Scottish Government's Armed Forces Veterans Guide For Healthcare Providers

Who is a veteran?

A veteran is anyone who has served for at least a day in HM Armed Forces, whether as a regular or as a reservist.

It takes all sorts
Veterans may be:

• Male or female
• Aged 16 to 100+
• From any ethnic or cultural background
• Single, partnered, married or in a civil partnership, divorced or widowed
• Physically fit and in good health, or disabled with major healthcare needs

They may have:

• Served for one day or more than 40 years (the average is 4-6 years)
• Been an engineer, personnel manager, linguist, caterer, radio technician, nurse, pilot or any of a wide range of trades or professions
• Served in Afghanistan, Iraq, Falklands, Malaysia, Germany, Northern Ireland, Bosnia, Hong Kong or almost anywhere

Many veterans have never been in combat and some have left before completing training. However many will have been involved in intense hazardous and highly stressful operations, including participation in the many combat operations of recent years. Only one year has passed since 1945 when no service personnel have lost their lives on active service.

What to ask

• Have you ever served in the Armed Forces?
• Which service were you in (Army, Royal Navy, Royal Marines, Royal Air Force)?
• How long did you serve for?
• How long ago did you leave?
• What was your job?
• Where in the world did you serve?
• Did you have any health problems whilst you were serving, or after you left?

Most veterans are happy to talk about their service. A few prefer not to, and an even smaller number are not allowed to. They will appreciate your understanding in respecting their privacy.

How many?

Veterans in Scotland - 400,000
People in Scotland in receipt of an Armed Forces occupational pension - 29,000
People in Scotland in receipt of a War Disablement Pension - 14,000
People leaving the services each year and settling in Scotland - 2,000
People medically discharged from the services each year and settling in Scotland - 100
Of whom, number of people discharged each year with a musculoskeletal disorder - 65
Discharged with a mental health problem - 12
Discharged with a serious operational injury - 10

All numbers approximate and subject to change.

Common health consequences

Musculoskeletal

Most service personnel have been very physically active, and many have sustained sports injuries during service. Over time, about 75% will develop long-term consequences such as:

• Osteoarthritis
• Knee, back and hip problems

Hearing

Military training involves exposure to weapon noise and often to other hazardous noise. Prior to the late 1970s, hearing protection was rarely used. During World War II and in more recent conflicts, people may have been exposed to intense weapon noise on military operations resulting in:

• Noise induced hearing loss

Mental health

• Adjustment reactions
• Common mental health disorders
• Post-traumatic stress disorder and other combat related stress disorders often manifest themselves many years after the cause of the trauma.

Most veterans have enjoyed their military service. Research has shown that even combat operations can improve mental health. A small number of veterans will require support. They may have found the transition to civilian life difficult, or they may have developed a mental health problem unrelated to their military service. Where the problem relates to their former military service, they will appreciate a sensitive, listening approach and, if necessary, referral to a specialist provider. Most veterans are no more likely to have a mental health disorder than the general population, but a small number will have complex mental health needs.

Quality care for veterans

• Know who they are - ask!
• Record their veteran status on practice computer systems
• Be aware of their military background but not polarised by it - most veterans' health issues are unrelated to their military service
• Know the privileges that veteran status confers
  • Priority NHS treatment for conditions contracted as a result of their service.
  • Access to veterans' charities
  • Access to MOD helplines
• Be aware that leaving the services is a "major life event"
• Accept that people recently discharged from the services
  will not "know their way around the system". Be prepared to
  offer guidance and support
• Understand that most veterans are proud, self-reliant and independent. Asking for help may not come easily to them. Be sensitive to their needs and aspirations
• Recognise that most veterans
  are highly skilled professionals.
  A "paternalistic" approach will rarely appeal to them
• Listen to their story! It will show understanding and compassion, and may reveal a history of hazard exposure or foreign travel which will assist in diagnosis

How do I...

Obtain a veteran's military medical record? Follow the link at www.veterans-uk.info/service_records/service_records.html

Find general advice on veterans matters and pension issues
Look at www.veterans-uk.info

Support a reservist (serving or veteran) with a deployment-related mental health problem? Contact the Reserves Mental Health Programme Freephone 0800 032 6258

Manage a veteran with medically unexplained symptoms after deployment?
Contact the Medical Assessment Programme Freephone 0800 169 5401

Find a charity providing support for homeless veterans? Look at
www.veterans-assist.org

Find more health information for a veteran? Go to www.nhsinform.co.uk/VeteransHealth

As a GP find out more about priority treatment for veterans? Look at
www.scotland.gov.uk/Publications/2008/04/30100639/1

Support a veteran with a service-related mental health problem? Contact the Combat Stress Regional Support Desk telephone 01292 561352

In Edinburgh & the Lothians, contact Veterans First Point www.veteransfirstpoint.org.uk or telephone 0131 220 9920

For general advice, see www.nhs.uk/Livewell/Militarymedicine/Pages/Mentalhealth.aspx