Armed forces families

LTP Priority: Wider Social Impact: Veterans Health and armed forces Interventions

Population Intervention Triangle: Segments (link to Section 1 PHE PBA): Service

Type of Interventions: Armed Forces Families

Major driver of health inequalities in your area of work

Families of armed forces veterans and serving personnel are often vulnerable and regularly deal with a number of disadvantages.  This includes accessing healthcare, continuity of care, access to screening & immunisation, access to diagnostics, local variation in commissioning and provision, change of care providers, transitional issues, young carers issues, family separation, domestic abuse and alcohol related issues (victims or perpetrators) and dealing with a plethora of non-health related issues (housing, social isolation/moves, education and employment).  The right level of support for families of armed forces veterans and serving personnel can often feel limited and difficult to access for both children and adults.

This finding has been repeated numerous times since 2009, however, The National Audit Office (NAO) report into Prison Mental Health Services, published in June 2017, noted: “Prisoners do not routinely receive continuity of care on release, making successful rehabilitation more challenging. It is important that prisoners have good continuity of care between prison and the community. Over half (57%) of prisoners sentenced in 2016 were sentenced to less than one year, and most will serve half their sentence in prison, and half in the community. It can be challenging for prison healthcare and Community Rehabilitation Companies to establish links with community health teams, particularly when a prisoner is released far from their home or at short notice”.

Target groups

Deprivation, Inclusion health group, Protected characteristics.

Intervention

Armed Forces Families

Description

To develop and implement a new and bespoke wrap around mental health service which takes into account many of the disadvantages and vulnerabilities families of armed forces veterans and serving personnel face. They may include issues associated with:

  • Mobility and frequent house and school moves
  • Separation and family breakdowns
  • Isolation
  • Mental health issues such as anxiety and depression
  • Physical and emotional health
  • Neurodisability
  • Access to services as a result of transient lifestyles
  • Involvement with the criminal justice system

Successful delivery of the HIS service and realisation of  positive outcomes for patients, efficiencies and integration across the system are dependent on links to the Mental Health Five Year forward View as well as a number of related services. It is particularly important that mechanisms which allow referral and flow between services are in place to ensure patients receive the right level of care and support dependent on the severity of their mental illness and at the right time. Services include:

  • IAPT
  • TILS
  • CTS
  • Interface with crisis care at Tier 4
  • Interface with secondary care services
  • Interface with urgent and emergency care services

Delivery and continuous improvement of the High Impact Service will be reliant on contribution and support from advocacy and third sector organisations and those with lived experience of armed forces life.

Evidence

Life for members of an armed forces family, whether they are regulars, reservists, veterans, spouses, partners or children, can have additional worries, including:

  • Stress around deployment
  • Extended and repeated periods of separation from spouses and partners
  • Social isolation from family and friends
  • Additional and sudden caring responsibilities

As many as 1 in 4 armed forces partners or family members of service personnel and veterans way their own mental health and wellbeing has been affected by their loved ones situation.

Many suffer in silence with 1 in 8 reporting that they would try to cope with issues alone.  The stigma of speaking up as an armed services partner or family member is the main reason many don’t speak up.

The impact of a dedicated service supporting the mental health of families and carers of armed forces personnel is expected to reduce inequalities by:

  • Encouraging better collaboration and engagement with families federations and other stakeholders
  • Improving broader determinants of health for families of veterans and those in service
  • Improving access to early intervention, care coordination and mental health support (especially in and after transition and for those moving whilst in service)
  • Supporting transition into and out of service
  • Increasing flexibility to address the disproportionately higher burden of illness, co-morbidities and poorer access to treatment and prevention programmes
  • Increasing capacity to support, care for and treat families of veterans and those in service with substance misuse (drugs, alcohol & tobacco) issues
  • Improve integration and pathways of care to include specialist intervention into crisis care for example
  • Increasing support for family members who suffer with complex long term mental health conditions
  • Supporting and encouraging families of veterans and serving personnel to engage with health services and take greater personal responsibility for their own healthcare needs
  • Supporting and encouraging peer support for families and facilitate ongoing contact with people with their own experience of the armed forces who understand each other’s culture and identity

By introducing services which support families of armed forces veterans and those in service, we expect to see improvements in health and care outcomes, quality of care and safeguarding.  In doing so:

  • Reduce the number of attendance at A&E and other urgent and emergency services
  • Reduce the number of admissions to hospital
  • Support the need to raise awareness amongst healthcare professionals around the relationship between life in the armed forces; and mental health issues amongst families and carers
  • Ensure continuity of care throughout transition in to and out of the armed forces.