Scoping Review: A Needs Based Assessment and Epidemiological Community-Based Survey of Ex-Service Personnel and their Families in Scotland

Scoping Review: A Needs Based Assessment and Epidemiological Community-Based Survey of Ex-Service Personnel and their Families in Scotland


1. Refers to the three main dimensions of emotional, social, and psychological wellbeing as defined in the consultation paper "Towards a Mentally Flourishing Scotland: The Future of Mental Health Improvement in Scotland 2009-2011".

2. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.

3. The mixed method used to conduct the interviews was adopted for pragmatic reasons to accommodate the short time-frame and modest budget.

4. 'The National Security Strategy of the United Kingdom: Update 2009. Security for the Next Generation, June 2009;

5. 'The Nation's Commitment: Cross-Government Support to our Armed Forces, their Families and Veterans, July 2008;

6. Full-time strengths include UK Regulars, Trained Gurkhas and fulltime Regular Service (FTRS).

7. The British Prime Minister, Gordon Brown MP, announced plans in October 2009 to raise troop numbers in Afghanistan by 500 to 9,500.

8. Dedicate their spare time to train and have a liability to be called up and deployed alongside their Regular counterparts. The minimum commitment is 27 days training per annum (or 19 days for some specialist units). They are paid an annual bounty (a tax free lump sum bonus for meeting their training commitment) and are paid per day or part day for training that they complete in addition to expenses. On mobilisation, they effectively become Regulars paid at full time rates according to rank. Should their civilian salary be higher than that accorded to their military rank, additional remuneration is paid and legislation is in place to protect their civilian jobs (Report on the Strategic Review of Reserves, 2009).

9. Former members of the Regular Forces who have liability for mobilisation.

10. Report on the Strategic Review of Reserves, MoD, 2009

11. For example, during WWII women were employed in a wide variety of roles, some of which (e.g., pilots) exposed them directly to the dangers of front line combat.

12. The exception to this is for those who apply for the position of junior soldier when the age limits are from 15.7 to 17.1 years.

13. The chain of command is the line of authority and responsibility along which orders are passed within a military unit and between different units. Orders are transmitted down the chain of command from the higher ranks to the lower ranks until it is received by those expected to execute it. In general, military personnel give orders only to those directly below them in the chain of command and receive orders only from those directly above them. The UK Armed Forces regard the chain of command as the "backbone" that enables them to work effectively.

14. For example, a number of navy ships and submarines have strong links with local towns and cities that bear their names including HMS Edinburgh and HMS Montrose.

15. Located in five of the 15 Local Authority areas, viz, Argyll and Bute, Moray, Fife, and the City of Edinburgh.

16. The term "Veteran" can also, exceptionally, include those members of the Merchant Navy who have contributed to military operations.

17. Some suggest that the obligations associated with the Military Covenant were evident long before 2000 (McCartney, 2007).

18. Defined by Strachan et al (2010) as consisting of: Serving personnel, Veterans, reservists and their respective families including the bereaved.

19. These include the fact that war can cause psychological and physical damage, which in some cases may be long term or even permanent (Alexander & Klein, 2008).

20. According to MoD figures, 12,000 Service personnel were involved in operations in Iraq and Afghanistan.

21. All three Services have agreed Harmony Guidelines to allow members of the UK Armed Forces to have sufficient time to recover from operations; for unit, formation and personal training and development; and to spend more time at home with their families. The RN guidelines determine that personnel spend, on Defence (2008), in 2007 around average, 60 % of their time deployed and 40 % alongside in their home port during a three-year period. The maximum individual threshold (separated service) is 660 days away from their normal place of work in the same three year period. The Army guidelines determine that soldiers can be deployed for one six-month tour in every 30 months (6 on, 24 off) and during that 30 month period a soldier should not expect to be away from his or her normal place of work for more than a total of 415 days. The RAF guidelines determine that personnel should not spend more than 280 days in every 24 months away from their normal place of duty.

22. In recognition of the challenges associated with being deployed on operational tours in conflict areas, the MOD introduced, in October 2006, a £2,240 tax free allowance for all Service personnel deployed to Bosnia, Iraq and Afghanistan.

23. The Veterans alleged that the UK Armed Forces had failed to support, train and prevent them from developing psychological injury and then to detect it and to provide appropriate treatment. All had served during the period 1979-1994, the majority in Northern Ireland, the Falklands or the Gulf.

