Delving Into The Back Catalogue!

Sometimes ….when clearing an old memory stick I come across a forgotten piece of work that is both interesting and sadly still relevant. Way back in 2009 I commissioned George Charlton to carry out a phenomenological piece of research into a group of veterans accessing our very first peer led support group in Sunderland. Pure phenomenological research seeks essentially to describe rather than explain, and to start from a perspective free from hypotheses or preconceptions (Husserl 1970). This abridged version called Camouflaged But No Longer Concealed describes the lived experience of five veterans accessing our support at that time. A ‘Where Are They Now’ exercise would be equally interesting to carry out, sadly I have no idea where most of them are so another lesson learned. Read on…

‘Camouflaged But No Longer Concealed’

When I commissioned this phenomenological enquiry into the feelings and experiences of a small group of Veterans who had served over the last 30 years, it was in order to give some insight into the issues facing Veterans and their families when making the transition back into civilian life. It was also an opportunity to ascertain, from the ‘forces mouth’ as it were, exactly what the issues and barriers were when trying to access mainstream services. Our aim was and is, to give veterans a voice so that they can contribute fully to a society that they struggle to identify with.

During a long career working in numerous frontline and Senior management positions within various social welfare settings I have noticed that increasing numbers of ex forces personnel are becoming ‘noticeably visible’ within areas such as the homeless sector, initially presenting as ‘rough sleepers’ or within mental health support services suffering from diagnosed or undiagnosed Post Traumatic Stress Disorder (PTSD). Many more present at Accident and Emergency departments or at GP surgeries, Drug and Alcohol substitute prescribing services and sadly in growing numbers within the Criminal Justice System.

Many if not all of the organisations commissioned to provide interventions to those in the above categories fail to ask if the individual accessing their services served within the Armed Forces and this omission in the assessment stage or at the Pre-sentence report stage frequently leads to a lack of understanding as to the ‘root cause’ of the multiple complex issues that they may initially present.

Similarly, Veterans are notoriously bad at asking for help and may view survival ‘on the streets’ or when experiencing acute adversity as a continuation of the field exercises or combat missions that they took part in whilst on active service. Couple this with a highly developed sense of pride and a stubborn independence not become viewed as a burden on society. It’s therefore not surprising that civilian orientated support services find it difficult to engage and sustain meaningful interventions with ex forces personnel. Several veterans have told me that they continue to feel a deep sense of shame long after discharge due to the fact they were medically or dishonourably discharged from the forces. It can be no surprise then that they do not readily access the support of the numerous Armed forces benevolent organisations available to them such as the British Legion, Combat Stress and SSAFA as this would invariably necessitate disclosure as to the real reason for discharge. 

Whilst the document raises many issues that are already in the public arena not a lot of qualitative research exists in relation to this subject matter. It is hoped that this work will become the catalyst for further research on a much larger scale that will allow us to understand the antecedents that either positively or negatively influence a successful transition to civilian life whilst at the same time, offering an insight into how services can be developed to meet this currently unmet need.

Tony Wright

     Chapter One

Introduction

This paper has been produced following the identification of a number of veterans receiving drug and alcohol treatment interventions within the Sunderland area. All of these individuals have spent various amounts of time within the Army, Navy or Air Force and this fact presented an opportunity to explore treatment effectiveness and also highlight any gaps in provision for this hidden population from the point of view of the armed forces.

We believed that conducting this survey would give us privileged access to a hidden population whose needs were greatly underrepresented within our local communities. We also believed that from the data received from the veterans taking part in the survey that we would be able to develop services in partnership with the respondents which would impact on there lives in such a way that they would arguably be in charge of their own destinies and outcomes in relation to that of their life journey. The methods used within this survey to date have not been replicated and there is little evidence to show that outcomes from research papers have been used directly by veterans taking part in research projects to design services for themselves with the help and support of third sector organisations.

The focus of the research was to ascertain the most appropriate interventions to offer to this client group on discharge from the Armed Forces whilst at the same time trying to understand ways in which better links and transitional arrangements can be forged to ensure continuity of care for the individual leaving the Armed Forces when returning to civilian life. The data sample was also seen as an opportunity to provide a base line measure from which to build service delivery.

The main objectives of the peer led Armed Forces survey are outlined below and the approach utilized in gathering data conforms to that recommended by the Audit Commission’s (2002) report on drug treatment entitled, ‘Changing Habits’, which states that all local drug strategies should be based on up to date information on drug use and trends. The Audit Commission report also recommended the use of consumer evaluation surveys to gather information on client satisfaction within specific drug treatment services. We believe this report covers all of these aims as well as meeting the objectives set out for the survey itself.

The objectives of the study are set out below:

Objectives

• To assess the nature of substance use in relation to the Ex Armed Forces personnel within the geographical area of the Sunderland.

• To explore the effectiveness of current interventions and wraparound services as experienced by the client whilst serving within the armed forces and also when discharged.

• To offer a snapshot of an opportunistic sample of ex service men within the Sunderland area, who have had issues associated with Mental Health, PTSD, homelessness and or drug and alcohol problems

• To assess the needs in relation to future development of service provision of this client group, in particular the development of a new and dynamic peer led veterans support service.

• To offer a user led perspective highlighting prevalent issues effecting today’s Veterans with the aim shaping future policy, planning and development.

• To provide a base line sample on which to conduct further research and evaluation relating to experiences of those individuals from an armed forces background who have been affected with Mental Health, PTSD, homelessness, Drug or Alcohol issues and involvement within the Criminal Justice System. We believe this survey meets those objectives.

Name

Regiment

Time Served

Reason for Leaving

Paul

ARMY

3 LI / 2 LI & Rifles

19 Years

SNLR

Steve

ARMY

Royal Logistic Corps

3 Years

Dishonorable Discharge

Mark

NAVY

Submariner

7 Years

Voluntary

Discharge

Geoff

ARMY

 Army Ordinance Corps

2 Years

Dishonourable Discharge

Mick

NAVY

Royal Marines

3 Years

Medical

Discharge

What was apparent at this point was that there were many other individuals who were keen to be interviewed, however for the purposes of this initial paper and baring in mind the scale of the research project that would have came to life as a result of letting the metaphorical ’snowball’ run its course, we had to cap the numbers and begin with what we had. During each of the face to face interviews I decided that I would make use of ‘open ended questions’ as a means of gathering data from the participants.  Denscombe, 2003 asserts when using open ended questioning styles, “As the answers are open ended, there is more emphasis on the interviewee elaborating points of interest” (Denscombe, 2003, pg, 167) This approach to questioning would hopefully capture the interviewee’s words, feelings, beliefs and experiences throughout the interview process and would be deemed as a ‘person centred’ and positive way to gather data from the volunteer respondents.  Once the interviews were complete I was left with the task of analysing the raw data and structuring information into a form via which I could present the findings.

Process of Data Analysis

This section of the methodology, relates to the process of analysing the raw data from the respondent’s interviews. For the benefit of the reader I have chosen to utilise thematic analysis as a means of immersing myself in the data and I feel that this has worked well with the chosen phenomenological study: 

           “Thematic Analysis is a process to be used with qualitative information; it is not another qualitative method but a process that can be used with most, if not all, qualitative methods” (Boyatzis, 1998, pg 4).

After looking at each of the questions I applied during the interviews and reading the transcripts fully, I felt that I was in a position to begin to look for any emerging patterns which seemed to hold meaning for the respondents. The emerging patterns were then documented on a note pad in no particular order, other than that of the heading of the questions asked during the semi structured interviews:

‘During the rediscovery, “fuzzy” stage of formulation of a research agenda, thematic analysis enables the researcher to access a wide variety of phenomenological information as an inductive beginning of the inquiry’ (Coffey et al, 1996, pg 27)

During the process of working through each respondent’s individual replies to the questions and comparing them to a different respondent’s transcript I felt I was able to see structures and various patterns forming which I was then able to code:

“Another pair of competencies involved are planning and systems thinking. They enable a person to organise his or her observations and identifiable patterns in to a usable system for observation” (Strauss et al, 1990)

For this task I decided that I would make use of different coloured highlighter pens, with each colour representing a repetition or, reoccurrence in the language used or the emerging themes within the interviewee’s responses.

As a result of using the highlighter pens and looking at the data on various occasions, I was aware, and also amazed, at how there seemed to be themes in the clients’ experience that jumped out of the page. I was also aware, when looking at the different responses from each of the interviewee’s, that in some way the same words were being spoken and the reoccurrence of these words seemed to aid me in choosing themes in which to write about:

“Themes are defined as units derived from patterns such as conversation   topics, vocabulary, recurring activities, meanings, feelings, or folk sayings and proverbs” (Taylor & Bogdan, 1989, p.131)

I felt that in some way, the process of working through the complexities of the meanings expressed by the respondent’s and the difficulties that could have arisen in understanding some of the slang words used to express various methods of drug administration such as, “having a dig” (method of injecting a substance) and, “having a toot” (smoking illicit substances) would have been made more difficult to understand without my privileged knowledge of “drug slang”.

As a result of tirelessly looking through the transcripts and identifying and gathering themes it became quite easy to see patterns emerging from the data. It seemed as if the themes which I had chosen to write about in this paper in some way chose themselves. This felt like a respectful way to begin to understand the phenomenon and collective experiences of the respondents:

“Recognising an important moment (seeing) precedes encoding it (seeing it as something), which in turn precedes interpretation. Thematic analysis moves you through these three phases of enquiry” (Boyatzis, 1998, pg 1)

In Chapter Four entitled, “Presentation of Results and Discussion” I feel it is important to mention why I offer to the reader, my interpretation of the raw data and why I have encompassed my own understanding of the phenomenon alongside excerpts the respondents’ spoken words from their transcripts:

              “A common objective in applied qualitative research is to explain, as well as to illuminate, people’s attitudes, experiences and behaviour.    Explanations may be sought in order to address the questions that triggered the research in the first place, or to account for issues and patterns of behaviour which arise from the research itself” (Bryman et al, 1994, pg 191)

Boyatzis (1998) in discussing thematic analysis and the process which a researcher undertakes makes a claim that the process of recognising patterns does not stop, and states that, ‘there is a natural continuation of the quest to search for patterns and themes’ (pg 136).

 It is apparent that the natural continuation of looking for patterns and themes is present even when presenting the findings in this paper. I believe at this point I was still in the process of analysing and learning from the client’s raw data and believe that my presence and comments does not detract from the realness of the data received from the respondents and like Bryman (1994) states, ‘a common objective in applied qualitative research is to explain as well as to illuminate’ (pg 191).

Methodological Approach

After much deliberation, it has felt important for me to utilise a phenomenological approach which allows the respondents’ views to be clearly visible and for me to be able to work within their subjective frame of reference, whilst still being aware of my own process in the whole task of gathering the data

              “In order to gain access to others’ experience, phenomenologists explore their own, but also collect detailed and exhaustive descriptions from their respondents” (Miles & Huberman, 1994, pg 200)

The methodology I have used is therefore, qualitative rather than quantitative, meeting the “criteria of appropriacy” (Morrison, 1993, pg 110).  It feels important for me to mention that in my opinion this method is most suited to the questions of human experience and ideally fits in with the task of understanding the life experiences and an associated feelings of ex service personnel:

“Phenomenological methods are particularly effective at bringing to the fore the experiences and perceptions of individuals from their own perspectives, and therefore challenging structural or normative assumptions” (Lester, 1999).

I was also aware whilst conducting this survey, that many of my own identities may well be present within the survey process i.e. that of the past soldier, the ex drug user in treatment, the recovered substance misuser, the civilian developing a way of working with drug users and also now the principal surveyor within the project and the implications and impact this may have on the overall process and findings.

It seems to me that my presence and my identity are, of course, something that will be present during the interviews and something which is impossible to remove from the process, and as a result it is important to acknowledge this may well have an impact on the way in which the respondent answer the questions that they are asked:

              “We bring to interviews certain personal attributes which are ‘givens’ and which cannot be altered on a whim to suit the needs of the research interview regardless of our sex, our age, our ethnic origin, our accent, even our occupational status, all are aspects of our self which, for practical purposes, cannot change” (Denscombe, 2003, pg 170)

It has also felt important to me, whilst conducting this survey, to find literature which I can triangulate into meanings expressed by the interviewees.

 I feel that it is not enough for me to have a belief in a way of working which is generated by my own experiences as someone who comes into contact with ex service personnel and take those beliefs as being a true account of how process is experienced by that of the individual.

“Equally, it is hard to imagine a practitioner being able to gain an adequate ability to conceptualise or understand clients and processes through firsthand experience alone” (McLeod, 1995, pg, 11)

As an individual using a ‘phenomenological’ approach, I am systematically trying to find new ways of seeing and understanding the subject of enquiry. It seems to me that this is essentially the best way of understanding the human experience of veterans and with this providing a valuable opportunity of developing a way of working which best meets the needs of the veteran population. 

Strengths and Weaknesses of this Approach

In researching the phenomenological approach certain aspects surrounding the theory have become very appealing to me. I have found that by utilising this approach has allowed me to explore and delve into the complex phenomenon I have chosen to focus on and has aided me to reflect the complexity of the social world in which ex service men live within on a daily basis.

It has been important for me to find a methodological approach which allows me to work in a ‘Person Centered’ way and which values the lived experiences of the respondents:

              “It carries an aura of humanism and, in its efforts to base its enquiry on the lived experiences of the people in the everyday world; it represents a style of research that is far removed from any high-minded, abstract theorizing” (Denscombe, 2003, pg 106)

Something I have been aware of which could be described as a weakness as a result of utilising this approach, is that working so closely with the human experiences of Veterans / drug users the data which is collected during the interviews may well have been unconsciously contaminated due to my own experiences as a en ex service man and ex drug user and the confusion between what is their experience and that of my own.

Myers (2002) argues that qualitative studies are tools used in understanding and describing the world of human experience and since we maintain our humanity throughout the research process, it is largely impossible to escape the subjective experience, even for the most seasoned of researchers:

“Despite the realisation that total objectivity is neither achievable nor necessarily desirable in qualitative research, researchers often are required to put aside assumptions so that the true experiences of respondents are reflected in the analysis and reporting of research” (Ahern,1999)

Reflexivity

Reflexivity in this paper has been addressed at various stages. I have found that throughout this survey it has been essential to reflect on my own personal experiences and I believe that the phenomenological approach has allowed me to achieve this goal.

Altheide and Johnson (1994) identified themes regarding reflexivity which they claim are significant whilst writing reflexive accounts, such as how contact was made with informants, issues of trust and rapport, how mistakes, misconceptions and surprises were experienced and dealt with.

It has been imperative within this study to make full use of questions, such as those outlined by Altheide and Johnson, and allow the answers to be fully present within the paper:

              “It is much more likely that readers will have confidence in qualitative research in which the writer deals with these issues openly, rather than ignoring them” (McLoed, 1994, pg 99)

It appears that the use of reflexivity in this paper has actually strengthened the whole process and has shown my openness in the task of conducting the survey.

“Reflexivity at the very least, involves a process of self awareness that should clarify how one’s beliefs have been socially constructed and how the values are impacting on interaction and interpretation in research settings” (Marcus, 1994, pg 568)

Generalisations

As a result of the small numbers of interviewees taking part in this survey I felt that it would be difficult and also unethical to generalize that the findings could be rolled out to the remainder of the ex service population. Morrison (1993) postulates that the phenomenological approach does not seek to generalize but,

“celebrates the particulars of the situation” and is rich in, “authenticity and honesty with high explanatory potential capable of identifying key features as experienced by the participants” (Morrison, 1993, pg 51).

Within this paper what has felt more important to me than the generalizability of the survey is the personal learning and understanding which I have gained and also the way in which it has highlighted the issues as seen through the eyes of those who have been interviewed throughout this process. This information will be invaluable in designing and developing services which are fit for purpose and truly needs led. 

Validity and Reliability

According to Moustakas, ‘the question of validity is one of meaning” judged by whether, ‘one’s own rigorous self-searching and the explications of others present comprehensively, vividly and accurately the meanings and essences of the experience’ (Moustakas, 1990, pg 32). I have been conscious of the question of my own, ‘self-searching’ and this is something I have been aware of at every stage of this study.

I have also been aware that over the years whilst working through the ‘transition’ from being an ex drug and alcohol addict and on to a clinician working within the field of substance misuse I have developed a ‘way’ of working in which I have become confident and this has proved to be effective and beneficial to the clients I serve. It seems that this view of me and my work is something which I have endeavored to place to one side whilst conducting the interviews with the respondents in this survey.

I believe that in order to capture the uniqueness of the phenomenological experiences of each of the respondents the survey would need to be governed by three factors which are outlined below:

“(a) ecologically valid (i.e. must examine real life circumstances of ex service personnel),

(b) Phenomenological (i.e. must capture participants’ self-reports of their subjective, internal experiences),

(c) Still generate findings with credible levels of internal and external validity” (Martin, 1992)

Another method which was encompassed into the final testing of the emerging themes was to use the Sunderland based ‘Forces for Good’ peer led Veterans Peer Led Support Group as a focus group in order to test the validity of the themes and also to bring the reality check to what was emerging as a result of the thematic analysis.

The members of the group in conclusion of the focus groups stated that the themes themselves were congruent with their collective experiences and as a result were happy that the analysis has highlighted issues that were prevalent to the client group and a true representation of the issues experienced by individuals who had spent time serving within the armed forces.

Ethical Considerations

In undertaking this peer led survey ethical considerations were of the up-most importance in anticipating any undesirable consequences for interviewees who took part in this study.

I believe I have been transparent throughout the whole of the survey process and have given as much information to the respondent as I possibly could. This it seems, aided the participants in deciding as to whether or not they wished to be involved in the overall process:

“We aim to benefit others, ensure that we do not harm, enable research participants to make choices by giving enough information as we are able to, and behaved in a fair and just manner” (Etherington, 2001, pg 13)

Another of the ethical issues which felt important to address during the survey was that of the Veterans self disclosure and how their anonymity would be protected.

Throughout this paper all of names of the respondents have been changed to respect their confidentiality and also to minimise the chance of the identification of the respondents.

The following chapter relates to the presentation of results and findings. Excerpts of the respondents’ raw data will be present in this section combined with a narrative account from the author.

Presentation of Results and Discussion

Introduction

Although this section of the paper will be dedicated to the presentation of findings from the participants’ interviews, it may at times seem to the reader that the author is undertaking many different processes during this chapter such as analysing, presenting and discussing the findings. Bryman et al (1994) postulates that there is an active continuum in qualitative research rather than a distinctive set of procedures and states:

“None the less, all our contributors subscribe to the view that analysis in qualitative research is continuous in that it interweaves with other aspects of the research process” (Bryman et al, 1994, pg 218)

It is with Bryman’s quote in mind that I feel the process of active analysis will be evident throughout this section and indeed be present long after this paper is completed.

The themes which have emerged as a result of analysis will be used as headings and then translated into narrative accounts outlining clearly what the respondents have said and my own interpretation or account of what has been said during each interview. Verbatim extracts from the interviews will be present in order to support the case and give the reader the opportunity to distinguish between what is the perception of the author from that of the spoken word of the respondent.

It is hoped that presenting excerpts of the raw data from the respondents in this section of the paper will offer an opportunity to present a more credible and plausible piece of work in which the reader is able to form an argument either to support or challenge the validity of this paper.

Narrative account of the themes which emerged as a result of data analysis

Through a process of thematic analysis there seemed to be a multitude of themes and sub themes which could have been utilised for the purpose of presenting the findings, however within this paper I have decided to look at seven of the major themes which seemed to offer the greatest opportunity for the voices of the respondents to be fully present within this paper and also to provide the greatest opportunities for learning as a result of the respondents life experiences.

Each of the interviewees were asked a number of questions and their responses have been clustered together to highlight different themes that emerged through the data analysis process. Once again, the author would like to reiterate that the names of the respondents have been changed so as to protect their anonymity.

