Veterans' health and wellbeing: a distinctive Scottish approach

Annex 2: Case Studies

Case Study 1

Jason Hare – Veteran and Operations Manager - Horseback UK

Serving his Country

Jason (Jay) Hare was a Corporal in 45 Commando Royal Marines where he experienced some of the world’s toughest and most hazardous environments, serving in Northern Ireland and Afghanistan. His case study provides an insight into the traumas he suffered and his hopes for the future.

Having previously been injured by an IED in Afghanistan in 2006, Jay then sustained severe injuries in 2008 after being blow up by another IED in Sangin, Helmand Province; frequently referred to as the ‘valley of death’. Aged just 27, the incident left him with life-changing injuries including, the loss of his left leg below the knee, several fingers, injuries to his right arm and right leg and serious injury to his face which required multiple reconstructive surgeries over a number of years.

Jay received treatment at Selly Oak Hospital and then the Defence Medical Rehabilitation Centre Headley Court. Remarkably, Jay was only in hospital for five weeks before being discharged and back home for Christmas 2008 - something he attributes to the exceptional treatment he received at Selly Oak. Subsequently he received further treatment at the Recovery Centre near Epsom and returned to 45 Commando in April 2009. He notes that the Recovery Centre wasn’t initially equipped to deal with such severe injuries, but quickly evolved due to the number of severely injured servicemen coming through its doors.

His welfare package extended to specialised support to his family, including the assignment of a welfare support officer. Part of this involved communication between families going through similar experiences, meaning they developed a close relationship adding an extra layer of support described by Jay as “crucial”.

Looking to the Future

Jay now works as Operations Manager at Horseback UK which uses horsemanship to inspire recovery, regain self-esteem and provide a sense of purpose and community to the wounded, injured and sick of the military community.

Aged 36, Jay already feels twinges in his prosthetic leg, other injured knee and back. He questions whether the same level of support he has received to date will be available in the next ten years. Now based in Aberdeen where he receives any treatment or assistance required, Jay worries that if he is to break his two prosthetics he would struggle to find funding for an equivalent replacement or new updated models. He questions what measures are in place to ensure that this is never a problem combat veterans will have to worry about.

Although Jay notes that it is highly promising and encouraging to see a variety of Scottish veteran charities allocated money, he is also concerned about enough funding being reserved for future resources to effectively deal with the delayed onset health conditions experienced by the ex-Forces community, such as PTSD and Adjustment Disorder.

He said: “The Armed Forces Covenant made a promise to the veteran community that we would be treated fairly. It stated that ‘British soldiers must always be able to expect fair treatment, to be valued and respected as individuals, and that they (and their families) will be sustained and rewarded by commensurate terms and conditions of service’. Are enough future resources in place to really deliver this promise? As Operational, we were told that we were going to be looked after if injured – that was the deal that was on the table and I hope that is still the case.”

Having said this, Jay is very positive of the current services and support that is available and believes that we need to keep this momentum going.

“Although I think that we definitely need to readdress how we are preparing for veterans’ future needs in terms of health and wellbeing, the current services available are the best that we have had access to for generations.

“Veterans also now have a louder public voice with a proactive Veterans Minister and the Scottish Veterans Commissioner working in parallel to improve outcomes for veterans in Scotland across a range of key areas - this is extremely encouraging.”

Case Study 2

Aidan Stephen – Veteran and Full-time Art Student

47-year-old Aidan Stephen served in the Army (Royal Armoured Corps) for seventeen years, during which time he undertook operational tours in Northern Ireland, Bosnia, Kosovo and finally Iraq in 2003. When he returned from Iraq, his life spiralled badly, and he was medically discharged from the army due to serious mental health issues. After an extensive range of support over several years, he is back on track, and is now active on the veterans scene where he shares his story at events. For the past two years, he has sat as a member of the Scottish Veterans Fund panel, which makes recommendations to Scottish Ministers on the allocation of funding to veterans projects.

“I was diagnosed with depression in 2000 while still in the Army, however I was deployed to Iraq in 2003 regardless. At the time, if you were suffering from mental illness in the army, only your superior officer would be informed – you didn’t want any of your juniors to know in case it lowered their respect for you and affected your leadership capabilities. There was a real stigma attached and I kept it very much to myself.

