Accusations are being made that the UK government is failing to meet the very standards it set for itself when it comes to veterans. Medical experts say former military personnel are not being given the priority NHS treatment they were promised in the military covenant that was signed into law in 2011.
Orthopaedic surgeon Tim Biggs and psychiatry specialist Neil Greenberg have both been quoted as saying that promises being made about veteran care are not being realised. Former soldiers say they are facing difficulties in getting NHS treatment and shadow ministers say the government of failing in its duty.
But this problem is not just about missing out on treatment. When veterans do get help, it is often not the help they need. Services still target veterans as a group, rather than as individuals with very individual needs.
The trauma and stress that service in war zones can cause mean that what happens to personnel after they leave is actually one of the most important aspects of military service. They suddenly find themselves away from what has been a life of strict discipline and intense pressure and can struggle to cope with the transition. Services are available to help but they often fail to recognise that each veteran is different. Services need to be more tailored to reflect the different problems faced by former military personnel, be they old or young.
Services to support military veterans in this part of their lives were only introduced after the World War I had ended. Back then, there was little help provided except what was offered by family and friends. But as governments started to experience the consequences of the psychological damage that can be done to personnel, they started paying large sums of money to develop proper services, such as the Ministry of Defence’s Medical Assessment Programme. Services such as Combat Stress, The Veterans’ Mental Health Charity, have also since been established.
Re-integration into society can be a tough social and psychological task. With or without the support of family and friends, veterans need to adjust to everyday life. They need to find housing and secure a stable income as well as access welfare services.
The general belief is that a veteran is someone who has served their whole career in the army, the Royal Navy or the Royal Air Force before going into retirement. But in the UK, a veteran is someone who has served and received pay, even if it is just for one day. That means veterans can be in their very early 20s or well into their 90s.
Given this expansive age gap, and the overwhelming variety and magnitude of combat experiences veterans are likely to have faced during their time in active service, no two veterans are the same. Their experiences can shape their psychological profile and their needs differ on a case-by-case basis.
In a recent study, we evaluated the effect of a new clinical and social service for military veterans in the north-west of England. A few years ago, the government introduced a scheme called Improving Access to Psychological Therapies, or IAPT. This was to support people in the general population who were suffering from depression and anxiety. The service we assessed in our study was the first to target IAPT therapy specifically at veterans.
We found that the success of a therapy was to some extent influenced by the type of veteran being treated. Those who had left the service early made more lasting recoveries from anxiety and depression, while those who had a physical disability or were abusing alcohol or drugs found it harder.
Although current services for veterans provide a variety of different treatments, such as self help, cognitive behavioural therapy, stress exercises or medication, very little is known about how different types of veterans are treated. This is because ours is the first to have evaluated treatments for different subgroups within one study. We need to have a better understanding of those groups and their therapeutic outcomes before services can be adapted.
Anxiety and depression are a serious burden to society – and depression is a major cause of death in adults. We need to find ways to improve the benefits of therapy to reduce this toll. Veterans are exposed to different life situations that could trigger anxiety and depression – and that may be particularly true for the younger ones. If they leave the service early, they may have done so intentionally or for a specific reason so they may need more tailored care than someone who has simply spent their whole career in service and needs help adjusting.
Veterans might make up a small part of the population but they often experience mental health problems when trying to adjust to everyday life. To date, only a few veteran-specific services exist.
It’s already clear that veterans need a different type of treatment to the general population because the problems they face are so closely linked to life in military service. But it’s also beginning to look like they need different treatments from each other. Some have served for decades while others have completed just one tour and come away traumatised. No two veterans are the same and we need to think in more detail about how to deal with their problems.