Force for Change

‘The armed forces community experiences a unique combination of pressures,’ national armed forces lead for WithYou, Andy Craze, tells DDN. ‘Operational stress, trauma exposure, sudden transition to civilian life, loss of identity, chronic pain – and sometimes fractured relationships.’

According to a study of almost 3,000 veterans by King’s College London, while ‘the majority’ of UK armed forces personnel coped well with military service and its challenges, and successfully adapted to civilian life afterwards, rates of common mental disorders and alcohol misuse were nonetheless close to double that of the general population – a rate that may have been heightened by the fact that many of those in the study had served in Iraq or Afghanistan. However it was something that could not be explained by ‘sociodemographic differences between veterans and the general population samples’, the researchers pointed out, while a ten-year study in the US found more than a quarter of American veterans to be consuming alcohol ‘at the at-risk-to-excessive level’. 

Alongside combat-related PTSD and the associated hypervigilance and hyperarousal, veterans can also face difficulties fitting back into society and relating to people who haven’t had similar experiences. They might also struggle with intense feelings of guilt, particularly if they’ve witnessed the deaths of friends or civilians. 

And while a sense of stigma and shame remains one of the biggest deterrents to anyone seeking help for drug or alcohol problems, this is often far worse for veterans. There’s a real sense of pride in the military, but with that comes the risk that the very act of seeking help could feel like a sign of weakness. According to Craze, this remains the ‘biggest barrier’ for most – ‘the belief that asking for help is weakness. Many veterans have spent years in environments where vulnerability wasn’t encouraged.’ 

WithYou has a long history of providing specialised support to veterans, and was the first drug and alcohol service provider to receive a gold award in the Ministry of Defence’s employer recognition scheme. Its Rebuild Project was launched to provide specialist trauma-focused support for female veterans (DDN, March, page 6) and, building on the success of that, the charity is now launching a new trauma-focused treatment pilot for veterans in North Lincolnshire, Wigan and Leigh, North Somerset, and Bournemouth, Christchurch and Poole.

The specialist support on offer at these pilot programmes is taking a different approach to previous veteran support services by making specific trauma-focused therapies – such as EMDR (eye movement desensitisation and reprocessing), CBT and cognitive processing therapy – a key part of the treatment pathway. The idea is to make sure that people don’t have to choose between ‘addressing their substance use and addressing their trauma’, putting mental health ‘on an equal footing’ with physical health.

The four pilot areas were selected ‘based on their existing psychological therapy provision’, including counsellors, mental health and wellbeing practitioners, explains Dr Claire Wyatt, WithYou’s national psychology lead. ‘This enables us to offer specialist trauma-focused therapy alongside existing support, in line with our stepped care model. Three EMDR-trained clinicians provide this specialist therapy across the four services, helping us build on existing resources and develop a sustainable approach to psychological support.’

WithYou recognises that psychological trauma can ‘have a significant impact on mental and physical wellbeing, relationships and substance use,’ she continues. ‘By offering evidence-based approaches including EMDR, trauma-focused CBT, cognitive processing therapy and compassion focused therapy, we can tailor treatment to individual needs rather than offering a one-size-fits-all approach.’ 

EMDR in particular can ‘help people process traumatic experiences without necessarily having to describe them in detail’, she explains, something that could be transformational for those who find talking about their experiences difficult or distressing. ‘Our aim is to make specialist psychological support more accessible as part of a holistic approach to recovery’, she states.

Several studies have concluded that veteran-specific – rather than generic – services are far more likely to be successful for this treatment population, as it can take a long time to build up the necessary amount of trust. It can also help if the counsellors have military experience themselves. Although the WithYou staff operating the new pilots don’t have military backgrounds, they ‘do bring specialist expertise in trauma-focused therapy’, Wyatt explains, including a counselling psychologist with extensive professional experience supporting veterans and serving personnel within a national armed forces charity. ‘We understand the importance of building trust and establishing strong therapeutic relationships, and our clinicians are experienced in creating safe, compassionate environments where individuals feel understood, respected and supported.’

Is there also an element of family support? ‘Absolutely,’ she says. ‘The pilot is open to the wider armed forces community, including veterans, serving military personnel and family members of those currently serving, or who have previously served. We recognise that the psychological impact of military service can extend beyond the individual to their families.’

The Rebuild Project was funded by the Armed Forces Covenant Trust, and while the new pilots aren’t, they have been ‘made possible through the learning, research and positive outcomes generated by the Rebuild Project, alongside investment in EMDR training for three members of staff,’ says Wyatt. ‘This is an important step towards developing a sustainable model of trauma-focused psychological support for the armed forces community, embedded within our existing services – rather than dependent on short-term project funding.’

Is there a sense that some of the issues people are struggling with might already have become ingrained before the transition to civilian life? The forces have long had a really significant drinking culture, for example. ‘Alcohol has historically been embedded in military culture and for some people it becomes a coping mechanism long after service ends,’ says Craze. ‘When you combine that with stigma around seeking support, you get a group of people who often present late, in crisis, or not at all. Specialist support helps break down those barriers.’ 

It’s important that veteran provision ‘recognises that military culture is different – and so is the way people seek help,’ he adds. ‘Veterans often avoid or delay asking for support, minimise their struggles, or feel they should “just get on with it.” Our programme is designed to meet people where they are. Without judgement.’  DDN