Military personnel, veterans and families

Introduction

A military veteran is a person who has served or is serving in the armed forces as a regular or a reservist as well as Merchant Navy seafarers and fishermen who have served in a vessel that was operated to facilitate military operations by the Armed Forces.  Veterans who have had direct exposure to acts of military conflict or combat may also be referred to as war veterans.

The needs of military personnel and veterans may be more acute due to the physical, mental and social health and wellbeing consequences of national service but awareness of and access to information and public and commercial services can be disrupted by serving in the armed forces.

Key inequalities and risk factors

Apart from the obvious risks and consequences associated with warfare, such as serious injury, disability and death, a number of risk factors exist which impact on the health and wellbeing of military personnel and veterans adapting to civilian life.

Factors affecting mental health

Ministry of Defence statistics indicate variations in presentations for mental health disorder depending on a range of factors:

• Military branch – Army and RAF personnel experience higher rates of mental disorder compared to Royal Marines
• Rank – higher educational attainment and socio-economic background are associated with lower levels of mental health disorder and this may explain differences in the rates between officers and other ranks
• Tour specifics – statistically significant higher rates of mental disorder were seen among personnel previously deployed to Iraq and/or Afghanistan compared to those not previously deployed there
• Age – rates of mental disorders are highest among those aged between 20-44 years compared to those aged under 20 years and 45 years and over
• Early service leavers (ESL) – studies show that ESL including those who failed to finish military training are at increased risk of adverse socio-economic outcomes such as unemployment, homelessness and crime, as well as poor mental health compared to other service leavers

It should be noted that reservist personnel have different entitlement to care, presenting to their NHS GP for treatment and therefore will not be included in the MOD statistics.

Factors influencing wellbeing

Other factors impacting veteran health and wellbeing outcomes and demand on services were summarised in the 2016 Foresight Report commissioned by the Big Lottery Fund:

• Substance-misuse – Post-combat alcoholism and isolation among certain age brackets is more prevalent among (ex)servicemen than they were in the general population
• Age – in 2015, 46% of ex-service personnel were aged 75+ compared to 10% of the general UK population and increase from 28% in 2005
• Social isolation – ex-service personnel are more likely to live alone than adults in the general population
• Employment – early leavers struggle in the labour market, with only 52% reported to be in education, training or employment six months after leaving
• Early leavers – more likely to be at risk of offending, unemployment, alcoholism, homelessness or mental health problems
• Social determinants & educational attainment – Poor pre-service circumstances may determine development of mental health problems after combat and may become ESL sooner. The suicide risk is positively correlated with a short length of service, and holding lower rank
• Service type – reservists have poorer health outcome than other services personnel

Current and ex-military personnel adjusting to civilian life or coping with other experiences of service are likely to experience much more common mental health issues or exhibit behaviours. Symptoms to look out for include:

• Feeling isolated or withdrawn
• Continuous low mood, tearfulness or sadness
• Feeling mood swings, irritability, anger or aggression
• Having no motivation, work or relationship problems
• High-risk or destructive behaviours
• Addictive behaviours (alcohol/drugs/gambling and/or food)
• Sleep difficulties
• Loss of appetite
• Feeling anxious, worried, distrustful or suspicious
• Distressing memories, nightmares or flashbacks
• Having suicidal thoughts

Facts, figures and trends

Contexts

The majority of people fare well after leaving the armed forces: suffering no ill effects, entering full time employment and leading meaningful and fulfilling lives. However, for some veterans it can be overwhelming – even traumatic – and they will need support adjusting to civilian life to deal with what we often take for granted as everyday things – applying for a job, finding housing or even registering with a GP.

According to a Foresight Report one in five veterans with a long-term illness attributes it to military Service, particularly musculoskeletal problems, hearing problems and mental illness. Over half of veterans aged 25-44 with a long-term illness attributed it to their Service.  The Operating Plan for England 2012-13 (Department of Health, 2011) set out the need to support service personal with the physical and mental consequences of serving in the armed forces as well as the practical challenges that veterans face transitioning back to the community.