“A few months after returning from Iraq, I attempted suicide and spent five days in a coma. When I woke up, I was admitted to a military psychiatric facility in Germany for four months, where I spent many hours heavily medicated and receiving electroconvulsive therapy ( ECT). Most patients were relatives of soldiers, and the support I received wasn’t suitable for my needs.

“I returned to Scotland where my wife and I separated and I ended up living alone in a small basement flat in Edinburgh, isolated with little family support. I was still in the Army at this point and they were trying to figure out what to do with me. I was sent to the Priory in Glasgow, a civilian mental health unit which treats people with addictions and eating disorders. This was one of the worst decisions made in the duration of my treatment. None of the staff were trained to deal with patients from a military background and none of my fellow clients shared my experiences, yet I had to participate in group therapy with them.

“One day, one of the patients said she was feeling low because she had eaten loads of chocolate cake that morning. Whilst acknowledging that seemingly minor issues such as this can have a much deeper psychological root for some people, I was suffering from night terrors and traumatic flashbacks to my time in the Army, and comments like this only increased the distance I felt between myself and everyone else at the facility, leaving me feeling even more isolated.

“I was then sent to Bedlam in London, regarded as the best psychiatric hospital in the UK at the time, where I was given more medication and ECT. In 2006, I was given medical discharge from the Army, and with no progress in the previous three years, I was now in the care of civilian doctors rather than military doctors. Both had told me that it was up to me to make the changes I needed to start getting better.

“I returned to my flat in Edinburgh and continued to spiral, culminating in an incident where I threatened to kill myself and self-harmed in public. I was arrested for this and ended up on remand for eight days. A doctor I spoke with while there told me to get in touch when I was out and he made me aware of veteran-specific support services that he thought would help me. This is where things finally started to turn around.

“When Veterans F1rst Point launched in Edinburgh in 2009, for the first time I had the opportunity to access peer-to-peer talking therapy. It was the first time I had really spoken to anyone about my experiences – until that point, my treatment plan had mostly included medication and ECT. I was diagnosed with PTSD which I got support for from Combat Stress, and accessed a range of other services through veterans charities.

“I had a real breakthrough with Poppyscotland and SAMH in 2011. After identifying that I wasn’t socialising enough and learning that art therapy had worked to a degree at Bedlam, they referred me to a project called Artlink. I really enjoyed it and Poppyscotland helped me explore art courses, taking me to visit Edinburgh College of Art. A woman at the Student Disability Service encouraged me to apply and I was accepted on my chosen course. I am now in my third year, and my mental health has improved massively.

“Looking back on my own experience, I would say that the value of recreational organisations and initiatives aimed at veterans, such as Horseback UK, should not be underestimated and the veterans support scene would benefit from more of these. For instance, I am not aware of any art organisation with a veteran-focus, despite art therapy being a common form of treatment for all people with mental health issues.

“Alongside reintegrating into the civilian community through art, actually talking to someone about my experience was key to making progress with my mental health. It seems obvious, yet it was six years after my suicide attempt before I was given the opportunity to do this with a fellow veteran, and I just didn’t feel like I could open up to anyone else. I felt like they wouldn’t understand and also that there were some things I could say which a civilian might consider reporting to the police. I think ensuring that peer-to-peer support is made available at the earliest stage possible would significantly improve the outcomes for Service leavers with mental health issues.

“All veterans have completely different experiences and needs, and have different ways of adjusting to the civilian world. However, being able to talk with someone openly and honestly provides the basis for developing a suitable treatment plan which can effectively address these.

“In addition to a one-to-one therapy setting, chatting on a social basis with other veterans is also extremely important, and I feel the support organisations which work best are ones which facilitate this through group settings. Building on the existing network of veteran cafes and respite break initiatives available in Scotland would be hugely beneficial in easing transition and combating isolation, which I know first-hand can be deadly.

“Although I have come a long way since my lowest point, I still have bad days which are unlikely to ever go away completely. Most veterans agree that continuity is essential - PTSD can’t be cured, only controlled, and long-term support for this is vital. Many of the initiatives aimed at improving veterans’ wellbeing can only provide certain types of support on a limited basis due to funding.

“Horseback UK runs a five-week course which many service users benefit from on a short term basis, however, for the impact to be maximised, their access to the service needs to be sustained. There needs to be more funding allocated to help veterans access specialised recreational programmes on a long-term basis, as recovery is a lifelong process.”