24. Twelve out of the 16 cases were found in favour of the MoD. The remaining four cases that lost the judgement pertained to individual issues rather than institutional failure (Over-Arching Review of Operational Stress Management: Phase 2-Training and Communication Strategies; 28 April 2005).

25. The prevailing controversy over defence policy and operations in respect of the Iraq invasion and, increasingly the campaign in Afghanistan, highlights the extent to which public support plays an important role in terms of determining military success from a moral, political, and economic perspective (Chalmers, 2009).

26. A phenomenon commonly referred to as the "military footprint".

27. The longest-lived founding member of the RAF and the only remaining First World War Veteran, Henry Allingham, died in 2009 aged 113.

28. Restrictions on military wearing uniforms in public were originally imposed following the IRA threats of the 1970s and 1980s.

29. The concept of social exclusion originated in the UK in the critical social policy of the 1980s (Levitas, 2006). It has become increasingly prominent in association with discussions pertaining to disadvantage which extend beyond material deprivation and encompass the notion of participation in mainstream social, cultural, economic and political activities (Morgan et al, 2007).

30. The inclusive definition of the term "Veteran" pertains to all military personnel who have served more than one day (together with widows/ widowers and their dependents) as well as those members of the Merchant Navy in recognition of their vital contribution to supporting military operations.

31. This is an annual meeting attended by a wide range of representatives from the Veterans community and Government. Its objective is to enable the Minister for Veterans to deliver the strategic priorities of the Veterans Initiative and to provide updates on progress achieved.

32. Although the enquiry ran in parallel to the production of the Service Personnel Command Paper on sustaining and harmonising cross-Government support for the UK Armed Forces community, it was commissioned as an independent endeavour.

33. Royal family; Government; House of Lords; Members of Parliament; Devolved Assemblies and Civic Leaders; MoD; Armed Forces support organisations and charities; Religious leaders; Service museums; Business and sport; City of London Livery Companies; Media.

34. Hansard 19 May 2008: Column 3WS.

35. A team comprising personnel from all three Services of the UK Armed Forces and MoD civil servants consulted with current and former Service personnel, their families, Service charities and Service Families Federations.

36. The first principle is that the Armed Forces should not be disadvantaged by a military career and associated lifestyle. The second principle is that, where appropriate, special treatment should be provided for those serving and ex-Service personnel who have been injured in course of duty).

37. The consultation process was closed on 29th August 2008.

38. A product of the Service Personnel Command Paper, the ERG was set up to oversee the implementation of the work and to provide a mechanism which would remind Government and the Devolved Administrations of the issues to be addressed in respect of their commitment to the UK Armed Forces. It comprises a wide range of perspectives including senior officials (Whitehall Departments, the Scottish Government and Welsh Assembly Government), and representatives from the major Service charities, the Service Families Federation, and academia.

39. Overall, it concluded that 15 of the 47 original commitments have been fully completed during the period up to 31 July 2009. A further 13 UK-wide commitments were anticipated to be fully completed within the subsequent 12 month period.

40. Two aspects were highlighted in terms of: (i) mechanisms to measure impact at ground level, and (ii) scope for the development of specific measures.

41. The Firm Base Forum is an advisory group and, as such, is not generally responsible for policy making. It's remit is bound by working practices and scope of the Concordat between the Scottish Ministers and the Secretary of State for Defence, Membership comprises Hd AFVIT, 1 Star representatives from the 3 Services (currently NRCSNI, Comd 51 (Sc) Bde and AOS), Chairman 'Veterans Scotland', CEs HRFCA and LRFCA and Secretariat.

42. This anticipated increase originates from the announcement to the House of Commons by the then Defence Secretary, Dr Liam Fox, on 18 July 2011 that more than 2,000 extra Service personnel will be based in Scotland despite the closure of RAF Leuchars.

43. ("The National Security Strategy of the United Kingdom": Update 2009. Security for the Next Generation, June 2009;

44. The White Paper ("Trust, Assurance and Safety - The Regulation of Health Professionals in the 21st Century") of February 2007 set out a programme of reform to the UK's system for the regulation of health professionals based on consultation on the two reviews of professional regulation published in July 2006 ("Good Doctors, Safer Patients") by the Chief Medical Officer (CMO) for England and the DoH's ("The Regulation of the Non-Medical Healthcare Professions"). It is complemented by the Government's response to the recommendations of the Fifth Report of the Shipman Inquiry and to the recommendations of the Ayling, Neale and Kerr/Haslam Inquiries ("Safeguarding Patients"), which sets out a range of measures to improve and enhance clinical governance in the NHS.