Overview of respondent’s demographics & feelings surrounding joining the forces

 Across the sample there were five individuals identified who expressed an interest to be involved in the survey process exploring the needs of Ex Forces personnel. All of the respondents who expressed an interest were male and were aged between 25 and 49 years of age. Each of the respondents stated that they had spent time within the Armed Forces and the general breakdown of the respondent’s demographics as follows:

 Each of the respondents (n5) within the interview process spoke about the reasons as to why they joined the Armed Forces and also of the feelings that they had prior to joining their respective regiments.  100 % of the respondents (n5) stated that joining the Armed Forces was something that they felt was hugely positive and something that brought up a range of emotions from excitement to nervousness and feelings of being proud about joining and the acknowledgement that joining the Armed Forces had been a lifelong dream.

 According to the HM forces web site there are many reasons for joining and include the following list which are stated as being good reasons to join the British Military, ‘answering the call to duty, taking a stance against terrorism, education and pension benefits, personal satisfaction and pride, family tradition, honour, devotion to duty, learning useful new skills, personal improvement, the opportunity to see different parts of the world, to do something different with your life’

 According to Gee (2008) recruitment literature for Army careers highlights some of the potential benefits as being , ‘career interest and challenge, comradeship, the active lifestyle, travel and training opportunities’, however Gee argues that, ‘It omits to mention or obscures: the radical change from a civilian to a military lifestyle, ethical issues involved in killing, risks to physical and mental health, the legal obligations of enlistment, the state’s legal and moral obligations to its armed forces personnel, and the right of conscientious objection’ (Gee, D, 2008).

 For the interviewees within the survey; joining the Armed Forces offered a number of opportunities which they could not find on ‘civvy street’, including travel, access to training, feeling a sense of duty, honour and wanting to better ones self.

 Throughout this section of the survey the respondents stated that their reasons for joining were not financial and although many wanted a better future for themselves it was consistent across all 5 interviews, that no respondent stated that their reason for joining was purely financial.

 According to the 5th City & Guilds Happiness Index (2008) cited at MOD Defence News (June, 2008) it is stated that, ‘financial rewards are not the answer to job satisfaction. Instead, having an interest in what you do for a living is the number one factor for ensuring on-the-job contentment, with 'happiness levels' remaining constant regardless of salary.

 Air Commodore Tim Winstanley, Director Training and Education within the Ministry of Defence postulate’s that, ‘Individuals join the Armed Forces for a huge variety of reasons. Like all occupational areas, there are issues which cause our people to be dissatisfied. However, the evidence we gather indicates that it is the variety, the job satisfaction and excitement of military service that provides overall contentment with the roles they perform’.

 Within the peer led armed forces survey each of the respondents had clear memories about their feelings and expectations prior to joining the armed forces and commented on how they were feeling at this time:

PAUL: “excitement” “I just wanted to serve my country, my blood is green”

STEVE: “I was excited and nervous and not knowing what to expect”

MARK: “excited man in an excited land, I wanted to travel and see the world”

GEOFF: “Scared but looking forward to building a future for myself”

MICK: “I was truly excited and wanted to be aboard a ship with a gun, I really wanted to be part of something that was elitist”

 Regardless of the reasons for joining, each of the interviewees talked passionately about joining the Armed Forces. It was interesting to see that each person when responding to the question about joining up talked with a smile on their face, their body language had changed and it was obvious to the author that each of these men were proud of their memories and that they had given a part of their life to the Armed Forces and this was summed up well in this section by Paul who served 19 years in the Light Infantry who states:

 PAUL: (with a smile on his face) “I never wanted to do anything else with my life, I was so proud when I joined the army, it was the greatest day of my life”

 The next section of this paper is pertaining to substance misuse including pre-entry into the force, substance misuse whilst in the forces and also the issue of post armed forces substance misuse.

Substance Misuse: The Complete Journey.

The next theme which arose out of the continued thematic analysis was that of substance misuse and the impact that this has had for the respondents within the survey. It is important to mention to the reader that within the title, ‘substance misuse’, alcohol use and its effects on the respondents will also be discussed within this section. Also, within this theme a number of sub themes emerged, that of substance misuse pre-Armed Forces, substance misuse during Armed Forces service and post Armed Forces substance misuse. Each of these issues will be looked at individually within this section.

Substance Misuse Pre-Armed Forces

Of the five respondents taking part in the survey, 40% of the sample (n2) stated that they had problems associated with alcohol or drug misuse. Two of the respondents claimed that they were heavy drug users prior to joining the Armed Forces and stated that their drug use was something that was still giving them great cause for concern. When asked about whether they had drug problems prior to joining and if so what they were using, the response from two of the respondents was as follows:

 STEVE: ‘yes I had a big problem, I was using from the age of 11 and a year before I went in the army I was using mushrooms, speed and necking about 25x10 mg benzos’ (diazepam) every day’

 Geoff: ‘I was bang at the drugs before I joined the army, I was using cannabis, LSD, speed, xtc, mushrooms and cocaine…. I would use fucking anything I could get my hands on.

 The remaining individuals (n2) did not view alcohol or drugs as being a problem prior to joining the Armed Forces. The two respondents who did have issues stated that one of the reasons that they thought about joining the Armed Forces came as a result of feeling that their drug use was out of control and that the structure of the Armed Forces may well act as a means of, ‘getting off the drugs’.

 Geoff: ‘I joined the army because I seen it as a way of getting discipline in my life and also a way of getting off the drugs’

 Steve: ‘I knew I was in the shit with the gear and the Army was my way of sorting myself out’

 What was interesting in this section is that both Geoff and Steve viewed the Armed Forces as a means of addressing substance misuse issues and both felt that the disciplined and structured environment that the Armed Forces would provide would in itself be a positive therapeutic environment and one which would go a long way to addressing their problems. 

 It is also interesting to consider that the armed forces sits potentially within the 4 tiered structure outline by the NTA (National Treatment Agency) and could be argued to fit within the Tier One bracket in that the armed forces are, ‘Non-substance misuse specific services requiring interface with drug and alcohol treatment’ (Models of Care, 2002, pg 12) and with that postulates that individuals coming into contact with this client group, ‘need to be sufficiently trained and supported to work with drug (and alcohol) misusers’

 It was reported by the respondents that they had not been drug tested prior to joining the armed forces, or when they arrived at their unit or as part of a CDT (Compulsory Drug Test). If testing had taken place and an adequately trained individual from the Armed Forces had been on hand then the appropriate referral could have been made to the relevant drug treatment agency to initiate a drug treatment intervention with a view to re enlisting the potential individual at a later date following successful completion of treatment.

 Substance Misuse During Armed Forces Service

‘Research into Compulsory Drugs Testing (CDT) of UK service personnel, published today by the Journal of the Royal United Services Institute (RUSI), has identified a rise in positive tests for illegal substances in the British Army from 517 individual cases in 2003, to 795 in 2005 (and 769 in 2006), and also a four-fold growth in soldiers testing positive for the class-A drug cocaine’ (RUSI, 2007)

Within the section of the survey each of the respondents were asked to comment on their own substance misuse including alcohol use during their time within the Armed Forces. Of the 5 individuals surveyed each of them stated that at one point or another they felt that their consumption of either alcohol or drugs could have been deemed as problematic. Out of the 5 respondents 40% (n2) stated that their drug and alcohol use was out of control during active service and the remaining 60 % (n3) stated that their misuse of alcohol was potentially out of control.

 One of the respondents (Steve) who admitted using drugs whilst in the Army spoke frankly of his drug use stating that he was using drugs as soon as he was out of basic training. The respondent went on to report that following basic training he could easily get his hands-on drugs as and when he needed them and stated:

 STEVE: “I could easily get drugs from a couple of guys within my unit; they used to get them from outside of the camp and bring them back in and sell them”

 Steve also went on to say that during a tour in Iraq he regularly stole Amitryptaline from the medics and would take the drugs whilst on Duty. Steve stated that as a result of the effects of Amitryptaline coupled with whisky which was smuggled on to the compound by Iraq’s civilians he ended up having a serious overdose which inevitably meant that Steve needed to be treated by the army medics whilst in Iraq.

 Steve went on to say that he was aware of many other soldiers within his unit who were actively using drugs on a weekend whilst on UK soil, he stated that using drugs was no big deal as long as you were able to do your job the next day no one really took any notice and stated that Armed Forces personnel would generally use ecstasy and cocaine as a drug of choice:

 STEVE: “everyone knew you just had to keep it a secret”

 When the respondent was asked if he thought drug use was a problem within the army he stated that:

 STEVE: ‘without a doubt, people just knew how long certain drugs would stay in their system’

 The respondent claimed that people were not concerned about compulsory drug tests within his unit as they had a way of getting around the test and this seems also to echo the findings within Professor Sheila Bird’s report focusing of compulsory drug tests within the British army which argued that:

 ‘Traces of cocaine are found in urine for only two to three days after use in contrast to cannabis which remains in urine for two to three weeks’ and goes on to say, ‘soldiers’ drug use may have shifted away from cannabis partly to minimise their chance of testing positive in CDT’ (Bird, S, 2007).

 One respondent (PAUL) who did not have a problem with drugs said that he was aware of others within his unit who were using illegal drugs, he stated that:

 PAUL: “there were a few lads in my unit who would smoke dope upstairs in the den, but no body said fuck all about it”

 Paul also made a statement which seems to suggest that military personnel are at times aware of when so called unannounced CDT’s will take place and stated,

 PAUL: “most of the lads were aware of the CDT teams and when they would come out, people knew what drugs they could take and get away with it before the CDT took place”

 STEVE: ‘A lot of the lads would use cocaine as it was out of your system quick enough and you would pass the CDT’

 Within this section another respondent (Geoff) also spoke openly about his substance misuse whilst in basic training with the Royal Army Ordnance Corps (RAOC) at Deepcut in Surry.

 Geoff stated that he had viewed joining the Armed Forces as he seen it as a way out of his addiction to ‘Class A’ drugs prior to enlisting in the Army, however because of worries of how he would cope without ‘Class A’ drugs, he decided to take a substantial amount of cannabis resin with him when he joined his unit.

 Geoff stated that it was not long into basic training before he and another recruit were smoking cannabis on the camp and as a result ended up getting caught. Geoff stated that he now realises how crazy it was to think he could get away with drug use whilst in basic training and stated that:

 GEOFF: “I was fucking stupid to think I would not get caught, it was almost like I had forgotten where I was”

 Geoff went onto say that when his room was searched the Military Police from Pirbright found a substantial amount of cannabis and tested him via a urine sample which also proved positive for other drugs within his system. Geoff claimed that before he knew it he was on CO’s orders and found himself being sentenced to a, “lengthy stretch” in the, “Glass House” (MCTC Colchester).

 The respondent went on to say that during this time following his arrest by the Military Police, he was never offered anything in the way of drug treatment and that he was placed within D Wing at the Glass House with a number of other Military personnel, many of whom were in jail for substance misuse offences. Geoff reported that at no point after his arrest was he offered an assessment to ascertain the extend of his substance related problems or indeed to ascertain whether there was a physical dependence to the drugs that he was using and the impact of stopping his drug of choice immediately without the aid of a pharmacological intervention.

 It was interesting to listen to Geoff talk about the fact that he enjoyed his time within MCTC and that the structured environment is something that he felt personally helped him to remain clean for a period of time, however he stated,

 GEOFF: “I was told by the commanding officer at the prison that he would make a recommendation to my CO that I should be allowed to stay in, but there was no hope I knew I would get fucking bladdered”

 As it turned out for Geoff he was Dishonourably Discharged from the Army and sent home without a means of travel, at no time prior to discharge was anything offered in the way of help and support for his addiction nor was anything offered in the way of housing or access to training when Geoff got home.

 Geoff stated that the only offer of support that was offered was that of a potential verbal reference that was made by a Staff Sergeant whilst Geoff was working as a runner for the admin department during a period of open arrest. Geoff stated that he was told be the Staff Sergeant that when he was discharged and got home, if he found a job to pass on the Staff Sergeant’s name and address and he would be more than happy to give Geoff a good reference.

 Geoff stated that a few months following his discharge from the army he managed to get through an interview to work in a DIY store in the North East and passed on the Staff Sergeants address to the manager for a reference.  Geoff stated:

 GEOFF: “when I gave his name for the reference he promised me, he wrote back to them saying that I was a drug addict who had been in jail and that I was a disgrace to the army”

 “Needless to say, I didn’t get the job, I felt betrayed and lied to by this man; stupidly I thought I could trust him”

 For both Geoff and Steve, the return back to the North East did not lead to a life without drugs in fact their problems would get worse before they got better. Both of these individuals would become further involved within the Criminal Justice System and spend many further years addicted to various substances.

  In an article published in ‘Scotland on Sunday’, December 2008 discussing the effects of alcohol within the Armed Forces it suggests that, ‘Nearly 6 out of 10 British soldiers drink so much they could be classified as alcoholics, according to a shocking internal report by the Ministry of Defence’.

Of the remaining 3 respondents within the survey  100% stated that at some point during active service their alcohol use was problematic even though they may have not have realised this at the time.

According to the Department of Health guidelines it is stated that men can drink between 3-4 units of alcohol per day without serious risk to health and that this amount is reduced to between 2-3 units per day for women.

In a statement made regarding alcohol treatment within parliamentary questions in January 2009 there is an argument to suggest that those individuals identified within the Armed Forces who were suffering with alcohol problems could gain access to support that would address problematic alcohol consumption via a range of interventions. It was reported within parliamentary questions that, ‘Service personnel identified by the chain of command as being at risk of alcohol misuse receive counselling and welfare support, this can include attendance on preventative early intervention programmes designed to alert them to the harm that alcohol can cause to themselves and others. More serious cases are treated through specialist medical and psychological treatment and rehabilitation, including where appropriate as in-patients’. (Parliamentary Questions, January 2009).

Within this section Paul, Mark and Mick spoke of their alcohol use during their time within the armed forces. When asked if they felt they had a problem with alcohol their responses were as follows:

PAUL: ‘I had a really bad drink problem; I would shake like crazy if I did not have a drink every day’

Paul spent in excess of 19 years within the armed forces and during this time became dependant upon alcohol. He stated that he became a daily drinker and this was a means of dealing with traumatic events which he witnessed during active service in Bosnia. Paul stated that his problems with alcohol was something that got him on CO’s orders on occasion but even on these occasions he was told to go away and sort himself out. Paul stated that he did ask for help around his alcohol problems, but nothing was ever done. Paul stated that:

PAUL: “Like me, many lads drank heavily but now’t was ever done, they were more concerned about keeping the numbers in the battalion rather than offering help to people when they needed it”

Paul stated that he has had problems with alcohol for around 12 years and he felt that he only received appropriate help for his alcohol issues following discharge from the Armed Forces. Paul seemed disappointed that the Army did nothing to help however he stated that he was making good progress currently with his alcohol issues.

What strikes me is how Paul’s alcohol dependence was never treated during his army career.

 As a result of Pauls excessive drinking his dependence upon alcohol was so great on discharge from the Army that he was admitted for detoxification, however Paul stated that the Army did not see this as a treatment intervention that was needed during active service.

It seems to me that Paul’s alcohol problem was serious enough to require a medical intervention when discharged from the Army. However, there is nothing to suggest in Pauls story that the seriousness of his drinking problems would have been any different while he was serving with his Regiment. The major worry for me is that of the untreated alcohol problem itself, which was obviously serious enough that Paul would shake and in his own words, “Need a drink every day”.

For Paul, his excessive daily heavy drinking coupled with the serious physical and psychological effects demonstrate someone whose life was during this time controlled by alcohol.

According to Patient UK ‘This is a serious situation where drinking alcohol takes a high priority in one’s life’ and stated that if an individual is alcohol dependant the desire to use alcohol will become overwhelming and will at times mean that the individual will have side effects such as, ‘feeling sick, trembling, sweating, craving for alcohol, and hallucinations and convulsions occur in a small number of cases’ (Patient UK, 2008)

In contrast to Paul, Mark did not view himself as having huge issues with alcohol whilst in the Navy however the quantities that he did drink well exceeded that of the government’s guidelines for safe alcohol use, however, he did state that when you did get time to yourself the culture was to drink:

MARK: There was a culture of drinking, every one was always at the NAFFI bar, every chance you got to buck the system you would have a drink.

According to research undertaken by Henderson et al (2008) looking at alcohol use within the Royal Navy conducted with 1333 respondents it found that, ‘The majority (92%) scored as hazardous drinkers on the AUDIT-C, 40% met the criteria for heavy drinking, 27% for very heavy drinking, 48% reported binge drinking at least once a week and 15% were classed as problem drinkers. (Henderson et al, 2008)

Mark reported that when he was ‘off shore’ on the Nuclear Submarine he worked on there was also a culture of alcohol misuse even to the point where he stated,

MARK: “you should only have had three cans per night but on the Sub you drank as much as you liked”

 Mark said that the men he deemed as having problems with alcohol, “always had enough in them to work”. Mark stated that alcohol used to be stored in the torpedo chutes and stated that on one occasion,

MARK: a bloke got a right beating for firing and loosing the beer out of the torpedo chute, one guy nearly got hung as well’.

Mark stated that the Navy was good for him and something that shaped him into the man he is today, Mark did not go on to have alcohol or drug problems and feels that his time in the navy was in his words,

MARK: “a supportive environment that was good for me, it helped me to grow up as I was getting in a lot of trouble before I went in”

The final respondent Mick also stated that he did not have a problem with alcohol or drugs prior to joining the Royal Marines. When asked about his alcohol use during his service within the forces Mick stated that,

MICK: I drank the same as everyone else, you worked hard and you played hard”

On further exploration of this subject Mick stated that when he did drink he drank between 10 to 12 pints on a Friday, Saturday and Sunday and also drank through the week. It feels important to mention that Mick’s drinking on the weekend alone well exceeds the government’s recommended weekly intake of alcohol for men. Mick stated that,

MICK: “everyone would drink as much as they could until you fell down”

According to Mick this attitude towards alcohol was par for the course and the norm where military personnel within his unit were concerned. Mick also commented that during his time within the Marines he was also aware of people who used drugs such as cannabis, speed and those also abusing prescribed medication such as codeine-based drugs.

Mick spoke of one colleague who was taking around 15 to 20 codeine tablets each day and that from time to time this individual would also sniff glue. The respondent said that things like this were no secret and reported that:

MICK: “whatever you did in your own time was your business, you were either a drinker or a drug user and as long as you could get up the next day, no one gave a fuck”

This attitude also seems to echo that of both Steve and also Paul who both stated that there was awareness among Armed Forces personnel of drug taking within the ranks which seemed to be swept under that carpet as long as the individual / individuals concerned were able to function and do their jobs.

Substance misuse post armed forces

Out of the 5 respondents within the survey, 60% (n3) went on to have major problems with alcohol and drugs on discharge from the armed forces.

As mentioned earlier Paul ended up with alcohol problems which eventually needed medical intervention as a means of controlling his alcohol use, his marriage broke down and he found himself physically and psychologically dependant on alcohol without any kind of support being put in place even though the Army was aware of his problems prior to discharge. When asked if Paul felt his problems with alcohol came as a result of being in the armed forces Paul stated that,

PAUL: “I never had a problem with drink before I joined the Army, it’s a massive problem in the Army, you drink to bond with your mates but it gets you in the shit”

Paul stated that he only received adequate support for his alcohol addiction when he left the Army, and until this time he was not offered anything in the way of support

For both Steve and Geoff post discharge their drug use got worse, both men spent time within the ‘Glass House’ (MCTC, Colchester) prior to discharge and also spent time within Civilian prisons following discharge from the Army. Both men went on to use drugs such as Heroin and Crack Cocaine and their lives took a downward spiral within the grips of addiction, Steve stated:

STEVE: “I think my drug use got worse in the Army and more so when I came out, I really felt let down and betrayed”

GEOFF: “the Army knew I had a drug problem, fucking hell I got caught for fucks sake, but they did fuck all to help me, I got not treatment, fuck all, the drugs for me just got worse after that”

After being discharged from the Army, Geoff went on to spend the next 10 years in the grips of addiction with his drug use escalating ‘year on year’. Geoff ended up as an injecting drug user and spent much of his life in trouble with the police and was sectioned on 2 occasions under the Mental Health Act due to significant events of self harm.

