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Mental health: delivering specialist support and care for military veterans

A new service, Op COURAGE, provides specialist services for veterans and their families

A new service, Op COURAGE, provides a front door for mental health and well-being services for veterans, many of whom have complex mental health needs

  • People who have mental health problems after leaving the safe haven of military life can feel isolated and overwhelmed
  • A new service, Op COURAGE, provides a front door for specialist mental health and well-being services for veterans and their families
  • Op COURAGE focuses on those in crisis, at risk of suicide or self-harm, or with other problems such as homelessness or addiction

Having been a mental health nurse in the RAF, Eleanor Duke has personal experience of what it is like to serve in the armed forces

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A new service, Op COURAGE, provides a front door for mental health and well-being services for veterans, many of whom have complex mental health needs

  • People who have mental health problems after leaving the safe haven of military life can feel isolated and overwhelmed
  • A new service, Op COURAGE, provides a front door for specialist mental health and well-being services for veterans and their families
  • Op COURAGE focuses on those in crisis, at risk of suicide or self-harm, or with other problems such as homelessness or addiction
People who have mental health problems after leaving the safe haven of military life can feel isolated and overwhelmed
Picture: iStock

Having been a mental health nurse in the RAF, Eleanor Duke has personal experience of what it is like to serve in the armed forces – and what it means when you leave.

One of the big challenges is access to healthcare, including mental health services. That is one of the reasons why she is delighted to have taken up a post as team manager for East Midlands High Intensity Service for Veterans, the newest part of the Op COURAGE programme to support the armed forces’ mental health and well-being.

Nurses, doctors and other NHS staff work with military charities to provide therapy, rehabilitation services and, if necessary, inpatient care to former soldiers, sailors and RAF personnel each year as part of the Op COURAGE service.

People leaving the military are not just leaving a job, but a whole world and lifestyle

Eleanor Duke, team manager for East Midlands High Intensity Service for Veterans
Eleanor Duke

Ms Duke and her team are working with individuals who have served in the military and need the highest level of mental health intervention – people in crisis, at risk of suicide or self-harm, and with other complex needs.

‘It might not be that it’s what people experienced in the military that had a consequence on their mental health, but it’s often moulded who they are,’ she says.

‘It’s often moulded the relationships they have with people. They might have settled away from family. And when they leave the military they leave what was almost a safe haven, where they’ve been supported, had immediate access to healthcare and access to housing support as soon as they needed it.

‘When they leave, they’re not just leaving a job, they’re leaving a whole world, a whole lifestyle. If they have a health problem they have to find a GP, register, then wait for an appointment rather than seeing someone immediately.

‘They are left feeling isolated and overwhelmed by this difficult-to-navigate environment.’

Of the 2.4 million military veterans in the UK, one in 20 will have post-traumatic stress disorder

NHS England director of health and justice, and armed forces Kate Davies says there are 2.4 million veterans in the UK, and one in 20 will have post-traumatic stress disorder (PTSD). Many will have severe and complex mental health needs.

Op COURAGE has three levels of service for veterans’ mental health and well-being. These were developed with input from veterans, as well as clinicians, who continue to be at the heart of the process and were instrumental in coming up with the new name.

What is Op COURAGE?

NHS poster for Op Courage, the mental health and well-being service for military veterans
Op Courage

Op COURAGE brings together specialist mental health and well-being services for veterans and their families in England. It has three tiers:
• Transition, intervention and liaison service – for problems such as depression and anxiety
• Complex treatment service – for more complex issues including post-traumatic stress disorder
• High intensity service – for those in crisis, at risk of suicide or self-harm, or with other problems such as homelessness or addiction

Ms Davies says: ‘We went back out to people with lived experience, clinicians and the military community, and said to them: “Now we’ve got the three elements of that service, what’s missing?”

‘They said that what was missing was one front door – and how that can come together under one title and identity that would let people know it’s out there, but also encourage people that it’s there for them.’

NHS England and NHS Improvement chief executive Sir Simon Stevens launched Op COURAGE officially at an event in March, along with Ms Davies and minister for defence people and veterans Johnny Mercer. The high-intensity service started last autumn.