45. The three Services are directly responsible to the Service Chiefs of Staff.

46. DMETA has command and control over: MoD Hospital Units; The Royal Centre for Defence Medicine (RCDM); The Defence Medical Rehabilitation Centre (DMRC) at Headley Court; The Defence Medical Training Centre (DMTC) at Keogh Barracks, and The Defence Medical Postgraduate Deanery (DMPD)

47. On the basis of the NHS Plan, the NHS provides a universal health service, which is available to all citizens of the UK based on their clinical need and not their ability to pay. Funded nationally, the provision of service must be responsive to the different needs of different populations.

48. The Concordat is an overarching agreement between the MoD and the DoH, which was signed on the 19th September 2002 by the respective Parliamentary Under-Secretary of State. It originated from the recommendation by the MoD Medical Quinquennial Review (MQR) to reinforce the relationship between the DMS and the NHS by a formal agreement between the DoH and the MoD.

49. The DoH is responsible for funding, directing and supporting the NHS.

50. Prior to the UK Armed Forces withdrawal from Iraq in 2009, medical care was provided by approximately 280 UK medical staff at the main base in Basra Air Station (National Audit Office, 2010)

51. The UK medical group in Afghanistan in the Summer of 2009 constituted approximately 360 staff who provided treatment and rehabilitation at the field hospital in Bastion in Helmand Province (the main site of operations for the UK Armed Forces). (National Audit Office, 2010)

52. This figure comprises categories the Department refer to as "very seriously injured" and "seriously injured" Service personnel.

53. Dedicate their spare time to train and have a liability to be called up and deployed alongside their Regular counterparts. The minimum commitment is 27 days training per annum (or 19 days for some specialist units).

54. Regular Reservists are former members of the Regular Forces who have liability for mobilisation.

55. Between October 2001 and the end of October 2009, a total of 522 military personnel have been seriously injured on operations in Iraq and Afghanistan (National Audit Office, 2010).

56. Their role is to provide the assessment and immediate treatment of all casualties (whether injured in combat or otherwise).

57. Both of these teams are responsible for the provision of first line treatment and guidance on the need for further treatment or referral.

58. Severe injuries include multiple fractures, amputations, loss of sight or hearing, brain injury or sometimes a combination of all of these.

59. The decision to evacuate is a clinical one.

60. However, an increase in the number of clinical staff deployed to field hospitals has resulted in more extensive treatment of operational casualties in theatre than was previously the case.

61. First introduced in April 2004, Foundation Trusts are a new type of NHS hospital run by local managers, staff and members of the public to meet the needs of the local population. They represent the Government's de-centralisation of public services and are accorded more financial and operational freedom than other NHS Trusts although they remain within the NHS. As such they are subject to the NHS performance inspection system.

62. This was the first major post-Cold War review of UK military requirements.

63. Acute Trusts are responsible for managing NHS hospitals to ensure that they provide high-quality healthcare and that they are cost efficient. They employ a large part of the NHS workforce. Acute Trusts can be regional or national centres for specialised care. Some are attached to universities and help to train health professionals. Acute Trusts can also provide services in the community through health centres, clinics, or in patient's homes.

64. The DCMHs are embedded within 15 Service units in the UK, 4 Service units in the British Forces Germany and 1 Service unit in Cyprus. The 15 UK-based Service units are: (Aldershot, Brize Norton, Catterick, Colchester, Cranwell, Donnington, Kinloss, Leuchars, Marham, Faslane, Plymouth, Portsmouth, Tidworth, Belfast, Woolwich).

65. Including Cyprus, Germany and Gibralter.

66. The DCMH mental health teams comprise psychiatrists, mental health nurses, clinical psychologists, and mental health social workers.