Case Study 3

John Johnston – Veteran and Research Project Officer, Borders General Hospital

John Johnston of Galashiels left the Army in 1988 after six years of service, despite enduring a severe injury to his back in 1983. On returning to Civvy street, John went on to fulfil a successful career in the prison service for 23 years until 2011 when his injury prevented him from continuing work. After medical assessment, he was categorised as disabled. Forced into unemployment, John felt a great sense of worthlessness which led to suicidal thoughts until Veterans First Point Borders intervened.

Leaving a Community

Leaving the Armed Forces where there is a real sense of belonging and comradeship is difficult, John explained, as you feel as if you’re going it alone in the civilian world. Employment within the prison service replicated this feeling of community for John, and it wasn’t until he had to stop working due to his Service-sustained injury that a sense of worthlessness set in.

His mental health rapidly deteriorated which led to the breakdown of his long-term relationship and suicidal thoughts as he resorted to living in his car.

He said: “I had hit rock bottom and felt as if I had literally been thrown on the scrap yard, I had lost a sense of belonging and felt as if I had no purpose with no job prospects.”

In September 2016 John initially approached Citizens Advice Bureau for housing advice, where a staff member recognised that he needed further support and directed him to Veterans First Point (V1P) Borders. Within just a few days, V1P assigned a peer support worker to John who was able to provide one to one support and that crucial feeling of military familiarity.

Within the subsequent days, John met with a psychologist who diagnosed him with clinical depression and high functioning autism. The lack of support in dealing with this was leading to his suicidal thoughts. Accessing the services through Veterans First Point Borders was the pinnacle moment of John transforming his future.

Why V1P Works

It can be extremely overwhelming for ex-Service personnel to even recognise that they are in need of help. The beauty of V1P, John explained, is that it can help you recognise that you do need support and that it is available.

John accessed the services at V1P from September 2016 to November 2017 where he was provided with weekly therapy sessions, open invites to group sessions and practical sessions such as CV writing to help him secure employment.

“The whole ethos of V1P is that they go the extra mile for everyone who accesses the service. They helped me get out of the house and meet with likeminded people which ultimately is the reason I am still here today.

“It gets people from all Forces backgrounds around the same table and creates that sense of belongingness that we have all been a part of. There is no medical jargon to cut through either which for many of us can be a deterrent from visiting health practitioners. Speaking with someone who ‘gets you’ from a Military perspective is fundamental.”

Support at V1P extends to volunteers setting up mock job interviews, a technique which helped John secure his role as Research Project Officer at the Clinical Governance and Quality department at Borders General Hospital.

John continued: “Even once you’ve finished treatment or completed a programme through V1P, it never closes its doors on you. 18 months ago I couldn’t see a future, but through its continued support I now welcome the light at the end of the tunnel.

“Now if I have an issue I can phone up and speak on the phone. That’s probably the most important part – I feel like a person rather than just being a statistic.”

Limitations and Looking to the Future

V1P is not an emergency service nor is it able to provide all levels of care, but what it does ensure is that when it can’t provide a certain type of support directly, it will signpost veterans in the right direction.

John noted that whilst he thinks the promise set out in the Armed Forces Covenant is valuable, more needs to be done to ensure that those who make the pledge are taking steps to fulfil it.

He also voiced concerns about what would happen if the service was ever to permanently close its doors.

He said: “I can confidently speak on behalf of almost all veterans who access V1P in saying that we would feel a great sense of loss if it wasn’t for the support, comradeship and friendship the service has provided.

“From personal experience I know how the mental health stability of veterans can go from one extreme to another rapidly, so having an instant support service in place is crucial and potentially life-saving. I don’t believe that veterans should get support first just because they were a soldier, but we should get some sort of recognition for our Service to the country in reflection of what the Covenant sets out to achieve.

“Accessing treatment through GPs can sometimes be months and that length of time can hinder veterans seeking support, so it would be a fantastic step in the right direction if a service similar to V1P Borders was rolled out nationally.”

After successfully completing his treatment, John now volunteers at V1P Borders.

Case Study 4

Andy McIntosh – Veteran and SSAFA Branch Secretary

Andy McIntosh, 44, from Strathaven near Glasgow, served as an Army Corporal with the Cheshire regiment for 15 years, serving in Bosnia, Iraq, Northern Ireland and the Falklands.

