Veterans Who Self Harm

The issue of self-harm within the military and veteran community in the UK is a complex and sensitive topic, and several factors contribute to its lack of open discussion:

  1. Stigma and Perception of Weakness:

    • There exists a pervasive stigma surrounding mental health issues within the military and veterans. Members may fear being perceived as weak or unfit for service if they disclose struggles with self-harm. This stigma can discourage open conversations and prevent individuals from seeking help.

  2. Military Culture and Toughness:

    • Military culture often emphasises toughness, resilience, and the ability to endure challenging situations. Discussing self-harm may be perceived as incongruent with these values, leading to underreporting and a reluctance to address mental health concerns openly.

  3. Fear of Professional Consequences:

    • Military personnel and veterans may fear that disclosing self-harm or mental health struggles could negatively impact their careers. Concerns about job security, promotions, or assignments may deter individuals from seeking help or discussing their challenges openly.

  4. Lack of Mental Health Education:

    • Despite increased efforts to promote mental health awareness, there may still be a lack of comprehensive mental health education within the military. This can contribute to a lack of understanding about self-harm and how to address it effectively.

  5. Challenges in Accessing Mental Health Services:

    • While mental health services are available within the military, challenges such as long wait times, concerns about confidentiality, and perceptions of inadequate support may discourage individuals from seeking help for self-harm.

  6. Norms of Secrecy and Elitism

    • Military personnel and veterans can often develop a strong sense of camaraderie along with a indoctrinated belief of elitism, which can foster a culture of secrecy. Individuals may be hesitant to disclose personal struggles, including self-harm, for fear of disrupting this sense of trust and unity.

  7. Mental Health Stigma in Society:

    • The broader societal stigma surrounding mental health issues can also affect the military community and veterans. The reluctance to discuss self-harm may be influenced by a fear of judgment or misunderstanding from civilian counterparts.

  8. Crisis Response Over Prevention:

    • Military organisations and service charities may focus more on crisis response than proactive prevention when it comes to mental health. Addressing self-harm may be reactive, emphasizing intervention rather than fostering an open dialogue about prevention and mental well-being.

To address these challenges and promote a more open discussion about self-harm within the military community in the UK, it is essential to:

  • Destigmatise Mental Health:

    • Challenge stereotypes and promote a culture that views seeking help for mental health issues, including self-harm, as a sign of strength rather than weakness.

  • Provide Comprehensive Mental Health Education:

    • Integrate mental health education into military training to enhance understanding, reduce stigma, and encourage early intervention.

  • Improve Access to Confidential Support:

    • Ensure that mental health services are easily accessible, confidential, and provide the necessary support for individuals dealing with self-harm.

  • Encourage Peer Support:

    • Foster a culture of peer support within the military community and veterans to encourage open conversations and provide a network of understanding.

  • Promote Leadership Involvement:

    • Leaders within the military should actively promote mental health discussions and create an environment where seeking help is encouraged without fear of reprisal.

  • Collaborate with Mental Health Professionals:

    • Strengthen collaboration between military organisations and mental health professionals to ensure that comprehensive and specialised support is available.

By addressing these aspects, it will be possible to create a more supportive and understanding environment within the military and veteran community, where self-harm and mental health issues can be openly discussed and effectively addressed.

Tony Wright CEO Forward Assist

 "Unseen Battles: The Plight of Disenfranchised UK Veterans at Christmas"

        

The festive season, traditionally a time of joy and togetherness, can be an especially challenging period for veterans who find themselves disenfranchised and disconnected from the support networks they once relied on within the UK military. Various factors, such as medical discharge, short-term service, early service leavers, bullying, harassment, military sexual trauma, PTSD, loneliness, muscular skeletal injuries, old age, bad life choices, suicidal thoughts, poor mental health, and a toxic culture within service charities, contribute to a complex web of challenges that these hidden veterans face. I want to explore the multifaceted issues surrounding disenfranchised veterans during the Christmas season, shedding light on the intersectionality of their struggles.

There are many facets to veteran disenfranchisement, not least the experiences of those that don’t feel wanted by the veteran community or those not driven to join associations or support groups. Veterans who experience medical discharge or engage in short-term service often find themselves abruptly disconnected from the military community. The lack of a gradual transition can lead to a sense of isolation, especially during the holiday season when the camaraderie of fellow service members is sorely missed. Veterans who have experienced bullying, harassment, or military sexual trauma may carry invisible wounds that affect their mental health. The stigma attached to these experiences can create a sense of shame, making it difficult for them to seek help or connect with others during festive occasions. Those grappling with post-traumatic stress disorder (PTSD) and muscular skeletal injuries face physical and emotional challenges that can be exacerbated during the holiday season. Crowded spaces, loud noises, and festivities may trigger traumatic memories, leading to heightened anxiety and a desire to isolate themselves. Older veterans and those grappling with the consequences of past life choices may find themselves on the fringes of society during Christmas. As physical health declines and regrets mount, the festive season can serve as a painful reminder of the passage of time and missed opportunities. As I’ve mentioned before in my other blogs, service charities, designed to support veterans, often find themselves in fierce competition for funding. This competition can foster a culture of prioritising positive narratives to attract donations or worse promoting false narratives such as all veterans are mad, bad or sad and couldn’t cope if it wasn’t for their charity’s specific intervention. The infantilising of military veterans’ narrative should be a concern for all those working in the sector as this rhetoric leaves the struggles of disenfranchised veterans and those that go on to have extremely successful second or third careers after returning to civilian life, in the shadows. The above notwithstanding, the false narrative of unity among service charities may further perpetuate a lack of targeted support for those in need.

Disenfranchised veterans often face financial difficulties, exacerbated by a lack of support systems. Additionally, race discrimination within the military and broader society can compound the challenges faced by veterans of colour, creating barriers to accessing the resources they require during the holidays. The intersectionality of poverty and fear of asking for help forms a vicious cycle for disenfranchised veterans. Financial difficulties may lead to an inability to access necessities, and the fear of judgment or rejection may prevent veterans from seeking the assistance they desperately need during Christmas. Veterans experiencing homelessness or relationship breakdowns face intensified struggles during the festive season. The lack of stable housing and fractured relationships further isolate them from the warmth and connection typically associated with Christmas. Veterans entangled in the criminal justice system may feel ostracised during the holiday season. The stigma associated with legal troubles can deepen their sense of disconnection, making it challenging to rebuild their lives and reintegrate into society.The problems faced by disenfranchised veterans during Christmas are rooted in a myriad of complex and interconnected issues. From the lasting impact of military service to the challenges posed by a competitive charity landscape, the holiday season can magnify the struggles these veterans endure daily. It is imperative for society, the military, and service charities to acknowledge the multifaceted nature of these challenges and work collaboratively to provide targeted, empathetic, and effective support. Only through a comprehensive understanding of the intersectionality of these issues can we hope to create a Christmas season where no veteran feels left behind or forgotten.

Tony Wright CEO Forward Assist

Moving On: The Pros and Cons of Service Life For Military Children

Being a military child comes with both advantages and challenges. Here are some of the pros and cons:

Pros:

  1. Cultural Exposure: Military families often move to different locations, providing children with exposure to diverse cultures and environments. This can lead to a broadened perspective and adaptability.

  2. Structured Environment: Military life often instils discipline and a structured routine, which can be beneficial for a child's development.

  3. Strong Support System: Military communities are known for their strong support networks. Families often form close bonds, providing a sense of belonging and camaraderie.

  4. Travel Opportunities: Military families may have the chance to live in various parts of the world, allowing children to experience different landscapes, climates, and lifestyles.

  5. Educational Opportunities: Military bases often have good educational facilities, and the experience of changing schools can make children more adaptable and resilient.

Cons:

  1. Frequent Moves: The most significant challenge is the frequent relocations, which can disrupt friendships, educational continuity, and a sense of stability.

  2. Parental Deployments: Military children often experience periods of separation from one or both parents due to deployments. This can be emotionally challenging and may contribute to anxiety or stress.

  3. Social Challenges: Constant moves can make it challenging for military children to establish lasting friendships. They may also face difficulty in adapting to new social environments.

  4. Educational Disruptions: Changing schools frequently can lead to gaps in educational continuity, making it difficult for children to follow a consistent academic path.

  5. Emotional Strain: Dealing with the uncertainty of a parent's safety during deployments can place emotional strain on military children. The stress can manifest in various ways, including behavioural issues or anxiety.

  6. Limited Control over Life Choices: Military children may feel a lack of control over their lives due to the nature of their parents' careers, leading to a sense of powerlessness.