The Armed Forces Covenant is a key mechanism in ensuring members of the armed forces community face no disadvantage compared to other citizens in the provision of public and commercial services; and that special consideration is appropriate in some cases, especially for those who have given the most such as the injured or the bereaved.

Changes to recruitment and deployment will increase pressures on health and social care services as personnel and their dependants revert to the primary care of the NHS (e.g. service leavers or following returns from overseas placements) but also as increasing numbers of reservists may active service and need additional support if they have been injured or affected by their duties.

Data about veterans and the 2021 Census

Census data specifically relating to veterans and armed forces leavers is not currently available, however, the Office for National Statistics (ONS) is consulting on topics proposed for inclusion in the 2021 Census. The ONS and the Ministry of Defence (MoD) are to establish a working group to better understand the need and the best way to meet that need. Specific questions may be beneficial, but anonymously linking MoD data sources to the 2011 Census and further analysis of information collected about armed forces leavers from the Annual Population Survey may be better.  This is because the MoD holds service and pension records electronically, which date back to 1971. This also gives access to a wider range of official statistics on the armed forces community more often and more promptly. This could then inform policy well in advance of the results of the 2021 Census.

Numbers of service personnel

UK armed forces service personnel statistics are produced monthly.  As of February 2017, the British Armed Forces are a professional force with a total strength of 196,420 UK Service Personnel comprising:

• 151,940 UK Regulars and Gurkhas
• 36,240 Volunteer Reserves
• 8,250 “Other Personnel”

However, the strategic defence and security review (SDSR) 2010 set out a wide reaching programme of manpower reduction targets and a redundancy programme which increased the number of service leavers and veterans and potential demand for community services.

Reservists

Volunteer Reserves voluntarily accept an annual training commitment and are liable to be mobilised to deploy on operations. They can be deployed on a part-time or full-time basis to provide support to the Regular Forces at home and overseas. Volunteer reserve personnel (which at 1 March 2017 comprised 18.5 per cent of UK Service Personnel) are set to increase under the Future Reserves 2020 (FR20) programme. This may increase the number of reservists who are exposed to active service but who may access NHS health services.

Active armed forces personnel in Bracknell Forest

Location statistics are produced quarterly (accessed 16 May 2017). The composition of armed forces personnel stationed in Bracknell Forest as of 1 January 2017 is as follows:

Source: Defence Statistics

This represents a decrease across all categories from figures  at 1 April 2012.

Ex-Services personnel in Bracknell Forest

The number of ex-services personnel in the borough is not known as there is no agreed single process for identifying them.  This is being explored as part of the Civilian Military Partnership action plan (set out below).

Proxy calculations

Pension and compensation scheme data can be used as a proxy for the number of veterans in an area, however, it should be noted that not all veterans are in receipt of pension or compensation payments. Recipients of the Armed Forces Pension Scheme (AFPS), War Pensions Scheme (WPS), or the Armed Forces Compensation Scheme (AFCS) are recorded annually.  In 2016, there were 862 recipients in receipt of AFPS, WPS or AFCS in Bracknell Forest. Of these, 774 were veterans.  There were 158 ‘Disablement Pensioners in receipt of the pre-2005 WPS and ongoing war pension’, of which 133 were veterans at 31 March 2016.

GP practices could include military information using Read codes which already capture patient information including occupation, social circumstances, ethnicity and religion, clinical signs and a variety of administrative items.  The use of this Primary Care data is currently limited by:

• Awareness of the existence of relevant Read codes by GPs and other primary care staff
• Inconsistent approach across the borough
• Awareness or willingness of the Armed Forces community to identify themselves as such when first registering with a GP

Health Services for Military Personnel

UK Armed Forces personnel and entitled civilian personnel may have their primary care provided by the Ministry of Defence (MOD) rather than the NHS if they have a Defence Medical Services (DMS) registration.

A wider awareness of DMS services will help civilian services understand the scope and extent of services previously provided to serving personnel and registered dependants and entitled civilians for continuity and consistency of health and care support. A comprehensive summary of DMS services are outlined in “Life Force: a practical guide for working together in support of our veterans”.

Quarterly DMS reports are designed to help military and civilian health and care professional make informed decisions about the commissioning of clinical services depending on the size and composition of the Armed Forces populations requiring access to care.

