Ex-forces personnel

The military needs to recruit about 20,000 men and women each year to the armed forces. This workforce is drawn from a broad section of society, including areas of high unemployment and people with few qualifications. Recruits are required to adapt to military life and ethos and, where essential, give up a few of the freedoms they had as civilians.

To equip personnel with the necessary skills and attitudes for the full spectrum of military operations (including war fighting), the services instil a culture of discipline, reliance on others and acceptance of orders. Although personnel can have a long fulfilling career, the majority of them will leave the armed forces at least 25 years before the current national retirement age and will need to pursue a second career. When individuals leave the armed services they are often referred to as ‘veterans’.

A veteran is anyone who has served for at least one day in the armed forces, whether regular or reserve. This also applies to Merchant Navy seafarers and fishermen who have served in a vessel at a time when it was used for military operations by the armed forces. 

The veterans’ community is a wide and disparate population (there are an estimated 4.5 million veterans in the UK). However, as an individual’s circumstances change over time, the needs of veterans will not be identical and will be determined by factors such as their experience before, during and after their military service, including their transition from military to civilian life.

The veterans’ community can be divided into three broad groups. These groups are veterans who:

  • Following a service career, return successfully to civilian life;
  • Have suffered ill health or injury as a result of service. In cases of death, their widows and dependants should receive proper support from the government or community;
  • Have been unable to make a successful transition to civilian life.

When servicemen and women leave the armed forces, their healthcare is the responsibility of the NHS. All veterans are entitled to priority access to NHS hospital care for any condition, as long as it's related to their service, whether or not they receive a war pension.

Last updated: 2016-01-27 11:22:56
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1. What are the key issues?

National evidence shows that:

  • More than one-quarter of service leavers reported that they found the return to civilian life was not as they expected or harder;
  • A small minority of service leavers experience severe difficulties such as homelessness;
  • Awareness of the different support which is available varies between service leavers, particularly between early service leavers and those who have served longer;
  • Some service leavers find it difficult to access services when they are discharged. This is due to the lack of information provided locally;
  • The processes, procedures and criteria that local services often apply make it difficult for service leavers to prove eligibility;
  • There is a lack of awareness and understanding of the unique experiences and challenges of service personnel of civilian professionals and institutions. This has an impact when considering the awareness of veterans’ health issues and in particular the special needs of older and disabled veterans;
  • Levels of alcohol misuse are substantially higher in UK armed forces personnel than in the general population;
  • According to British research, 9% of people who experience combat develop late onset post-traumatic stress disorder (PTSD);
  • The National Ex-Services Association indicates as much as 7% of the UK prison population (over 6,000 prisoners) are veterans;
  • The main findings from a survey of 10,000 serving personnel were:
    • 4% reported probable post-traumatic stress disorder;
    • 20% reported other common mental disorders; 
    • 13% reported alcohol misuse.
Last updated: 02/10/12

2. What commissioning priorities are recommended?

2012/01

Raise awareness of the entitlement of veterans to priority access to NHS care by NHS staff.

2012/02

Work in partnership with other agencies and the voluntary and community sectors to prevent homelessness, tackle unemployment and other social exclusion issues amongst veterans, where the problems have arisen from their service.

2012/03

Ensure the effective and timely direct transfer of medical records from Defence Medical Services to GPs when individuals leave the armed forces.

2012/04

The Joint Health Overview and Scrutiny Committee of North East Local Authorities report on the regional review of the health needs of the ex-service community was formally launched in March 2011. The report identified 47 areas for improvement, including 12 areas specifically related to mental health. These include:

