidence-based research to quantify the impact its model of care has on In-Pensioners and will seek to address two main aims: to gain an understanding of the current RHC model of care and to inform future RHC care provision.
A mixed-method approach will facilitate the collection of quantitative and qualitative data to support the research question.

The research will follow a phased approach with Phase 1 being a systematic narrative review to identify, evaluate and amalgamate evidence of existing care provision both empirically and from grey literature data.

Phase 2 will review RHC documentation with findings evidencing In-Pensioner outcomes, model of care contribution to longevity and Quality of Life (QoL) and identify the value of service provision, enabling comparisons with similar models of care.

Phases 3 and 4 will see semi-structured interviews of key staff and In-Pensioners to reflect on the interpretation of RHC policy against actual care delivery and capture generic and rich lived-experience data.

The findings will inform RHC strategic direction as it continues to deliver care provision to current and future generations of veteran, identify the value of its interventions, and explore the sustainability and development of service provision. The findings will also look to inform wider social care provision which may contribute to national health and social care policy.

Primary Care Networks: From Opportunity to Reality

Name: Jessica Gates
Supervisors: Dr Gemma Wilson, Prof Alison Steven, Dr Lesley Young-Murphy (North Tyneside CCG), Dr Lynn Craig (North Tyneside CCG)
Funding: North Tyneside Clinical Commissioning Group
Date: 2019-2023

The NHS Long Term Plan (2019) set out a new service model, aiming to improve options for patients by providing joined-up care in the appropriate setting. Primary Care Networks (PCNs) are a key part of this plan and will aim to move away from reactive care and towards proactive and preventative care. PCNs are groups of GP practices within a local area with responsibility for 30-50,000 patients. PCNs encourage collaboration and resource sharing between practices, and are required to deliver a set of national service specifications. PCNs are a new initiative as of 2019 therefore there is a lack of research in this area. This PhD project will develop an evidence base and will be fundamental to understanding PCNs and advancing this field of knowledge.

This study will take a mixed methods approach, primarily utilising data from a series of semi-structured interviews which will be conducted with a range of staff members working in general practice and based in North Tyneside PCNs. This research will also analyse routinely collected metric data from each PCN, to understand whether the intended contract outcomes are being delivered. Detailed case studies will be created for each of these PCNs, pulling together this data, in addition to data from a systematic narrative review and documentary evidence (NHS documents, policy documents). These case studies will illuminate both the perceptions and realities of how the PCNs are evolving. By working closely with North Tyneside CCG, this project aims to inform primary care policy in North Tyneside and shape the development of future services.

'In Search of the Self' - Examining the role of the self-concept of former members of the British Army within a Transitions Environment

Name: Nicholas Harrison
Supervisors: Dr Matthew Kiernan, Dr Gemma Wilson
Funding: Self-funded
Date: 2018-2023

The UK veteran population is estimated to number between 2.9 and 3.1 million (gov.uk 2019).  Working age veterans are nearly twice as likely to be unemployed than their equivalents in the UK general population (Royal British Legion 2014) and a review of veterans' transition into the civilian world found that a mere 35% said they had a clear idea about what area of work they would go into when they left the forces (Ashcroft 2012).  Whilst ensuring veterans experience a positive cultural adaption from resettlement to retirement is a priority for social science research and public policy (Williams et al. 2018), there exists a relatively small amount of exploration into the personal experiences of transitioning soldiers from the British armed forces (Binks 2017, Flint 2013, Walker 2010).  An apparent lack of direction amongst serving individuals, coupled with high numbers of unemployed veterans, forms the premise on which this study is based.   It argues the need to explore in more considerable depth the individual experiences of service personnel through the transitionary period from military to civilian life as it is today.  The author believes there is a particular need to investigate what role the self plays at this time.

Qualitative, social applied research, using framework analysis is being used. The objective is to allow each personal journey, from the army to the civilian world, to illuminate the authentic and individual experiences.

A Narrative Inquiry: Understanding the emotional response of being a young carer of a combat veteran with PTSD from the perspective of the young carer and their mother

Name: Paul Watson
Supervisor: Dr Matt Kiernan, Dr Sharon Vincent
Date: 2016-2021

Aims: The aim of this research is to explore how parental combat related PTSD affects the internal and external emotional responses of their child – the young care. Moreover, this research will investigate the impact the role of a young carer has on the relationship to their parent with PTSD, from the perspective of the young carer and the mothers of the young carers.
Methodology: A qualitative methodology - Narrative Inquiry was used to understand the lived experience of being a young carer of a veteran with PTSD, through the art of ‘story telling’ and bringing the young carers and their mothers narrative alive.

Findings: The focus of the lived experience according to Denzin (1989), are called ‘epiphanies’, which radically alter and shape the meanings in which people assign themselves and their life projects. These epiphanic moments leave a mark on a person’s life. There are four forms of epiphany: a Major upheaval, which changes a life for ever (for example, a parent is diagnosed with combat related PTSD); the cumulative, referring to the final build-up of a crisis in a young carer’s life (for example, witnessing a parent’s mental breakdown); the illuminative, where the underlying existential structures of a relationship or situation are revealed (for example, a parent is emotionally unavailable) and the relived moment, where the person after the event comes to define it in consequential terms (for example a young carer gradually understands the presentation of the parent) (Denzin, 2008).

A symbolic interactional study attempts to capture these moments, to give meaning to the narratives. Such a strategy presents three levels of cultural analysis: the contextual text, its meaning, and its connections to lived experience. Therefore, in the context of young carers of veterans with a mental health issue, their narrative and that of their mothers; with the use of symbolic interactionism, have provided a useful method of exploring how they make sense of their everyday lives, making sense of the trauma of a parental mental health issue and therein the effect on their own emotional health and wellbeing in their activities of daily living.