Geoff spoke of his resentment towards the Army as a result of lack of support that was offered to help with his drug problems and although Geoff acknowledged that the Army was not totally responsible for what happened in relation to his drug addiction, he did state:

GEOFF: “if I had been offered treatment by the Army, I don’t know my life may have turned out very different, I might have got my shit together sooner “

All of the men in this section either had problems with drugs or alcohol or knew someone that did during their time within the Armed Forces. All of the respondents reported that alcohol and drugs was a huge problem within the Forces and that at no time during their own service did any senior officer or NCO offer advice about safe drinking levels or about what to do if an individual had a drug / alcohol problem.

Conclusions drawn from the Henderson (2008) report claimed that, ‘Excessive alcohol consumption, especially binge drinking, is significantly more prevalent in the Royal Navy than in the general population’ and that, ‘Such high levels of drinking are likely to impact upon occupational efficiency and have both short-term and long-term health effects’ (Henderson et al 2008).

It could be argued as we come to the end of this section that the Armed Forces does not offer appropriate treatment to individuals with drug problems and that the ‘zero tolerance’ culture adopted by the Armed Forces potentially places individuals effected by substance misuse issues in a position where they cannot ask for help for fear of immediate discharge and with that the added pressure of being made homelessness as a result of discharge.

 ‘The British army tests 85% of personnel annually, and those caught are almost always discharged’ (Parliamentary questions Watson in answer to Moore: 58313)

 As a result of the fact that discharge will potentially be the final outcome this will leave many of those individuals concerned unemployed and, in many cases, sent back to their home towns or cities without the prospect of employment or even a roof over their heads.  This in turn places the individuals who are using the drugs / alcohol problematically in the position of having no idea of how to access treatment or harm reduction information which inevitably will leave the individual concerned at risk of further exacerbated drug / alcohol related problems following discharge.

 Mental Health & PTSD

Because of the stigma of mental illness and the avoidance of the phenomena associated with PTSD, many service men and women suffer in silence and fail to seek help or discuss their symptoms, taking their problems with them when they are discharged’ (McCrone et al, 2003)

 In this section of the survey the respondents were asked if they had ever suffered from Mental Health problems or Post Traumatic Stress Disorder. Of the 5 respondents interviewed 40 % of the sample (n2) stated that they had suffered from Mental Health problems (Geoff and Steve), 20 % of the sample (n1) stated that he currently suffers from PTSD (Paul) and 40 % of the sample (n2) stated that they did not feel that they suffered from adverse Mental Health problems or PTSD (Mick and Mark).

 Both Geoff and Steve spoke of how they felt that mental health problems had been something that was present for them prior to joining the armed forces, however they both claimed that they felt that being in the Army had in some way exacerbated their mental health problems.

 GEOFF: ‘I think I had mental health problems before I went in the army, I used to cut myself up a lot with razor blades but I think it got worse when I was in the army’

 STEVE: ‘I was always getting fucking bullied and people used to take the piss out of me, I still struggle mow with my mental health’

 Geoff stated that when he was in MCTC Colchester, he was to use his words, “mentally tortured” by one member of the prison staff, who shall remain nameless within this paper. Geoff said that during his time in the ‘Glass House’, he was goaded, belittled and told that he was worthless on a daily basis. He said that he felt like hurting himself on many occasions as a result of the relentless name calling and, “beasting” that came from one particular member of staff:

 GEOFF: ‘He would always call me names and scream and shout at me, he would call me a fucking horrible Geordie maggot and say that I was a fucking disgrace to my family’

 Geoff acknowledged that it was not appropriate for him to have used drugs within the Armed Forces and that his actions had invariably landed him in Prison, however he did say that no one deserved to be treated in the way he was by the staff member in Colchester prison:

 GEOFF: ‘This guy always made me feel ill, I was never treated like a human being off him, he always treated me like shit’

 On discharge from the army, Geoff went on to have many years of mental health problems and spent long periods being prescribed anti psychotic drugs. Geoff difficulties resulted in regular self harm and, over a number of years, progressively got worse – with him using drugs, alcohol, and prescribed medication as a means of dealing with his ongoing mental health problems. Geoff spent much time under the supervision of psychiatrists and psychologists and was, on two occasions, sectioned under the Mental Health Act following attempting to take his own life.

 In total, Geoff spent 10 years within Drug and Alcohol services and Mental Health Services trying to get his life in to some kind of order.

 Steve, in this section, spoke of his love for the Armed Forces and how much it meant to him to be in the army. He said that all he wanted to do was be a soldier and have a new family as his own family did not communicate with him.

 He spoke about being in Iraq and how, over a period of time, he was bullied persistently by a female Sergeant. Steve stated that he tried to complain about the bullying on many occasions but said that no body would take his seriously and claimed:

 STEVE: “I wish I had never bothered trying to make a complaint as I got more stick as a result of it, you had young lads who had a stripe on their arm who thought they were God giving it out to me all the time”

 In a report named ‘Informed Choices’ (2008) which looked at the Armed Forces recruitment practices within the UK, it is argued that, ‘Bullying and harassment remain major problems for the armed forces in their own right, and also adversely affect retention of personnel’, and  conclusions were drawn that, ‘The forces need to: acknowledge the problems, clarify to new recruits the policy on bullying, remove humiliating practices from all aspects of training, and restore faith in the complaints system by providing an independent complaints channel’.(Gee, D, 2008)

 Steve said within this section that he still thinks about making a complaint as he attributes his current anxiety and depression to the fact that he was treated so badly when he was in Iraq. Steve himself stated that he did not know what the future held for him. He did, however, go on to say:

 STEVE: “I could not see a future for myself earlier on when I came out, but things are looking much better for me now”.

 When Steve was discharge from the Armed Forces, his marriage broke down - ending up in divorce. He became homeless, unemployable due to lack of skills; he began to use Class A drugs (heroin) on a daily basis and was given a custodial sentence for a period of time. Steve, over the past two years, has worked hard to get his life back in order, entering voluntarily into substance misuse treatment and he has been prescribed substitute medication which he is in the process of reducing. Steve attends many educational courses and seems to have real control over his life. Further, he aspires for the future.

 Steve now attends a peer led support group and is an active and valuable member of group.

 Within the survey, the one respondent (Paul) stated that he suffers with PTSD and spoke of his experiences regarding PTSD, both during his time within the Armed Forces and also the impact currently on his life. Paul said that he was diagnosed with PTSD whilst serving in the army and this diagnosis was made by a psychiatrist at a Military Hospital in Bulford.

  Paul stated that even though he was diagnosed with PTSD, nobody really took it seriously:

 PAUL: “I was grilled by the Army about my Mental Health, they gave me a fucking hard time, but I was never offered any real help”

 Paul spent in excess of 19 years within the Army, during which time he served in many countries including Bosnia, Serbia, Afghanistan, Iraq, Sierra Leone and Northern Ireland (to name but a few). Paul stated that it was during this active service that he felt that he may have developed PTSD,

 PAUL: “I think I seen far too much when I was way too young”

 Paul went on to discuss his time in Bosnia and Serbia. He said that during his time in these countries he saw countless dead bodies which were lying in ditches by the roadside. He said that even now he could not come to terms with some of the things that he saw whilst he was on active service and this was something that he knows will affect him for the rest of his life. Paul stated that he is haunted by these memories and at times cannot get the graphic images of these dead individuals out of his head:

 PAUL: “those bodies we found were rotten, every day I can smell that smell, it was fucking horrible”

 Paul states that even now he can be walking down the street and he experiences the images and smells from his time spent in Bosnia and Serbia. He went on to state that this is something very traumatic for him but something he has begun to get used to. Paul stated that there was no opportunity for support of a means to off-load for soldiers who were witness to traumatic events.

 Further, he said on one occasion he had seen bodies of dead children and this had affected him significantly, speaking of feeling let down that he was offered nothing to help him to process what he had seen and claimed:

 PAUL: “There was fuck all you could do , you were just expected to get on with it”

 Within this section Paul was encouraged to talk openly about his experiences and it was amazing for the author to see the physiological changes within Paul when he talked about the forces.

 There was no doubt that Paul was a man who dedicated much of his life to the Army and no doubt that he loved everything connected to the Army. His eyes lit up when he talked and it was also interesting how his shoulders went back and he seemed to grow an inch taller when he spoke of the time he served - it was almost like he was bracing up to stand to attention. In this section, the author was in awe of the energy that Paul had put in to his career. Paul received 9 medals during his time in the Army one of which was awarded for finding a weapons stash whilst of duty. Paul has ended up with fluid on his lungs as a result of sleeping on the floor of a metal factory for months during a tour of Bosnia.

 Paul stated that the treatment he received from Bulford for his PTSD was the only support that he received and when he left the Army this treatment stopped.  There were no subsequent referrals for support and, as a result, there was no continuity of care which left Paul without the treatment he so desperately needed.

 According to Iverson et al (2005) in a paper entitled, ‘Goodbye and good luck’, which focuses on the mental health needs and treatment experiences of British ex-service personnel, it argues that, ‘There was a sense that even those who had seen a psychiatrist were not engaged with ongoing service provision; few of those with one or more diagnoses had community psychiatric nurse input’ and argues that, ‘ex-service personnel are reluctant to seek help, both while in service and after leaving’. Iverson concludes that, ‘the military therefore should continue to encourage a culture in which consulting about symptoms is acceptable – a cultural shift that will benefit individuals even after they have left the armed forces’ (Iverson et al, 2005).

 On return to his home town of Sunderland, Paul went to SSAFA to see if they could assist him with regards to getting back in to treatment. He stated that a member of staff from SSAFA had promised that he would support Paul. However, to date this has not happened and Paul stated that he had called SSAFA on many occasions but that nothing ever seemed to happen:

 PAUL: “I feel let down by them I’m sure there ignoring me as they never call me back”

 Over a short period of time after Paul had returned home, he stated that his behaviour became out of control, he was angry and snapping at the simplest of things. Paul stated that his marriage broke down and he ended up leaving the family home with no where to stay and no support in place and that he felt isolated and held no hope for the future. He began to drink more in order to deal with and to manage his emotions, and also to combat the images and memories that he had from his time within the Army. He spent a period of time during this section of the survey talking once again about the, “dead children” that he had witnessed and how there is not a day goes by where he is not tormented by these intrusive images and this time in his life.

 Paul stated that he has a massive problem with PTSD and that and prioritized this above all else in his life - especially most recently since he has begun to self harm.

 Within the survey Paul’s story was extremely powerful. However, it should be noted that this should not, in anyway, detract from the experiences of other individuals who decided to discuss their mental health problems. However, the graphic content of Paul’s responses in this section was something that left the author with a real sense of what many of our Armed Forces personnel experience on a day to day basis and also the lack of support that is offered to Veterans who have experienced combat stress.

 Of the two remaining respondents Mark & Mick, both felt that their mental health did not suffer as a result of being in the Armed Forces. Both did mention, however, that they were both aware of many within their units who, in their opinion, were suffering with mental illness. Mick spoke of older men within his unit who had spent time serving in Northern Ireland and stated:

 MICK: “You stayed away from these lads, and you accepted that some of  the people you were working with … were fucking mad”

 Mick highlighted that everyone was aware of the people within the unit that you had to give a wide berth to and claimed:

 MICK: “When you wanted to wake them up you would have to poke them with a stick or something because they would go nuts, they were crazy and violent”

 It is clear, as we come to the end of this section, that all of the respondents were in some way affected by mental health issues - either that of their own or that of someone else’s.

 There once again seemed to be a general acceptance that drug and alcohol issues exist within the armed forces and that mental ill health is something that people suffer from but not much attention is paid to. These revelations would suggest that more work needs to be done to understand the wider mental health implications of this group of individuals but, more importantly, that effective treatment interventions coupled with integrated care pathways need to be developed in order to ensure that those who do suffer with PTSD or combat stress do not suffer in silence. 

 The final word should go in this section to a young man (Anthony Parsons) suffering with combat related PTSD who stated:

 "PTSD is the fear controlling you. Exposing your fear is controlling your PTSD!"

Housing & Homelessness

The next common theme which emerged from the survey was that of post discharge housing.

 Each of the respondents was asked about their housing situation following discharge from the Armed Forces, and also about the provision that was put in place by the Armed Forces when each of the respondents left.

 Official statistics show that “approximately 24,000 people leave the Armed Forces every year, of which a small proportion may be vulnerable to homelessness” (Dandeker, C, 2005).

 In this section 100 % of the respondents (n5) stated that prior to leaving the Armed Forces nothing was discussed or put in place regarding where they would be housed. The respondents reported that they were never questioned regarding their housing situation or, indeed, where they would sleep the following night after leaving their unit.

GEOFF: “When I did leave the army, I had no where to go, I had no means of getting back home and when I did get home, I had no where to live. Not once did the Army ask me how I would cope - they didn’t give a fuck”

MICK “When I was discharged from the Navy I had nothing and no where to go, they knew I was leaving without a home to go to”

 STEVE: “I have spent years between my gran’s house, my mam’s house, hostels and prisons. I have never really had a place to settle or call home since I came out”

 PAUL: “I had to sort myself out, the Army never asked me fuck all about where I would go or what I was going to do”

 MARK: “I didn’t know what I was going to do - I managed to find myself a caravan and lived in that for 9 months”

 Each of the respondents spoke about their personal struggle to find suitable housing or, in some cases, finding housing at all. For 60 % of the sample (n3) they were fortunate enough to find friends or relatives who were prepared to take them in for a period of time. One respondent lived in a caravan for 9 months and one respondent went on to live on the streets for a period of time following discharge from the Armed Forces.

  A feasibility study commissioned by the MOD and the Office of the Deputy Prime Minister focusing on the extent, cause, impact and cost of ‘rough sleeping’ and homelessness among Ex Service Personnel in England postulates that:

 “The Homelessness Directorate (ODPM) has been working with the Ministry of Defence (MOD), the Armed Forces and ex-Services charities to ensure that the best advice and support is given to Service leavers who are at risk of homelessness and to rough sleepers who have been in the Services”. (KCMHR, 2005).

 Within this section there seems to be incongruence between the current legislation and policy that exists and how this translates down to grass roots level and impacts on the lives of the individuals leaving the Armed Forces.  All of the respondents within the “Camouflaged but no longer Concealed” paper stated that nothing meaningful was offered either prior to leaving the Forces or post discharge and, as a result, further problems were caused for the individuals concerned when returning home.

  Only one of the respondents within this paper (Paul) stated that he had received support from the British Legion and that the support he had received had facilitated him to securing a tenancy with a private landlord:

 PAUL: “The legion was dead helpful to me, they gave me money for a bond and helped me kit it out”

 Paul went on to say that had it not have been for the support of the British Legion his life would have continued to take a downward spiral and he is sure that his life would have ended up far worse than it had if not  for the  support offered. 

 The remaining 80 % of respondents stated that they were not aware that the British Legion or any other organisation could have offered adequate support around housing support. It seems this was something that the Armed Forces neglected to tell them.

 Once again it is argued within the Kings College (2005) report that in partnership with the Rough Sleepers Unit (now incorporated into the Homelessness Directorate), the MOD has developed a number of initiatives to help vulnerable service personnel pre-discharge, at the point of discharge and post discharge’ (pg 16).  An overview of the initiatives are as follows but it should be mentioned that none of the respondents were at any time offered support of this nature at any point either pre or post discharge.

 The report postulates that a welfare package has been established to help Service personnel in their transition back into civilian life by which Unit Commanders, as part of their welfare responsibilities, are required to be aware of the trigger factors that lead to vulnerability to homelessness and to take necessary action.

 Secondly the 2005 report states that a project called SPACES which is funded through the MOD acts as a housing referral and advice centre aimed at helping service personnel who are at risk of homelessness following discharge from the armed forces.  Since the opening of the project in 2000 it is reported that, leading up to 2005, the SPACES project (which is managed by English Churches Housing Group [ECHG]), has received some 1,500 referrals and has placed approximately 390 people in accommodation’

 (Dandeker, 2005).

 Although the armed forces should be commended for the good work which is undertaken regarding resettlement, the number of individuals identified within the KCMHR report who were placed in accommodation (390) seems to a relatively small number if we take in to account the initial number of referrals (1500) in 2005.

 The final initiative identified within (2005) report postulates that two organisations are in place to deal with the issue of resettlement. The Galleries Project’ in Richmond, North Yorkshire, provides 13 short-term accommodation units for vulnerable, single Service leavers immediately after discharge from the Armed Forces and also identifies another organization which offers the following interventions. This is Project Compass, which is a 12-month pilot scheme in London that aims to provide new opportunities for 30 homeless ex-Service personnel by providing modules to develop their self esteem and motivation and providing support and assistance for those who have complex need. Further, it provides opportunities for employment training and subsequent employment placement. (KCMHR, 2005).

 It should be acknowledged that the armed forces appear to be developing initiatives that are focusing on the needs of service personnel post discharge. However, once again, there seems to be a very little thought going into the number of physical places i.e. homes on offer or additional support for individuals leaving the forces. If we consider the number of places on offer at both the Galleries project and the compass project we find that there are around 43 places which will be offered on an annual basis to service men and women leaving the forces.

 With this in mind, the armed forces needs to do much more work to provide access to appropriate social housing and wrap around support services which can help with the transition in to ‘civilian life’

 In August 2007 in a report by the National Audit Office looking at individuals leaving the services it was argued that, ‘the survey found that 5%, mostly young and of junior rank, of Service Leavers had experienced homelessness (including staying with friends). The majority, 51%, had been homeless between one and six months, 14% between seven and 12 months and 12% for over one year’ (National Audit Office, 2007).

 The findings within the National Audit Office paper could be argued to echo the experiences of this individuals within the ‘Camouflaged but no longer Concealed’ paper ie that little support is put in place for individuals leaving the armed forces and this it seems  this is echoed by the respondents within the paper - all of whom stated that nothing was done in order to support them during their transition from the armed forces in to civilian life.

 Education Training and Employment

In this section of the survey the respondents identified that there was little support offered in relation to education, training and employment when leaving the Armed Forces. Each of the respondents said that when they were discharged from the forces they felt that they would have to fend for themselves in every aspect of their lives and employment was one factor which gave them great cause for concern.

 Out of the sample 100% (n5) stated that one of the 3 major factors which were causing problems when they left was that of gaining employment.

 Within this section Paul stated that he felt let down by the army after giving, ‘19 years of his life’ and being told to leave the camp with not so much as a warrant card to get home:

 PAUL: “I just walked past the guard room and stuck my fingers up at those pricks who were laughing at me. I couldn’t believe it - I didn’t even get a train ticket home. I had to make my own way back from Salisbury to Sunderland, they didn’t give a shit about me”

 Paul stated that he was not offered any pre-discharge employment advice and nor was he signposted to an organisation that could offer training or additional support such as the British Legion. Paul spoke of his concerns and said that he was so frustrated and worried about his future return to civilian life.

 PAUL: “I didn’t know what I was going to do for a job or how I was going to get one, all I knew was how to be a soldier and without that I was fuck all”

 Like the remainder to the respondents in this section, Paul felt vulnerable when discharged from the armed forces and also felt extremely isolated, de-skilled and de-motivated:

 STEVE: “I didn’t have anything positive to do with my life when I left the army, I felt so alone”

 Steve stated that when he left the army he had no formal qualifications that would help him to get a job when he came out. He said that he would have loved to continue doing cookery as he had been a chef in the Army but, as he had gained no formal qualifications during his time served, he was stuck when it came to finding a job post discharge:

 STEVE: “All I wanted to do was get a job, get some new friends and ry and get my family back”

 Unfortunately, like Paul, Steve said that he was not offered help prior to leaving the Army or told where he would be able to get support from once he had left. To date Paul has not had a job since leaving the Armed Forces.