Andy decided to leave the military in 2003 with an exemplary record to pursue a different career path. After leaving the Forces, he found employment as a shift worker in a factory in Bellshill and later started to work as a depot manager in the East End of Glasgow. Whilst at work in 2008, a persistent kidney pain that Andy had been experiencing worsened and he collapsed. He was taken to hospital and treated for a kidney infection, but through further medical testing it was discovered that Andy had over 150 blood clots in his lower leg, afflicting the main vein that carries blood from the leg to the heart.

Andy explained: “I had been in excruciating pain but had just put it down to a chronic kidney infection. It was difficult to believe that I’d been suffering such serious injury. The medics traced it back to the trauma of an explosion in Northern Ireland. Even though I had walked away relatively fine at the time, I was now experiencing the aftermath.”

Andy was referred to various vascular specialists across the UK and was told that he would never be able to work again. There was a glimmer of hope when he was referred to a specialist professor in London. Through consulting with a global vascular specialist based in Amsterdam, he proposed a procedure that would help Andy walk again if he could get physio to help his legs. With support from Poppyscotland and Erskine, he was given access to intense physiotherapy treatment to help him get to the required level of health. Unfortunately, despite his efforts, the specialist deemed the treatment too risky, and Andy’s hopes were quashed.

He said: “Being offered the chance of walking again and getting so far down the procedure line for it to then be, what felt like, snatched away, left me in a really dark place.

“I didn’t have an income and found myself in crippling debt, losing my house. Us in the Military are quite a proud lot and if I’m honest I didn’t want to ask for help, nor did I know who to approach for help – I was at my wits end.”

Whilst attending a talk by former British Army Officer and motivational speaker Chris Moon, Andy was advised to approach Poppyscotland and the Armed Services Advice Project ( ASAP). This was a turning point.

He explained: “An ASAP advisor visited me and helped me organise my finances. The beauty of the help that I received was that I didn’t feel I was being judged by my situation. They didn’t put any blame on me and told me to stop beating myself up. All they wanted to do was get me back on the right track. I also had the difficulty of dealing with my physical disability and had become a recluse, refusing to go out in my wheelchair. It just wasn’t who I was and I was finding it difficult to adapt. That’s when David McAllister, branch chairman for SSAFA Lanarkshire, visited me on behalf of Poppyscotland. He could see I was struggling with this new lifestyle and he helped me get a mobility scooter which has given me my life back.”

Looking to the Future

Through regaining confidence and use of his mobility scooter, Andy has now returned to work and is the SSAFA Lanarkshire’s branch secretary and a case worker.

He said: “It’s great to give something back to SSAFA, and it’s fulfilling to be able to speak with veterans who are referred to us who can relate to me and my experiences. For many veterans, speaking with someone on their level can be more effective than going to their GP or a psychologist.

“Since starting the role, my eyes have been opened to the amount of veterans out there that are struggling and with so many charities, many ex-Service personnel don’t know which one is right for their needs. As a company, Veterans First Point (V1P) has been one of the biggest benefits in the last 18 months – the work they provide is phenomenal and it would be good to see this or a similar project rolled out nationally.

“I think we also need to consider how we’re going to ensure that we can sustain this level of support in the future. I’m an example of how health and wellbeing issues can arise way down the line after leaving Service, and I know that I’m not the only veteran in this situation. We need to ensure that we are equipped to meet the demand of veterans who require health and wellbeing services in the future, which is likely to increase if anything.”

Case Study 5

Sharon Fegan & Lauren Anderson – V1P Therapists

Sharon Fegan, a psychological therapist and occupational therapist, and Lauren Anderson, an occupational therapist, both work at Veterans F1rst Point (V1P) Lothian, a service staffed by an alliance of clinicians and veterans with the aim of providing a one-stop-shop for the ex-Forces community. The service is delivered in partnership with the NHS, with a total of six V1P centres throughout Scotland.

Although they provide support and treatment for a wide range of issues, veterans experiencing mental health issues form the largest proportion of service users that Lauren and Sharon work with.

Meaningful occupation based on individual aspirations

On the subject of treatment, Lauren says: “Our central aim is to ensure that our clients are engaged in diverse and meaningful occupation that will lead to regular social contact, routine, and improved self-esteem. Whether that is employment or leisure activities depends on the individual’s situation, taking into account a range of factors including mental and physical health, their aims and their abilities.

“The service users I see are seeking fulfilment through employment, and the key challenge I face with them is helping them identify a starting point. Collaboratively, we figure out what they are able to do, what they want to do and where they need to start to get there. Veterans sometimes require additional support and experience to navigate the employment “highway” of the civilian world.