  • A strong role for the new local Health and Well-being Boards in assessing needs and co-ordinating service provision;
  • Enhanced awareness among primary care providers and GPs of the particular mental health needs of the ex-service personnel and particularly of the need for priority treatment for health care needs arising from their service;
  • Appropriate training is required by commissioners of NHS services. This should guide them on how to:
    • Produce guidance specifically for primary care providers and GPs to explain the priority healthcare entitlement;
    • Identify ex-servicemen and women;
    • Adapt their systems to accommodate priority treatment for the ex-service community;
    • Accept referrals from ex-service charities, including the Royal British Legion and Combat Stress, but also smaller local organisations providing for some of the most marginalised/excluded ex-service personnel;
  • Local authorities and GP consortia should be actively engaged in joint planning and commissioning of services with the NHS;
  • Local authorities should be actively engaged in the North East NHS Armed Forces Network and consider how they can take on a leadership role in relation to veterans mental health issues;
  • Primary care and acute trusts should take steps to improve awareness of veterans mental health issues among health workers generally, including appropriate training and supervision.

Some groups within the ex-service community may need special attention, including prisoners and early service leavers (those who leave the service after less than four years).

Last updated: 02/10/12

3. Who is at risk and why?

Centre for Military Health Research at King’s College London

The Ministry of Defence and NHS Partnership Board commissioned the Centre for Military Health Research at King’s College London to review recent and upcoming research publications. The following factors were identified as increasing the risk of alcohol misuse and/or mental health problems:

  • being young;
  • being male;
  • being in the Army, rather than another branch of service;
  • holding a lower rank;
  • experiencing childhood adversity;
  • being exposed to combat;
  • deployment length over the “Harmony Guidelines” (in the case of the Army, roughly 12 months front-line service over a 3-year period);
  • being a Reserve;
  • having a mental health problem while in service;
  • Being an early service leaver;
  • Post-traumatic stress disorder makes up only a minority of cases of mental health disorders.

Suicide

Those who leave the services early and were young are up to three times more likely to commit suicide than the general population

Length of service

Those who had served a shorter time found the transition to civilian life most difficult.

Socioeconomic

Many recruits are drawn from educationally and socially disadvantaged backgrounds and, in many cases, also join with weak basic skills.

Last updated: 02/10/12

4. What is the level of need in the population?

Association between active service and mental health problems in armed service personnel involved in recent conflicts has been reported in UK research. A very recent study of 10,000 serving personnel (83% regulars; 27% reservists) found lower than expected levels of PTSD. Common mental disorders and alcohol misuse were the most frequently reported mental disorders among UK armed forces personnel. In particular, levels of alcohol misuse overall were substantially higher than in the general population.

The main findings were:

  • 4% reported probable post-traumatic stress disorder;
  • 19.7% reported other common mental disorders;
  • 13% reported alcohol misuse; 
  • Regulars deployed to Iraq or Afghanistan were significantly more likely to report alcohol misuse than those not deployed; 
  • Reservists were more likely to report probable post-traumatic stress disorder than those not deployed; 
  • Regular personnel in combat roles were more likely than those in support roles to report probable post-traumatic stress disorder;
  • Experience of mental health problems was not linked with the number of deployments.

Referrals of veterans to Tees, Esk and Wear Valleys NHS Foundation Trust are reported to be at the rate of approximately 10-12 veterans per quarter, or up to 50 a year.

Source: An evaluation of six Community Mental Health Pilots for Veterans of the Armed Forces (K Dent-Brown, A Ashworth, M Barkham, Saxon, D et al).

Last updated: 02/10/12

5. What services are currently provided?

Mental health

Veterans' Wellbeing Assessment and Liaison Service (VWALS)

The VWALS is a new mental health and wellbeing service to support veterans and their families in the north east. the service is accessable directly, through GPs or another health, social care or third sector service.

Medical Assessment Programme (MAP)

MAP offers help and treatment to any veteran of any conflict, no matter how long ago, and their carers (Tees, Esk and Wear Valleys NHS Foundation Trust).

The Service Personnel and Veterans Agency (SPVA)

The SPVA is part of the MoD, acts as a single point of contact to provide advice for serving military personnel, ex-service personnel and their dependants.

Combat Stress

Combat Stress provides specialist residential and community outreach mental health care for veterans.

Pilot projects

The MoD and NHS are running six veterans mental health pilot projects across the UK. The aim of these projects is to increase knowledge and understanding of veterans’ mental health needs among mainstream NHS staff, to improve access to mainstream NHS services.