In summary, being a military child involves a mix of positive and challenging experiences. The lifestyle can foster resilience, adaptability, and a strong sense of community, but it also brings about disruptions and emotional challenges associated with frequent relocations and parental deployments.

Tony Wright CEO

 

Invisible Older Veterans With Diagnosed or Undiagnosed PTSD

As we approach the festive period, it is essential to shed light on a critical issue that often remains hidden — undiagnosed post-traumatic stress disorder (PTSD) among older veterans in the United Kingdom, particularly those residing in care homes. While public awareness of PTSD has grown, there is still a significant gap in recognising and addressing the mental health needs of this invisible population. This blog explores the challenges faced by older veterans in the UK, the implications of undiagnosed PTSD, and the urgent need for increased awareness and support in care home settings.

Older veterans in the UK, who may have served in conflicts like the Falklands War, Northern Ireland, or even World War II, carry hidden traumas that often go undiagnosed. The passage of time does not necessarily diminish the impact of wartime experiences, and for many, the scars of combat persist into their later years. Undiagnosed PTSD can manifest in various ways, affecting not only the mental but also the physical health of veterans.

One of the primary challenges faced by older veterans in the UK is the lack of recognition and diagnosis of PTSD, especially in the context of care homes. The symptoms of PTSD can be misattributed to the natural aging process, making it difficult for healthcare professionals to identify the root cause of veterans' distress. Consequently, many veterans suffer in silence, and their mental health needs remain unaddressed.

Stigma surrounding mental health issues remains a significant barrier to the diagnosis and treatment of PTSD among older veterans in the UK. Traditional notions of masculinity, prevalent during the time these veterans served, may contribute to their reluctance in seeking help. Cultural barriers within care home environments may exacerbate this stigma, perpetuating the idea that mental health concerns are best kept private.

The sense of isolation experienced by older veterans in care homes can further compound the effects of undiagnosed PTSD. Unlike their military service years, where camaraderie provided a support system, care home residents may find themselves without the companionship and understanding of peers who share similar experiences. This isolation can intensify feelings of loneliness and exacerbate mental health challenges.

Addressing undiagnosed PTSD among older veterans requires a targeted and specialised approach. Care homes in the UK should invest in training staff to recognize the signs of PTSD in older residents. Additionally, mental health professionals with expertise in geriatric PTSD should be integrated into care teams to provide tailored support and treatment.

Increasing public awareness is crucial to breaking down the stigma associated with mental health issues among older veterans. Community engagement programs, workshops, and educational initiatives can play a pivotal role in fostering understanding and empathy. By involving families, friends, and the wider community, we can create a supportive environment that encourages veterans to seek the help they need.

As we reflect on the past year, it is imperative to recognise the invisible population of older veterans grappling with undiagnosed PTSD in UK care homes. By addressing the unique challenges faced by these individuals, fostering awareness, and promoting a culture of openness and understanding, we can work towards ensuring that the mental health needs of our older veterans are met with the dignity and respect they deserve in their later years.

Tony Wright CEO Forward Assist

Veterans, Self Medication, Loneliness and Isolation.

Veterans, like any other population, may engage in self-medication with drugs and alcohol for various reasons. It's important to note that not all veterans turn to substance abuse, and many successfully manage their mental health without relying on these substances. However, some veterans may face unique challenges that contribute to self-medication. Veterans may experience trauma during their service, leading to conditions like PTSD. Some individuals turn to substances as a way to cope with the symptoms of PTSD, such as intrusive thoughts, nightmares, and hyperarousal. Many veterans with lived experience of in-service sexual violence report self medicating themselves drugs and alcohol in the absence of specialists trained in supporting military sexual trauma survivors. Similarly, Veterans may suffer from chronic pain due to injuries sustained during their service. In an attempt to manage pain, they might resort to self-medication with drugs or alcohol, especially if they face barriers in accessing effective medical treatments. The transition from military service to civilian life can be challenging, and veterans may struggle with feelings of depression and anxiety. Substance use can be an attempt to self-medicate and alleviate these mental health issues temporarily. Many Veterans may feel isolated or alienated from civilian society, especially if they have difficulty reintegrating into their communities. Substance use may provide a way to cope with feelings of loneliness and disconnection. In addition, some veterans may face challenges in accessing mental health services due to factors such as stigma, logistical barriers, or inadequate resources. As a result, they may turn to self-medication as a readily available means of managing their symptoms and situation. Lets not forget, the military culture can sometimes foster a high tolerance for alcohol consumption, and veterans may continue this behaviour when they return to civilian life. Socialising with peers who also engage in substance use can contribute to the adoption of these behaviours. Currently, veterans may experience financial stress as they transition to civilian life, and this stress can be a contributing factor to substance abuse.

In summary, it's crucial to recognise that these factors are interconnected, and individual experiences may vary widely. Substance use is a complex issue with multifaceted causes, and addressing it effectively often requires a comprehensive approach that includes mental health support, rehabilitation services, and community integration programmes. Military service may give you a lot of unhealthy coping mechanisms and its essential that you reach out for help when you need it. If you or someone you know is a veteran struggling with substance abuse, seeking professional help from healthcare providers, mental health professionals, or veterans' support organisations is essential.

Tony Wright CEO Forward Assist

Should UK Veterans and Their Families Be Given Free Medical Health Insurance For Life?

The question of whether the National Health Service (NHS) is the right organisation to deliver veteran healthcare is a complex and nuanced issue. It involves considering various factors, including the specific needs of veterans, the future capabilities of the NHS, and the potential challenges associated with integrating veteran healthcare into the existing healthcare system, even with funding from the Government. On one hand, the NHS is a comprehensive and established healthcare system with a broad range of services. It has experience in providing healthcare to diverse populations, including individuals with complex medical needs. Integrating veteran healthcare into the NHS could potentially leverage existing infrastructure and expertise, ensuring a seamless transition for veterans from military to civilian healthcare.

 However, there are concerns that the NHS may face challenges delivering and addressing the unique healthcare needs of veterans, such as service-related injuries, for example, muscular-skeletal problems, mental health issues such as military sexual trauma (MST), traumatic brain injuries, Gulf War illnesses and the associated, practical and psychological difficulties faced by veterans and their families when adjusting to civilian life.

 As such, Veterans may require specialised care and support that goes beyond the scope of general healthcare services. Additionally, there may be a need for coordination between military medical service providers and civilian healthcare providers to ensure continuity of care for all veterans, past and present.

 It's essential to consider the views of veterans themselves, as well as experts in both military and civilian healthcare settings when evaluating the appropriateness of the NHS for delivering veteran healthcare. Implementing a system of veterans' priority access to healthcare services over the general public can indeed raise concerns about potential divisions and equity. While there may be a desire to recognise and address the unique healthcare needs of veterans, it's crucial to balance this with the principles of fairness and equal access to healthcare for all citizens. Potential issues and considerations include giving veterans priority access could create a two-tiered system. This may be perceived as unfair and could lead to resentment among the general public, especially if it results in longer wait times or reduced access for non-veterans.

 Prioritising one group over another could strain healthcare resources and potentially lead to disparities in the allocation of funding and personnel. This might impact the overall quality of healthcare services for both veterans and the general public. Perceptions of fairness and equity are critical in maintaining public trust in the healthcare system. If the public perceives that certain groups are receiving preferential treatment, it could erode confidence in the healthcare system as a whole. Prioritising one group over another may raise legal and ethical questions regarding equal treatment under the law. It's important to ensure that any policies align with legal and ethical standards.

 Other concerns about the NHS include, the NHS has often faced financial challenges, leading to debates about funding levels and the ability to meet growing demand for healthcare services. Staffing levels, including shortages of healthcare professionals, have been a longstanding issue. This can impact the delivery of timely and high-quality care. Waiting times for certain treatments and surgeries have been a concern, and addressing these delays has been a priority for improving patient care. Keeping pace with technological advancements and incorporating innovations into healthcare practices is an ongoing challenge for many healthcare systems, including the NHS. The NHS is subject to public and political scrutiny, and debates about its structure, funding, and management will be ongoing.

 It's essential to note that assessments of the NHS's performance may vary, and opinions on whether it is "failing" can depend on individual experiences, political viewpoints, and specific criteria used for evaluation. If there is a genuine need to address the unique healthcare needs of veterans, policymakers should carefully consider approaches that promote inclusivity and fairness. This might involve positive publicity campaigns about veteran centric health services without compromising the overall access and quality of healthcare services for the general public.