67. For example, in the Medical Care for the Armed Forces (7th Report of Session 2007-08), House of Commons Defence Committee 18th February 2008. HC327, in providing evidence as a witness on the 11th October 2007, Dr Christopher Freeman was cited as saying that he was "…not convinced that the Priory's clinicians had the relevant expertise, and that they lacked the ability to relate to the experience of Service personnel." (p.29). Furthermore, he expressed concerns about the financial benefits derived by the private sector in delaying the discharge of patients, which resulted in a tension between the NHS and the private sector.

68. South Staffordshire and Shropshire Healthcare NHS Foundation Trust, Cambridge and Peterborough NHS Foundation Trust, NHS Grampian, Hampshire Partnership NHS Trust, Lincolnshire Partnership NHS Foundation Trust, Somerset NHS Foundation Trust and Tees, and Esk and Wear Valleys NHS Foundation Trust).

69. The bespoke MoD definition of "operational stress" is "…an individual or group reaction to stressors relating to the operational context which, if not managed, my result in impaired performance and possible effects on health". (p.8, Overarching Review of Operational Stress Management; Phase 2 Training and Communication Strategies)

70. CISD was enthusiastically embraced in the late 1980s and 1990s as a suitable means of relieving distress and preventing the onset of PTSD particularly for the military and the emergency services (e.g., Mitchell & Everly, 1995). Subsequent evaluations (including a Cochrane Review [Rose et al, 2009]), however, provided evidence to suggest that mandatory, one-off CISD sessions increase the risk of making some individuals feel worse, probably through "retraumatising" them (Alexander & Klein, 2008).

71. The criteria for entry into the RMHP are restricted to current and former members of the Reserve Services who must have been demobilised since January 2003 (following overseas operational deployment) and whose mental health problems resulted primarily as a result of their operational service as a Reservist.

72. NICE is an independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health. The guidance is developed using the expertise of the NHS and the wider healthcare community including NHS staff, healthcare professionals, patients and carers, industry and academics.

73. These reasons include a lack of suitably trained personnel; a failure to respond to a psychological therapy, and the patient's aversion to psychological treatments.

74. This summary of the individual's Service medical history (form Fmed 133) is a two page document which comprises five parts. Part 1 is addressed to the civilian GP; Part 2 is to be completed by the individual; Part 3 is only to be used in cases of medical discharge; Part 4 provides Service vaccination history, and Part 5 is to be completed by the President of the Medical Board/ Unit Medical Officer. It includes details of disabilities, immunisations, clinical conditions and any other significant treatments received.

75. For MoD personnel, all medical records are contained in form Fmed4, which is archived by the three Services.

76. PCTs are local organisations at the centre of the NHS which work with Local Authorities and other agencies to ensure that the health and social care needs of the local community are met.

77. Originally, the term "war pensioner" embraced Veterans who were injured or disabled as a result of service in the UK Armed Forces either before the First World War or between 21st October 1921 and 2nd September 1939. The definition of a war pensioner has been extended over time to include Veterans of more recent operations.

78. The updated guidance was issued by the Chief Executive of the NHS in England (David Nicholson CBE) to the Chief Executives of the PCTs, NHS Acute and Mental Health Trusts and the NHS Foundation Trusts.

79. This also included cases where a health professional suspects that a Veteran's condition may be associated with his/her military service.

80. The extension of priority treatment to Veterans in Scotland applied to new GP referrals from 29 February 2008.

81. The restriction placed on "new" GP referrals from the 1st January 2008 was to avoid incommoding other NHS patients who had already received dates for appointments. Only in exceptional circumstances would there be a justification for priority treatment despite having either been referred to treatment or undergoing treatment before this date.

82. Access to free prescriptions is currently restricted to war pensioners.

83. For example, the "diversity" policy incorporated within the Armed Forces Overarching Personnel Strategy (MoD, 2002/2003)

84. Also known as the "Ex-Services Mental Welfare Society".

85. The Combat Stress Treatment Centres are Tyrwhitt House (Leatherhead), Audley Court (Shropshire) and Hollybush House (Ayrshire), which are situated in the catchment areas of the Surrey and Borders Partnership NHS Trust (South East Coast SHA), Shropshire County PCT (West Midlands SHA) and Ayrshire and Arran NHS Trust respectively.

86. Over the past five years, Combat Stress has routinely collected clinical audit data on new patients admitted to all three of their treatment centres.

87. The HASCAS Review was led by Professor John Hall and advised by the Health Care Commission and the Mental Health Care Commission.