 Within this survey Mark stated that he had put his notice in around 18 months prior to leaving the Navy and that during this time he also had not received any support or advice about moving on in ‘civvy street’. When asked what was offered Mark stated:

 MARK: “ Nothing whatsoever, no resettlement package, nowt, I was discharged from Rosyth with no job or home to go to, the only thing they tried to do was get me to stay in and talk me out of it”

 The theme within this section of lack of support around education, training and this is also echoed by both Geoff and Mick.

 GEOFF: “I was offered fuck all prior to being discharged, I ended up coming back home without a clue about what I would do for work, it took me six months after that to get a job, but it was shite with no prospects”

 MICK: “All I was offered was £1600 and an opportunity to do my driving lessons and test which they would pay for”

 Mick went on to say that no one had spoken to him about what he would do on discharge or how he would manage in the future. He stated that he was made aware that as he had a medical injury as a result of being in the Forces he could, “Jump to the front of the NHS queue” but stated that other than this he was given a warrant card to get home and that was all that was offered.

 Both Mick and Paul did attend SSAFA for support around getting into employment. However, both respondents claimed that they felt that they were not listened to and there was nothing really meaningful in the way of employment on offer.  Mick stated that a “bloke at SSAFA” had said that there was nothing available at the time and would get in touch when something came up but according to Mick, they never called or sent anything that could help him. Mick stated:

 MICK: “29 years later and I’m still waiting to hear from them!”

 100% of the respondents felt that something should have been done to assist them regarding education training and employment prior to leaving the Armed Forces and that had this have been the case they all would have felt more hopeful about their futures post discharge However, as it turned out, each of them were unhappy that nothing was on offer.

 40 % of the sample (n2) are currently unemployed, both of them wanting to work but to date having had little in the way of success. Both individuals have, however, successfully undertaken voluntary placements and try hard on a regular basis to better themselves - with one individual (Paul) most recently completing an FA accredited football coaching course and the other (Steve) completing a course which will further assist him in his search for employment.

 Of the remaining 60% (n3) all stated that following discharge from the Armed Forces they needed to’ re invent’ themselves. The respondents stated that they felt they had no transferable skills and the only way they would progress in the future was to retrain themselves following discharge.

 Of the three remaining respondents all eventually went into paid employment roles. It is important to mention that for these respondents the qualifications achieved and their subsequent employment were a result of their own hard work and did not happen overnight. The concept of re-inventing themselves was something that evolved over a period of 5 or more years.

 The Armed Forces and the Criminal Justice System

As a result of the survey process another emerging theme was that of the Criminal Justice System and how this had played a significant part in the lives of a number of respondents within this paper.

 According to NAPO, the estimated current population of individuals detained within the prison system is 93, 574 (NAPO, 2008). Of this number an estimated 7,350 are believed to have been in the Armed Forces. This amounts to 9.1% of the prison population.

 Of the five individuals who took part in the survey 60% (n3) had spent time within a custodial setting following discharge from the Armed Forces and 40 % (n2) also spent time within MCTC Colchester pre-discharge.  One respondent within the sample reported that although he had not been formally in trouble with the Police or the Criminal Justice System, his behaviour post Armed Forces relating to violence towards others was something that the individual now found disturbing and something he feels would have had him locked up if he had been caught by the Police:

 MICK: “When I came out I would get hammered on the drink and go out looking for trouble, I used to go crazy and got into a lot of fights”

 Both Steve and Geoff reported that criminal activity became a way of life for them following dishonourable discharge from the Army. Both men spent a period of time within MCTC Colchester, with Geoff spending 2 years for possession of a substantial number of drugs and Steve spending a number of months in Prison for theft which he reported was to fund his Crack Cocaine addiction whilst in the Army. Both individuals spoke openly about their convictions within the Forces and reported:

 STEVE: “I got done off the Civvy Police a couple of times for drunk driving and then I finally got jailed at Collie (Colchester) and then chucked out for shop lifting”

 GEOFF: “I had been in bother before I joined the Army but never now’t serious, but getting caught with the drugs at my unit was just too much for them, jail and then binned”

 Both Steve and Geoff in this section spoke of how they felt that their substance misuse within the Army was something they deemed as problematic. Both men felt that their drug use was out of control when they were sent to MCTC with Geoff stating:

 GEOFF: “If I didn’t get caught when I did I would have soon enough, I was hooked and I was kidding myself that I could stop using when I joined up”

 Following an inspection of Military Corrective Training Centre Colchester by HM chief inspector of prisons (2008) it was reported that 15% of detainees stated that they had a problem with drugs and 28% had a problem with alcohol on arrival (pg 43).

 Neither Geoff or Steve within the ‘Camouflaged but no longer Concealed’ report was offered any kind of treatment intervention when they were initially jailed and held in close arrest within the guard room awaiting CO’s orders. Again, it was reported that neither man was offered a comprehensive assessment on arrival to MCTC to ascertain the physical and psychological dependence to their respective drugs of choice.

 Her Majesties Inspectorate of Prisons Inspection report (2008) postulates that, ‘The centre had a comprehensive drug and alcohol detoxification policy” which had been produced in August 2008 and reports that the policy ‘had been used for one detainee in relation to alcohol’. 

 Also within the Chief Inspector of prisons report (2008) it is argued that Staff within MCTC, ‘anticipated it (the policy) would not be needed often’, However, this is of some concern as it was reported that ‘16% (of the respondents) stated that it was easy or very easy to obtain illegal drugs whilst detained at the centre’, and, ‘Drug testing was undertaken on a random basis, usually if requested by the sending unit’ (pg 44).

 It feels important to mention that the 2 respondents within the paper who were held within MCTC, their release from the military prison led to discharge from the Armed Forces due to the severity of their crimes. During their time within the Military Prison and also whilst held in open arrest back at their Units whilst awaiting discharge, neither man reported being offered any support around their substance misuse. Nor were they offered any training or support in relation to their resettlement needs. This was summed up in a quote by Geoff who stated:

 GEOFF: “When I got back to my unit after being in the Glasshouse I was treated like shit……. I felt degraded and was threatened, nobody really cared about me- they just wanted me out”

 Following discharge both Geoff and Steve ended up within the criminal justice system, with their substance misuse escalating and resulting in more crime to fund their drug addictions. This in turn resulted with the 2 individuals ending up within civilian prisons and also receiving Probation Orders on completion of custodial sentences.  One of the respondents within the paper (Steve) is currently on a DRR (Drug Rehabilitation Requirement) order for his persistent crimes and states that it is the best thing that has happened in his life in a long while as a result of the structure which came as result of being on the court order.

 Steve reported that the structure of the order and the medical intervention which he receives for his heroin addiction has led to him being free from drugs now for in excess of 9 months and able to hold down Voluntary Work and Educational Courses for which he is truly grateful and states has giving him a chance at having a life worth living.

 STEVE: “I feel like I am getting better now and my confidence is getting better as well”

 The other respondent within this section (Geoff) who spent time within MCTC and also within the Criminal Justice System went on to do well following a period of time engaged within Specialist Drug Services and also having access to Education, Training and Employment opportunities all of which were found by civilian services post- discharge from the Armed forces.

Geoff went on to become drug free and has sustained abstinence from drugs for in excess of 9 years, with him progressing to win a National Training Award. 

Geoff also reported that as a result of the structure of being in treatment, coupled with the learning opportunities he found himself being offered were hugely significant to his recovery. This was only second to the support and belief that was offered by individuals who did not see him as a lost cause.

 The experiences of these two men seems to suggest that had they have been afforded the opportunities of having access to pharmacological interventions regarding their substance misuse and also access to educational interventions and ongoing support pre-discharge, their stories once discharged would potentially have been very different.  However, as identified earlier in this section, neither man was offered a comprehensive assessment of need either pre MCTC.

 This it seems is qualified within the 2008 inspectorates report of MCTC which postulates with regards to assessment that “The initial reception screen was perfunctory (see health services section) and did not elicit much information about drug or alcohol abuse” (pg 43) and poses the argument that, ‘We did not believe that issues of concern, especially in relation to mental health, were always identified (see paragraph 4.34). Of equal concern was the fact that in the two weeks prior to the inspection, 46 of the 80 detainee admissions had arrived between 5pm and 6am. Seven (9%) had arrived after 10pm when staff from the medical centre were not on duty, so they did not see a member of the health services team until the following morning’ (HM Chief Inspector of Prisons ,2008, pg 47).

 Once again this suggests that a more ‘Person Centered’ and individually tailored, needs led way of working with ex Forces Personnel who are within the Military Criminal Justice System would go a long way towards helping individuals who are experiencing problems with substances and potentially offending whilst actively serving within the Armed Forces.

 Recommendations coming out of the 2008 report with regards to the,’ primary care’ of those individuals receiving a custodial sentence within MCTC Colchester suggest that, ‘The health needs assessment should be repeated to ensure that the relevant services are being provided for detainees’ and, ‘Detainees’ poor perceptions of the quality of care provided by doctors should be investigated and any necessary action taken’ (pg 43)

 Recommendations were also made regarding those individuals affected with substance misuse issues and also receiving custodial sentences within MCTC suggests, ‘There should be effective lines of communication (with the consent of detainees) between the welfare officer, medical centre staff and mental health staff so that detainees requiring help with drug and alcohol abuse issues receive a comprehensive care package’ and also postulates that, ‘The initial reception screen should identify detainees with drug or alcohol abuse issues and symptomatic relief should be provided if required’ (pg 43).

 According to the National Association of Prison Officers -who conducted a report in 2008 looking at the extent of ex armed forces personnel within the criminal justice system - ‘large numbers of ex-service personnel are being convicted for a range of offences, primarily involving violence, within a short period following discharge from the forces. The majority are drug or alcohol related’ (NAPO, 2008).

 Within the NAPO report which focused on a number of case studies of individuals within a custodial setting, it is argued that ‘The case histories examined by Napo show that the majority of the ex-soldiers were suffering at some stage from post traumatic stress disorder (PTSD) and that very few had received any counselling or support at any time after discharge’.

 This it seems would suggest that the Armed Forces have a far greater role to play in the identification and treatment of PTSD and substance misuse - be it either pre or post discharge as evidentially many men and women are leaving the Forces with issues surrounding PTSD and developing substance misuse issues. It could be argued that closer working links with the PCT, Criminal Justice System, statutory, non-statutory and third Sector organisations is something that should be key to implementing integrated care pathways and ensuring tailor made packages of holistic support and care are offered to ex forces personnel prior to leaving the armed forces.

 NAPO concludes within the report that ‘It is apparent that there are alarming numbers of former service personnel serving sentences in prisons in England and Wales and also under supervision by the Probation Service in the community’

 The NAPO report goes on to suggest, ‘It is also apparent from these case studies and from evidence gathered elsewhere from military support organisations that the amount of assistance available on site and at the point of discharge from the services is minimal’. This it seems also echoes many of the respondents within the ‘Camouflaged but no longer Concealed’ paper who stated that transitional arrangements, resettlement arrangements and additional support on discharge were none-existent and eloquently summed up by one respondent Paul who stated:

 PAUL: “I got no help at all in fact I was told I had 2 days to get off camp, they just gave me no fucking help at all”.

 Throughout the ‘Camouflaged but no longer Concealed’ paper each of the respondents stated that help and support post discharge was something that they would have all benefited from and this in itself would have been something that would have made the transition back to civilian life a more pleasant, meaningful and rewarding experience for all. Instead without support respondents left with feelings of fear, anger, and resentment and little hope for the future.

 Identity

The final theme to emerge from the survey process was that of ‘Identity’ and the impact that being in the Armed Forces had regarding the ‘self’ and the identity of the individuals within the paper. For all of the respondents within the paper there was no doubt that being in the Armed Forces was something that had changed their lives in a profound way and something that will remain significant to them for the rest of their natural lives.

 PAUL: ‘I have been out a while now, but I’m still a soldier in my heart. That will never go’

 According to General Sir Richard Dannatt, (2008),

“Humans are naturally team players; we all seek the company of others and like to share our experiences”

The British Army is the ultimate team. It has an excellent reputation across the world, which is built on trust. Much is expected of you as a British Soldier; you will be required to serve in dangerous places, risk your life for your teammates and put up with uncomfortable conditions.

Our Values and Standards are essential to the British Army, they define what the British soldier is. They are more than just words, we must all believe in them and live by them. I expect you to behave and conduct yourselves to the highest standards at all times’

 Significant for me within General Sir Richard Dannatt’s quote is the point at which he states, ‘our values and standards are essential to the British army, they define what the British soldier is. They are more than just words; we must all believe in them and live by them’.

 It seems important to mention that the values and the way of life that is internalized into any member of the Armed Forces and internalized within the self concept of the individual is not something that leaves a person on the day of discharge. It seems that once you give yourself to the Armed Forces it’s a case of “once a Soldier, Airman or Seaman, always a Soldier, Airman or Seaman” and for this group of men this seems to be a positive label that sticks for life.

Each of the individuals within the survey talked about their loyalty and commitment to their respective Regiments and claimed that although for many their time out of the Armed Forces was significant, there was something deep inside them that they felt still made them think and feel like an Armed Forces member.  All of the individuals missed the camaraderie and the feeling of belonging to something great.

 For many leaving the Armed Forces was like losing a family member. Yet, they were proud of their time within the forces. It seemed clear to the author that for each of the respondents talking openly about the forces was something, at times, they found difficult. There was a sense of disloyalty at times when they spoke of what they deemed as failings within the Armed Forces. I know each of them were still loyal to each of their respective regiments, but each of them also felt passionately about wanting to be heard and how their voices could perhaps influence change within the wider Armed Forces structure and beyond.

 Conclusion

It feels like words could not do justice to any of the respondents when beginning to explain the depth of feeling - both individually and collectively that existed in relation to time these men have spent within the armed forces and also following discharge. It is really important to make it clear that each of the men who talked so openly about their time within the armed forces did so with a sense of pride and honour. Pretty much every one of them stated that their time in the armed forces was the best thing that had ever happened to them and it had shaped them in to the men that they were today.

 However, as we have found throughout the survey, there have been times when these men have felt let down by an institution that they valued so highly. It seems that the message which comes through loud and clear is that each of the men within this survey felt at some time that when they were discharged - that was it. You had to fend for yourself, you had to find your own way, and for the respondents in the paper, this is where they struggled the most.

  It’s hard to imagine what it must feel like to give 19 years of your life to the army in the case of one of the respondents just to be discharged without any idea about what the future would hold.  Each of the men within the survey agreed that much more needed to be done to ensure that the transition from armed forces life into civilian life was much smoother. Each of them felt that the armed forces did not do enough around this issue.

 Each of them had a story to tell, some more traumatic and disorganized than the others. Yet, they draw strength from one another and in the room where they meet there is something very special that happens, they are a team again. They have a new family and new support mechanism. They have the chance to make sense of their past and also the opportunity to help others who have been through the same issues as themselves. All of a sudden, the common bond is their again and to witness this is totally magical. It could be argued that everyone needs someone in life and for the respondents in this paper it is no different, being part of this group has given them a purpose and also a place to further develop their self-concept and future lives.

 Final Comment

Former servicemen and women are recognised as one of the country’s greatest assets. The training they receive during military service allows many to re-establish themselves successfully as they integrate back into civilian life. However, in recent years a growing number has become involved in the Criminal Justice System and/or drop out of the welfare support system becoming homeless, disenfranchised from main stream services and socially isolated.

Subsequently, mainstream services struggle to engage with this group simply because of a lack of understanding of the cultural differences between military and civilian lifestyles. As a result of this, unemployed, homeless ex forces personnel are probably the most feared, misunderstood and marginalised minority groups within our society.

Whilst it is recognised that many leave the armed forces and continue to contribute positively to society a significant number have great difficulty coping with the transition from the institutionalised lifestyle military service brings. Many find it difficult to cope with the lack of structure, a loss of identity and many miss the camaraderie and social activities that dictate service life on an hourly and daily basis.

The reintegration process to civilian life is exacerbated on many different levels dependant upon how an individual exits the services. Many are discharged following successful and lengthy periods of service but struggle to find sustainable employment; others are medically or dishonourably discharged following their involvement in unacceptable and/or criminal activity. The latter find it extremely difficult to re-establish themselves in the civilian Job Market.

A growing number of individuals are returning to civilian life following active service in the numerous theatres of war that have been fought almost continuously since the end of World war Two. For example; Northern Ireland, The Falklands, The Balkan Campaigns and The Gulf wars involving Iraq, Afghanistan and other Middle East Countries. It is a matter of considerable debate as to impact combat experience is having on any given individual’s ability to readjust to the sedentary lifestyle of peace time Britain.

Many servicemen and women are reluctant to accept or acknowledge that they need help and support and may in fact exhibit a stubborn independence that alienates them from the main stream welfare services. As a result, they ‘fall through the net’ of service provision. Many can be accurately described as suffering chronic social exclusion. In order to cope with their change in circumstances many become alcohol and drug dependent. This factor alone, notwithstanding any undiagnosed mental health problems and associated anti social behaviour has led to a disproportionate number being incarcerated within the Prison System.

Former service personnel are often vulnerable people with complex needs. A range of flexible responses and options are necessary to help them address and manage their changing needs. These may include help with managing their drug and alcohol use, dealing with mental health issues, managing debt, developing life skills and helping rebuild relationships

We work with a range of partners, to identify and promote practice which supports positive steps that can help build confidence and self esteem. This includes participation in activities involving peer led support groups, the arts, sport, volunteering and a range of other activities that involve setting and achieving goals.

Current research indicates those experiencing homelessness or rough sleeping have six or more unmet needs. It is our aim to offer a confidential, bespoke and individualised package of care and support in collaboration with the client to address each individual’s unique unmet needs.

Tony Wright

 References

Ahern K.J. (1999) Qualitative Health Research. Vol. 19, No.3, Sage

Altheide D.L & Johnson J.M (1994) Criteria for assessing interpretive validity in qualitative research, in N.K Denzin & Lincon, Y.S (eds), Handbook of Qualitative Research, Sage, London

Author Unknown (2008) Happiness Index, City & Guilds.

Author Unknown, The Military Covenant cited at, www.army.mod.uk

Author Unknown (2006) Reasons to join the British armed forces. Cited at: http://www.hmforces.co.uk/training/articles/13-reasons-to-join-the-british-armed-forces

Author Unknown (2009) Parliamentary Questions, cited at www.parliament.uk , 12th January 2009.

Bird S. M (2007) RUSI, Compulsory testing in the British army: Testing the data, Royal United Services Institute.

Boyatzis R.E. (1998) Transforming Qualitative Information: Thematic Analysis and Code Development. Sage Publications, London.

Charlton G. (2006) Know the Score: Geographical Variations of Drug Use and Trends. Safer Sunderland Partnership, City Print

Charmaz K. (1995) Constructing Grounded Theory: A Practical Guide through Qualitative Analysis. Sage Publications, USA

Coffee, A. and Atkinson, P. (1996) Making Sense of Qualitative Data Analysis: Complementary Strategies. Thousand Oaks CA: Sage.

Dandeker, C (2005) Feasibility Study on the Extent, Causes, Impact and Costs of Rough Sleeping and Homelessness Amongst Ex- Service Personnel in a Sample of Local Authorities in England. KCMHR

 Denscombe M. (2003) The Good Research Guide, for small-scale social research projects. 2nd Ed: Open University Press: London

Department of Health (1999) Drug Misuse and Dependence - Guidelines on clinical management, HMSO, London

Ethrington K. (2001) Research with ex - clients: a celebration and extension of the therapeutic process. Cited in British Journal of Guidance and Counselling, (2001) Vol. 29, No.1

Gail, J (2008) A psychological treatment programme for traumatised ex-military personnel in the UK. London

Gee, D (2008) Informed Choices, Armed Forces Recruitment Practices in the United Kingdom, Joseph Rowntree Foundation.