Housing

Joint Service Housing Advice Office (JSHAO)

Provides service personnel, service leavers and ex-service personnel still occupying service family accommodation as irregular occupants with comprehensive advice on housing options (including civilian housing information, advice and where possible placement into social housing).

MOD Referral Scheme

Provides a route into low-cost, social housing for Service leavers, married or single. It is administered by the JSHAO.

Single Persons Accommodation Centre for the Ex-Services (SPACES)

Spaces is designed to help single persons leaving the Service to find appropriate accommodation. It is an accommodation advice and placement service.

SSAFA Forces Help

A national charity helping all veterans and their dependants on a range of welfare issues including housing.

Veterans Aid (formerly EFC - the Ex-Service Fellowship Centres)

The objective of Veterans Aid is to relieve distress among ex-Service men and women of the Royal Navy, Royal Marines, Army, Royal Air Force and the Merchant Navy and their widows or widowers who are in crisis.

Home Base

A service for people who are facing homelessness as they leave the armed forces. It is run by Community Housing and Therapy (CHT) and aims to help clients integrate successfully into civilian life.

Stoll (formerly Sir Oswald Stoll Foundation)

A charity with a mission to ensure vulnerable and disabled ex-Servicemen and women live as independently as possible. It provides housing and support for vulnerable veterans including those who have experienced homelessness and other issues.

Prisoners

Prison In-Reach

The Prison In-Reach project provides support to veterans who are serving prison sentences and to their families, with the aim of aiding rehabilitation and reducing the risks of re-offending.

Last updated: 26/11/13

6. What is the projected level of need?

The circumstances of future veterans will be very different from those of many of today’s veterans. For example, there will be fewer veterans of the conscription era and a greater proportion of veterans will be former reservists. These changed circumstances will bring with them different opportunities, expectations and requirements. Likewise, the nature of conflict is evolving as a result of changing technology, different sorts of threats and the increased emphasis on peace-keeping and similar operations. In particular, service in the armed forces is likely to remain a unique experience with challenges and opportunities that have no parallel in civilian life and which may affect personnel well after they return to civilian life.

Last updated: 02/10/12

7. What needs might be unmet?

  • The level of resettlement support is determined by the length of military service and is not dependent on the rank of the service leaver.
  • Service leavers who are discharged compulsorily have no entitlement to formal support.
  • All early service leavers are often discharged at very short notice making it difficult to provide appropriate support packages to prepare them for the transition to civilian life.
  • There is a lack of awareness and understanding of the unique experiences and challenges of service personnel by civilian professionals and institutions. This has an impact when considering the awareness of veterans’ health issues and in particular the special needs of older and disabled veterans.
Last updated: 02/10/12

8. What evidence is there for effective intervention?

Content under development.

Last updated: 11/10/11

9. What do people say?

The University of Sheffield Centre for Psychological Services Research

During 2008-11 the Ministry of Defence (MoD) funded a programme at six sites within the NHS to test out ways of providing mental health care to veterans of UK armed forces. The Centre for Psychological Services Research was commissioned to undertake an evaluation of these sites, in comparison with three existing services for ex-service personnel.

Responses were received from 13 clients at Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV), from a total of 70 questionnaires distributed (a response rate of 18.6%). The themes from the questionnaire were identified as follows:

  • Problems with distance to services;
  • There is a need for more sessions/centres/staff;
  • There is a problem with seeing non-forces staff;
  • There is a need for assessments/treatments/information in and when leaving forces;
  • There is a need to let the client set the pace of therapy.
Last updated: 02/10/12

10. What additional needs assessment is required?

Content under development.

Last updated: 11/10/11

Key contact

Name: To be advised

Job title:

e-mail:

Phone number:

References

National Audit Office and Ministry of Defence Leaving the Services 2007

Ministry of Defence Strategy for Veterans 2006

Chief Medical Officers Letter Gateway Reference 13406 Access to health services for Military Veterans – Priority Treatment 2010