DMS usage

Of the 176,921 UK Armed Forces and entitled civilian personnel with a DMS registration, 139,061 were UK forces personnel and 15,739 eligible civilians of which:

• 10% were female
• 55% of males were in the 20-34 age band

This is representative of the services population as whole.

Of the civilian registrations by gender and age band, 50% were for those aged 0-14 and 24% were for females aged 25-39. These represent the main categories of dependents for the Armed Forces personnel: children and partners and potential users of civilian services and support.

Local data on DMS registrations released in February 2017 give information by age band:

And gender:

Key: ~ denotes numbers fewer than 5 supressed for anonymity

Mental health

Assessment and care-management within the Armed Forces for personnel experiencing mental health problems is available at three levels:

• In Primary Health Care (PHC) by the patient’s own Medical Officer (MO)
• In the community through specialists in military Departments of Community Mental Health (DCMH)
• In hospitals, either the NHS or the contracted In-Patient Service Provider (ISP)

The level of care a patient may require is determined by a number of factors, including the severity of symptoms and the degree of risk posed by the patient’s current condition.

Mental health assessments

The MOD collects data on initial mental health assessments of UK armed forces personnel seen at MOD specialist mental health services.  The 2016/17 report shows a rising trend in the percentage of UK Armed Forces personnel presenting at both MOD DCMH and in-patient provider.

This may be a successful effect of campaigns run by the MOD to reduce stigma, resulting in more UK Armed Forces personnel presenting for assessment or a true rise in mental disorders among military personnel.

2015/16 data (published June 2016) shows rates of mental disorders are highest among:

• those aged between 20-44 years compared to those aged under 20 years and 45 years and over
• females than men
• non-officer ranks

Mental health assessments leading to diagnosis of mental disorder

There is also an increasing proportion of personnel seen at MOD Specialist Mental Health Services being assessed with having a mental disorder:

Mental health diagnosis

The MOD statistics report adjustment disorders were the most prevalent disorder during the period July-September 2016/17, accounting for 32% of all new episodes of care seen at a MOD DCMH. Contrary to expectation, post-traumatic stress disorder (PTSD) rates remained low with less than 0.1% of all serving UK Armed Forces personnel assessed with this disorder between July-September 2016/17, that is not to say that this will not present later in life, however.

Statistics from 2015/16 data (accessed 16 May 2017) shows the proportion and trend by disorder type over time:

 

Substance misuse and alcohol

The proportion of mental disorder assessments for psychoactive substance misuse due to alcohol as a proportion of all mental disorders fell from 10% in 2014/15 to 5% of all mental disorders in 2015/16.

Anecdotal widespread use of psychoactive substance misuse due to alcohol in the Armed Forces is overstated as figures actually show that the percentage of personnel assessed with these disorders remain a rare event (0.2% and 0.1% respectively).

Suicide

The annual Statistical Notice provides summary information on suicides and open verdict deaths that have occurred among serving UK regular Armed Forces personnel during the 20-year period 1997-2016. Since the 1990s, there has been a declining trend in male suicide rates which remains a rare event, evidenced by the small number of deaths in each year.

Figures for the 20-year period 1997-2016 are 325 suicides and open verdicts (308 males, and 17 females) giving rise to a male suicide rate of 8 per 100,000 personnel at risk in UK regular Armed Forces – statistically significantly lower than the UK general population. Rates differ by armed service:

• the Naval Service suicide rate was 8 per 100,000
• the Army rate was 10 per 100,000
• the RAF rate was 6 per 100,000

Barriers to good health and wellbeing outcomes

Government figures only show figures for serving personnel.  Ex-service personnel may exhibit signs and symptoms of trauma at a later time, and identifying service or ex-service personnel in NHS and social care assessments will be an integral part of understanding, treating and managing any of the behaviours and symptoms mentioned above.

The Big Lottery Fund commission research into emerging social needs.  The 2016 Foresight Report into veteran health and wellbeing synthesised a number of key issues affecting the health and wellbeing of ex-service personnel including early leavers and veterans.