“At Veterans First Point Lothian, a supported employment model known as Individual Placement and Support ( IPS) is used. IPS is the most effective approach in helping people with mental health conditions gain employment and involves one-to-one support, rapid job searching, and ongoing support for an unlimited length of time once the individual is in work.

“Much of our day-to-day work involves providing practical employment support such as writing CVs and cover letters, liaising with employers, honing interview techniques, and learning how military skills can be transferred to the civilian workplace. In addition to this, I will provide ongoing emotional and practical support to veterans and their employers once they are in work. Although it is not essential for IPS to be delivered by an occupational therapist, our core skills help enhance this role with regards to mental health training, assessment skills, job retention and symptom management.

“At V1P Lothian we have seen a rise in physical problems, most commonly loss of hearing, general wear and tear, frailty, and occasionally weight management, breathing difficulties and malnourishment. As a team, we signpost and support veterans towards the most suitable services to assist with their physical issues, whilst looking at how we can manage the emotional aspects through meaningful activity.

“As with the elderly in the wider population, one of the biggest challenges we face is social isolation and the team facilitates group activities and attendance at drop-in sessions to combat this. Some veterans are fit enough to get themselves to such activities, but for those that aren’t we would work with partners to assess carer needs and assist with putting any requirements in place.

“Our focus is not solely on a client’s symptoms, but their aspirations. On the whole, age isn’t a huge consideration; we work with the individual to identify their needs and goals, breaking down barriers to help them to engage in their desired occupations and activities.”

Instilling a greater understanding of veteran-specific needs across the sector

Sharon continues: “We are working in an environment that was developed by and for the ex-Forces community, therefore we are always aware of our client’s Service background, with colleagues who are veterans themselves offering valuable insight on effective communication. We have access to a veteran’s military records which also gives us greater understanding of their military experiences, and we work in partnership with veterans’ statutory services and charities to best meet the needs of a veteran, which is difficult in mainstream services given the range of service charities in Scotland.

“For veterans accessing services in a wider healthcare setting, their clinician may not even know they are a veteran, and their knowledge of veteran-specific issues and preferences may be limited.

“For instance, we’ve found that, across all healthcare settings, veterans frequently turn up 15 minutes early for their appointment, and when clinics are running late, this may result in a substantial wait which may lead to feelings of frustration around the support some veterans are accessing. Additionally, veterans, the majority of whom are male, are less likely to approach services for help and given they are mainly from the most deprived sections of society they are even less likely to access services. Due to the complexity of some veterans’ experiences, many face multiple barriers to accessing the relevant care.”

Lauren adds: “Language is also a hugely important aspect of treating the ex-Service community. Since I began working at V1P, I’ve picked up a great deal of military terminology which I previously didn’t know. Building a good relationship with veterans in a therapy context involves showing appreciation and respect for their background, and acknowledging that there are aspects of Service life you don’t know about, but which you hope to learn from them.”

Sharon continues: “Students and trainees come to V1P for placements as they would in any other health setting, and we have developed practice education placements for them. At a very early stage in their career they are learning how clients from a Service background might differ from civilian clients, and the best ways to approach this. Considering ways in which this increased awareness could be replicated across all positions in the NHS would be a really positive step towards improving engagement with veterans.

“I was recently helping a client complete a PIP form and I noticed a question about having served in the Armed Forces was included. This is something which I think should be added to all forms when registering for health services. Through basic training, an affirmative answer would prompt a range of considerations for the clinician at the outset, such as whether or not there are any other physical or mental health issues, and how this client might require additional support to access public service systems.

“As standard, GPs in Scotland include the question on their registration forms, however, unfortunately, many still do not know what to do with that information. It would be beneficial to provide a short crib sheet on their system to give options for onward referral and analyse that information.”

Occupational therapists as the specialist and influencers in engaging with veterans

Lauren says: “Occupational Therapists are trained to promote physical and mental health and to work in both health and social care. These skills could potentially be utilised in V1P Teams to holistically address the needs of veterans and minimise onward referrals, or where appropriate, expedite the most appropriate supported onward referral.”

Sharon adds: “Many of the current Scottish Government policies around health, wellbeing and justice are positioned within a rights-based approach. Our profession’s resulting connection to occupational justice and people’s right to engage in meaningful activities that influence health and well-being supports our unique understanding of the multiple factors that can limit or diminish engagement with occupation. A key message for the Scottish Government is that occupational therapists are the ‘go-to’ experts to influence and drive change towards the promotion of occupation for people and communities, including veterans, and increase their access and engagement.

