I met Peter and Simeon a few months ago, but both of them had been known to me, as they were always to be seen street drinking and sleeping rough in Liverpool City Centre. Peter had been on the streets for nearly 12 years. He served in Northern Ireland, and on returning to Liverpool after his eight years of military service, he felt like he never fitted in – that no one understood him, and no one really wanted to. Where his closest relationships had previously been with other squaddies, he soon found a new relationship with alcohol.
Now 46 years old, Peter is finally having a crack at this thing called recovery. The same for Simeon, 58, who has been homeless for nearly 20 years. Over the years, many workers approached Simeon to chat about potential treatment options, but were always met with a refusal. Albeit a polite and jovial refusal, it was still a ‘no’. Asked why he finally agreed to go into detox and rehab he answered, ‘Because this place is for military veterans, and the only time I felt like I had a family was when I was in the army.’
Alcohol misuse has been an inescapable way of life for many who have served in the armed forces. Alcohol has always been associated with rituals and camaraderie and historically was seen as a means of managing difficult situations out in the field – the so-called ‘rum ration’ in the Royal Navy was only abolished in 1970. The levels of alcohol use and misuse during military service often increase when personnel return to civilian life, amplifying its negative effects both for men and women. It’s why we see so many ex-service personnel within the criminal justice system, often for offences of drunkenness, fighting and spousal abuse. In the health services we see increased hospital admissions for poisoning, injury, dependency and addiction.
A member of the armed forces with a drinking problem is a major cause of concern in the military. Once the problem has been identified, commanding officers have to take action to correct it and this often leads to discharge, contributing to the numbers of early service leavers. Misuse of prescription medication and some illegal drugs are also on the increase, but there are very few statistics on this as the Ministry of Defence has not been as responsive as, for example, the USA Department of Defense. However, the MOD is working hard to start shifting the drinking culture and looking at new ideas, such as dry bars, coffee clubs and gaming and WiFi leisure activities on base. I have built up links with army Colonel David Wheeler and we both recently attended an all-party parliamentary group at Westminster, to discuss these issues raised by Alcohol Concern to the minister for the armed forces, Anna Soubry MP.
As head of service in my previous job I noticed that military veterans were not doing very well in treatment. They seemed to have a lot of difficulty engaging in interpersonal group therapy. Many got really agitated with some lines of enquiry made to them by the so-called ‘civvies’ in the group, and some would not go anywhere near expressing emotions.
One guy told us that he couldn’t share his experiences in the group because he felt so ashamed of what he had been a part of when on a tour of duty in Northern Ireland. Other non-military people had asked him if he had ever killed anyone, and why he acted so aggressively against the Irish. Another described drinking a bottle of vodka most nights to help him sleep, as he couldn’t remove the images and smells from an incident he’d been involved in during a tour in Afghanistan.
Having become known in Liverpool for setting up UK firsts in the recovery movement, I was contacted by Paula Gunn in early 2013. Paula, who had set up The Bridge House abstinence-based housing project, wanted to create something for ex-service personnel as she too had noticed a repeated pattern emerging through her work. She was very persuasive and passionate in asking me to come and work with her to lead on this new project and the result was Tom Harrison House (THH) – the first military veteran specific addiction treatment centre in the UK.
Paula founded the charity and named it after her grandfather, Tom Harrison, a naval man who served during World War II. She has now been 17 years in recovery herself, but while in the grip of active addiction, she was comforted by her grandfather who told her of his experiences in the navy and gave her stories of hope and inspiration.
We set about gathering evidence of need for the centre. This proved to be an arduous task, as there was no UK-based evidence on the benefits of a military-specific treatment centre. So I looked to the USA, where far more research has been done, even making a visit to the first ever veteran addiction treatment centre there, Ed Thompson House, which is part of the Samaritans Village services in New York City.
The experience of observing for a day in this treatment centre really blew me away. As I talked to all the guys in the centre and the staff who worked there, I had not one single doubt that THH would be as much needed in the UK as Ed Thompson House is in the USA. There was such inspiration there. I knew we could replicate what they had created, in the cultural context of the UK.
THH has been commissioned to run a pilot project of six months’ treatment space for the new programme I developed. The programme is evidence-based, health and wellbeing-focused, with a clear and assertive linkage to mutual aid. Because of the risk of triggering any symptoms of other co-occurring disorders, the programme doesn’t have a huge focus on psychotherapy – instead it promotes self-efficacy, physical and emotional health, discipline, structure, life skills and community engagement. The culture of the programme is kindness, co-operation, curiosity, generosity, honesty and acceptance. The team here comprises professionals from a variety of relevant backgrounds and brings a mixture of recovery, therapeutic and military experience.
Because military veterans are much less likely to seek out help for mental health issues and addiction due to feeling that this is a sign of weakness, THH sees people who are often very ill, have spent many years in active addiction, and many have co-occurring disorders and have been homeless for lengthy periods.
With Merseyside having more than 30,000 ex-service personnel and an increased cohort of reservists, plus at least an additional 4,000 returning service leavers coming back to the area, there is no shortage of referrals for the project.
The team at THH are receiving referrals from other areas of the country too. Given that participants in Combat Stress residential programmes have to be clean and sober to attend and many other veteran-focused mental health care requires sobriety to engage in appropriate post-traumatic stress disorder treatment, THH will be the first point of call for those needing additional help and support to take the first steps to recovery. Additionally, during the last few weeks many other agencies have approached THH as they now want to replicate this model in their geographical area.
Peter has just become the first ever graduate of a military-specific addiction rehab in the UK and the first to wear a THH medal of accomplishment. We will continue to fly the flag for him and other veterans who have found it hard to cope and used substances to self soothe, leading to loss, shame and chaos. Our aim is to walk with them on a road of honour, hope and healing.
Jacquie Johnston-Lynch is head of service at Tom Harrison House
Trust in me
Gaining trust is one vital component of providing help to veterans, delegates at DrugScope’s annual conference heard
‘One of the difficulties of working with veterans is being able to find out who they are, where they are, and engaging with them,’ veterans’ substance misuse case manager at Combat Stress, Matt Flynn, told delegates at DrugScope’s conference. ‘Trust is a substantial issue. You need to be able to understand the shared lingo and the humour – that’s your way in.’
Combat Stress is piloting a network of substance misuse case management services across the UK, financed by the Big Lottery and the Armed Forces Covenant (Libor) Fund. As well as improving outcomes for veterans, the aim is to provide training to mainstream treatment services and become a specialist resource for any professionals working with veterans.
The organisation’s Wiltshire pilot is run in partnership with Turning Point in ‘a significant military area’, said Flynn – himself a reservist – with veterans estimated to make up at least 12 per cent of the local population.
Well-managed expectations are vital to a successful service, he stressed, as ‘veterans tend to come into treatment believing they’re going to be fixed at the end’, along with fluid care planning and regular reviews that allow people to ‘remain engaged and understand what their care pathway will look like’. Referral can come from veterans themselves or their families, the voluntary sector, assertive outreach, veterans’ agencies or the armed forces, and treatment ranges from guided self-help to residential and community detox, prescribing and one-to-one or group work.
‘There’s also a big role for exit planning,’ he says. ‘That’s crucial in terms of managing expectations. There are lots of different agencies across Wiltshire, and the work now is about drawing them all together and creating really good referral pathways.
‘Part of the challenge facing veterans is that they’re no longer the squaddie or the airman they once were. In substance misuse services they have to mix with “civvies” and, to be honest, they hate it. Part of the skill on the part of the nurses is being able to manage that.’