How to Find Your Way Around

1. How to Find Your Way Around 1. You can play the PowerPoint, and find the Test here

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4. Veterans First Service e-Learning

5. Aims and Objective • This module describes who veterans are and illustrates how veterans and their families may have health needs and help seeking behaviours that differ from other patients • You will also learn some of the ways in which the NHS has responded to these needs and how care for veterans can be evaluated and commissioned

6. What is a Veteran? • In the UK, a veteran is defined as anyone who has served for at least one day in HM Armed Forces (Regular or Reserve) or Merchant Seafarers who worked alongside Service personnel in legally defined conflict situations. Those who leave before 4 years of service are known as early service leavers • There are about 5 million veterans in the UK, half of whom served before 1960 • 8% of population are Veterans

7. Specific Challenges • Adjusting to a new way of life • Economic implications of change in employment status • Risk of death or serious injury is 150 times greater than the general population • Military culture places a high value on personal fitness which may make it hard to accept illness, particularly mental health issues

8. How to Support • Highlight veteran status on referral to service. Discuss his/her immediate needs and treatment options • Upon referral to other colleagues again highlight Armed Forces Veterans status as an indicator of social class • Also a need to discuss with other clinical colleagues the Military covenant and what it means for us as a service in response to veterans needs • Establish whether your patient is in the Military or is a dependent of a serving member

9. Military Covenant MILITARY SERVICE SHOULD CARRY NO DISADVANTAGE FOR VETERANS OBTAINING HEALTHCARE. THE DEPARTMENT OF HEALTH DIRECTS THE NHS TO PRIORITISE VETERANS’ TREATMENT FOR SERVICE-RELATED CONDITIONS SO AS TO PREVENT ANY OVERALL DISADVANTAGE.

10. Military Covenant As this patient is a military veteran, and his (or her) current condition may be related to military service, this referral should be considered for priority treatment under the rules set out in the NHS Operating Framework 2008/9, paragraph 3.15, 2009/10, paragraph 66 and 2010/11 paragraph 2.55.

11. Scope of the Issue • Recent conflicts have heightened awareness of the mental health problems that some veterans experience • Since 2009, the veterans' mental health charity Combat Stress received 1257 new referrals, an increase of over 2/3 since 2005 • The overall prevalence of Post Traumatic Stress Disorder (PTSD) in the Armed Forces remains low (4%) and there has been no dramatic increase in rates since operations in Iraq began in 2003 • Therefore, the focus in primary care should be on identifying other more common mental health problems such as anxiety, depression and substance misuse

12. Post Traumatic Stress Disorder (PTSD) PTSD most commonly presents with re-experiencing symptoms, including flashbacks of the traumatic event, or with avoidance behaviour, where the patient avoids trauma-related situations or general social contacts. Patients may also complain of emotional numbing or hyper-arousal symptoms. PTSD develops only after exceptionally threatening or catastrophic events, rather than after more common traumas such as divorce, loss of employment, etc. (NICE CG, 26 March 2005).

13. Suicide • There is evidence to suggest increased suicide rates in young veterans • There is little difference overall from the equivalent serving or civilian general populations • There is increased risk for men with short length of service in the armed Forces, which is maintained over time • Personnel who leave the services having only served for short periods of time are at increased risk of suffering mental health problems • Those who have served for longer periods, and therefore more likely to have been deployed on numerous tours of duty, generally enjoy good mental health once they leave

14. Long Term Conditions • Phantom limb pain • PTSD • Anxiety • Adjustment disorder • Drug and Alcohol • Facial Disfigurement • Depression • Hearing Loss • Genital Blast Trauma

15. Transfer Arrangements The majority of those in the Armed Forces leave their time in service fit and well. Unfortunately, however, some do sustain serious injuries, which will result in them being medically discharged from service. People in this situation should have their care transferred from the Ministry of Defence (MoD) through to the NHS, according to a protocol agreed by the Department of Health (DH) and the MoD.

16. Support • Some veterans returning to civilian life after military service have severe, multiple injuries – their care is the responsibility of the NHS • They may have continuing syndromes of chronic pain and adjustment difficulties, including sexual difficulties • For veterans who have sustained a traumatic amputation, consider complications such as phantom limb pain • There are many charities that may be able to help and support injured veterans

17. Significant Others • Handout

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