Veterans Mental Health and Wellbeing Pathway – National Framework

Annex B

Veterans Link Scotland feedback – perceived challenges to accessing mental health services

Overview

VLS is an inclusive group of veterans from tri-service backgrounds with a wide range of knowledge, skills and experiences. Some have accessed mental health services and some have re-trained as mental health professionals since service and work across the NHS and the third sector. Despite its breadth, the group does not include any merchant naval veterans and has only a few women veterans or veterans from minority ethnic backgrounds. To assist in policy design, the group provided feedback on a range of elements and has been collated here. The quotes present in the document have been taken from the original Scottish Veterans Care Network Action Plan, the principles of which informed the initial development of a mental health and wellbeing pathway for veterans.

Barriers and challenges:

The group felt that there were a number of barriers, both external and internal, that made accessing mental health services more challenging.

Knowledge - some of the group highlighted that they did not have a clear understanding of what mental health services were available, either in the NHS or third sector, or how to access them. They also noted that mental healthcare professionals rarely asked them if they had served, which meant that they were less likely to be guided towards veteran-specific services or support

Administration - some of the group, who had previously accessed mental health services, highlighted how difficult it was to navigate the myriad of different forms they needed to complete, often online, before they could access support. They noted that much of the information requested was common to all forms and yet could not be shared.

• Transportation -
  • lack of transport. Some of the group struggled to access services due to a lack of suitable transport, unreliable public transport or the discontinuation of public transport routes. Although this was noted more frequently by veterans in remote and rural areas, it was also highlighted by veterans living in more urban areas
  • lack of awareness. Few within the group knew about alternative transportation options, which had resulted in some veterans struggling to attend appointments or feeling that they had no other option but to cancel them
  • lack of collaborative planning. Some of the group highlighted that they had been allocated appointment times that they could not meet due to a lack of transport; for example, first appointment in the morning or last appointment in the afternoon when they lived up a significant distance away and relied on public transport
• Trust - some of the group highlighted the impact of the stigma associated with reaching out for help with mental health issues, and how the response of the service and the waiting times could have an adverse effect on their confidence and the level of trust they had in the services they needed to access. Some of the group noted that a lack of awareness of the barriers and challenges faced by the Armed Forces and Veterans community when accessing services as well as a lack of understanding of service life made it more difficult to trust some healthcare professionals
• Passage of information - some of the group, who had previously accessed mental health services, highlighted how they had to repeat their story multiple times as they struggled to access mental health services. They noted how difficult they had found re-living the trauma over and over again, and the adverse impact that it had on their lives, as well as how frustrating it was that information could not be shared

Feedback on the Mental Health Pathway – the group considered the key elements of the Pathway, which would be required to ensure all the needs of veterans are met and that will ensure they can access the most appropriate support at the right time.

• Improved understanding and awareness - the group highlighted the need to reduce the stigma surrounding mental health and increase understanding of what services and support were available to the Armed Forces and Veterans community. They also noted the need for mental health services to have a greater understanding of the barriers and challenges faced by the community when accessing healthcare services, as well as the impact of service life
• Improved access to mental health services - the group highlighted that the pathway to the centralised hub and subsequent mental health services should be accessible through various routes, and coordinated and supported throughout to ensure success; for example, self-referral and referrals from the traditional pathways such as a GP or Community Mental Health Teams or through other governmental departments such as the Defence Transition Service, Veterans Welfare Service or Department for Work and Pensions as well as third sector organisations
• Improved access to non-clinical services - the group highlighted that holistic support was critical for those struggling with issues, which either impact on their mental health or were being impacted by their mental health; for example, employment, financial or housing issues
• Improved understanding of services - the group highlighted how clear, easily accessible information on what services are available as well as what can be expected in terms of access to those services, waiting times and treatment options within their area is critical
• Service development or improvement - the group highlighted how trust could be increased through the design of local veteran-specific services with the views and needs of the Armed Forces and Veterans community at their core
• Improved integration - the group highlighted how the integration of veteran-specific physical and mental health pathways was critical as physical and mental health issues can impact on each other. They also noted how integration within the community; for example, with the third sector, local organisations, can encourage integration into civilian life and increase social support
• Increased family involvement - the group highlighted that their family were often instrumental in them asking for help and that they continued to require support from their families while receiving treatment. They highlighted how challenging this can be for the families, who also need to be supported, not only as a support mechanism for the veteran but also as individuals with unique mental health needs linked to the challenges of service life. Those who had accessed mental health service previously, noted that they were more likely to remain in treatment where they had the appropriate support from family and friends

Feedback on the veteran peer support worker – VLS considered the role of the veteran peer support worker. The key considerations for a role considered as critical to the mental health pathway are detailed below:

• Lived experience - the group felt that the role should be accessible to those with lived experience. This would not preclude the right veteran with the right qualities, aptitudes, knowledge, skills and experience, rather to open up the role to include Armed Forces family members, who had significant lived experience of service life and the barriers and challenges that the Armed Forces and Veteran community face. It was also hoped that the expansion of the role to include family members might encourage under-represented veteran groups such as women, LGBTIQ+ and those with an ethnic minority background to reach in and engage with services
• Greater recognition - the group felt that the job description should be developed further to reflect the complexity of a role that requires a plethora of knowledge, skills and experience across multiple organisations, systems and processes, often in difficult circumstances
• Career pathway development - the group felt that a career pathway was required to ensure that peer support workers can learn, grow and develop within a pathway that recognises their increasing knowledge, skills and experiences as well as ensuring that they can viably remain in role in terms of career progression and pay
• Flattening the tiers - the group felt that there was both a need and a place for peer support workers throughout the whole mental health pathway, regardless of the three tiers. They felt that the case management role that they undertake as well as the support and advocacy that they provide were key to success