 Balancing the needs of different population groups while upholding principles of equity is a complex task that requires thoughtful planning and consideration of potential consequences. In the past, the quality of care provided the National Health Service was excellent. Sadly, in recent years it appears to be getting worse with many GP’s suggesting that their patients go private if they can afford it. However, let’s not forget that NHS treatment is free for everyone at the point of treatment and life-threatening conditions are supposedly a priority. Waiting times, especially for low-priority, routine procedures such as knee and hip replacements post-operative, physiotherapy and dental care, to name but a few, are at an all-time high.

 In conclusion, while the NHS has the infrastructure and experience to deliver healthcare services, careful consideration and planning are required to ensure that, timely medical interventions and care for veterans and their families is available when needed.

 The status of the National Health Service (NHS) in the United Kingdom could vary based on different perspectives, and opinions on its performance may differ. The NHS faces ongoing challenges, such as funding constraints, workforce issues, and increasing demand for healthcare services. Therefore, perhaps it would be better to give veterans and their families, especially those medically discharged from service, free, life-long private health care insurance?

 (For the most up-to-date information on the current status of the NHS and any recent developments, I recommend checking the latest reports from reputable news sources, government health agencies, or official NHS publications.)

 Tony Wright CEO & Founder Forward Assist

 

Do We Need Armed Forces Charities?

As the NHS pick up and run with the veteran health care ball (Operation Courage), I am beginning to wonder if we actually need a service charity sector?

It’s fantastic to see hundreds of isolated veterans now accessing professional help and support from the plethora of expert practioners already embedded in the NHS. Its long overdue, and I like many others can’t quite get my head around where it went wrong in the first place. One of the reasons we didn’t have, until recently, a Department for Veterans Affairs, (a development I really support by the way) was because the NHS was designed to pick up all the holistic health needs of returning veterans when it formed on 5th july 1948.

In its short tenure, the UK Department for Veterans Affairs has, in just over four years managed to put veterans back in the position they should have been in at the end of World War Two. Perhaps that’s because there just wasn’t anyone back then to champion the cause of veterans other than a small group of service charities that were formed at the end of WW1. These charities picked up the tab for Government and operated, in the main, via a network of volunteer support. The landscape really changed when ‘Help for Heroes’ stepped into the service charity arena to meet the unmet needs of veterans who were seriously injured in both Iraq & Afghanistan. It was a game changer.

Lets not forget the old guard didn’t like it, but the great British public knew all too well that veterans were for all intents and purposes, dumped when they left the military. When I was growing up my Father and Great Grandfather both suffered from depression, alcohol misuse and episodes of violent behaviour. Yet, no one made the link between their service in WW1 & WW2. Like others, they would never talk about their time in the services.

It’s only now as I search my family tree that I find out that they were both in the thick of in France 20014-18 and Europe 1944 -45. As they returned home, thousands of veterans were told to get on with their lives and suffer in silence, many living in poverty and having to take any work they could to survive. Interestingly, in my house the only person to be given medication for depression was my Mother and that was due to trying to cope with my Fathers explosive anger issues and violence.

I predict that as care planning and coordinated care pathways become the norm veterans will eventually, of their own volition, gravitate towards the various support services that are being developed in the NHS to meet individual veteran need. This is a good thing. The need for veterans charities to identify, engage and connect with specialist NHS services will become redundant as, quite rightly, veterans take responsibility for accessing their own health care needs. A similar process is happening in the States as thousands of Vietnam Veterans gravitate back to the free health care provided by the US Dept Veterans Affairs after years of rejecting the services on offer.

Simultaneously, the NHS will, as it collects data become more savvy at identifying the causal factors of some of the presenting issues. At the moment veterans are viewed as an homogenous group and bizarrely, the general public are under the misguided impression that all veterans are combat veterans with PTSD. Nothing could be further from the truth and it will become apparent in due course, as we enter another economic downturn, that millions of pounds are spent on those who meet the criteria of Veteran simply because of the anachronistic misnomer of ‘one days service’. I would like to see this criteria reclassified so that funding reaches those that need it most.

Someone should ask the large charities just how much is spent annually on individuals with under 12 weeks service? It will be interesting and shocking data.

What will also become apparent, is that the vast majority claiming monetary support cannot attribute the cause of their problems with any aspect of Military Service. Yet the cash cow keeps on paying up and as one veteran said …”If the cows there… milk it ” This has to stop.

We need to ensure that those that deserve a gold star service get a gold star service.

Tony Wright CEO

The Complex Dynamics Surrounding the Adoption of the Term "Military Sexual Trauma" by the UK Ministry of Defence

The issue of sexual trauma within the UK military is a deeply sensitive and complex topic that demands careful consideration and understanding. One aspect of this discourse is the terminology used to describe such incidents, with "Military Sexual Trauma" (MST) being a term that has gained prominence across the world. However, the adoption of this term by the Ministry of Defence (MoD) is not a straightforward process and is influenced by various factors. This blog will delve into the reasons why the MoD might hesitate to embrace the term MST, examining cultural, institutional, and policy-related aspects.

  1. Stigma and Perception: One primary reason for the reluctance of the MoD to adopt the term MST may be the fear of perpetuating stigma. The use of the term itself acknowledges the prevalence of sexual trauma within the military, which some stakeholders may perceive as damaging to the institution's image. The military often values a strong and resilient image, and acknowledging the existence of sexual trauma may be seen as a threat to that perception.

  2. Cultural Barriers: Military culture is often characterized by a sense of discipline, hierarchy, and camaraderie. The term MST may be viewed as disruptive to this culture, challenging the traditional norms that prioritise cohesion and unity. The acknowledgment of sexual trauma might be perceived as undermining the trust and brotherhood that is crucial for effective military operations.

  3. Historical Context: The military has a long history of dealing with issues internally, and there might be a hesitation to adopt new terminology that implies a need for external intervention. Admitting to the prevalence of MST could open the door to increased scrutiny from external entities, including human rights organizations and the public. This historical context may create resistance within the military leadership to embrace the term.

  4. Legal Implications: Accepting the term MST could have legal ramifications for the MoD. It might imply a level of accountability that the institution may be hesitant to shoulder. Legal implications could involve compensation claims, investigations, and potential changes in military justice procedures, which could be perceived as a threat to the established order.

  5. Challenges in Implementation: Adopting the term MST would necessitate a significant shift in the way the military addresses and handles sexual trauma cases. This could require the development of new policies, training programs, and support systems. The logistical challenges associated with implementing these changes may be a factor in the resistance to adopting the term.

  6. Internal Resistance and Denial: Within the military, there may be a resistance to acknowledging the extent of the problem. Some individuals in positions of authority might deny the prevalence of MST or downplay its significance, viewing it as an isolated issue rather than a systemic concern. This internal resistance can impede the adoption of the term within the organization.

  7. Perceived Threat to Discipline: The military places a high value on discipline and order. Acknowledging the existence of sexual trauma within the ranks may be seen as a threat to discipline, as it implies a breakdown in control and a failure to maintain a safe and respectful environment. This perception could hinder the acceptance of the term MST.

Conclusion:

In conclusion, the adoption of the term Military Sexual Trauma by the Ministry of Defence is a complex and multifaceted issue. Stigma, cultural barriers, historical context, legal implications, challenges in implementation, internal resistance, and the perceived threat to discipline are all factors that contribute to the hesitation in embracing this term. As society continues to evolve, it is essential for the military to address these issues transparently, fostering an environment that prioritises the well-being of its members while maintaining its core values and principles. The journey towards acknowledging and addressing military sexual trauma requires a delicate balance between accountability, cultural sensitivity, and a commitment to fostering a safer and more inclusive military environment. What we do know is, adopting a Catholic Church approach to dealing with sexual violence and abuse is not sustainable or morally acceptable in the short and long term.

Tony Wright CEO Forward Assist

Exploring the Complex Landscape of Depression Among UK Armed Forces Personnel

Depression among UK Armed Forces personnel is a multifaceted issue with roots in various aspects of military service and societal factors. This blog aims to delve into the reasons for depression among military personnel in the United Kingdom, considering both the unique challenges faced within the armed forces and the broader societal context.

  1. Operational Stress and Trauma:

Military personnel often face high-stress situations during deployments, training exercises, and combat operations. Exposure to traumatic events, such as witnessing casualties or experiencing life-threatening situations and in-service sexual assault and violence can contribute to the development of depression. The repeated exposure to stressors, known as operational stress or military sexual trauma can have long-lasting psychological effects, impacting mental health even after returning from deployment or when returning to civilian life.