Girbich C. (1999) Qualitative Research in Health: An Introduction, Sage London

Heckathorn D.D (2002). "Respondent-Driven Sampling II: Deriving Valid Estimates from Chain-Referral Samples of Hidden Populations". Social Problems 49: 11–34

Henderson et al (2008) Alcohol misuse in the Royal Navy, Cited in Occupational Medicine Online Journals.

 HM Chief Inspector of Prisons. (2008) Report on an announced inspection of The Military Corrective Training Centre, Colchester, HM Inspectorate of Prisons.

 Hotopf M, et al (2006) The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study, Lancet 2006.

 Iverson, A (2005) ‘Goodbye and good luck’: the mental health needs and treatment experiences of British ex-service personnel, cited in British Journal of Psychiatry 2005, 186.

 Iverson, A et al (2007) Factors Associated with Heavy Alcohol Consumption in the U.K.Armed Forces: Data from a Health Survey of Gulf, Bosnia, and Era Veterans, cited at Military Medicine 172.

 Lester S. (1999) An Introduction to Phenomenological Research. Cited at: http://www.devmts.demon.co.uk/resmethy.htm

McCrone et al. (2003) Post traumatic Stress Disorder (PTSD) in the Armed Forces: Health Economic Considerations, London.

Mcleod, J. (1995) Doing Counselling Research, Sage, London

McLeod J. (1999) Practitioner Research in Counselling, Sage Publications: London.

Miles M & Hurberman, A. (1994) Qualitative Data Analysis: A Sourcebook of New Methods, 2nd Edition, Sage, London

Misuse of Drugs Act (1971) cited at http://www.drugs.gov.uk/drugs-laws/misuse-of-drugs-act/

Models of Care (2002) Treatment of Adult Drug Users, NTA, London.

MOD (2008) Armed Forces rank near top in UK job satisfaction, cited at http://www.mod.uk/DefenceInternet/DefenceNews/PeopleInDefence/ArmedForcesRankNearTopInUkJobSatisfaction.htm

Moustakas C. (1990) Heuristic Research. Sage, London

Myers M. (2000) Qualitative Research and the Generalizability Question: Standing Firm with Proteus. The Qualitative Report, 4

Myrdal G. (1970) Objectivity in Social Research. Duckworth, London

NAPO (2008) Ex-Armed Forces Personnel and the Criminal Justice System cited at: www.napo.org.uk

National Drug Treatment Monitoring System (2006) cited at http://www.nta.nhs.uk/frameset.asp?u=http://www.nta.nhs.uk/programme/national/monitoring.htm

National Audit Office (2007) Ministry of Deference: Leaving the Services. London.

National Treatment Agency for Substance Misuse (2002) Models of Care for the Treatment of Drug Misusers, Department of Health, London

Scotland on Sunday (2008) British Army Losing the Battle with Booze.

Taylor et al (1989) Introduction to Qualitative Research Methods: The Search for Meanings,3rd ed, John Wiley & Sons, London.

Author: George Charlton MA

‘Camouflaged But No Longer Concealed’

©UK Copyright Services Registration No. 308592

The Big Comeback!

This week we were able to host our first ‘face to face’ consultation / get together with a small group of veterans in the Cafe area of our Veteran specific Health & Wellbeing Community Hub. All the veterans involved were members of the ‘Two Jabs Club’ and we were joined by North of Tyne Mayor Jamie Driscoll who was able to hear first hand about the impact the C-19 lockdowns have had on their mental wellbeing and physical health. It was humbling to hear how important the Veterans ‘Drop In’ and Cook2Give community lunches and health promoting activities are to both veterans and their families. They were missed.

It was strange to sit in the Cafe, listening to individual stories of resilience and how they had occupied their time to reduce the impact of loneliness and social isolation and support one another. What was clear everyone had become extremely skilled in the use of Zoom, Facetime or Teams and our safe & well telephone calls ,virtual support service and emergency food hampers had been very well received. As we talked the Kitchen and Staff offices were being deep cleaned in anticipation of a return the workplace on June 21st. The pandemic will leave a legacy, not just the possibility of poor mental health or increased anxiety and/or depression as people return to work, volunteering or social activities, but also an appreciation for the simple things in life, camaraderie, laughing together, eating together and spending physical time in close proximity with those whose company we both enjoy and appreciate.

Its been a tough 15 months for everyone. Even natural introverts like myself have started to get a little stir crazy but recent forays into the real world were both strange and bewildering. On one trip into Newcastle City Centre for a meeting with one of our Trustees we found roads had been changed, buildings erected in places that had once been empty and bizarrely parking spaces moved. It was strangely unsettling and resulted in a warning notice from the council being issued for travelling up a bus lane that had once been my preferred route home. The lesson is, life goes on and change is constant and we can only hope we can adjust and adapt to the new world that awaits. Whatever happens … its going to be different and the rejuvenation of people and communities will be a bottom up phenomena. For those of us working in this citizen space there are no certainties but we all need to move away from the ‘Can I help you?’ question to ‘Do we help?’ Its a fundamental shift that will keep your organisation or community functional, meaningful and effective. As David Bowie said …“ Tomorrow belongs to those that can hear it coming”

So until we meet again …Masks on and listen in!

Tony Wright CEO

Be Careful Out There Its…Toxic

In my experience as the founder of two registered charities designed specifically for disaffected marginalised veterans with multiple and complex needs, there is sadly, a deep seated reluctance and resistance for the larger more established Armed Forces Benevolent Charities and statutory organisations to accept, engage or indeed financially support 'grass roots'  innovative organisations and interventions that address the needs of veterans holistically, practically and conscientiously. (The Armed Forces Covenant Fund Does…. but it won’t last forever… so get it while you can.) The reluctance of wealthy service charities to share the donations has been a source of great disappointment to me and others trying to address unmet need with honourable intentions. The reason that we have an increase in the numbers of’ veteran centric’ support groups , not for profits and charities registering with the Charity Commission is quite simply because of unmet need. The big service charities are just not cutting it and do not have their finger on the metaphorical veteran pulse.

Help for Heroes is a perfect example of how a gap in service provision was met by a new organisation with a fresh approach to dealing with a problem that was inadequately addressed for years. In the 70’s-90’s the best a veteran with a spinal injury could get was a referral to Stoke Mandeville Hospital, whom at that time were leading the world in this specialism. However, the reality is a lack of war will mean veterans slip out of the public consciousness and the recent C-19 pandemic has once and for all, disabused the world that only veterans get PTSD and Moral Injury. In the absence of veterans with visible disabilities the main service charities are now focussing on veterans with hidden wounds. Poor mental health and all its comorbidities are driving significant change and what was ignored for years is now big business. The fact of the matter is …its getting competitive out there and NHS waiting lists are getting longer. It may be that the best you can get in the interim is ‘tea & sympathy’ and even that’s better than nothing, and may keep some veterans alive until professional help becomes available. Notwithstanding, the recent introduction of the UK Department for Veterans Affairs, which was recently and somewhat unfairly described as a ‘self licking lollipop’ by one MP, has yet to find its raison d'etre and with a much predicted 40% cut in funding and the exit of Johnny Mercer MP, its unlikely it ever will. Spoiler Alert …that’s bad news!

As I have mentioned on numerous occasions the tab for the ex service community has always been picked up by the British Public via its financial support of a few charitable organisations that cannot possibly meet the complexity of issues and needs  presented by returning veterans . The concept of the Armed Forces Covenant is great but one which according to the Armed Forces Bill means LA’s need only pay ‘due regard to’ the presenting needs of veterans. So what does ‘Due Regard’ really mean:

“To 'have due regard' means that in making decisions and in its other day-to-day activities a body subject to the duty must consciously consider the need to do the things set out in the general equality duty: eliminate discrimination, advance equality of opportunity and foster good relations.”

So now we are in the ‘deserving v’s the none deserving’ arena and the difficulties faced by thousands of veterans following military service will be ignored as it is not a statutory duty to support veterans. Other than grassroots organisations, which I hasten to add do not have a collective voice, none of the big service charities have a proven track record of representing and/or understanding the needs of marginalised veterans. This agenda should not be driven by politics but moral responsibility.  My worry is that the lack of qualitative and ethnographic research into the issues facing Armed Forces Veterans on return to the civilian community, and much of which doesn’t reflect well on the MOD’s Duty of Care or institutional reputation, will inevitably lead to those in power inventing a new reality to avoid taking responsibility for those ill prepared for civilian life. As we have already seen, the suits at MOD have inferred the problems many veterans have are due to issues they had before they joined.

The traditional and established Armed forces organisations are having great difficulty coming to terms with the fact they are in fact an anachronism. In the same way veterans need to re-invent themselves when they return to civilian life so do the big service charities and in the absence of any decent research in the sector the real experts just need funding to change the landscape. The guinea pigs are wearing the white coats at the moment and are driven by compassion and a desire to meet the needs of veterans, rather than to guarantee their own corporate survival or public image.  Times have moved on and we are in many ways in unchartered waters, in order to work effectively we need to collaborate and work together, statutory, voluntary, private business, large and small community group or social enterprise. Everyone has a role to play to address this issue. The answer is not going to come from the top so a model that allows the wealthy service charities to share their reserves rather than hold onto them is preferable to the current system which deliberately stops organisational development on the ground. Not giving the majority a voice so they can participate in this agenda is neither helpful or productive. At the moment its all a bit of a ‘‘Cluster F#*K.”

Hey Ho… only 34 weeks until Christmas!

Tony Wright CEO

Change Involves A Period Adjustment: Not Medication or Labels!

Anyone who has changed jobs knows how stressful it can be on the first day in a new role, for those leaving the military the assimilation experience can be extremely unsettling and isolating. As the veteran moves from one working environment to another, readjusting to life on Civvy Street, requires them to think, feel and act in a very different way, dependant upon the career chosen. When we take into account the returning veteran will, after years of service, bring unique life experiences to the new workplace that by definition, will separate them from work colleagues, its potentially problematic. For those with multiple deployments in war zones or those that were sexually assaulted, harassed or bullied during service or suffered discrimination because of race, class or sexuality the range of feelings experienced when taking up a new role can range from acute anxiety, uneasiness to abject fear. Watching how others behave becomes the norm for veterans struggling to adapt and fit in to the new environment. Sadly, many don’t. It’s a well recorded phenomena that veterans frequently change employment during the first five years of leaving military service. Not fitting in, can cause additional stresses and many seek medical advice at this time and are given prescription drugs to cope. Here-lies the problem, change and adjustment are part of life and and the human responses and feelings described above are normal and to be expected and can be worked through. The problem is many, once medicated are viewed by others and sometimes themselves as mentally unwell or ill. This label may well open up new doors with regard to accessing certain benefits or support but the downside is pathologizing change can have negative consequences such as loss of confidence, poor self esteem, unemployment, relationship breakdown and a host of other unintended consequences. One veteran told me that the biggest mistake he ever made was to willingly accept a diagnosis of a psychiatric disorder in the hope he would get help to get well. Sadly, despite being in his early 40’s he hasn’t worked for the last 10 years as potential employers are put off by the long history of unemployment and his honesty in telling them about his diagnosis. The sad fact is, when it comes to mental health, prejudice and discrimination is both alive and well. In our society the impact of trauma is at best misunderstood and at times ignored. Not all veterans have been traumatised by service and those that have are probably undiagnosed. As I alluded to in a previous blog, it will be interesting to see how dedicated mental health support for military veterans is prioritised and delivered against the backdrop of a post Covid-19 pandemic and the anticipated 15 million people of all ages who also need priority mental health support in the coming years. If you are in the ‘talking therapies’ business its going to get busy and if you are in the pharmaceutical trade you are going to get rich.

Tony Wright CEO

Forward Assist

Veterans Are Not A Homogenous Group!

A veteran is someone who served in the military for more than one day but is that all most have in common?

Do all veterans share the same outlook on life or the same views? Sometimes there is strong disagreement and very different behaviours.

Should veterans be respected for their service, or defined by it?

When organisations or individuals speak for veterans, do they develop their rhetoric, based on a lack of quantifiable data, to paint a distorted picture and cause damage to the ‘veteran’ brand? Homelessness, unemployment, suicide etc – are they as big an issue as some organisations want us to believe? Does the lack of data mean these issues are glorified in their fundraising activities? It is certainly an effective way of raising funds.

A serving soldier is often portrayed as a hero whereas a veteran is often expected to be broken or in need. Neither label, hero or broken, is appropriate to the majority military/ex-military personnel. What impact do the negative stories have on recruiting, or on the mindset of employers, or in the expectations of service leavers? What about the families?

There are about 2.5m veterans, with circa 65% over the age of 65. Over the next 20 years there will be a sharp decrease in the number of veterans. Which military-focused organisations want to see their income drop by a similar percentage? Is it better therefore to maintain problems rather than focus on solutions and the best interests of the veteran and their family? If underlying issues were addressed would many charities no longer be needed?

Are veterans more or less likely than civilians to be homeless? The best data available says less likely, although many veterans may not declare so it is unknown. Of the circa 1000 veterans Forces in the Community have engaged with less than 20 have spent one or more nights rough sleeping whereas over 100 have experienced sofa surfing, often due to relationship break ups or poor family dynamics. The biggest cause appears to be relationship breakdowns.

The number of British veterans in prison is also unknown although attempts are being made to record those who declare. It is not always safe to identify as a veteran. Much is made of veterans being the largest occupational group in prison but it is important to realise ‘veterans’ are the only occupational group identified. Interestingly when numbers of veterans in prison are quoted they often include veterans from other armed forces, not just British veterans.

Unemployed veterans - actual number unknown although the RBL do highlight this as a possible area for concern. One of the biggest issues the charity has experienced has been the frequency of job changes, especially in the 5 years after leaving service. One veteran listed 23 jobs in 5 years.

Including veterans, there are 16 people per day, circa 6,500 per year, who end their life by suicide in the UK. It is unknown how many veterans end their life each year although a figure of about 80 is shared around social media. In comparison it is reported there have been over 1,500 construction workers who have died by suicide in the last 5 years.

Suicidal ideation is incredibly complex, and it is far too simplistic to blame the MoD or assume a suicide has anything to do with being a veteran. I do believe a factor is a comparison between who I was and what I had whilst serving and my life as a veteran. A recurring issue is the loss of belonging, of no longer feeling part of something. For others who have attempted to end their lives, it’s about the loss of family. Many veterans I have worked with over the years have an underlying sense of not being good enough, that pre-dated military service and reappears after leaving.

PTSD is commonly talked about as a major risk for suicide but is it? Studies suggest PTSD is no more of a risk than many other diagnoses.

The prevalence of PTSD within the civilian population is approximately 4.0%. There are therefore roughly the same number of civilians with PTSD, 2.3m, as there are veterans in total. Whilst PTSD is still very much associated with military more needs to be done to educate the wider community so veterans are seen in a more favourable light and not likely to be labelled as damaged.

Many recruits join up with childhood trauma which can have an impact throughout life. An attraction in joining the military is to feel part of something, to experience belonging. Many of the veterans I work with came from disparate backgrounds where physical, sexual or emotional abuse was frequent. Joining up was often to escape, to belong somewhere, to have the chance of a better future or to attempt to make the family proud. Many new recruits often have experience of life where they did not feel good enough, for many reasons including poverty, poor family life, abuse, neglect, bullying and a lack of opportunities. It's very easy to train someone who is already devalued to sacrifice themselves to save others if need be. In this shared experience recruits begin to feel accepted for whom they are, of being good enough - I am acceptable to others and more importantly, to myself.

But after leaving service and when something goes wrong the underlying not good enough process is exposed. Many veterans have talked of feeling like they are a burden to others - a common suicidal thought. A similar sacrificing process where many are prepared to die for the perceived benefit of others.

Too many veterans report a negative experience in their last few weeks/days/hours. The leaving process creating feelings of rejection and shame. All ranks from WO1 downwards have made similar comments. Most of the veterans the charity receives have been out for between 6 and 15 years, having served for a similar duration. If this negative experience prior to leaving was more positive would veterans seek support a lot sooner when needs are less complex? If you feel rejected by your family the last thing you want to do is seek help from them. 

If veterans are looking to belong but feel adrift from society the pressure to be accepted in the workplace can be great. Any sign of not fitting in and the job is no good. How many veterans choose jobs where they work alone?

Over the last decade the charity has worked with hundreds and hundreds of veterans of all ages, male and female. Whilst housing, employment and welfare support are established areas of need more focus should be directed at the underlying issues that often cause these difficulties.

One of the major challenges is difficulty in forming and sustaining close relationships. How many serving personnel/veterans rush into poor relationships? It can be a trauma response and lead to abusive relationships. The relationship forms with the focus on pleasing the partner with little or no interest in the (female or male) veteran’s needs. Partners often state the veteran can be emotionally devoid or cold. How many veterans seek solitude in times of relational/emotional distress? As the relationship develops unconscious self-sabotage behaviours appear to protect the veteran but often are a cause of breakups.

Is the value of belonging (family) focused on a concept, ‘the military’, rather than meaningful relationships with real people? Does this prevent integration into society and balanced relationships?

So additional support and education should be offered to new recruits to help them recognise and work on the areas of their life they are not consciously aware of so that change can be given a chance and future distressing issues minimised. The leaving process is too late when the responsibility is then shifted to the NHS or charities, and the harmful ways embedded.

The term 'veteran' references a passionate group of individuals with a wide range of abilities, hopes, wants and needs. Some need support, others offer it. Some care about others, some care little for themselves, and others do not care at all.

Why are the issues faced by veterans today virtually the same as they were 10, 20, 30 years ago? The collective bank accounts of all the charities, associations etc would suggest money is not the problem, so what is? Money is often provided as a solution but often only provides a short-term fix for more complex issues. Many believe egos and politics within this sector prevent real change.

Having met, worked with and supported over one thousand veterans over the last decade I can honestly say I no longer see the ‘veteran’ label as the primary label for the issues faced by fellow human beings. I’ve worked with murderers, thieves, rapists, sex offenders inc paedophiles who have been through prison – all veterans. I am used to veterans not turning up to appointments or cancelling as much as I am to those who arrive 5 minutes before the agreed appointment time, or earlier. Sometimes ‘veteran’ is used to avoid taking responsibility – “I’m homeless because I’m a veteran” or ‘I’ve served my country now my country needs to serve me” and sometimes the internal ‘adapt and overcome’ belief hinders support – seeking or receiving.

Professional sports people, actors and other professions that run alongside civilian life experience similar issues to veterans. The change from who I was to who I now am can be overwhelming.

Does veteran status hinder transition? Can one truly transition when the primary descriptor is an anchor to the past?

To achieve change for veterans the dialogue needs to change. Veterans do not all want or deserve the same. Veterans do not all think the same, walk the same, love the same, eat the same or drink the same, although 'too fast' is an often used descriptor! Being labelled as a veteran may provide a sense of belonging but should not define life after service. Focus on the person not the label.

For those who choose to speak on behalf of veterans please consider the damage you could be causing by assuming your perspective is relevant to and for all veterans.

We all need to be seen for whom we are and not solely defined by a period of our lives.

Rick Harrington Founder & CEO

Forces in the Community

'LINE OF SIGHT’: ART SESSIONS AT FORWARD ASSIST

Way back in 2019, it seems like years ago now, and just before the life changing impact of the C-19 pandemic, we commissioned Michael Mulvihill from Newcastle University to deliver art classes to a group of military veterans. The project included educational field trips to help reduce social isolation and loneliness. This is his blog…

Last month we started ‘Line of Sight’, an art project at Forward Assist veterans charity in Newcastle. The project is funded by National Lottery Awards for All and is inspired by a conversation with Forward Assist about veterans experience and the range card. The range card is used by all branches of the military to direct live fire, either from artillery, portable firearms such as machine gun or mortars, or weapons delivered by aircraft. Yet beyond the battlefield it seemed the range card was helping some veterans to transition into the seemingly uncertain environment of civvy street, by being a emblem of certainty.