• 40% of the adult ex-Service community has some difficulty with health/wellbeing
• Reported mental health problems have doubled since 2005. Only 5% have sought help for mental health problems.
• Half of the community affected by long-term illness or disability, most often a physical condition.
• Isolation / mental health issues particularly affect those aged 35-54
• 5% report some unmet need for support, rising to 25% among the unemployed
• 7% of prisoners identified (n=4700) as having an ex-service background, rising to 13% in high security and category B prisons
• Veterans were more likely to be serving longer sentences and for more violent offending than the general population
• 2013 data found that female Service personnel are around five times more likely than women in the general population to be alcohol dependent (5% vs 1%)
• 2015 data found that working age veterans are less likely to be in work (63%) than men in the UK general population (77%)
• Dependants, who are mostly female, are also less likely to be in work (56%) than women in the general population (67%)
• Of those of working age within the ex-Service community, 10% have no formal qualifications, doubling to 20% of those aged 55-64 limiting chances for good employment with poor ICT a dn transferable skills cited as specific barriers

Health conditions

The over 65s are currently the largest veteran group, making up around 60% of total UK veterans. The biggest issues this group was confronted with were mobility, isolation and independent living.  The report cites findings from a 2014 UK Household Survey of the Ex-service Community to compare prevalence of specific conditions compared to the general population as a whole as follows:

Condition	Ex-servicemen	General Population
Long-term illness that limits activity	24%	13%
Depression	10%	6%
Back problems	14%	7%
Problems with legs & feet	15%	7%
Problems with arms	9%	5%
Heart problems	12%	7%
Diabetes	6%	3%
Difficulty hearing	6%	2%
Difficulty seeing	5%	1%

Homelessness

Issues with accommodation – both finding and maintaining stable accommodation – is a widely reported problem for service leavers, veterans and their families.

The University of York report on meeting the Housing and Support Needs of Single Veterans in Great Britain found that single service leavers have been identified as a group that may struggle with successful transition to civilian life, particularly finding accommodation, placing them at risk of homelessness.

Research into the housing-related support needs of homeless veterans for the Office for Public Management (OPM) Group (2016) found that there is a higher prevalence of homelessness amongst ex-Army personnel compared to other areas of service in the Armed Forces.  Homeless veterans tended to have an older profile, presented with higher rates of alcohol and/or drug misuse, suffer from physical and/or psychological injury or illness, suffer relationship breakdown (with families and partners) or issues following time served in prison.  In terms of housing support, homeless veterans often prefer to live in veteran-only supported housing because of a shared understanding of military culture and the mutual support this provides.

Employment

The Career Transition Partnership (CTP) exists to support Service leavers in their transition from the military to civilian life/employment.  Support is available to eligible personnel two years before leaving the Armed Forces, through to two years after. The type of employment support offered is dependent on a combination of the length of time served in the Armed Forces and the reason for leaving.  All regular and Gurkha personnel are eligible for CTP resettlement provision including those medically discharged, or leaving the Armed Forces due to redundancy.

The types of benefits available to Service leavers include: training grants, allowances, travel warrants, resettlement leave, transition workshops, one-to-one career guidance support, subsidised vocational training support, housing advice, financial briefs and job finding support.

Published in January 2017, the 2015/16 estimated employment rate for service leavers was 80% (based on a population sample) was still higher than the UK employment rate of 74%.  However, there were variations: army personnel, females, BAME personnel (in particular Non-UK BAME (foreign and commonwealth residing in the UK)) and those who medically discharged were significantly more likely to have lower estimated employment rates. It should be noted that females were more likely to be economically inactive than unemployed.

For those in employment up to six months after leaving service 23% were employed in skilled trade occupations (for example electrical trades) compared to 11% in the UK population.

Costs of poor transition

The Forces in Mind Trust 2013 Transition Mapping Study modelled baseline costs of poor transition in 2012 as £113.8 million:

The 2012 baseline cost components were calculated as:

Issue	Cost, £m
Alcohol misuse	£35
Mental health issues (“common neurotic disorders” together with PTSD)	£26
Unemployment	£21
Family breakdown	£16
Homelessness	£5.5
Prison	£4.4

Adjusted for higher outflow numbers in 2013 and 2014 and recruitment in 2015, the costs of poor transition were projected to be £122m, £111m and £98million respectively.