88. This was based on evidence derived from Combat Stress data which demonstrated that despite the increasing number of Veterans requesting help for mental health problems, the figures failed to "…reflect the heterogeneity of diagnoses seen in clients nor their differing support needs." It also established that some of those presenting to Combat Stress had a mental health need that could be adequately managed by NHS GPs or other specialist community-based services. In the case of those with complex problems of a severe and enduring nature, issues were raised regarding the accessibility and acceptability of treatment centres.

89. Issued by the MoD Service Personnel and Veterans Agency (SPVA), this core briefing paper was updated to May 2008.

90. The UK Trauma Trust in Hull Humber and East Yorkshire has a special interest in Veterans because of the relatively high numbers who reside in this region. It is the base for the National Gulf Veterans and Families Association and the mental health charity, MIND, has a sponsored self-help group for Veterans with mental health problems in Leeds.

91. This figure is subject to variation depending on when the clinical audit data was obtained. Hence, the discrepancy between the figure cited by Hart & Lyons (2007) and the figure cited by Fletcher (2007) reported in Section 3.

92. Epidemiological data are widely recognised as a prerequisite for the identification deficits and problems in health care systems and for offering guidance on service planning and resource allocation (Jenkins et al, 2003).

93. The term "prevalence" refers to the total number of cases at a single point in time.

94. The term "incidence" refers to the total number of new cases which arise over a period of time [typically in one year])

95. This paper was based on the outcome of a HASCAS meeting of the 3rd August 2006 at the MoD, which was subsequently detailed in the HASCAS paper of July 2006 ("Mental Health Services for Veterans: a Proposed Service Model").

96. These included those Veterans who had: (i) severe and chronic mental health problems; (ii) long standing physical illness and injuries (the majority of whom were considered to be the older Veterans); (iii) encountered the Criminal Justice System (some of whom may also have served a custodial sentence); (iv) homelessness, and (v) unemployment.

97. As part of the Humber Mental Health Teaching NHS Trust Service a specialised psychological trauma service has existed for some time in Hull and the East Riding of Yorkshire. As the only trauma service in the UK Trauma Centre network that refers to having a special interest in Veterans it provides them with a direct referral service from GPs in the region.

98. The CPSR is an interdisciplinary collaboration between the University of Sheffield's School of Health and Related Research (ScHARR) and the Department of Psychology. Officially launched on the 9 November 2007, the aim of the CPSR is to improve decision-making, and the quality and outcome of services for the treatment of psychological problems.

99. Funding from the Comprehensive Spending Review 2007 was secured to pay for the major training programme to enable the availability of sufficient suitably trained therapists in accordance with the progressive expansion of the IAPT. By 2010/11 it is intended that 3,600 new mental health therapists will have received training under the aegis of the IAPT.

100. Regional performance indicators are used to establish PCT coverage, capacity building of a skilled workforce, and extending access to NICE-compliant services.

101. The Prison Healthcare Policy Unit at the NHS has replaced the former directorate of Health Care for Prisons at the Home Office.

102. The ONS Survey of Psychiatric Morbidity among prisoners in England and Wales was carried out in 1997 on behalf of the DoH (Singleton et al, 1998). Key findings from that survey showed that over 90 % of prisoners suffered one or more of the five psychiatric disorders assessed, viz, psychosis, neurosis, personality disorder, hazardous drinking and drug dependence.

103. The National Service Framework for Mental Health recommends better mental health assessment for prisoners. The Department of Health's NHS Plan calls for more comprehensive mental health services in prison.

104. Since June 1995, the prison population in England and Wales has increased by 60 % (Ministry of Justice, 2007, Lord Carter's review of prisons: Securing the future: Proposals for the efficient and sustainable use of custody in England and Wales).

105. To ensure a comprehensive consideration of the "offender pathway" and the associated mental health services, agreement was obtained to extend the review period to 12 months.

106. The term "diversion" refers to "…a process whereby people are assessed and their needs identified as early as possible in the offender pathway (including prevention and early intervention), thus informing subsequent decisions about where an individual is best placed to receive treatment, taking into account public safety, safety of the individual and punishment of an offence." (p.16, The Bradley Report, April 2009).

107. The UK Armed Forces Pay Review Body (AFPRB) is responsible for undertaking an independent review to establish pay for Service personnel, the recommendations for which have been fully implemented by the MoD in the last 10 years.