How one Marine got his life back on track

Former Royal Marine Anthony Muckell
Anthony Muckell

When Anthony Muckell, pictured, left the Royal Marines his life fell apart.

Support from the high intensity service, part of the Op COURAGE programme, helped him get it back on track.

‘At my lowest point I attempted suicide twice, spent time in a psychiatric hospital and prison,’ he says. ‘This led to me losing my job and homelessness. I was unable to explain what was wrong with me, which meant I didn’t get the help I needed, which meant giving up on life.’

Mr Muckell, who lives in London, says any veterans, or families of veterans, should contact the NHS veterans' service’.

‘The people who work there understand our needs and the help we need. If you know a veteran in need then please help them to make contact with their local NHS veterans’ service.’

Versions of the new service are now rolling out to all English regions, and they are expected to treat about 500 people a year, focusing on those in crisis, at risk of suicide or self-harm, or with other problems including homelessness or addiction.

Importance of being ‘veteran aware’ and veteran-sensitive assessments

Heather Steers, head of nursing at Combat Stress, a charity supporting veterans and their families across the UK, welcomes the launch of Op COURAGE.

Heather Steers, head of nursing at Combat Stress
Heather Steers

Ms Steers says: ‘We’ve been calling for a more strategic approach to mental health, and the fact that NHS England has brought the services under one banner makes it so much easier for veterans to see. It’s helpful to have it in one place.’

As well as specialist services for veterans, all those involved are keen to raise awareness of the specific needs of those who have served in the armed forces, the importance of being ‘veteran aware’ and conducting veteran-sensitive assessments.

Ms Duke says this can be as simple as asking someone if they have served, being aware that this could be having an effect on their mental and physical health, and acting or signposting accordingly. Veteran mental healthcare is challenging but incredibly rewarding, she says.

Veteran mental healthcare – how to get it right

People with PTSD are unlikely to be any more violent or unstable than other people with mental health problems

Written by Heather Steers, head of nursing at the charity Combat Stress

In the two years after leaving the RAF, Ms Duke worked in a child and mental health service and a local crisis team, then saw the team leader job advertised.

Not essential to have personal experience of serving in the armed forces to work with veterans

‘It sounded too good to be true. It just had everything I wanted in a job. It had management elements, it was working with people in crisis, and obviously it fitted with my experience of being in the military and working in military mental health – it was all there in the job spec.’

Having said that, Ms Duke stresses that it is not necessary to have personal experience of serving in the armed forces to work with veterans.

‘Being a veteran myself, I think it helps start conversations – and it probably helps with understanding acronyms. I don’t for one minute think it makes me better at my job – different people offer different things, and it’s good to have a mixed team.’

Since it started in October her service has had 46 referrals, completed 295 veteran contacts either face-to-face or by phone or video link, and has completed six veteran carer-specific assessments.

‘It’s important to say – and it’s not a cliché – that everyone comes through with different needs,’ she says.

Understand and be aware of their needs, and listen to what they say

‘A lot of veterans put up defence mechanisms, because of how they perceive themselves. That can be hard to work with for professionals who don’t have the same understanding of why someone is presenting in a particular way – they might be very angry, for example.

‘It’s also important to support families. Military families have lived as part of a community, and when they leave they don’t have the community they had, they don’t have the people to go to, to talk to, who might understand why their loved one is acting in a particular way.’

She believes it’s important to support mainstream services to understand and be aware of the needs of veterans.

‘Whether it’s in the GP practice or A&E or cancer services or whatever, we need to ask the question, “Have you served?” We need to start these conversations, and then we need to listen.’

Mental health support for veterans: where to go in the UK

  • Combat Stress provides specialist treatment and support for veterans, focusing on those with complex mental health issues related to their military service. It also has a 24 hour helpline (0800 138 1619) for veterans and their families, as well as online self-help
  • Walking with the Wounded works with the NHS and supports disadvantaged veterans focusing on employment, mental health and well-being, and care coordination
  • Veterans UK is part of the Ministry of Defence and provides free support for veterans and their families, including a helpline (0808 1914 218)

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