  1. Post-Traumatic Stress Disorder (PTSD):

A significant subset of military personnel experiences post-traumatic stress disorder (PTSD) as a result of exposure to traumatic events. PTSD is closely linked to depression, as the persistent intrusive memories, hyperarousal, and avoidance behaviors associated with PTSD can contribute to the development of depressive symptoms. The stigma surrounding mental health issues may also deter individuals from seeking timely and appropriate help.

  1. Deployment and Family Strain:

Frequent deployments and extended periods away from family can strain personal relationships. The stress of separation, coupled with the uncertainty of military life, can contribute to marital and familial discord. Research suggests that relationship strain is associated with an increased risk of depression among military personnel, highlighting the importance of addressing family dynamics as part of a holistic mental health strategy.

  1. Stigma and Barriers to Help-Seeking:

Despite increased awareness of mental health issues in recent years, stigma remains a significant barrier to seeking help within the armed forces. Military personnel may fear negative repercussions for their careers or be concerned about being perceived as weak. Addressing the stigma surrounding mental health and fostering a culture that encourages open dialogue is crucial in creating an environment where individuals feel comfortable seeking assistance.

  1. Transition to Civilian Life:

The transition from military to civilian life can be a challenging period for many service members. The loss of the structured military environment, camaraderie, and a sense of purpose can contribute to feelings of isolation and aimlessness. This abrupt shift can be particularly difficult for those who have experienced trauma during their service. Adequate support and transitional programs are essential to help military personnel navigate this critical phase.

  1. Financial Pressures:

Financial pressures, including the challenges of readjusting to civilian salaries, loss of status and potential difficulties finding employment, can contribute to stress and depression among veterans. The adjustment to civilian life may come with unexpected financial burdens, adding to the overall stress of the transition period.

  1. Reintegration Challenges:

Reintegrating into civilian society may pose challenges for military personnel who have become accustomed to the unique culture and lifestyle of the armed forces. Feelings of isolation, a lack of understanding from civilians, and challenges in adapting to civilian workplaces can contribute to a sense of alienation, potentially leading to depressive symptoms.

  1. Personality Factors and Predisposition:

Individual differences in personality traits and coping mechanisms can influence how military personnel respond to stressors. Some individuals may be more predisposed to developing depression based on factors such as resilience, coping skills, and pre-existing mental health conditions. Recognising these individual differences is crucial for tailoring mental health support effectively.

Conclusion:

Depression among UK Armed Forces personnel is a complex issue shaped by a combination of operational, interpersonal, and societal factors. Addressing this challenge requires a multifaceted approach that encompasses prevention, intervention, and ongoing support. By fostering a culture of openness, providing mental health resources, and addressing the unique challenges faced by military personnel, the armed forces can work towards mitigating the impact of depression and promoting the well-being of their personnel. Additionally, collaboration with mental health professionals, community organisations, and policymakers is essential to create a comprehensive support system that addresses the diverse needs of military personnel and veterans.

Tony Wright CEO Forward Assist


Its Estimated that 80% of All In-Service Sexual Assaults & Rapes Are Unreported.

It's important to note that the reasons why individuals, including male soldiers, may not report sexual assault are complex and multifaceted. There are various factors that can contribute to underreporting, and it's not limited to a specific gender or population. However, I'll provide some general insights into factors that might influence underreporting of sexual assault in the military, and why there may be challenges in recognizing the impact of military sexual trauma by UK charities:

  1. Stigma and Fear of Retaliation:

    • Victims of sexual assault may fear stigmatisation or retaliation, particularly in military environments where there can be a hierarchical structure and a sense of camaraderie. Reporting sexual assault can be perceived as a threat to one's reputation or career.

  2. Command Climate:

    • The culture within a military unit, known as the command climate, can significantly influence whether individuals feel comfortable reporting sexual assault. If there is a perception that superiors may not take the issue seriously or that there will be negative consequences for reporting, individuals may be hesitant to come forward.

  3. Lack of Trust in the System:

    • If survivors lack confidence in the military justice system or believe that their complaints won't be handled appropriately, they may choose not to report the assault. Concerns about the efficacy of investigations and the potential for retribution can contribute to this lack of trust.

  4. Perceived Lack of Support:

    • Some survivors may feel that they won't receive adequate support from their peers, superiors, or military institutions. The fear of isolation and judgment can discourage individuals from reporting.

Regarding the recognition of military sexual trauma by UK charities:

  1. Limited Awareness:

    • There may be limited awareness and understanding of the prevalence and impact of military sexual trauma among the general public and within charitable organizations. This lack of awareness can contribute to insufficient resources and support for survivors.

  2. Complex Nature of Trauma:

    • Military sexual trauma can have complex and long-lasting effects on survivors. Charities may face challenges in addressing these unique needs, and there may be a lack of specialised services or programs tailored specifically to individuals who have experienced military sexual trauma.

  3. Policy and Legal Barriers:

    • Charities may encounter obstacles in addressing military sexual trauma due to policy and legal restrictions. Ensuring that services are aligned with legal frameworks and policies while still meeting the unique needs of survivors can be challenging.

Efforts are being made globally to raise awareness, improved reporting mechanisms, and provide better support for survivors of sexual assault in the military, regardless of gender. Advocacy, education, and changes in institutional culture are crucial in addressing these issues.

The Collaboration Catch 22

Collaboration among organisations in the military charity sector is essential for maximizing impact and addressing the diverse needs of veterans and service members. However, despite the shared goal of supporting those who have served their countries, collaboration within this sector often faces numerous challenges.

One significant obstacle to collaboration is the competition for limited resources. Military charities rely heavily on donations, grants, and government funding to operate effectively. In the face of finite resources, organisations may be hesitant to collaborate for fear of losing out on crucial funding. The competitive nature of fundraising can create an environment where organisations prioritise their own interests over collective efforts. This competition for resources can hinder open communication and trust among military charities, preventing them from working together to create comprehensive solutions.

Another factor contributing to the lack of collaboration is the diversity of missions and approaches within the military charity sector. Each organisation often has a specific focus, whether it be mental health support, housing assistance, education, or job placement. While this specialisation allows charities to address specific needs more effectively, it can also create silos that make collaboration challenging. Organisations may fear diluting their impact by working with others whose missions differ, leading to a lack of cooperation in pursuit of common goals.

Additionally, organisational pride and a sense of independence can hinder collaboration. Many military charities are founded and run by individuals with strong personal connections to the military, often veterans themselves. This personal investment can lead to a strong sense of ownership and a desire to maintain control over programs and initiatives. As a result, there may be resistance to relinquishing autonomy and pooling resources with other organisations, even if it means achieving greater overall impact.

Bureaucratic barriers and differing approaches to problem-solving can also contribute to a lack of collaboration. Each organization may have its own set of policies, procedures, and methodologies, making it challenging to align efforts seamlessly. Differences in organisational culture and leadership styles can further complicate collaborative initiatives, as individuals may find it difficult to navigate and reconcile conflicting approaches.

Despite these challenges, the benefits of collaboration in the military charity sector cannot be overstated. Collaborative efforts can lead to more efficient use of resources, reduced duplication of services, and a holistic approach to addressing the multifaceted needs of veterans and service members. Overcoming the barriers to collaboration requires a shift in mindset, emphasizing the shared commitment to the well-being of those who have served and recognising that collaboration can lead to greater collective impact than individual efforts alone.

In conclusion, while collaboration among organisations in the military charity sector may face obstacles, addressing these challenges is crucial for maximizing the support provided to veterans and service members. By fostering a culture of collaboration, breaking down silos, and emphasizing the common goal of serving those who have served, military charities can work together more effectively to create lasting and meaningful positive change. Tony Wright Forward Assist CEO


At Last...UK Women Veterans Given A Voice At The House of Commons!

Almost 18 months , I attended an amazing event hosted by Sarah Atherton MP and Emma-Lewell Buck MP in the House of Commons which gave a group of women veterans the unique opportunity to debate the following question; Are UK military charities doing enough for women veterans? The women involved had all taken part in the Forward Assist Veterans Debate training project which was funded by the AFCFT . After the debate those in the room were asked to vote on which team had made the most compelling argument. It was a unanimous vote from the audience that indicated n emphatic…No! Military charities were not doing enough for women veterans. This year, 2023, we have seen considerable progress Salute Her UK has made in raising awareness of women veterans issues and designing services to meet their unique physical and mental health needs. Yet… the fight goes on and in 2024 we will be back in the Palace of Westminster with another group of women veterans debating a topic that is both relevant and interesting to their community.