108. The JCCC was officially launched on 11 April 2005 by the MoD to administer in-Service casualty and compassionate case by facilitating and co-ordinating support, advice, and payment to bereaved families.

109. The IPPH provides residential and nursing care to people who qualify for admission under the 1947 Polish Resettlement Act.

110. The "Japanese Asset Scheme" was launched in the 1950s to distribute former liquidated assets to Far Eastern Prisoners of War. Eligibility was extended in March 2001 to provide the £10,000 ex gratia payment to those prisoners of war who had a birth link with the UK followed by an announcement in March 2005 that 500 additional ex gratia payments would include former prisoners of Japan who had resided in the UK for at least 20 years since WWII as at November 2000 when the scheme was first launched. The Veterans Agency paid totals of £3.21 million in 2003/04 and £1.8 million in 2004/05.

111. The RHQ in the UK are responsible for the aftercare of Service personnel on leaving the Army. The level of welfare assistance provided is dependent on individual's circumstances. However, they provide a "gateway" to a large number of ex-Service welfare organisations.

112. Chaplains are addressed both officially and otherwise by their ecclesiastical title or official appointment, not by their relative rank or military title. They are known as "padre" by all ranks. When dressed in combat uniform, chaplains are distinguishable by the sign of the cross on the collar and the title "padre" on their name badges.

113. Each unit with an overall strength of 25 personnel or more has a UWO.

114. Formed in 1998, the CTP contract was renewed for a further 10 years in 2005. It incorporates nine Regional Resettlement Centres (RRCs) in the UK, one in Germany, and one in Nepal. The core RRC is based in Aldershot, but all offices are linked to a central database of service leavers, employers and jobs. CTP staff who understand the military way of life and the challenges facing those making the transition from service to civilian life. Although primarily focussed on helping Service leavers to find suitable employment in a second career, the service also assists those who plan to retire or who are seeking full time education. The CTP seeks to administer a high quality, no cost recruitment service for employers seeking the best. This includes an online vacancy database, employment fairs around the UK, and a team of employment consultants available to advise and assist with employer's recruitment needs.

115. The Early Service leavers initiative derives from one of the recommendations made in the Dandeker et al (2003) report to broaden the CRP arrangements to include more vulnerable service leavers.

116. The ESP comprises an interview with a Career Consultant or one-day workshop, and thereafter a job finding service with access to an Employment Consultant for up to two years post-discharge.

117. The CTP Full Resettlement Programme builds on the ESP through providing access to vocational training, coaching in job interview technique, CV writing, and dedicated career consultancy support aimed at improving Service leaver's employment opportunities.

118. Service leavers who have served overseas and wish to be discharged and settle in the country in which they have served are advised to seek advice on matters relating to that country. Service leavers leaving the Army from the UK and returning to their country of origin are advised of the same.

119. The DSS was established in 1988 following the split of the Department of Health and Social Security (DHSS) into separate departments for health (DoH) and social security (DSS).

120. The DWP was formed from the DSS to absorb the employment functions which had previously been the responsibility of the Department for Education and Employment (DEE) since the dissolution of the Department of Education (DoE) in 1995.

121. The compensation award for tariff level 1 (i.e., the most serious injuries) was £285,000.

122. The use of this term also included service-related illness or death.

123. Entitlement for an extension on compassionate grounds is at the discretion of HIC in consultation with the appropriate Local Service Commander at non-entitled SFA charges.

124. As amended by the Housing (Scotland) Act 2001.

125. The term "social landlords" includes Local Authorities and registered social landlords.

126. Those leaving under medical discharge may normally remain in Service families' accommodation for 3 months after discharge.

127. In Scotland the Housing (Scotland) Act 1987 amended by the Housing (Scotland) Act 2001, states that people are homeless if there is no accommodation they are entitled to occupy. Entitlement means having either: (i) an interest in it [i.e., by virtue of being either the owner or the tenant]; (ii) a right or permission, or an implied right or permission to occupy, or (iii) some other enactment or rule of law giving the right to remain in occupation or restricting the right of another person to recover possession. Furthermore, in Scotland a person is also considered to be legally homeless if they have accommodation but: (i) they cannot secure entry to it; (ii) they have nowhere they entitled to place it and live in it (e.g., a caravan); (iii) it is probable that occupation will lead to violence, or threats of violence which are likely to be carried out, or (iv) it is overcrowded and may endanger the health of the occupants.