This brought to mind art historical work about spatiality in Dutch Landscape painting from the 17th Century being a direct result of innovations in targeting advanced artillery, with the task of targeting the canons falling to the royal artists and geographers. Other academic work has demonstrated that artist throughout history have also been active participants in battlefields by collecting data and intelligence on bridging points, fortifications and landscape features. Innovations such as oil paint in metal tubes that helped the emergence of outdoor painting, were also seen as a threat to combat forces on the battlefield of the Franco Prussian War by being manoeuvrable and easily concealed . Many of these battlefields were captured by the Impressionist painters such as Monet, Degas and Renoir with several of these works being seen, by military of the time, as being operational objects.

So there seemed to be a great opportunity for an art class based on artistic and military seeing with an aim to aid veteran to move from the regimented but predictable structure of military life, to the less certain and arbitrariness of everyday. The first class was held in the mid August and after a pause for the bank holiday resumed last night. Straight away the veterans got to work decoding landscape paintings by Renoir or van Ruisdael identifying areas of risk areas, or tactical advantage. For example  a Renoir cornfield presented a risk to infantry that could be mitigated by an air bursting artillery barrage over a distant village and large amounts of smoke across the fields depending on the wind direction. The dips and contours of what had been a flat landscape became very apparent while problems of spatial depth became a matter of using the same skills as ranging firearms.

Perspective drawing and spatiality can be tricky skills to teach. However, it seemed even in the first art class that these are tacit abilities taught through military training, which the veterans have brought to the art session and re-applied into landscape painting. What had seemed like a novel notion of combining art history with veterans experience of landscape has suddenly became embodied and actual.

Michael Mulvihill

Entitlement, Expectations, Disappointment & Post Traumatic Embitterment Disorder

“Embitterment is a persistent negative feeling in reaction to common negative life events, and is a reactive emotion towards injustice, insult or breach of trust. Embitterment is a gnawing feeling and has the tendency not to stop.”

I first encountered the term Post Traumatic Embitterment Disorder (PTED), during a Winston Churchill Memorial Trust funded research trip to the USA in 2011, it stuck a chord as it accurately described the symptoms displayed by hundreds of the veterans we have worked with over the last 10 years. On return to the UK I bought a copy of the book Posttraumatic Embitterment Disorder: Definition, Evidence, Diagnosis, Treatment (2006) Linden, Rotter, Baumann & Lieberei.

It has turned out to be one of the most influential book I have ever read. Yet, PTED is neither recognised or discussed and has fallen out of favour, probably because it didn’t get a classification as a disorder in its own right in the Diagnostic and Statistical Manuel of Mental Disorders. Which is a shame as it accurately describes many of the people referred to our service.

In a recent edition of Professional Social Work one article was entitled;

‘Great ideas never die but they can be buried alive’

Personally, I believe Post Traumatic Embitterment Disorder is a perfect case in point.

Over a lifetime’s work in Social Work, Criminal Justice and social welfare settings I have met hundreds of people who are unable to move on from traumatic life events, injustice or violation of their basic beliefs. These days, we might call it Post Traumatic Stress, Moral Injury, Adjustment Disorder or a host of other terms. Shame, guilt, disappointment and a sense of failure can all lead to self harming behaviours and a belief nothing will ever change for the better…at that point some people may start to think they have become a burden and loved ones might be better off without them. Dangerous territory.

After a year of repeated lockdowns, the terms normally associated with veterans mental health such as PTSD or Moral Injury are now used on a daily basis to describe the millions of individuals who have struggled to cope with the fear of catching, a potentially life ending virus. A virus that has, the potential, to ‘take you out’ in little more than 28 days. For frontline health workers the fear of catching the C-19 virus is ever present, and the daily dread of inadvertently passing it on to loved ones never goes away. Others are struggling to cope with loss and bereavement at a time when its essential we all isolate ourselves from each other. Social isolation and a real sense of disconnection from ‘normal life’, has created an upsurge in depression, anxiety, poor sleep, self harming behaviours, debt, alcohol misuse, loneliness, fear, domestic violence and relationship breakdown. Experts in the field talk of an anticipated tsunami of mental health disorders, with requests for mental health support estimated to be in the region of 15 million people. If this is the case , the reality is, this will overwhelm mainstream services and people will be added to waiting lists that could go on for years.

Veterans are currently being promised fast track mental health services and support, and if not handled sensitively, this prioritisation has the potential to be divisive and cause conflict between those viewed as deserving or undeserving.

These day’s, many people have a sense of entitlement. Entitlement is described as a pervasive sense of deservingness. People with a sense of entitlement believe that they should get what they want because of who they are! The Government has promised veterans entitlement to fast track medical services because of their unique experiences in the military.

Rightly or wrongly, the problem is, once promised, people will have high expectations. However it might not be possible to deliver on those promises. It could be something as simple as supply and demand and this will inevitably, lead to disappointment, psychological distress, anger and resentment. Yet, millions of others will probably feel the same way, and if Local Authorities and mental health services are , as the Armed Forces Bill implies only required to pay ‘due regard’ to the Armed Forces Covenant, the needs of the majority will prevail, and veterans may go to the bottom of the list when it comes to mental health treatment, housing or practical support.

As ever, the role of the much maligned small military charities will be crucial in helping support those feeling betrayed by a system, that promised so much.

Whatever happens… its going to be interesting.

Tony Wright

Forward Assist

Its Time For Men To Step Up to The Plate & Challenge Sexual Assault in The Military

Our recent interviews with women veterans and our ethnographic study ‘No Man’s Land’ indicated that women veterans are reluctant to report sexual harassment and assault whilst serving in the military. Many, sadly viewed it as a normal aspect of military service and it was only with the passage of time  that they accepted that the behaviour they experienced was unacceptable and for some deeply traumatising.

Some women, were told to just accept it as ‘part and parcel’ of life. Many of the women we interviewed said that after reporting assaults to senior officers, the problem was frequently minimised or dismissed as something they had brought upon themselves, either through their behaviour, excessive alcohol misuse or the way that they dressed at the time of the assault. Either way, the problem was almost always located with them and not the perpetrator. Advice ranged from telling women to ‘toughen up’ and stand up for themselves and forget about it, as taking it any further would negatively impact on their future career.

Since we published the No Man’s Land report in 2019 the response to the findings has been telling. Many men, especially those in positions of authority, struggle to accept or talk about this issue and are in denial as to the extent of the problem and choose to remain silent. As a result, many women feel that they don’t matter, they are not valued and whilst serving they have no rights.

The military has a problem, for decades many assaults have gone unreported. Its time men stepped forward to do the right thing and not side with a system that is both abusive and damaging. Not having the moral courage to call out sexual abuse and harassment for what it is really isn’t in the best interests of the military or the victims and survivors. Men must do more to support women during and after military service.

So how do we do this? Its actually a leadership issue and men and women in positions of authority, need in the first instance, to listen to the lived experience of those who have been let down by the system. Adopting a Catholic church approach to investigating current and historical allegations of abuse is not the way forward. Its time to stand up and challenge gender based violence at every opportunity and not turn the other cheek and think its not my problem. Siding with the institution or a dysfunctional system is an indication of silent complicity and by proxy promotes the abuse of human rights.

There are a few men out there who are not afraid to step up to the plate and intervene when others are acting abusively and we salute them, but leadership really starts with each and every one of us and we all need to make it very clear that the sexual abuse, harassment and gender based violence of any kind is unacceptable.

Like all change… it has to start somewhere.

Tony Wright CEO

Forward Assist

The Long Term Effects of Military Sexual Trauma (MST)

The day the soldiers stop bringing you their problems is the day you stopped leading them. They have either lost confidence that you can help them, or concluded that you do not care. Either case is a failure of leadership. —Colin Powell

The term, soldier; refers to any person who serves in the armed forces and engages in any form of military service for their country.  They live by the values set by the military: loyalty, duty, respect, selfless-service, honour, integrity, and personal courage.

Yet, for many women undergoing basic training, their first encounter with a patriarchal power structure, can be traumatic and demeaning. The hierarchical ‘male dominated’ structure leaves many women feeling undervalued, unappreciated and having to work twice as hard as others just to prove themselves.  It is not hard to see how basic training can create an environment in which sexual predators can thrive without fear of punishment, the power imbalance is extreme. The group of women veterans I work with often report that they never felt accepted into a male-centric world and were often made to feel unwelcome, outsiders or ‘under the microscope’ and micro-managed. This, not surprisingly led to many feeling undervalued, lonely, isolated, homesick and many chose to leave.

Its a sad fact that many women who serve in the armed forces experience some form of harassment and/or Military Sexual Trauma. (MST) Yet, in the main it generally goes unreported.

Lets explore the differences between MST and rape - historically rape has been legally defined as the unwanted penetration of a woman’s vagina by a penis or other item (Bourke, 2007). Military Sexual Trauma (MST) has been defined as sexual harassment that is threatening in character or physical assault of a sexual nature that occurred while the victim was in the military, regardless of geographic location of the trauma, gender of victim, or the relationship to the perpetrator. Its not hard to see how one can lead to the other.

For many women, reporting a sexual assault is harrowing, women report feeling isolated as other personnel in the unit turn their backs on the victim/ survivor, often siding with the perpetrator. The unit’s collective shunning, heightens the victim’s emotional pain and complicates recovery from the trauma. The act of MST by a comrade or high ranking Officer is often perceived as a double betrayal and destroys trust in individuals and the system. Many women who access the specialist support of Salute Her tell how reporting an assault during their career is effectively ‘ Off Limits’ - they worried that had they reported problems, they would be humiliated, not believed, ostracised and the problem located with them not the perpetrator.

‘I think the main problem with the Military is that men can do what they want, women are there to be used and abused , you couldn’t tell anyone, why would you,  no one would believe you’

It is no secret to us, that sexual assault in the military is widespread, however the evidence is anecdotal and determining the number of victims depends on more research and whether the question is asked in the first place. Sadly during the course of running this project we have frequently been told that the reason for so little research into this area is due to the military and academics not liking to talk about sex, as its not British. Well, in my view neither is rape!

A large percentage of women Veterans who access Salute Her report that they were reluctant to complain about harassment, bullying and inappropriate behaviour during service as they were fearful that they would not be believed, blamed or feared the ramifications for their careers and friendships.

Those who do make a formal complaint are often left feeling dissatisfied with the outcome of the investigation and follow-up action was for many non-existent. Similarly, many said they had experienced negative consequences for the rest of their careers and were left feeling humiliated.

Military Sexual Trauma isn’t a diagnosis or a condition, but rather a lived experience, there are no “common symptoms” of MST.  The onset of these reactions may not be immediate; it’s not uncommon for problems to materialise weeks, months, or years after the traumatic event.

Military Sexual Trauma can often result in symptoms of Post Traumatic Stress Disorder. There are a number of reasons why MST and PTSD are so closely linked, many of which include having to live and work with the perpetrator after the event to the point of even possibly relying on them for safety or to provide essentials like health care or food.

Many women may have already left military before first experiencing the traumatic effects of MST. These devastating life experiences can have a prolonged effect on not just their physical and emotional wellbeing but impact on future employment opportunities, personal and professional relationships and many struggle to cope and function years after the assaults took place.

In my opinion, the sacrifices women service personnel and veterans have made for this country are equal to that of their male counterparts , and we owe them all a debt of gratitude, equal respect and adequate specialist support services that are able to meet their unique needs.

 Paula Edwards

Mental Health Therapist and Salute Her Project Lead.

Supporting Those With Invisible Wounds!

I don’t think anyone would disagree that we have a ‘duty of care’ when service personnel come home from war or active service disabled, maimed and/or with mental trauma. The larger service charities do a fantastic job in supporting those with physical injuries; the provision sadly becomes less comprehensive for those that are left with the ‘invisible wounds of war’ such as operational combat stress, traumatic brain injury, moral injury, military sexual trauma, survivor guilt ,compassion fatigue and adjustment disorders.

Mental trauma as a result of service life is on the rise and the spate of suicides amongst former service personnel in the US and the UK is an indication that the access to specialist ‘wrap around’ support is not as comprehensive as it should be. This is not just an issue of veterans gaining access to specialist mental health support when it is needed, but also about supporting our veteran’s transition back to the civilian community and assisting in what can be a very difficult assimilation process.

This process can take decades, as veteran issues are complex and at times compounded by socio-economic and psycho-social factors that can exacerbate general and complex mental health issues and negatively impact on future life chances if not managed in a ‘holistic’ and coordinated way. It is not just the responsibility of the MOD/ NHS or service charity sector to ‘pick up the tab’ when our soldiers return home, we all have a moral and collective responsibility to welcome former military back into the communities in which they choose to live. Far too often we meet veterans who self isolate, are lonely and choose to live an insular, solitary existence. Many have been wrongly diagnosed, prescribed the wrong medication, traumatised in many different ways and left to suffer in silence .

Its a sad fact that a significant number become dependent on prescribed and/or illicit drugs including alcohol and eventually end up ‘self medicating’ in the absence of veteran specific psychological services or support. A growing number of veterans are becoming involved with the Criminal justice System, yet it is debatable if poor decision making can be directly attributed to service life.

The above notwithstanding, we should not have to wait until the soldiers and veterans of this country commit suicide to indicate something is fundamentally wrong with the system of support made available to them. In many ways politicians do not understand the issues.... simply because the ‘grass roots’ veteran population does not have a voice and MP’s traditionally seek the opinions of the larger service charities. Most of whom, are far from the beating pulse of real life and lived experience. Sadly MP’s only get to hear what the stakeholders think they want to hear. I am of the view that the Defence Committee should consult with the plethora of grassroots organisations that support veterans if it is serious about creating a country that is is best place in the world to be a veteran. The bar has been set … so its time to jump over it!

Tony Wright CEO

The Forward Assist UK -USA Veterans Exchange Programme.

In 2011, Tony Wright CEO was awarded a Winston Churchill Memorial Trust Travelling Fellowship and embarked on a life changing, six week research trip, travelling across America visiting numerous veteran centric projects on the way. On return to the UK he put the learning into practice and to set up both Forward Assist, Salute Her and the UK-USA Veterans Exchange Programme which funds and facilitates week long trips to the USA for UK Veterans. Participants act as cultural ambassadors while being offered a fully immersive life-changing lived experience. The goal is to promote communication and connection for veterans on both sides of the Atlantic which in turn helps support a successful integration back into civilian life and encourage grassroots improvement and the development of veteran services in both countries. To date we have facilitated nine research trips with another two planned for 2021-22

On return to the UK we consult with participants and evaluate feedback from both parties: Below is just a flavour of the feedback.

“A wonderful cross-cultural experience that enabled veterans from both countries to share experiences” “Meeting amazing people from America who have had similar experiences was amazing”

“It was interesting to greet the British who shared the same experiences. We built an international comradery and friendship”

“Gained an insight into how other cultures (countries) do things.”

“ Meeting gentlemen from another country who had the same experiences as you do. Then being able to go out and go hunting and fishing among other things with them was wonderful”

“The welcome we received from all the people we have met has restored my faith in human nature”

“A great experience which one will never forget”

“Experiencing different cultures and fantastic outdoor activities allowed me to make new friends and this experience is going to help me when I get home”

“ I was surprised how far behind the UK is in relation to the care of the veterans and their well being”

“I realised that I need to be more of a family man when I get back home.”

“Our two countries are intertwined with a common language, culture, religions and national interests global politics require that our troops serve shoulder to shoulder for the betterment of the world”

“To be honest, the most important thing that I have learnt is how phenomenal the experience is and how the whole of the USA cares and loves their veterans.”

“ I have learnt that its OK to demonstrate my love for my wife from the role models I saw in the US”

“ I have learnt to listen and be more tolerant of people”

“I have never experienced so much respect or love from people I only just met”

“ I’m going back on my own next year to stay with my new friends”

“ Never thought I would have had a change to participate in such a pioneering exchange programme”

“it enriched my life”

“People showed me how to be a good father and husband”

“I have learnt that I can actually be sociable with people”

“ The support American veterans receive from the CJS should be mirrored in the United Kingdom”

“ Instead of incarceration we should mentor them to help others”

“It seems USA are definitely more advanced in looking after their personnel after leaving the Armed forces”

“Laying a poppy wreath at the Tomb of the Unknown Soldier in Arlington Cemetery was a unbelievable honour and an experience I will remember for the rest of my life”

“My time at Boulder Crest Retreat has changed my life”

“First time in Seattle and it blew my mind”

“I want to live in Texas”

“The welcome I received at Boulder Crest Retreat in Arizona was unbelievable and the learning has changed my life. I was also involved in writing a country song with my group and its been recorded, unreal!”

I couldn’t believe how open our American colleagues are to share learning and best practice, it doesn’t happen in the UK”

“ Women veterans are really respected in the USA”

“I can honestly stay coming to the UK has been the best experience of my life”

“An amazing project and I am going to fundraise to bring more US veterans over next year”

Women in Defence Inquiry – a story of corporate-level ‘gas-lighting.’

I wanted to share my experience of being one of the instigators of the UK MOD’s ‘military #MeToo moment’. and give you a sense of the build up to the Women in Defence Inquiry, currently led by Sarah Atherton MP, and how she worked with the Secretary of State for Defence, to ensure that she could hear the voices of serving personnel as well as veterans (lifting a long-term gagging order on service personnel speaking to parliament officially).

Over 4000 service women and some families submitted stories during December 2020. A steady stream then submitted throughout January, with the review extended until February 2021. Many veterans’ charities also submitted case-stories of the thousands who came to them. One of those charities was Forward Assist.

Over 8 months, I have listened to stories of serving women being raped, drugged, assaulted, abused in training, held back in careers, ignored as veterans, given ill-fitting equipment (and the cold shoulder if they were first into a previously male-only post).  This has been a tough ‘ask’ - to summarise this level of suffering, as well as recommend solutions on how to address such low standards of care in the armed forces. It is not only women who suffer – this is a story of abuse of power and includes stories of toxic women in leadership positions – and men and ethnic minorities as victims as well as perpetrators.

What did this look like in numbers?

163 individuals contacted me. Most were uniformed, but some were non-uniformed staff and family members. At least 33 were still serving (some withheld details), with a further 63 having left in the last 5 years. 3 were parents of serving women, 5 were civil servants, working in defence.  130 were from the Army; 31 were RAF and 2 were RN – this was partly because my call out for stories mentioned army only. The range of ranks was difficult to assess - issues were the same for officers and other ranks with some nuances: sexual favours for promotion or for turning a blind eye to minor indiscretions were only reported by other ranks and class discrimination for promotion and postings were more prevalent in officers.

Over 75% did make complaints and all of those felt ‘fobbed off’, either through being told they misunderstood the incident or coercion to withdraw their complaint or change details. This is ‘gas-lighting’ at a corporate level. Nearly all had been affected by gender-negative incidents during their careers, but most handled it - usually without support from leadership. Only 1 individual contacted me to say she had never experienced adverse incidents and wanted her voice to be heard that she felt there were no issues. Several senior officers did contact me and attempt to influence my future media engagements, to paint a more positive military picture (but more serving officers contacted me to say it was about time this issue was addressed).

The comments on suffering were NOT about the crime or level of poor behaviours – most women in defence are robust and accept the military environment as emotionally and physically tough. The greatest suffering came from the inability to be heard when something went wrong – nearly every one of those 163 described how witnesses had turned a blind eye, or their leaders had coerced them to withdraw a complaint – and how they were punished rather than the perpetrators – through leaking of their allegations to the wider military unit or being shunned for speaking out.  

The UK MOD is the only public body allowed to investigate and adjudicate on what is a wrong and who should be held accountable. And it is clear from the common themes of these stories that the MOD is abusing this power for its own ends. That is the real ‘wrong’ – that the UK MOD treats its people as disposable when they are at their most vulnerable.

The MOD leadership & policy makers should hang their head in shame, as I have on their behalf.

At the end of this inquiry, defence ministers will also be aware of the extent and tactics of the MOD. I hope that this time, some good will come from the bravery of these women in coming forward.

Diane Allen joined the Army when she was a teenager and was one of the first women to attend Sandhurst in the 1980s. She served in the regulars, in Northern Ireland and Germany, before a switch to the reserves, finally leaving in January 2020, as a Lieutenant-Colonel. She now lives in Gloucestershire, with her partner, when they are not away adventuring.