“Proactive Outreach in The Criminal Justice System”

We have come a long way since the then Justice Secretary, Kenneth Clarke on 30 June 2010 at the Centre for Crime and Justice Studies in London said:

“….My priorities are to punish offenders, protect the public and provide access to justice. They seem to me the obvious and basic aims of my office, my department, and my team of Ministers. The proposals I’m going to outline today in relation to the courts, legal aid and sentencing will have proper regard to each of these priorities. Reoffending has been rising again in recent years. It appears to be up by about 8% for adults between 2006 and 2008. It is astonishing that nearly half of offenders sent to prison are reconvicted of another offence within a year of their release. More than half of the crime in this country is committed by people who have been through the prison system. The rate of reoffending is even higher – 60% – for the 60,000 prisoners who serve short sentences each year”.

He went on to state that Prison doesn’t work and if anything a spell of incarceration is likely to have a cataclysmic negative impact on many aspects of the prisoner’s life, during and after the sentence has been served.

He stated that “…. It is virtually impossible to do anything productive with offenders on short sentences. And in the short time they are in prison many end up losing their jobs, their homes and their families. The voluntary and private sectors will be crucial to our success. We want to make far better use of their enthusiasm and expertise to get offenders away from the revolving door of crime and prison.”

The Covid-19 Pandemic resulted in a chronic backlog in the Criminal Justice System with more than 53,000 cases waiting to go before the Crown Courts. It now June 2022 and I have no idea where the waiting list is in comparison to other years. Someone, somewhere came up with the idea to create dozens of additional “Nightingale Courts” to help with demand during the pandemic. The Guardian reported that this constituted the greatest threat to the proper operation of the criminal justice system in history.

The wheel has gone full circle, with a shift from the Advise, Assist & Befriend approach to Enforcement and Punishment and back again. Personally I believe that the Probation Service must return to ‘social work’ values in order to survive and as a consequence positively influence clients and keep them from offending in the community.

 This will involve practicing ‘effective’ case management on a daily basis in the communities in which the clients live. The short sighted thinking that led to the ‘enforcement and punishment’ model being rigorously adopted and implemented, albeit under threat of financial cuts. resulted in the prison population being at an all time high.

  If the Government wants to save money and in doing so become effective in reducing offending behaviour then it must  change the way the Criminal Justice System currently works and adopt a  Professionally managed, ‘proactive outreach’ service to address the multiple and complex needs of the ‘revolving door’ clients that reoffend within two years after release.

 Many people involved with the Criminal Justice System are very often disenfranchised individuals with complex needs. They frequently have unmet needs and  issues relating to  problematic drug and alcohol misuse, poor mental health and a significant number are the product of abusive relationships (past and present), dysfunctional parenting, and a significant number  have unresolved issues relating to adverse childhood experiences, bereavement and  debt. 

 ‘Many prisoners have experienced a lifetime of social exclusion. Compared with the general population, prisoners are thirteen times as likely to have been in care, thirteen times as likely to be unemployed, ten times as likely to have been a regular truant, two and a half times as likely to have had a family member committed of a criminal offence…fifteen times as likely to be HIV positive.’  Social Exclusion Unit

  If an individual is homeless or sleeping rough then this will necessitate an approach that allows professionals and support workers alike to prioritize the individual and leave the comfortable surroundings in which they work, ‘hit the street’ and practice proactive outreach and engage with ‘the person’ until they have built up a relationship that then enables them to positively influence change.

 ‘Client pinball’ is a term I use to describe one of the major downfalls of current practice, where workers arrange a series of appointments over a set period of time. They then instruct the client to attend each and every appointment in the belief that their part of the contract is fulfilled. Yet the reality is that the individual bounces from service to service until all the problematic areas of their lives are supposedly addressed. In reality they may not even make the first meeting and if they do, it is unlikely they will find the impetus to make the other appointments as arranged. Signposting, is in my view,the last ‘great irresponsible act’ it meets the needs of the organization and its responsibility under contractual obligations to evidencing requirements in relation to data collection but it does nothing to ensure contact is made with specialist services. When it is later discovered appointments have not been kept then the client is labelled unmotivated and breached.

  If the Criminal Justice System is sincere about working towards a seamless sentence where sentences are ‘managed effectively within a framework that supports compliance, then there will need to be a shift in the way Probation Officers work with the client throughout the lifetime of the order. This will necessitate the introduction of a ‘refer and chaperone’ approach that will increase engagement and reduce the risk of reoffending whist at the same time developing a rapport between the client and his/her Probation Officer/Support worker.

 If the Probation Service takes the view that a reduction in offending behaviour is its ‘raison d’être’ then it will need to change its practices as much as the social excluded/hard to reach offender is expected to change his or her behaviour. For many this change of practice and culture will be viewed as abhorrent, impractical and far too risky. Yet the fact of the matter is the above are ‘lame’ excuses and do not stand up to scrutiny. The fact is ‘risk’ can be managed by working in pairs and having appropriate safeguarding practices built into working practices. The crux of the matter is that the supervision of offenders is not a 9-5 Monday to Friday operation.

 As the Carter report (2003) made very clear:

 ‘…believing that offenders in the community will reduce their re-offending through occasional interviews with Probation Officers is naïve.’

I would take it a step further and say that sitting in an office waiting for someone not to turn up is morally wrong and not cost effective . The adoption of proactive supervision and the introduction of a mobile community based outreach team could ameliorate the need for breach proceedings being implemented thus saving thousands of pounds by avoiding the need to return an offender to jail. (Current cost £42,000 per annum, per prisoner)

 Running parallel to the necessary change in culture and function would be the need to allow the Probation Service to adopt an eclectic mix of interventions and partnerships which will be fundamental to its future development. I do not however support the argument that promotes the contracting out of current services. The key strengths of the Probation Service are that the staff are/were highly trained, responsible accountable and that it has superb policies and procedures already in place. They just need to be adapted to allow more contacts to take place in the community.

 I believe that Probation Officers could become fantastic case managers if they operated in a proactive way, within the community and were given much more personal discretion to case manage and make ‘on the ground’ decisions as to issues such as licence recall or the instigation of breech proceedings.

 I would argue that if Probation staff spent six hours a day making home visits they could begin to build up a picture of their client’s lives and, gain a better understanding of the complex issues that act as barriers to accessing services; especially if they are related to drug and alcohol dependency, peer pressure or a lack of financial resources to keep appointments. For some people the choice to change sometimes does not exist.

 For many there is but an ‘illusion of choice’.  Pathways into support services need to be brokered and the proactive probation outreach worker could ‘champion’ and advocate access to specialist and multiple support services, especially if that individuals previous behaviour has resulted in them having sanctions imposed upon them that excluded them. However it may be that they are in fact barred from accessing a service or organisation because of draconian outdated practices.  It is regrettable that millions of pounds have been spent on updating and refurbishing buildings in for the most socially excluded but very little has been spent on training and up skilling the staff that work within them.

 A multitude of Government funded interventions have proved how effective ‘outreach’ can be in all its manifestations. More recently, the piloting of innovative interventions to address social exclusion and homelessness proved that getting individuals off the street and accessing support is possible if there is a will to do so. Post Covid, the ability to ‘fast track’ clients to specialist services, such as health visitors, housing, state benefits, dentists, psychologists, mental health nurses, heath care assistants and indeed General Practitioners hinders the workers ability to affect positive change.

I truly believe that if the professional is prepared to think beyond the label of ‘offender, rough sleeper, prostitute, problematic drug and alcohol user etc’, it will in turn assist the individual in thinking beyond the label of ‘authority figure’ or any other professional title, and by doing so allow them the opportunity to challenge their own behaviour and expectations.

 The problem I came across, time and time again was the entrenched belief that socially excluded individuals brought it all upon themselves, and that wonderful ‘all singing and all dancing’ services were on offer 24 hours a day,but the socially excluded individual chose not to engage.

Many were shocked to find out that agencies did not work together and integrated pathways existed in name only and many people still slip through the health and social care safety net. This highlighted the need for mandatory multi-partnership training for every agency involved in the client’s journey. Unfortunately institutional silos still need to be broken down to improve inter-agency partnership working and create the so called ‘virtuous circle’.

 In Summary, if the Ministry of Justice is serious about offering a more effective service for less money then it needs to be  prepared to start with a clean sheet and let go of the tenets of wisdom within the  current mechanisms of service delivery. Many of the points made may be uncomfortable for some managers and even for some practitioners. I have found that at times, the most successful interventions are disconcerting for some as they have clearly gone against the grain of agency principles. If meaningful rapport is to be established and engagement is to be genuine and fruitful, then it must involve daily and weekly contacts in the community. For this to be made possible, good line management must be in place. This means senior probation officers being prepared to defend against professional tensions and assist in the management of risk by moving away from an office based appointment system to community based interventions. The adoption of a proactive  outreach approach that allows individuals to remain in the community of their choice, whilst accessing all necessary wrap-around support services will in my opinion lead to significant reductions in re-offending, excellent compliance with community based orders, and sustained retention with the multitude of services that already exist in the community. Finally, in relation to the question about military veterans needing a separate criminal justice pathway to everyone else, the answer is no.