128. These funds supported the programmes run by the Joint Service Housing Advisory Office (JSHAO) costing £140,000 per annum; the Single Persons Accommodation Centre for Ex-Services (SPACES) costing £110,000 per annum, and the Shelter Armed Forces Project (AFP) at a cost of £35,000 per annum.

129. ESAG was established in 1997 following concerns about the number of ex-Service personnel who experience homelessness and the implications for their welfare.

130. To establish a local connection means that individuals must have close family ties within the area, or the individual or member of his/ her family has either resided in the area prior to enlistment or has obtained permanent, civilian employment in the region.

131. That report was founded on a review of the causes and nature of homelessness in Scotland, the data for which derived from 13 research projects commissioned by HTF.

132. The HMG meets approximately quarterly and submits a report to the Scottish Parliament on an annual basis.

133. According to the Scottish Council for Single Homeless, the Homelessness etc. (Scotland) Act 2003 is one of the most "progressive pieces of legislation in Europe". In particular, it introduces a cultural shift in how LAs can respond effectively to homelessness in the 21st Century such that the focus is placed on available resources on re-housing homeless individuals successfully as opposed to investigating how best to ration them out of the system ( policy.htm)

134. This represents an amendment of section 25 of the Housing (Scotland) Act 1987 (c.26). Section 25 refers to "persons having priority need for accommodation".

135. The 14 day administration period pertains to Regulation 91(1) of the Housing Benefit (General ) Regulations 1987.

136. This includes availability of the SPVA Veterans UK website to prison staff via computer systems to enable details of the help provided to all Veterans by the SPVA and other service providers to be shared with ex-Service offenders.

137. The Royal British Legion, SSAFA Forces Help and Combat Stress all provide welfare visits to Veterans in prison and support to their families. These visits do not count against an offenders personal visit allowance.

138. SACRO is a voluntary organisation with the mission to reduce conflict and offending through the provision of a range of Community Mediation, Youth Justice and Criminal Justice Services. In respect of the last named, the aim is to contribute to community safety by addressing the risk of re-offending among service users. SACRO also has a strategic objective to engage in research in order to evaluate and provide evidence on the impact of its services through the analysis of conviction data.

139. The partner organisations are: KPGM; Business in the Community; The Royal British Legion; Sir Oswald Stoll Foundation, and Barclays Bank.

140. The companies providing placements and job coaches include: Bain & Co; Barclays Bank, Chelsea Football Club; Freshfields; KPMG; S2 Securities, and the Royal Mail.


142. The expertise of the team comprised psychiatry, military sociology, anthropology and related medical and social sciences (Dandeker et al, 2003).

143. The sample comprised those in the KCL military cohort who: (i) had been identified as having mental health problems at two points on the earlier follow-up, and (ii) who were unemployed at the last follow-up.

144. Set by Government and used to assess the performance of the NHS based on standards pertaining to patient safety issues, quality of healthcare provision, and the extent to which services are focused on meeting patients' needs.

145. The work of KCMHR originally began as the Gulf War Illnesses Research Unit (founded in 1996). The change in name to KCMHR reflected expansion of its military-related research portfolio. Launched in 2004, KCMHR comprises a collaboration among the three parts of King's College London (KCL), viz, the Institute of Psychiatry (IoP), the Department of War Studies, and the Medical School (KCMHR, 2006, 2010).

146. Dandeker et al (2005) define a small sample as being fewer than 100 participants.

147. These comprised: South Stafford and Shropshire Healthcare NHS Foundation Trust; Cardiff and Vale University Local Health Board; Camden and Islington NHS Foundation Trust; Tees, Erk & Wear Valleys NHS Foundation Trust; Cornwall Partnership NHS Trust, and NHS Lothian.

148. This is the nine item depression scale of the PRIME-MD Patient Health Questionnaire.

149. The Work and Social Adjustment Scale (WSAS) is a self-report scale of functional
impairment attributable to an identified problem (Mundt, 2002)

150. Whilst V1P scored the highest out of the six pilot services, it scored less than the Northern Ireland pre-existing service.

151. The Alfred Anderson Plan was named after the last World War One Veteran in Scotland, who passed away in November 2005.