Guest Blog by Veteran & Author Diane Allen OBE

See: https://www.forewarned.uk/

The Transition Process .. Is The Weakest Link

Every year, thousands of people leave the Armed Forces and return to live and work in the civilian community. For many the transition is seamless, yet for a significant number the journey is made difficult by an inability to adjust and re-establish themselves and settle back into in the community. These adjustment issues may lead to relationship difficulties, alcohol and drug misuse, homelessness, involvement with the Criminal Justice System, and for those suffering from diagnosed or undiagnosed mental health problems , self imposed isolation, self harm or suicide. An increasing number may find themselves marginalised and disenfranchised from main stream services and support simply because they have difficulty asking for help.

The civilian community and indeed many service providers continue to have difficulty understanding the needs of former service personnel. Part of the problem lies in the misconception that the Armed Forces continue to provide holistic support for its members after they have left the services and that their needs are completely unique and different to that of the general population.

There is also a misconception that everyone who leaves the forces has a sound knowledge base of what is available, unfortunately this is not true and even if they did many would not ask for charity. Re-unions and Regimental dinners facilitate the maintenance of lasting friendships and facilitate sociability yet many choose to avoid such get togethers preferring to focus their efforts on reinventing themselves via a new career on Civvy Street. Yet, Civvy Street can be a lonely place simply because the relationship with serving friends and colleagues may fundamentally change after they leave simply because they live for all intents and purposes in very different worlds.

The reality is, that there are a myriad of complex transitional glitches to contend with. Those serving 22 years plus may never of had an job interview which places them at a disadvantage to others seeking employment. Adjustment and the a loss of identity when transitioning into the civilian community should not be underestimated. However, many successfully re-engage with the civilian community via their enrolment on leadership/managerial courses in facilitated by Universities or Colleges of higher education. Yet, those that are medically discharged must cope with the restrictions their disability/impairment has on future employment opportunities and relationships whilst coming to terms with a change in circumstances that was not expected and lack the emotional resilience to do so.

It would appear that there is growing evidence to suggest that a significant number, perhaps as many as 30% end up in a life categorized by them as failure and disappointment. Many are recruited into the Armed Forces from areas of multiple deprivation and join the Armed Forces as a way to escape poverty and  improve limited life chances, for early service leavers failing to make a career in the military is said to be viewed negatively by significant others and for many disenfranchised youths its viewed as the last chance saloon. That said, for thousands its probably the best decision they ever made. A military career can be life changing for so many. Its the transition back to civilian life that so many find difficult and where resources should be targeted. We shouldn’t let veterans become homeless and left begging for change’ . Leaving the military technically homeless is in many ways as bad as being physically homeless as the struggle to get established is both arduous and difficult and can take years. Sadly many individuals return to the civilian community ill prepared for civilian life and subsequently end up ’Sofa surfing’ or sleeping rough. Many report being directed to the homeless sector and told by well meaning housing workers that the only available housing on offer is within the temporary accommodation sector, which more often than not are multi-occupancy dwellings. I have met many former soldiers who report that they prefer living on the streets to living in a homeless shelter. As one veteran said,

 ‘you go in clean, but come out with a drug habit, in a box or in handcuffs .’

In my view, multiple occupancy dwellings in the homeless sector are the last place a veteran should be placed. The hidden population that are homeless veterans, has no political voice and has no vehicle to express or channel any dissatisfaction with the services currently on offer. The current system is a ‘one size fits all’ it is only in recent years that Veteran centric accommodation projects have appeared but its a post code lottery if you have one in your area. The projects do a great job supporting homeless veterans but its when they have to move out and live independently that the real problems start. Many are in a revolving door situation and its Government that should provide effective support and funding to meet the distinct and unique needs of veterans. Government has a duty of care to look after those that have served and a moral responsibility to pick up the tab for veteran care and not leave it to the charity sector.

The complexity of the issues facing former serving personnel returning to live in the civilian world is only going to increase as pressures are placed on all services post Covid 19 . The answer to this current and ongoing problem will come from, and be driven by the small service charity sector. They understand the issues their comrade’s face when they slip through the net and fail to engage with mainstream services and they also know why it happens and how to re-engage them when it does. Government and the UK Department for Veteran Affairs need to consult with those at the pointy end if they want to know what’s really going on! In our experience, if the support is given at the right time, in the right place by the right people then it is accepted without prejudice. Lets not forget that the civilian communities greatest asset is its former military community.

Tony Wright CEO

Learning From America ...

My career, working with Veterans who have multiple complex needs started in 2017, with a specific focus on developing a specialist and holistic service to meet the needs of women who served in the military.

At the time of commencing my employment with Forward Assist, the organisation was in the process of developing their services which meant I was able to take a hands on, strategic approach to build upon pre-existing service provision. Before starting in my role as the ‘Salute Her UK’ women veterans lead, I had held many positions within a variety of mental health trusts, voluntary sector organisations and private practice. I worked with individuals, suffering from addictions, mental health difficulties, including bipolar disorder, personality disorder or depression, and with those in acute crisis at risk from self-harm or ending their life. I specialised in working with those who were most at risk, using a ‘think family’ model of engagement. So, working with those who had suffered trauma was no stranger to me. However, I would come to learn that the sexual trauma experienced by women in the military and the life long impact such trauma had on their lives as veterans was both shocking and and appalling. I thought I’d seen it all. How wrong I was!

I have learned so much from the founder of Forward Assist, Tony Wright about the many unique challenges that Women Veterans face, the fact they are a hidden invisible population was a revelation to me and I had never considered that they would simultaneously be struggling and suffering from a range of mental health problems as a result of traumatic experiences.

There is virtually no research in the UK that looks into the needs of women veterans, past and present. The reality is that once military service is complete, women personnel embark on a long, lonely , arduous journey back to civilian life, a journey fraught with difficulties.  Women are the fastest growing cohort within the armed forces and I would argue that this transition can be more traumatic than that of their male counterparts.

Given there wasn’t a template to work from or research to reference, I carried out a ethnographic data analysis and mapping exercise and was both surprised and shocked to find so many women veterans struggling with adjustment issues and poor mental and physical health problems. There is lots of research in the USA that suggests that women feel uncomfortable in male-dominated veteran environments, and that they prefer to access support and treatment that is gender specific and sensitive to the needs of women.

I was given the opportunity by our CEO along with a women veteran volunteering with Salute Her, to travel to America in 2019 to research and learn everything I could about the needs of Women Veterans. I have brought back this knowledge and examples of good practice and aim to raise awareness of the currently unmet needs of women veterans so that we can all take a collective responsibility to improve services to women in the United Kingdom.

My trip involved visiting several women centric organisations, including meetings at the Department of Veterans Affairs, where I met Andrea Goldstein - senior policy advisor for the Women Veterans Task Force. Andrea talked openly about her experience as a woman who served in the Navy. While serving as a troop commander in Special Operations Forces, Andrea was instrumental in developing best practices to integrate women into previously all-male teams.  Her work includes cross-sector collaboration to facilitate organisational culture change from within, and a focus on incorporating a gender perspective into policy, plans, and operations in the defence and security sector. Andrea visited the UK a few months later and visited Forward Assist to hear about our work and kindly facilitated the opening night of the Salute Her Women Veterans Art Exhibition at Newcastle University.

Carrie Ann Alford, Director of Policy & Planning, Virginia Department of Veterans Services facilitated numerous visits to grassroots services that supported women and their families after service. I wanted to meet with those who had strategic insight and that had built a service from the beginning so I could learn about the challenges they faced and how to overcome them. It was also important to meet other mental health therapists who could speak the same professional language.

Running like a gold thread, through all the organisations I visited was the fact that they all worked in collaboration with each other, they all supported each other and shared resources. This is in direct contrast to my experience in the UK where it appears organisations compete for funding, recognition and sometimes veterans!

Evidence shows that collaborative working is essential for good treatment outcomes, both clinical and holistic. If the needs of all Veterans are to be met in an effective, sustainable way, organisations in the UK need to find a way that they can work together collaboratively.

The Department of Women Veterans provide community-based trauma centres specifically for women veterans. The centres provide a wide range of social and psychological services, including readjustment and transitional therapy.  Individual, group, marriage and family therapy sessions are available and what excited me the most was to see the use of Dialectical Behaviour Therapy (DBT)

In UK, DBT is typically used with those who have a diagnosis of Personality Disorder, so it was refreshing to see it adapted for use within military trauma settings .  What impressed me most was the vast array of services that what were dedicated to women’s health care needs, such as gynaecology and maternity alongside multi disciplinary mental health services and gender specific inpatient units. The VA also use electronic health records to closely track physical health care including breast and reproductive care in order to produce better health care outcomes for women.   All VA staff use a ‘care coordination’ model of care. Many Veterans in both the UK and USA present with multiple complex needs so I would argue that we should adopt this model. The principles and practicalities of care coordination should be taught and adapted for use in the United Kingdom by all services including the voluntary sector.

I was delighted to meet with two trauma therapists and two Social Workers from the Virginia Department of Veterans Services and visited one of the specialist centres for Women Veterans. During my visit they presented the different aspects of their work and explained their roles in relation to the various programs they deliver. In the VA, social workers support trained mental health therapists in all patient care areas. Unlike, the UK social workers are responsible for ensuring continuity of care through the admission, treatment, and discharge processes of military veterans.

The trip was also educational, and I was deeply moved when we visited The Women's Military Memorial Centre at Arlington Cemetery. The sheer size of Arlington Cemetery took my breath away. We were honoured to visit the part of the cemetery that is dedicated to women who have served in the military and learn that there is a place to learn about the extraordinary servicewomen who have stepped forward to defend America. For more than 30 years, the Memorial has been permanently documenting military women’s experiences and their impact on American, military and women’s history.  If you get the chance do visit.

Working Together

Forward Assist and Salute Her work in partnership with Boulder Crest Retreat and have funded two women veterans from the UK to take part in their retreat programme. Boulder Crest Retreat is a not for profit organisation that offers transformative retreats for combat veterans and their families. The Warrior PATHH programme is a lifelong, posttraumatic growth-based training programme. The week long training consists of intensive workshops, that is then followed up by 18 months of connection and training from both peers and psychologists via the online PATHH platform. Boulder Crest Retreat is based in Virginia and Arizona and no expense has been spared. Veterans stay in beautiful, luxurious log cabins and eat nutritious meals, yoga , exercise and meditation to boost wellness. The UK veterans that have accessed this programme describe it as a life transforming experience.

I have to say that wherever I went in America I met the most warm hearted friendly and helpful people, the trip was amazing and insightful. As a therapist I am used to reflective practice and do so daily, and as my trip came to an end I was grateful I was able to learn from so many, especially the strong women who had took it upon themselves to develop much needed services. I remain both humbled and inspired.

In my experience many male professionals in the UK find it difficult, or have a resistance, to identifying the unique impact trauma has on women. The fact that women veterans are a hidden, marginalised and frequently ignored forgotten population creates real difficulties for practitioners and especially women who report feeling not valued and their military service doesn’t seem to matter.

This has to change and the UK Government should accept responsibility and provide and contribute to the development of specialised gender specific, trauma informed, mental health services. Organisations need to come together and assist in the design of gender specific services for women veterans and help identify hidden women veterans living in the community, whilst proactively targeting them with information on specialist support services, entitlements, employment opportunities, health information and benefits.

We all have a collective, moral responsibility to ensure that trauma in women, especially Military Sexual Trauma (MST) is acknowledged and screened for to ensure that women get the service they need at the time they need it most.

Paula Edwards Salute Her Project Lead

The Ethical Dilemmas of Working With Those That Self Harm.

What is self-harm? :

 “Self-harm is when you hurt yourself as a way of dealing with very difficult feelings, old memories, or overwhelming situations and experiences. The ways you hurt yourself can be physical, such as cutting yourself. They can also be less obvious, such as putting yourself in risky situations, or not looking after your own physical or emotional needs’” (MIND)

Self harming behaviour is a coping method used by some people as a way to help them manage intense and painful emotions. The need to purposely inflict physical harm on themselves, for example cutting, can provoke confusion, anxiety and concern for all those involved in delivering care and support. Just talking about self harm can cause intense feelings and emotions and many end up questioning their own morals, values and beliefs on the matter.

Self harming behaviours can cause deep feelings of disgust and unease for the observer and whilst understandable, such responses are counterproductive. Simply because they fail to provide any sort of solution for people who self-harm and such judgemental views can alienate and stigmatise. The majority of people who self harm do so in private and secretly.

A judgemental attitude can lead to professionals projecting their own anxieties and escalating responses which do nothing to address the underlying causes of this misunderstood and complex coping mechanism.  We need to start thinking about self-harm in a more rational way that takes in to account the perspectives of person who injure themselves rather than simply trying to stop their behaviour or overreacting to what are essentially none life threatening self inflicted injuries.

Self-harm doesn’t have age restrictions, research has shown that children as young as five years old and elderly people in their nineties can and do use self harming behaviours as a way of coping and expressing difficult emotions. More women seek help for self-harm than men – however, research suggests that men are equally likely to hurt themselves as well as face more cultural barriers when asking for help. The roots of self-harming behaviour are often found in Adverse Childhood Experiences including physical, verbal, sexual abuse and neglect . Or , it may be a nurtured maladaptive coping strategy, strengthened and developed over time to help some cope with being an emotional hostage to trauma they cannot articulate. Whatever the reason, it rarely has anything to to do with wanting to die, contrary to belief most people who self-harm, do so to preserve life. 

“In case you didn't know, dead people don't bleed. If you can bleed, see it, feel it, then you know you're alive. It's irrefutable, undeniable proof. Sometimes I just need a little reminder.”

Mental health issues can affect anyone, at any time, and military service personnel are no different.

Research suggests that some veterans are at an increased risk of self-harm, the risk reduces steadily the longer someone serves but I think the biggest risk factors come from pre-service life experiences coupled with adjustment and assimilation difficulties. after service.

During basic service recruits are indoctrinated to believe that they are ‘the best’ and in many ways better than their civilian counterparts. This re-programmed concept of self is both functional and necessary during military service. It takes on average just three months to strip military members of their civilian identity and replace it with a military mindset that reflects military culture and life. However, this causes significant adjustment problems when they return to civilian life. The loss of identity, structure and team membership can result in deep feelings of alienation and disconnection when returning to a fast-moving world where thousands of people are competing for both jobs and security . The reality is most people end up doing nothing more than trying to survive. To not spend the same time and effort to reverse the process at the end of a servicemember's time in uniform is neglectful.

The long term consequence of not adopting a reverse culture training programme can result in many feeling that they are no longer in a place that they recognise as home, and consequently become isolated lonely and depressed. This can lead to self-harm, confusion anxiety and a sense of hopelessness.

There are over a hundred military service charities in UK that support the well- being of veterans and their families. There are also over three hundred specialist mental health/suicide and self harm organisations.  I think we are now at the point where there is so much replication and duplication in this sector that it has become damaging and toxic.

If I feel this way, how on earth do Veterans feel? Something isn’t right and it isn’t working. An article printed in the Guardian stated 70% of the public think there are too many charities doing similar work and competing with each other. Sadly, it would appear to be true , we recently picked up a referral who had twenty two different agencies working with him and none of them were in contact with each other.

Care planning and care coordination is the way forward but in a sector where everyone is fishing in the same pool and competing for funding, we are a long way off the delivery of needs led, coordinated specialist support where the veteran is at the centre, for those that self harm the need is acute.

 Paula Edwards

Mental Health Therapist

Salute Her Women Veterans Project.

Help for Zeros

Help for Zeros

The Armed Forces Covenant

According to the MOD, ‘the Armed Forces Covenant sets out the relationship between the Nation, the State and the Armed Forces. It recognises that the whole nation has a moral obligation to members of the Armed Forces and their families, and it establishes how they should expect to be treated. It exists to redress the disadvantages that the Armed Forces community faces in comparison to other citizens, and to recognise sacrifices made. In some cases this will require special consideration, especially for those who have given the most such as the injured and the bereaved. The principle behind the Covenant is that the Armed Forces Community should not face disadvantage because of its military experience. In some cases, such as the sick, injured or bereaved, this means giving special consideration to enable access to public or commercial services that civilians wouldn’t receive. The Covenant covers issues from housing and education to support after Service. It is crucial to the Government that it, and the nation, recognises the unique and immense sacrifices military personnel / veterans have made for their country.

Yet, its a matter of conjecture if those at the highest level across Government are sticking to the promises made in the Covenant.’

“....People facing multiple needs and exclusions are in every community in Britain. They suffer several problems at the same time, have ineffective contact with services, and are living chaotic lives. Each problem exacerbates the other and people easily end up in a downward spiral of mental ill health, drug and alcohol abuse, crime and homelessness. One estimate suggests that there are approximately 60,000 adults in this situation in England at any one time.” The Revolving Doors Agency

Sadly, these include increasing numbers of military veterans.

Question: Is the Nation embracing the Armed Forces Covenant and providing the necessary support for former servicemen and women who experience social exclusion, have multiple ‘unmet’ complex needs and are involved with the Criminal Justice System?

The majority of veterans go on to forge impressive second careers. Those veterans with physical injuries undoubtedly receive very high levels of medical provision and rehabilitation support. Yet, many others suffering mental illness and other psychological issues struggle to cope, become excluded and end up in prison. At a time when members of the military are being upheld as an example of professionalism and national pride and the family promoted as a vital ingredient of a harmonious society, this situation is surely wrong. The impact is profound resulting in massive human and financial costs.

• An estimated 12% of our homeless population are veterans – (Shelter).

• The number of veterans committing suicide is increasing.

• Examples of family breakdown, domestic violence and divorce are increasing.

• Approximately 8% of the prison population are veterans (7,000+), with many others on Probation and Community Supervision Orders (6,000+).

• Disturbingly, many veterans in prison are held in Vulnerable Prisoner Units.

• Annual Prison costs - £45,000 per person, per annum, plus: -
  Cost to Victims, Police, Courts, Health, Social Services, Impact upon Families and Children, Education, Benefit Payments and lack of earned taxable income and NI.

• Total cost of offending – approximately £170,000+ per person, per annum –

• Total cost to the state – Many hundreds of £M’s, plus family / social breakdown. Causes of Crime. In discussing this issue, it is essential to recognise why people become involved in crime, all of which is well researched

• 75% of prison population experience mental health illness.

• A lack of confidence, self-worth, self-esteem, basic and key skills, employment and income.

• Family breakdown.

• Feelings of fear, shame and guilt, particularly relevant to former military personnel.

• Lack of appropriate role models and support.

• Alcohol and drug misuse, primarily as a result of the above.

Those who, after leaving the service become involved in crime, experience most if not all of these problems. Many also suffer experiential flash backs to incidents associated with combat related trauma. Importantly, we need to get away from the mantra that only those who have experienced service life can understand the impact this can have on the individual. The reality is trauma… is trauma… is trauma. The best therapists I have seen are all civilians but experts in their field. Yet, a disconnection with society still exists for many veterans.

“ As far as I am concerned I left the military 15 years ago and I am deep undercover in the civilian community: I dress like them...I act like them but I don’t trust them and have nothing in common with them”

Former SNCO Royal Marine Commando (Following discharge he reported he was sectioned under the Mental Health Act and also convicted of a violent offence.)

“ I returned home to live in a North East ‘pit village’ in the late 70’s and have never spoken to anyone, other than you, today, about what I experienced in Northern Ireland. I’ve been married over 40 years and my wife has no idea what’s going on in my head.....I didn’t think you could be lonely when you were married, but trust me you can! She thinks I just ‘go on the occasional bender’ for no reason and she hasn’t made the connection with the news or documentaries on the ‘troubles’. Some days I am still there.... if I had only pulled the trigger things might have been so different”

Former member of the Parachute Regiment SNCO 2010

The Armed Forces Benevolent Organisations work hard to ‘mop up’ the social and economic fall-out and wider needs of what is becoming a significant disenfranchised group of society. The Royal British Legion proudly promotes the fact that it gives out one million pounds worth of financial and welfare support every month. The fact that it has to do this is a sad indictment of the levels of deprivation and need that exists. Add to this the money paid out by Help for Heroes, Combat Stress, SSAFA and the other veteran specific charitable organisations and the true cost of looking after our former service personnel totals billions of pounds.