 Tony Wright CEO

 

 

What Are Adverse Childhood Experiences and How Do They Impact on Adult Life?

I often reflect on my life, as have many of us, wondering how my prior experiences have influenced my life, my psychology, work choices, relationships, parenting skills, children’s development and health.

My personal and professional research into this concept has led me to understand more about ACE’s (Adverse Childhood Experiences) and I've realised that no one is immune, we have all sustained ACES in some shape or form and some more than others.

The experiences we have early in our lives and particularly in our early childhoods have a huge impact on how we grow and develop, our physical and mental health, and our thoughts, feelings and behaviour.

Trauma is not just experienced it can also be inherited. This happens when trauma has been passed from one individual or generation to another. It often manifests as inter-generational trauma.  Whereas collective trauma is the effect shared by a group after witnessing traumatic events where they’ve been targeted.

Recent research in the UK indicates that one in five adults have experienced at least one ACE, before the age of 16 years. Females and minority groups are at greater risk of experiencing four or more ACEs.

General population studies of Adverse Childhood Experiences have also observed a relationship between exposure to Adverse Childhood Experiences and future violence, whether as a victim, a perpetrator, or often both. A nationally representative study of almost 4,000 participants in England found that respondents with four or more Adverse Childhood Experiences were seven times more likely to have been a victim of violence in the past year, and were eight times more likely to have committed a violent act than those with no Adverse Childhood Experiences. In Wales these figures were more pronounced, as those who had experienced four or more Adverse Childhood Experiences were 14 times more likely to have been a victim of violence in the past year, and 15 times more likely to have been the perpetrator of a violent incident.  Little is known about the long term impact of ACEs, however what we do know is that the issue is complex and multifaceted.

 What Counts as an Adverse Childhood Experience?

Adverse Childhood Experiences (ACEs) are traumatic events that children can be exposed to while growing up. 

ACEs can be direct and indirect, including neglect, physical, emotional and sexual abuse, divorce substance misuse, violence, mental illness, domestic violence, disability and social factors such as financial hardship, homelessness, discrimination and low-level educational attainment.

The impact of ACEs

Experiencing ACEs can have a huge impact on physical and mental health in adulthood compared to the general population.  

Trauma survivors are -

·         3x more likely to suffer from a heart attack

  • 5x more likely to suffer from mental health problems, such as anxiety, depression, and complex post-traumatic stress disorder.

  • 14x more likely to die by suicide

  • 11x more likely to have drug and alcohol addiction issues

  • 35x more likely to experience intimate partner violence

 The longer individuals experience an ACE and the more ACEs someone experiences, the bigger the impact it will have on brain development and how threats are perceived.  When faced with a threat, our bodies naturally produce cortisol, the stress hormone which helps us respond in a natural and healthy way to protect us and keep us safe from harm.  Cortisol is responsible for the fight, flight and freeze response. Recent research demonstrates that adults who have sustained childhood trauma have elevated cortisol production leading to cortisol suppression. In layman’s terms this means that trauma survivors live in a constant heightened state of flight or flight.

 Exposure to ACEs can also impact on:

  • The ability to recognise and manage different emotions.

  • The capacity to make and keep healthy friendships and other relationships.

  • The ability to maintain employment.

  • Healthy development of problem-solving skills

While everyone's reaction to trauma is unique, there are some common reactions. Knowing and understanding the formulation of trauma is key to learning to not only survive but also thrive.

 What Needs to Change?

We need to start from the beginning. We have seen the same approach or small variances to tackling complex social problems time and time again. Rather than making the necessary but difficult societal reforms that would lower the probability of abuse happening, we wait for horror stories to happen and then try to alleviate their effects - what Geoffrey Rose referred to as a ‘focused rescue mission for vulnerable individuals’

In the case of ACEs, this means that the prevention strategy is often too late to implement as the damage has been done. It takes a survivor of trauma approximately ten years to come forward and ask for help.

A new narrative needs to be introduced on how people think about the causes of ACEs and who can help prevent them, shifting the focus from individual responsibility to community-based solutions. We need to stop vilifying those who are seek help with parenting challenges or for substance misuse, depression, and suicidal thoughts.

When trauma has not been preventable, training in trauma-informed care is essential for mental and physical health-care providers, police and ambulance staff. Universal screening and assessing for ACEs, especially in regard to determining how trauma affects healthy functioning is critical to developing person centred, needs led care plans.

A trauma-informed care approach should be used with all trauma survivors, this approach actively engages those with a history of trauma whilst recognising the presence of trauma symptoms. The approach acknowledges the role that trauma has played in survivors’ life as well as validating that they are doing the best that they can with the skills they have learned.

 Paula Edwards: Mental Health Therapist

 

The Saviour Complex...

As I have mentioned several times before, the Veteran support landscape in the UK is huge; with Facebook, twitter, Linked In and a plethora of other social media groups being added everyday. All purport to offer dedicated support to veterans in need. I don’t think anyone is able to accurately assess how many service related support groups actually exist or how they replicate or duplicate each others services as its an ever changing landscape. What I do know is that there is no quality control on the effectiveness of services on offer or indeed evidence of those delivering front line services are assessed as to their ability to offer quality care to those with multiple and complex needs. Its a complex world when one has to deliver and/or access the professional services that can truly help individuals in need move on with their lives. Its interesting that peer led and/or mutual interest support groups are frequently ignored, despite having a key role connecting veterans to the communities in which they live. Everyday I see the larger military charities and at times Government following the lead of the grassroots organisations by taking up causes they had previously ignored. For example. Suicide, Homelessness, gambling , addiction, women veterans, support for minority groups etc

Veterans issues are multiple and complex as is the desire of many of those that want to help support them. We all have a touch of the “Saviour Complex”. Yet, like it or not, many of the larger service charities dismiss the role community based organisations play and in Westminster I’ve heard the service support landscape described as the ‘Wild West’. Yet its clear practice wise that larger organisations have lost their way and all are having an identity crisis as they try desperately to reinvent themselves after years of being the ‘go to’ organisations on veterans issues. These days its those charities that ambush ideas and bushwhack best practice which they present as their own. Anyway it is what it is! Moving on…

Someone defined the Saviour Complex as;

“A psychological construct which makes a person feel the need to save other people. This person has a strong tendency to seek people who desperately need help and to assist them, often sacrificing their own needs for these people.”

The reality is, that if you work in the caring profession you are very lightly to have a touch of the saviour complex anyway. It comes with the territory. The problems arise when the need to give back overwhelms the lives of the volunteer service provider. Trying to save those that don’t want to be saved or being so giving of yourself and time that one becomes emotionally and physically exhausted, all create their own problems. The business of trying to ‘save people’ doesn’t allow individuals to develop problem solving skills for themselves or promote personal responsibility or emotional resilience. If you are involved in this work you should frequently ask yourself if you are trying to help people because its essential that you do… or is it about making yourself feel better. Tough choices.

Coping With The New Reality...

Since the lifting of lockdown and the slow reopening of services and the incremental shift to ‘normality’ its becoming apparent things are not what they once were and many of the people accessing our service are vociferous in their unhappiness. For example, every day we get calls or visits from veterans expressing their concerns about the withdrawal from Afghanistan, the threat of terrorism, empty shelves in supermarkets, food poverty, difficulties in getting fuel for motor vehicles (especially for those registered disabled) Hospital waiting lists, delays in repeat prescriptions, the inability to get certain prescribed medication, difficulty getting to see a GP, traffic jams, road works, lack of dental appointments and access to NHS dentists, delays in getting cancer treatment, mental health counselling, restrictions on international travel and holidays, relationship difficulties, problems parenting, redundancy, the increase in the cost of living, tax, unemployment, Personal Independence Payments withdrawn, increase in gas and electricity costs, worries about leaving the EU, debt, domestic violence, how to access flu-jabs, vaccine booster jabs and the lack of social housing.

They also worry that the UK Military are having to be called in to prop up services such as lorry driving and fuel deliveries, helping at vaccination centres and driving ambulances instead of doing what they are paid for … protect the country.