“It’s important we instigate a sector-wide shift where we see staff develop a greater understanding of what support veterans actually need, as opposed to administering treatment programmes based on what they think veterans need.”

Case Study 6

Jane Duncan – Veteran and Veterans Support Advisor

Jane Duncan is the Veterans Support Advisor for Renfrewshire Council, East Renfrewshire Council and Inverclyde Council. Having served 22 years in the British Army, Jane is a veteran herself and therefore has a wealth of understanding about the resources that are crucial to ensuring Military personnel are provided with the right services and tools when returning to Civvy street.

The idea of implementing a Veterans Support Advisor arose in 2012 when all three Councils signed the Armed Forces Covenant and it was decided that to maximise their commitment, a lead individual was necessary. Commencing the role in 2014, Jane underpinned what services were already in place and what needed to be implemented to improve services and opportunites for Military personnel within these regions. It was quickly apparent that whilst there was information and services available, these were not readily accessible for veterans due to poor communication.

After reviewing what initiatives, services and tools were already available within these Councils and NHS boards, Jane initiated a veterans’ ‘Mini Champions’ programme. She built upon the information and tools already in existence and used this material to train individuals within Council teams such as employment, finance and housing so they were equipped to provide veteran specific advice.

Having the ‘Mini Champions’ programme ensures that someone within the local area is immediately aware of an issue faced by a veteran and in turn can guide them to the support available; whether it is locally or nationally. Many veterans voice that it can sometimes be overwhelming to know what support is available so having someone trained within their local area can remove this barrier.

Why ‘Mini Champions’ Works

The ‘Mini Champion’ programme extends to equipping veterans with the confidence to attend local social groups which is a valuable network for veterans.

Jane commented: “There is no reason for any veteran to feel alone or isolated when leaving the Armed Forces and joining social clubs can often be a crucial element to help build confidence and give a sense of purpose.

“When you leave the Armed Forces, you leave a community, and that is very difficult to step away from. Replicating that community sense via social groups and organisations can, for some, help Military personnel feel part of a tight knit group and most importantly, valued.

“My role extends to liaising with local clubs and initiatives within the area to ensure that they are equipped with the knowledge of how to help veterans in their community integrate. We need such clubs and groups to welcome veterans, and recognise the pool of talent and skills they withhold.”

How have Attitudes Towards Veterans Changed

Through the implementation of Jane’s role, she has noted that there has been a huge shift in attitudes towards veterans within the three Councils she works with.

She said: “The appetite from Renfrewshire Council, East Renfrewshire Council and Inverclyde Council to help veterans integrate into the community has significantly increased since 2014 and they all want to play their part in ensuring that the region is viewed as a place to settle for veterans. They want ex-Service personnel to know that they, and their families, are welcomed to the area and that there is support and help in place at a local level.”

Looking to the Future

Jane fundamentally believes that there would be great benefit for each Council in Scotland to implement a Veterans Support Advisor role but if it were to do so, then it would need to be coordinated through a body such as Veterans Scotland.

“I would love it if every veteran in Scotland was able to contact their local authority directly and get the support they required. Whilst it’s great to promote national level services, it can be difficult for veterans to know who to turn to for advice. The ‘Mini Champions’ programme acknowledges a veterans’ query immediately and can help prevent it manifesting onto a larger scale.”

Case Study 7

Warwick Shaw – Veteran and NHS Borders Veterans Champion

Warwick Shaw is the NHS Borders Armed Forces and Veterans Champion. He has worked within the NHS after a fulfilling career in The Royal Artillery, Regular Army, for 19 years. Throughout his career in the NHS, he has always been personally interested in the care and provision for Armed Forces veterans due to his Military background and had a watching brief for arising ex-Forces issues. Warwick was depute for five years before his appointment to the role of Armed Forces & Veterans Champion.

What is an Armed Forces And Veterans Champion?

The NHS Armed Forces and Veterans Champion has a responsibility to provide support to past and present Armed Forces personnel, as well as their families, within their local authority area, to ensure their needs are met. The Borders no longer has the capacity levels of a large number of serving personnel to set up specific veterans services as in other locations. Instead, Warwick has concentrated his efforts and resources on equipping GPs with information and the right tools that they could use to help veterans.