‘Hero to Zero’ is a much hackneyed term, used by the media on both sides of the Atlantic to describe former servicemen and women that have lost their ‘media’ imposed status as a ‘HERO’.

For those suffering with mental illness, becoming drug and alcohol dependant, homeless or involved with the Criminal Justice System, the tendency is to conveniently forget the sacrifices made and resort to labels such as failure, waster and criminal. Yet, the Military Covenant says ‘it is crucial that it (the Government) and the nation recognise the unique and immense sacrifices military personnel / veterans have made for their country.” Surely this should also include the general well-being of families and those suffering with mental illness. Veterans who fall upon hard times should not be dependent on a mix of ‘means tested’ state and charitable hand outs or subjected to further exclusion.

During my 37 year Social Work career; working in numerous frontline and senior management settings, I have noticed increasing numbers of veterans presenting as homeless or in need of mental health support services, often suffering from diagnosed and undiagnosed mental health problems (anxiety, depression, adjustment disorder and combat related Post Traumatic Stress. Many others are presenting at Accident and Emergency Departments or GP surgeries, Drug and Alcohol substitute prescribing services, recovery centres, Alcohol Anonymous, Narcotics Anonymous or Cocaine Anonymous meetings and, sadly, in growing numbers, within the Criminal Justice System.

12 years ago, I founded a Community Interest Company (Superseded by Forward Assist in 2013) My aim was to establish a ‘needs led’ service for veterans, designed specifically to establish support for what was a ‘disparate’ and ‘hidden population’ within the Criminal Justice System and other social welfare services. Over the years the numbers awareness and need have increased significantly. Of note, at that time, most of the associated intervention services commissioned by the 12 regional Local Authorities to provide interventions with veterans failed to ask individuals accessing their services if they had served within the Armed Forces. This fundamental omission at first point of contact, the assessment stage or during the writing of a pre-sentence report can lead to a missed opportunity to understand the ‘root cause’ of the multiple complex issues that may exist. A mandatory inclusion in an assessment process would allow all civilian based welfare organisations to assess the level of need and ‘flag up’ the possibility that the presenting behavioural manifestations may or may not be directly related to military service or the transition from it.

Sadly, in too many cases, those that do ask don’t know what to do with veterans after the initial identification. Rather organisations attempt to ‘shoe horn’ veterans into existing provision that is neither appropriate nor relevant to the veteran’s individual needs. Similarly, Veterans are notoriously bad at asking for help and may view survival ‘on the streets’ or when experiencing acute adversity as a continuation of the field exercises or combat missions that they took part in whilst on active service. Couple this with a highly developed sense of pride and a stubborn independence and desire to not to become viewed as a burden on society; it’s not surprising that civilian orientated support services find it difficult to maintain a meaningful relationship with former military personnel.

Many veterans continue to feel a deep sense of dislocation within the civilian community long after discharge, and their ability or indeed inability to re-invent themselves or assimilate back into society is very much dependent upon how they exited the armed forces. In our experience, the reintegration process to civilian life is exacerbated on many different levels dependent upon how an individual left the military. Many are discharged following successful and lengthy periods of service but struggle to find sustainable employment; others are medically or dishonourably discharged following their involvement in unacceptable behaviour or criminal activity. The latter find it extremely difficult to re-establish themselves in the civilian job market or reconnect with family or friends.

The issues facing former service personnel are both multiple and complex and in many cases exacerbated as they make the transition from Military to Civilian and/or Custody to the Community.

“We need to rehabilitate veterans not incarcerate them”

Judge Russell: Buffalo Veterans Court New York USA

Many veterans are in receipt of state benefits with a large percentage claiming Disability Living Allowance as a result of physical injuries that they described were the result of the ‘wear and tear’ during service life. A large number report that they suffer from multiple mental health conditions with having problems maintaining paid employment. Very few report that they had a better job with more status than the one they held whilst serving in the military. At least half of the veterans we work with have direct experience of homelessness at the point of referral, but a larger percentage report being technically homeless on discharge from the military. Many have alcohol and drug related dependency issues and most describe alcohol as ‘Army Medicine’ - they celebrated with it and commiserated with it during times of stress or bereavement and it continues to be a problem long after service life ends. As a result, many have convictions for drink driving offences.

“...a full english breakfast....a six hour period since your last drink... a shit, shower and a shave and we were ready to fly!”

Former Royal Navy Helicopter Pilot

Almost all the veterans involved with our service have had multiple relationships after leaving the services and several had been married three times or more. Divorce was a shared experience and many described themselves as absent parents. The vast majority lived alone or with partners that owned their own homes. A small number that were subject to Community based Court Orders admitted having committed domestic violence. The damaging impact upon children and its associated costs is likely to become apparent in time. Many reported experiencing chronic social exclusion and associated isolation. In many cases it was self imposed following a relationship breakdown and/or the result of negative experiences of trying to engage with civilian based support services that did not understand them. Others said that they had no idea what services were available from the Royal British Legion, Combat Stress, and SSAFA.

A significant number of veterans accessing our service reported that they felt that they did not have transferable skills and many reported that they had no idea how to write a CV, send an email or set up a direct debit. A large number admit having poor literacy and numeracy skills and others admit that they could not cook and had no understanding of Government recommended guidelines in relation to calorific intake, nutrition or the negative effects of excessive alcohol misuse, and the dual use of prescribed/illicit street drugs.

“Since leaving the mob two years ago I have lived on ‘pot noodle sandwiches’ and take-away food”

Iraq /Afghanistan: Veteran

Many veterans report that they had financial difficulties and unpaid debt. Most need advice information and guidance in relation to Military pensions, Criminal law, and Family law, Prison law, Housing law and Mental Health law.

Referrals from GP’s CPN’s and other mental health support workers including Combat Stress account for nearly a third of the case load. Despite the evidence of the effectiveness of interventions, very few organisations currently contribute financially to the services offered. Nearly a third of all referrals are ‘self referrals’ and result from ‘word of mouth’ recommendations from group members, family members or partner organisations. The North East is allegedly the largest recruitment area for HM Armed Forces. The low numbers for the RAF, Royal Navy and Royal Marines can be attributed to the national geographical spread of the respective operational and strategic headquarters. Nonetheless, it is worrying to note how many former Army personnel end up with ‘unmet’ multiple and complex needs.

“When I left the Army after 18 years service.... it was pack your kit..... I’m escorting you to the gate...have a nice life”

Infantry Soldier diagnosed with PTSD: Discharged as ‘Services No Longer required’ after failing Mandatory Drugs Test X2

Whilst we accept that more research needs to be carried out to establish a direct link with combat operational experience and poor social outcomes, it is clear that there is a correlation between self reported problems that are associated with transition, assimilation, adjustment and identity following service life. Unresolved issues relating to bereavement, guilt, shame, addiction and anxiety when coupled with episodic bouts of insomnia and loneliness all impact negatively upon the ability of many veterans to remain in a permanent employment position or comply with community based Court Orders. This is particularly relevant if the issues are socioeconomic/psychological or physical in nature and ignored. Multiple and complex needs require wide-ranging and far-reaching sustained interventions.

These difficulties can be unique to an individual and may need to be ‘unpacked’ separately or collectively in unison with an empathetic mentor or caseworker. Short sighted and ‘top down’ solutions that look for ‘quick fix’ results via brief therapeutic interventions or adopt a ‘refer on’ approach to problem solving will invariably result in failure and continuing long term damage to psychological wellbeing. Similarly, it is unrealistic to expect a small number of incongruent and financially competing Public and Private Sector organisations and Armed Forces Charities to be able to understand or meet the needs of those hero’s reclassified as ‘zeros’. In all walks of life prejudice and discrimination exist and it is a sad fact that those former service men and women that end up in the Criminal Justice System and/or who live chaotic lives, continue to be viewed as ‘unworthy’ by those tasked with the responsibility of supporting them.

The introduction and implementation of the Armed Forces Covenant and the locally driven Armed Forces Forums will hopefully help to ensure organisations ‘sit at the same table’ and look at how the needs of veterans can be collectively met. That said, currently there appears to be a reluctance to share good working practices, information or planned initiatives. In practice the referral of veterans to other organisations within the network is limited. This reticence is often driven by individual egos, institutionalised and organisational cultures and/or perceived competiveness in regard to funding and reputation.

It is essential that any process of localised ‘grass roots’ qualitative and quantitative statistical data be collected, shared and acted upon. This requires meaningful and respectful partnerships where organisations work closely with one another, acting selflessly in the interest of the ‘greater good’ and individual veterans. Specially designed service delivery models with integrated pathways, specialised support and targeted funding would significantly improve the engagement of marginalised veterans and their families, thus reducing the social isolation, the risk of offending and the massive associated costs. If we really care about veteran offenders then we need to collectively work together to help them change their lives for the better. Similarly, the many organisations that now purport to work with veterans involved with the CJS should reflect upon that statement and adjust their own behaviour and responses to ensure that service delivery is both collaborative and in the best interest of the veteran and not that of their organisation.

Tony Wright CEO Forward Assist

The 2021 Mental Health Tsunami...

I think everyone can agree 2020 was just weird! For the first time in my life, and I guess many others every appointment and arrangement both business and private was cancelled or put on permanent hold.

We decided to ‘shut up shop’ as it were in early March 2020 ,a week before the country were told to go home, self isolate and work from home. Our contingency plan was simple; cease all face to face interventions and go digital. Its been an interesting transition and for us, one we couldn’t have envisaged without actually been forced to think creatively. We thought the lockdown would exacerbate existing problems such as isolation and loneliness, and for those those suffering from depression we expected an influx of self harming behaviours. Interestingly, it never actually panned out like that, as those we had regular virtual contact with actually enjoyed the immediacy of a ‘one to one’ virtual connection whilst sat in the comfort of their own home. Of course, there were those that needed a little practical help with food parcels and delivery of prescriptions etc but all of those issues were very quickly addressed through multiple partnerships and the willingness of many to work together for the first time. Such relationships have endured and so far we haven’t had a crisis we couldn’t address collectively, and this is simply because everyone is just that little bit more flexible empathetic and understanding. Yet more importantly, there is a willingness across all services to make themselves available to help out those in need. That is the power of community! That isn’t to say that uncertainty about the future isn’t a problem… it is! Lockdown 3 will test the mettle of all, and the worry is frontline workers will become exhausted either before vaccination or very soon after. Burn out will happen. Mental Health counsellors will in the coming months be needed more than ever with an estimated 13 million people across the country in desperate need of specialist support and advice. The reality is, there just isn’t enough to go around so people will have to wait even longer for ‘needs led’ person centred support, which will cause significant problems in the long run.

We all know that in the absence of talking therapies people either self medicate or are medicated by the state, both routes create problems for both the individual and society. In the coming months the resilience of the great British public will be tested further and communities will have to find ways to support each other. The crisis has shone a spotlight on the really important things in life and for many the loss of personal freedom and employment will weigh heavy on society and individuals alike for years to come. National debt has rocketed in the last 10 months and its clear things are going to get a lot worse before they get better. However, the perennial question of who nurtures the nurturers will need to be factored into any sustainable intervention. If we lose sight of the crucial contribution of low paid frontline workers, volunteers ,carers, medicos, and community leaders we are in trouble. Asset Based Community Development will help us build on the assets that are found in the community and mobilises individuals, associations, and institutions to come together to realise and develop their strengths. Community Self help is the way forward and we all need to have a say in how ‘change’ in the next ten years will impact our lives…so if you can, be of service to others and get political. The time has come to look to the words of JFK and …

"Ask not what your country can do for you, ask what you can do for your country."

Good Luck… we are all in this together.

Tony Wright CEO

Ten Years Since the Launch of Armed Forces Community Covenant.

This year is the 10th anniversary of the introduction of Armed Forces Community Covenant which was launched in 2011. Since that time every local authority in the UK has signed ‘ a community covenant partnership’ with their local Armed Forces Community. Many local authorities introduced the role of Armed Forces Champion. The Ministry of Defence Guidance, Armed Forces Covenant for communities guidance states:

“The role of a ‘champion’ is often to make sure that the local authority achieves its commitments to the armed forces community and any blockages are resolved.”

Since then we have also witnessed the formation of the UK Office for Veterans Affairs in 2019 whose raison d'etre is;

“Lead UK Government efforts to make sure the United Kingdom is the best place to be a veteran anywhere in the world, helping the nation fulfil its lifelong duty to those who have served in the Armed Forces”.

Yet, there is considerable disconnect between the rhetoric and the reality. There are thousands of grass roots veteran centric, charities, CIC’s, unincorporated community groups and individuals who support military veterans 365 days of the year. Yet, it sometimes feels that its ‘open season’ on small charities as their contribution is frequently dismissed, ignored or discredited.

The C-19 pandemic and subsequent lockdowns are a perfect example of how the wider community came to the aid of isolated lonely veterans and families , some delivering Christmas Dinners to those in need on Christmas Day. Sadly, these outstanding examples of community cohesion and endeavour go unnoticed and remain unrecognised by the very people who are supposed to be representing and championing the needs of the community.

Similarly, the Government continue to consult with the larger service charities who at times are unaware of issues on the ground and/or unable to understand the grass roots need of those they claim to represent. There is little if any recognition given to those whose contribution is voluntary, in fact there are looked down upon by many in the sector. Yet, where would we be without them?

We would be a very wealthy charity if I had a pound for every time I heard the well hackneyed lament that there are too many charities in the service sector or that any organisation working with veterans must be accredited in keeping with an ‘Ofsted’ style inspection and registration system. Yet, the vast majority of those suggesting such a move, have no professional qualifications in the Health and Social Care sector.

Armed Forces Champions come and go, so its almost impossible to build a long term working relationship with one particular individual , others don’t come from an Armed Forces background and some of those that do, work or volunteer for larger military charities with the potential that the needs of their employer or subconscious bias come before those of the community they represent. This leads to mistrust, it is divisive nature and certainly not in the interest of those we seek to serve …Veterans!

Several of my associates across the country have described the bi-annual forums as nothing more than ‘taking shops’ with no direction or cohesive strategy to work collectively or stop the never ending duplication of services, which if not managed properly, causes confusion for those seeking help and support. Others argue that at best, they signpost veterans to support … a start and better than it used to be, but an irresponsible act if there is no follow up on progress made or if the veteran in question doesn’t actually engage with the service provider. Navigating government bureaucracy is at best confusing, but amidst a worldwide pandemic, its almost impossible.

When life eventually returns to the new normal many veterans will feel angry, disillusioned, unsupported and ignored. So we should all expect a tsunami of complaints and requests for mental health support in the coming months and years. Not connecting to a society that promises so much help will lead many into self imposed isolation, loneliness , marginalisation, and self harming behaviours. Lets remember there is so much more to life than getting a job and getting somewhere to live, albeit its a starting point, but not the ‘be all and end all’ Its at that point the work really begins as veterans struggle to adjust to an alien civilian world with all its capricious vagaries.

In the anticipated economic downturn getting a job may not be an option. Homelessness, incarceration, domestic violence, addiction, suicide, and poor mental health may become bigger problems than they already are. Yet, I haven’t seen any evidence that the powers that be, are doing anything all to put in place a strategy to address the anticipated need for a significant uplift in, personalised. practical and mental health support for veterans and their families.

In the absence of direction from the centre, this is the perfect time to reintroduce and adapt the guiding principles of Asset Based Community Development & The Big Society. See: https://vimeo.com/15218724

This time we need to promote citizenship which fosters Post Traumatic Growth by allowing veterans to be of service to others. Now is the time to embrace the healing powers of ‘Associational Life’ and tap into the support from the plethora of individuals with ‘lived experience’, community support groups and informal networks already in existence.

(Thanks to Cormac Russell for permission to use his infographic)

Tony Wright CEO Forward Assist

Saints And Sinners: UK Veterans in The Criminal Justice System

Mental Illness Is Not A Disease.

In the last 100 years, Psychiatry has made significant advances, gone are the days when recovery from a psychiatric disorder was reliant on the draining of blood from Galen’s Four Humours (Greek physician, AD 129 – 216)  Yet how far have we really come in understanding Mental Health and what does recovery looks like?

It is not surprising that having ‘mental health’ problem carries with it a great deal of stigma as the the early response and treatment involved sending individuals to institutions (asylums) for so called treatment and never letting them out!

Throughout our lives we have probably all been guilty of using slang terms to describe those who have a mental illness. Children are taught to view people as either ‘normal’  or ‘abnormal’ based upon the behaviour they could see, and how the person fitted into or didn’t fit into their communities.  Using labels like, ‘schizo’, ‘crazy’ or other clinically diagnostic labels like ‘ Personality Disorder’  ‘ Post Traumatic Stress Disorder’ or Anxiety can trap suffers into thinking that they have ‘something’ wrong with them or worse, that this ‘something’ means they are broken and defective.

Labels are overly used in psychiatry and it does not sit well with me. In my experience it can give some people licence to behave badly,  ‘it’s not MY fault I’m sick’.  Even the term ‘mental illness’ or ‘mental health’ has negative connotations implying that there is a right and wrong way to be.

Psychiatry is often based on a chemical imbalance theory or uses a medical model to diagnose and inevitably treat mental illness. Often taking into consideration genetics, patterns of behaviour and the presentation of clinical symptoms. This model of  treatment loses sight of and strips away those personal life experiences that influence all behaviour be that good or bad. People forget that reacting to trauma and the associated stressors is perfectly normal.

This level of misunderstanding can often lead professionals down a rabbit hole,  if the clients  presenting issues are not understood the fall back position is to rely on the trusty medical model. Creating a false sense of hope for the patient and the family. Sometimes making them believe that medication is the only way to manage mental illness and when the ‘magic pill’ outcome fails , trust and hope is often destroyed.

In my experience working with Veterans is no different. Returning to civilian life after serving in the military is a difficult challenge that thousands of Veterans must face. For some, this will necessitate that they will need to learn how to manage both physical and psychological wounds.

Many of the Veterans  we work with often identify with feeling that life is harder for them to manage than most. Yet, what if a large part of the problem didn’t have anything to do with mental illness or impositions faced during transition?  What if it had more to do with a lack of community connection, boredom, loneliness and not understanding how to manage difficult thoughts and feelings ?

For serving military personnel time is structured with numerous tasks to complete, service personnel are always busy and rarely on their own. There isn’t enough time to think or feel, in fact it is actively discouraged.

In the civilian world time is a Veterans enemy.  Suddenly they are thrown into a world where employers expect employees to work autonomously even when they are part of team. Colleagues go  home to their families, the landscape is constantly changing and expects constant adaptation.  There is no protective military cocoon.

Medicalising veterans issues doesn’t help anyone. I have a growing sense of unease that instead of helping Veterans we are trapping them in state of unwellness.

Don’t get me wrong, some Veterans will need medication to help them with their problems and traditional psychiatry can and will help.

Yet, we have found the adoption of a psychosocial model to support veterans  gain control over their individual and social environment results in far more  positive and sustainable outcomes.

Teaching Veterans how to ask for help, coping skills, resilience, problem solving, self regulation, the importance diet and nutrition and the challenges that they are likely to face during a life lived well. For example, relationship breakdown, loneliness, unemployment and the impact of growing old disgracefully, not only empowers Veterans, it also provides them with individual tools that allow them to face and solve problems as well build resilience to deal with life’s stressors.

Psychiatrist, Professor Sir Simon Wessely, was probably right when he said,’ his heart sank every time there was a mental health awareness week’ simply because;

“ We don’t need more people to be aware. We can’t deal with the ones who are already aware”

 In summary, lets look at different ways to support veterans, especially ones that don’t label them or stigmatise.

 Paula Edwards

Salute Her Project Lead & Mental Health Therapist.