All of which causes psychological distress and emotional instability especially amongst those who are lonely and isolated and struggling to adjust to life after lockdown. Throughout the last 18 months there has been a pervading sense of ‘lost trust’ in Government and local leadership, simply because the rhetoric just isn’t meeting the reality. As such many feel that their standard of living and quality of life has decreased significantly causing increased anxiety for the future … So, where is all this going? No one knows. Yet the third sector continues to deliver, punching way above its weight and often with no increase in funding. It really is time to adopt a ‘ Asset based community development (ABCD) approach. ABCD is a localised and bottom-up way of strengthening communities through recognising, identifying and harnessing existing 'assets' (i.e. things like skills, knowledge, capacity, resources, experience or enthusiasm) that individuals and communities have which can help to strengthen and improve things locally. Instead of looking at what a community needs or lacks, the approach focuses on utilising the 'assets' that are already there.

The approach facilitates the empowerment of individuals and communities by helping them to identify and share their strengths and then work together to create their own social innovations. We say…bring it on!

Meeting The Needs of Veterans With Musculoskeletal Disorders

At Forward Assist and Salute Her UK we strive to deliver services that are needs led and person centred and to do that we have regular consultation sessions with all those that access our service. In recent years there has been considerable emphasis on the invisible wounds of war, be that Post Traumatic Stress Disorder, Adjustment disorder, transition difficulties and/or problems trying to assimilate to the civilian community when service life ends. Yet, the data suggests that for all three services, the main causes of medical discharges were Musculoskeletal Disorders and Injuries followed by Mental and Behavioural Disorders.

According to the MoD this was in line with findings from the previous years when 2 in 5 personnel (42%) were medically discharged as a result of multiple medical conditions. Many service personnel people develop joint and soft tissues disorders ranging from minor injuries to long-term conditions. Long-term conditions include osteoarthritis in knees, hips, shoulders, ankle and foot injuries including associated back pain. The key co-morbidity risk factors for this veteran cohort include loneliness and isolation, obesity, poor mental health, inactivity and further injury due to trips and falls.  The impact on family and carers cannot be underestimated and for many, it becomes almost impossible to maintain relationships and/or employment.

When one takes into consideration that the Government plan to extend the retirement entitlement age to 69 years at some point in the future, it’s very clear that many will be economically inactive well before that age due to both mental and physical disabilities related to service life.

Instead of throwing millions of pounds at the mental health issues let’s use the data to develop services for the silent majority. We need to look at a quality of life model which includes social support and help with resilience, pain management and the development of coping skills and resources for persons recovering from injury and those that care for them. For many a return to work will not be a viable option. Family breakdown has a negative impact on all parties involved and access to suitable housing for those with musculoskeletal disorders is already limited if none existent.

As someone on a waiting list for bi-lateral knee replacement the system does not appear to working as many, including me have been waiting over 12 months or more for surgery and in my case no one can tell me where I am on the waiting list which would indicate that there isn’t one!

The C-19 pandemic notwithstanding and its obvious impact on NHS staffing (bless em!) it would appear that the NHS are unable to address the extended waiting list conundrum, never mind deal with the predicted 15 million that need to access counselling for unresolved bereavement issues, moral injury, depression and anxiety. Much of the work of Forward Assist and Salute Her UK is directed towards supporting those men and women with severe musculoskeletal injuries (joint and muscles) and the multi-faceted symptoms common to mental health disorders, such as unresolved trauma, distress, anxiety/depression, sleeping disturbance, adverse alcohol & drug misuse, smoking, adverse nutrition behaviour all of which is compounded by a lack of community connection. We actively encourage Occupational Therapy students to spend time on placement with the team and their input and expertise is invaluble in supporting this particular group of underserved veterans.

For those with a genuine interest in this subject matter please see:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1001267/UK_service_personnel_medical_discharges__financial_year_2020_21.pdf

 

Why Embracing Uncomfortable Feelings Is Good For You!

The ultimate measure of a man is not where he stands in moments of comfort, but

where he stands at times of challenge and controversy.”

Martin Luther King Jr.

Many of us have become used to feeling emotionally uncomfortable even if that means living in a constant cycle of despair. Many suffers of trauma possess a natural inclination to stick with the status quo, to resist the unknown, to stay safe. I have often heard those who don’t understand mental health say ‘they are taking the easy road ' or that ‘they need to pull their socks up' However, staying the same or doing nothing often means that the drive to survive is overwhelming or intense emotional feelings are too painful to manage. The truth is, in order to thrive we must begin to learn how to find comfort in the uncomfortable.

 We live in a society where many believe that life is only about creating a perfect life on social media, the pursuit of which creates instant contentment. Whilst contentment is an important part of life, to reach this state of mind we must experience pleasure and pain, fulfilment and suffering, ease and difficulty, love and hate.

By focusing on the comfortable side of life it becomes very easy to cut ourselves off from the full emotional experience and in doing so lose out on psychological growth. One of the things I often say to the women veterans I work with, when I can see pain, a lack of emotional regulation and turmoil etched onto their faces is to relax and be comfortable with the temporary discomfort. Get comfortable with the uncomfortable. Embrace it, hold it, welcome it, allow it and most importantly feel it.

 Emotional dysregulation is frequently seen in people with psychological disorders, addiction, and those engaging in self-harm, it can also be present in women who have experienced Military Sexual Trauma. Many of the women I see also struggle with meta-emotions, in other words struggling with how they feel about feelings. I enjoy working with these clients because they usually don’t come to me saying, ‘I am struggling with meta emotions’ so it can be incredibly empowering and life-changing for them to make the connections through the work we do together and realise how changing the way they relate to their emotions can help them in so many other areas of their life.  

For Example:

 Kelly, (not her real name) recognised that she viewed her PTSD as weak and shameful, the intense meta emotions she experienced made things worse. To prevent herself from experiencing these emotions she avoided situations that triggered her. Through our work, she began slowly permitted herself to feel some of the emotions relating to her military service and stopped avoiding situations. She found it helpful to label the emotions that sometimes appeared and practised emotional regulation skills coupled with compassionate imagery. Kelly practised the use of adaptive coping skills which improved her quality of life and reduced her use of dysfunctional coping strategies. She allowed herself to feel uncomfortable. It was life changing.

 To quote Jason Reynolds;

 “Be not afraid of discomfort. If you can't put yourself in a situation where you are uncomfortable, then you will never grow. You will never change. You'll never learn.”

Paula Edwards Salute Her Project Manager

 

Why Being Trauma Informed Matters...  

Trying to implement trauma specific practices without first implementing trauma informed organisational culture change is like throwing seeds on dry land “  Sandra Bloom

Serving on the frontline within a military context may damage people and create scars that are naked to the eye.  One thing the last year has shown us all is that the term  ‘front line’ is no longer restricted to just a military environment. We are more than a year into a global pandemic that has turned the lives of millions upside down. This has led to a ‘collective trauma’ the like of which we havent seen since WW2. This type of trauma can affect societies, populations of any size, nations, and even has a worldwide reach. One of the unique challenges of addressing Covid related trauma is gaining an understanding of the degree to which it has impacted on lives. There is a concern about contracting Covid, a concern about losing connection with friends and family, a fear of dying and having to be hypervigilant all of the time.

Movie producers over the years have taken the opportunity to make millions out of  ‘ war porn movies’  such as ‘ Full Metal Jacket’   ‘ 1917’  and  ‘The Deer Hunter’.  There are so many movies made about war and soldiers suffering from  mental health problems that when you hear the words PTSD your mind can’t help but lead you to think about those that have served in the military. But trauma is far reaching and the impact is devastating. Trauma affects billions of people worldwide every year, In the 2014 Adult Psychiatric Morbidity Survey, 3.7% of men and 5.1% of women screened positive for PTSD. Women aged 16-24 were most likely to screen positive (12.6%). & between the ages of 55-64 it transpires that this was the only age category where men were more likely to screen positive than women.

The definition of trauma is anything that is ‘deeply distressing or disturbing. The definition of trauma is broad because trauma is defined by a person’s subjective experience of it rather than the trauma itself.

Psychological trauma is unique to the person who experiences the event and specifically how overwhelmed they are in terms of their ability to integrate their traumatic experience.

Therefore, a traumatic situation causes psychological trauma when an individual feels psychologically, physically, and emotionally overwhelmed. That “event” can be almost anything: ranging from involvement in a car crash, the death of a relative, childhood bullying, a house fire and/or involvement in war.