Prevention, Care and Support

Bracknell Forest Council and its partners signed a Community Covenant with the Royal Military Academy in 2011.

An action plan is now in place as part of the Civilian Military Partnership covering:

• Information and access to community care/psychological care for armed forces families/spouses accessing services through NHS GPs
• Recording veteran status in GP records with specific military codes on the GP EMIS clinical records system
• Exploring data sharing between GPs and the Civilian-Military partnership of numbers of veterans in the area
• Registering veteran and reservist status in hospitals to ensure clear pathways to health support
• Secure inclusion of veterans needs in NHS’s Sustainable Transformation Planning
• Ensuring health and social care needs are understood for active regulars, reservists, service leavers and veterans to ensure information needs are met under statutory duties under the Care Act 2014
• Closer links with Children’s Centres for support children and young people of forces families

Want to know more?

Call to Mind (Community Innovations Enterprise, 2015) – NHS England & Forces in Mind Trust  commissioned summary of the extent to which the mental and related health needs of veterans and family members are being addressed in Joint Strategic Needs Assessments (JSNAs) in England and the development of pathways to care.

Capitalising on military talent (Business in the Community, 2017) – A toolkit written in partnership with military recruitment specialists, Salute My Job, is designed to help businesses strengthen their workforce by offering veterans fulfilling second careers and maximising the wealth of transferable skills, including leadership, teamwork, problem solving and a strong work ethic from within the ex-service community.

Career Transition Partnership ex-service personnel employment outcomes statistics (Ministry of Defence, 2017) – Annual statistics on the estimated employment outcomes for ex-service personnel who used the services provided by the MOD Career Transition Partnership (CTP)

Defence Medical Services Review (CQC, 2015) – A review of findings into the care and treatment military personnel receive (including recommendations), including their involvement in care decisions, infection control, nutritional maintenance, keeping people safe and support, training and supervision.  Follows on from the original 2008 report.

Life Force (Kirkless Council, 2011) – a comprehensive assessment of the needs of army personnel including veterans, including how to engage with veterans to assess needs to access appropriate support and a comprehensive

Health and social outcomes and health service experiences of UK military veterans: a summary of the evidence (King’s Centre for Military Health Research, 2009) – a review of post-2003 evidence into the general the health of the veteran community comparable to the general population covering mental health, suicide, alcohol misuse and barriers experienced by veterans in accessing healthcare including fear of stigma, self-efficacy and not knowing where to go for help.

Meeting the Needs of Homeless Veterans (Spear, 2014) – Despite the title, this report which considers the support Veterans and their families need, (including in relation to housing, health, economic, and employment) and the wider issue of social integration. Also, recommendations to inform best practice in the provision of support services to Veterans dealing with the ex-Gurkha and British Veterans as distinct groups.

The Transition Mapping Study: Understanding the transition process for Service personnel returning to civilian life (Forces in Mind Trust, 2013) –  Sets out the entire transition process from military to civilian life currently works and how it is viewed by stakeholders and recent Service leavers.  Vital information for those involved in supporting the transition of military personnel and their families from a career, and a life, in the Armed Forces back into the civilian world.

Veterans in the UK: Issues Facing the ex-service community (Trajectory, 2016) – A report exploring issues and emerging needs related to Veterans in the UK. Specifically mental health, physical health, criminality, alcohol misuse, unemployment and housing needs.

Why do some ex-armed forces personnel end up in prison? (BMJ, 2011) – Editorial exploring how individuals’ needs can best be met both in prison and in the community by exploring why ex-services personnel become involved in the criminal justice system, the underlying causes and problems facing transition back into civilian life.

This page was created on 27 February 2014 and updated on 17 May 2017.

Cite this page:

Bracknell Forest Council. (2017). JSNA – Military personnel and veterans. Available at: jsna.bracknell-forest.gov.uk/ageing-well/keeping-well/excess-winter-deaths (Accessed: dd Mmmm yyyy)

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