He explained: “By signposting help and resources, such as SSAFA and Veterans Scotland, we can cut out the middle man and allow GPs to direct veterans towards the right support as soon as they are seeking advice.”

Services Implemented

In 2015, Warwick, in cooperation with other NHS Scotland Boards, saw an opportunity with available LIBOR funding and helped establish a Veterans First Point Borders service.

Warwick explained: “V1P has been a great tool and we have had about 80 referrals since establishing the service, of which about half are still accessing the advice and services that are provided.

“The fundamental element that makes V1P a success is that veterans are provided with a peer support worker who, through shared experiences, one to one dialogue and assistance, ensures that veterans feel like they are being listened to and someone is actually trying to help.

“As well as being more equipped to understand veterans, using peer support workers has the secondary benefit of overcoming funding challenges, being more cost-effective than exclusively hiring clinicians.”

Does the Current System Work?

Warwick believes that the peer support work delivered through V1P is key to facilitating successful support for veterans; repositioning the support as chatting to someone at the same level, as opposed to them being a ‘ recipient’ of care. It also encourages ex-Military personnel to feel part of a network, heightening their self-esteem and preparing them to move on to new ventures.

He commented: “I think what we’re doing is good but what we need to really showcase this is more financial support and ultimately rolling the programme out across the whole of the UK. We aren’t looking for all singing, all dancing services but veterans do deserve the right to dedicated support.”

He continued: “As an ex member of the Forces with physical injuries, I don’t think I should get any more service than someone who sustained injuries from say a car accident, but I should get at least the same level of care.

“Veterans with severe and enduring conditions should have equal access to specialist treatment and care, regardless of their geographical location.”

How Could the Role of NHS Veterans Champion Be Improved?

Warwick highlighted that whilst the current system does work for the veterans who access the service, there is a large pool of veterans who are unaware that his role and support exists.

He commented: “ NHS Armed Forces and Veterans Champions are a complete mystery to veterans. V1P is helping raise awareness but the people who do access V1P did not know that there was a Veterans/Armed Forces Champion within NHS Boards or local authorities. I have never been approached directly by an ex-Servicemen.”

This insight indicates that there is a need to highlight that such bodies are available to veterans, although Warwick noted that Armed Forces champions could not cope with the demand from every single veteran in Scotland, so that’s why it’s so important to have a strong relationship with the likes of SSAFA and V1P.

He noted: “V1P is an excellent model that I think should be made exemplary across Britain. Equally I think what should be rolled out across Scotland and perhaps Britain is for veterans to have access to NHS services through a GP rather than going to a specialist who they may only see infrequently.”

Case Study 7

‘Joe’ – a veteran

‘Joe’s’ story was shared with us by Charlie Allanson-Oddy, Consultant Psychological Therapist at Veterans First Point Lothian. It gives a glimpse into the struggles and challenges faced by someone with PTSD and, in this case, a successful adjustment to civilian life.

‘Joe’ was medically discharged due to PTSD following events in Afghanistan in 2012. Following discharge he had been allocated a veterans house but was isolated and finding it very difficult to communicate with his neighbours. Eventually Joe attended the V1P Lothian offices in June 2016.

A Clinical assessment was offered but not attended. After discussion with Veterans UK another assessment was offered which Joe attended. He continued to present with PTSD and aspects of Generalised Anxiety Disorder ( GAD) – difficulty in eye contact and a reluctance to discuss anything relating to events on a tour of Afghanistan.

Joe was offered Acceptance and Commitment Therapy ( ACT) one of the Cognitive and Behavioural Therapies particularly effective in reducing avoidances. In Joe’s case these avoidances were maintaining his trauma symptoms and affecting his quality of life significantly. Eventually, Joe was able to discuss in detail the events from his tour of Afghanistan that had so greatly affected his confidence in himself and other people and to take part in a range of social activities that had become increasingly difficult for him over the last few years.

He was encouraged to increase his activity levels and he now attends the gym regularly. He was also referred to the Citizens Advice Bureau ( CAB) for a benefits related appeal. CAB attended the tribunal with him and helped to win his appeal.

Internally referred by his clinician to Occupational Therapy ( OT), Joe now attends sessions with both the psychological therapist and occupational therapist. The OT meets Joe to discuss work options and as part of the graded exposure to work, and supports him to apply for jobs.

Joe is now largely free of symptoms, applying for jobs and continuing his adjustment to civilian life.

Scottish Veterans Commissioner

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