The real problem is making sure that everyone can access good quality care when they need it most. Mental Health & Psychological therapies can do more harm than good if they are of poor quality or the wrong type. With long NHS waiting lists, the obvious place for sufferers to turn to is the 3rd sector, which on the whole are usually helpful to people who are distressed, but in a minority of cases when it goes wrong it can leave vulnerable people more unwell than when they first sought help.

Recently I spent over a week trying to organise a care coordination meeting for a Veteran. The details of the case are not what matters here, it is necessarily vague  to protect confidentiality.

However, it is fair to say that the end result was a severe deterioration in the mental health of the client with an increased risk to others and self. The client did not trust mental health services , but I felt that the risk issues were so acute that it required a multi disciplinary  meeting to share information and pool resources as well as look at statutory involvement.  Various professionals were already involved from the health, social care and criminal justice sectors, numerous initial assessments had identified various complex needs however, no one had been allocated to undertake the work, so although it was an open case there had been no service provision for several months.In the mean time my client was trying to actively end their life every other day.

 I’m not sure that my involvement did any good at all for the veteran in the end, my client was clinging to life and still waiting for a service to meet their needs. Despite spending hours and hours on the phone and writing emails, it did raise an important question, what if I wasn’t there? What if there wasn’t someone with a title, qualifications and a comprehensive understanding of NICE guidelines to advocate on their behalf to try and get services to do the right thing?

If this is a struggle for the veteran community, then it must be a struggle for society too — yet, we can put and end to this, simply by working together.

It  starts with the simple act of changing the narratives of trauma. Trauma affects everyone, not just veterans. When veterans see their trauma as being relatable to the wider civilian population, it will reassure them that they are worthy of equitable help and access to services. When civilians see their trauma as being worthy of treatment alongside veterans, it will encourage all trauma survivors to speak up and that can only be a good thing.

In recent years the number of Veterans Charities has steadily increased, in 2019 there were 1,519 registered military charities in the UK,  fast forward two years and there are now over 2000. Most Veterans Charities are designed for all adults, age 18 and older,  both men and women. This broad-based, support-for-everyone approach might not be as effective as a utilising a trauma informed approach.

For Veterans with PTSD, it is extremely common for their memories to be triggered by sights, sounds, smells or even feelings that they experience. These triggers can bring back memories of the trauma and cause intense emotional and physical reactions, such as increased heart rate, sweating and muscle tension. For a veteran who has been  re-traumatised multiple times, either by accident or not, they often report that their trauma-related symptoms get much worse.  This creates a barrier to seeking help and support.

This is why veteran specific trauma-informed care needs to be taken seriously. The goal is to help PTSD sufferers in any way possible, not make things worse. This requires a sensitive, and above all, flexible approach to some very real, very serious problems. No one person experiences PTSD the same way, so a cookie-cutter approach will never work.

Trauma-informed care is different in that it does not have any specific rules. The nature of PTSD is so diverse that no one approach will be applicable to two different people suffering from it. Instead, there are six guiding principles that can be adapted and interpreted in ways that make for a better use in the specific setting it’s being employed, and for the individual that needs the help.

Trauma-informed care is based on the understanding that:

  • A significant number of people living with mental health conditions have experienced trauma in their lives.

  • People are doing the best that they can.

  • Trauma may be a factor for people in distress.

  • The impact of trauma may be lifelong.

  • Trauma can impact the person, their emotions, and relationships with others.

Trauma is defined by the impact that an experience has had on the individual… rather than by the event itself.”

​​​ Core trauma-informed principles:

  • Safety – emotional as well as physical e.g. is the environment welcoming?

  • Trust – is the service sensitive to a veterans needs?

  • Choice – do you provide opportunity for choice?

  • Collaboration – do you communicate a sense of ‘doing with’ rather than ‘doing to’?

  • Empowerment – is empowering a key Veteran focus?

  • Respect for Diversity – do you respect diversity in all its forms?

To provide trauma-informed services, all staff, from the receptionist, therapists, project workers and support workers,  to Trustees and Directors, must understand how trauma impacts the lives of the people using the service,  so that every interaction is consistent with the recovery process and reduces the possibility of re traumatisation.

 Never understimate the importance of collaborative care and if you nothing else this year do your very best to ensure timely access to high quality, efficiently delivered health care. It is a moral and economic imperative. Promotion of health, prevention of illness and early intervention are needed now more than ever. Veterans charities will continue to play a central, and increasing role in efforts to improve veteran health and wellbeing in the post C-19 months and years that follow.

Paula Edwards

Mental Health Therapist

Salute Her UK Project Lead.

 

Adjustment to civilian life can be a challenge for some veterans.

 Each year between 8,000-16,000 service personnel 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 brings with it an inability to re-establish connect and/or settle back into in a society they no longer identify with. This can lead to relationship difficulties, alcohol and drug misuse, unemployment, homelessness, involvement with the criminal justice system, and – for those suffering from diagnosed or undiagnosed post traumatic stress disorder (PTSD) – self-imposed isolation, self harm or suicide. Many may find themselves marginalised, disenfranchised from mainstream services, and experience chronic social exclusion. Whilst many personnel leaving the military may initially experience some uncertainty and a loss of confidence, most make the adjustment successfully. At other times, the problems may not go away – and for some, become worse.

 Some of the reasons why making the transition can be challenging include:

 ·       The military has a unique culture, one that is very different to civilian culture. Some discharged members may experience ‘culture shock’ as they try to adjust to civilian life and a civilian workplace.

·       Some former military personnel report feeling isolated or ‘different’ to civilians and some find it hard to develop new friendships once they leave the military.

·       To many the military is more than a job, it is a ‘way of life’ involving values, priorities and beliefs about the world that often affect all aspects of a person’s life.

 Those leaving the military with service related problems such as chronic ill health, injury, post traumatic stress disorder (related to war or service related trauma), anxiety disorders, chronic pain or depression may experience additional adjustment difficulties.

 ‘Social issues’: that can impact on a soldier’s ability to make the transition to civilian life.

 •     Have trouble readjusting to family they have not lived with for a long period. This can include parenting responsibilities.

•     Feel cut off from people or feel unable to connect with anyone.

•     Find it hard to accept the difference between civilian life and experiences in military service.

•     Feel ashamed, angry or humiliated if they left the military involuntarily.

•     Experience a loss of role, identity or purpose.

•     Find it difficult getting a new job. Further, a new job can be challenging if they have to readapt or learn new skills.

•     Have concerns about supporting the family, possibly on a lower wage.

•     Have financial problems.

•     Feel less valued or appreciated with a sense of diminished status in life.

•     Find it challenging making new friends, and coping without old friends.

•     Find civilian life chaotic due to perceived lack of structure, order, and direction.

•     Not know what to do with free time.

  Many Veterans accessing the help of Forward Assist experience:

 •     Reduced physical capacity due to service-related injuries or illnesses.

•     Increased anxiety, worry or a general sense of nervousness.

•     Feelings of panic or feeling overwhelmed.

•     Anger, aggression, irritability or rage (including road rage and physical fights).

•     Sleep disturbance, such as increased sleep, disturbed sleep, insomnia or regular nightmares.

•     Unusual or increased levels of conflict in relationships.

•     Depression, hopelessness or suicidal thoughts or plans.

•     Reduced ability to concentrate or manage work tasks.

•     Increased or excessive use of alcohol (including binge drinking), prescription drugs and illegal drugs.

•     Avoidance of social activities and friends.

•     Not feeling interested in hobbies or activities that used to be important or enjoyable including sex and intimacy.

•     Somatic complaints such as headaches (not related to an existing injury or illness) unexplained aches, and tension.

•     Difficulty coping or planning ahead, or continuing in day to day activities.

•     Feeling lost, lonely, worthless, or having no purpose.

•     Lowered self-confidence or self-esteem.

•     Feeling unsafe or needing to ‘patrol’ at night.

•     Transitioning members may experience one or more of these symptoms or problems in the early stages of their transition to civilian life.

 How ‘Forward Assist’ help military personnel to help themselves!

 •     Forward Assists Qualified Social Work and Mental Health Therapists assist veterans if and when they experience difficulties.

•     We facilitate the opportunity to talk to people in similar situations and learn as much about transition as possible.

•     We encourage veterans not to take on too much at once, plan and structure their days/weeks.

•     We look for work that will meet their needs and match their skills.

•     We help veterans develop personal contacts and friendships outside of military networks.

•     We promote the importance of including physical activity, recreation and relaxation into their everyday life.

•     We encourage veterans to take time to enjoy and be involved in relationships with others (for example, partner and/or children).

•     We encourage veterans to draw on previous experiences of change and help them to develop new coping strategies.

 Tony Wright

CEO

Forward Assist