152. Major Jim Panton is currently Chief Executive of Erskine; a charitable organisation founded in 1916 to provide nursing and medical care for Veterans in Scotland.

153. The "lead" organisations identified were: ABF, BLESMA, Combat Stress, EHFS, OAS, RAFA, RAFBA, RBLS, Regimental Associations, RNA, RNBT, SNIWB, SSAFA Forces Help, WPWS, WWA.

154. The three exceptions were the ABF, the RNBT, and the Regimental Associations.

155. The three exceptions were the RNA, the WPWS, and the WWA.

156. Poppyscotland estimated that, by 2025, there will be approximately 50,000 Veterans over the age of 80 years resident in Scotland.

157. Flanders House was the EHFS residential care home located in Anniesland (Glasgow). Following its sale to Erskine for a"nominal" sum, the site was used for the construction of a purpose-built home ("Erskine Glasgow") which was officially opened in October 2007.

158. EHFS provide an annual grant to assist with the RBLS provision of war pensions advice.

159. The WPWS and RBLS were found to be the main providers of war pensions advice to Veterans (although BLESMA and Combat Stress also provide such advice to their specific client groups).

160. Veterans Scotland is the umbrella group for ex-Service charities in Scotland, which is funded by the Veterans Challenge Fund and ex-Service charities.

161. The term "active referral" pertains to one where the referring agency initiates contact with the recipient agency about the client rather than simply advising the client to contact another agency, but does not contact the second agency on behalf of the client (i.e., "passive referral").

162. Clients were "fast-tracked" through the system to receive appointments in the CAB or at home within one week.

163. The eight participating CABs were: Bridgeton; Drumchaple; CAD; Central; Easterhouse; Maryhill; Parkhead, and Pollock.

164. Comprising four subscales to assess somatic symptoms, anxiety and insomnia, social dysfunction and severe depression, the GHQ-28 is a well-established self-report measure of general psychopathology with good psychometric properties for use with non psychiatric samples.

165. The Scottish treatment centre based in Ayrshire.

166. Following the baseline study and prior to commencing the pilot, this question was changed to: "Are you a dependant of anyone who has ever served in the British Armed Forces?"

167. ESAG was established in London in 1997 as a result of concerns about the welfare of homeless ex-Service personnel and the scale of ex-Service homelessness in London.

168. ESAG has either developed or supported a number of homelessness initiatives including the Ex-Service Resettlement Project, Home Base, The Sir Oswald Stoll Foundation, SSAFA Forces Help Homeless Division, Project Compass and Veterans Aid.

169. Linear tactics were represented by clearly defined front and rear lines, with serried ranks of advancing and (less serried) ranks of the retreating forces.

170. "Swirling" tactics refer to a very different combat environment, one characterised by fluidity, changing boundaries, greater personal vulnerability (particularly for the infantry) and more insecurity, particularly with regard to the risk of "friendly fire" or "blue on blue" tragedies.

171. AUDIT is widely used measure comprising 10 items to assess alcohol consumption, alcohol dependence, and the consequences of alcohol abuse in the previous 12 months.

172. "Hazardous" drinking was defined by an AUDIT score of 8 or more (Fear et al, 2007)

173. An AUDIT score of 16 or more is defined as a "high level of alcohol problems" (Browne et al, 2007).

174. The Millenium Cohort Study was launched in 2001 with the principal goal of enabling a prospective evaluation of the long-term health of military service members and the potential influence of deployment and other military exposures on health (Ryan et al, 2007)

175. Boss (2002) introduced the useful concept of "ambiguous loss", reflecting the fact that a body, or even a body part, can facilitate grieving.

176. A link was made between the DASA database comprising data held by the Manpower Branches of each of the three Services and the suicide databases held by the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (April 1996-December 2005).

177. These included deaths receiving either a suicide or undetermined verdict (Kapur et al, 2009)

178. (

179. For example, on the 25 July 2009 The Telegraph ran a story with the headline "Traumatised former soldier committed suicide after Afghan repatriation"

180. (see: former soldier committed suicide after Afghan repatriation).






186. The BSA sample is selected each year from the Post Office Address File (PAF), and comprises around 3,300 interviews with adults (aged 18 years and above) across Britain.

187. This goes beyond what the Priority Treatment scheme in England offered where Reservists were excluded from entitlement to priority treatment according to clinical need.


Email: Ewen Cameron

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