Veteran mental health in context
Thankfully most veterans leave their service enriched by the experience, with a wide range of valuable skills to bring to their civilian life. However, a small but significant proportion of former servicemen and women struggle with a range of mental health problems such as anxiety, depression and PTSD.
There are also issues with accessing mental health services. Research within our own organisation demonstrates that veterans take an average of 13 years to seek help from Combat Stress after leaving the military. Although the time taken to access help is gradually reducing, especially in younger veterans from the more recent wars in Iraq and Afghanistan, there are numerous factors that contribute to this help-seeking delay.
Worry about the potential stigma of mental health issues, exacerbated by a military culture that has historically discouraged displaying any perceived vulnerability, is likely to contribute.
Our own research has also shown that more than 80% of the veterans we support tried to get help for their mental health from the NHS and MOD before contacting us.
The Emotional Impact of the COVID-19 Pandemic
Many individuals in our communities are likely to be at increased risk of developing emotional health difficulties as a result of their COVID-19 experience. There are a wide range of potentially triggering factors, including:
- Worry and health anxiety about self, family, friends and colleagues
- Social distancing and lockdown measures preventing social contact and engagement in familiar routine
- Changes to employment status (e.g. furloughed/lost job) and/or financial concerns
- Juggling multiple competing priorities, potentially including caregiving, home-schooling and home working
- Grief and loss of loved ones who may be directly impacted by COVID-19.
There are likely to be a wide range of responses to these potential triggers. As a result of their particular experience in the military, veterans may possess both strengths and vulnerabilities at this time.
Why may veterans be well equipped to cope at this time?
The military experience may enable veterans to be well equipped for dealing with this crisis. Depending on the nature of their service, former service personnel could be familiar with:
- Dealing with unpredictable threats
- Skilled at executing instructions methodically
- Competent at focussing on what can, rather than what can’t be done
- Strong ability to problem solve and improvise under pressure
- High sense of purpose, identity and pride
- Ability to use humour and camaraderie to cope and maintain perspective
These are all strengths that can be drawn on by throughout this crisis. Indeed, the lockdown measures may be relatively familiar for those veterans who experienced restrictions upon their movement such as periods of confinement to barracks.
Why might veterans be struggling at this time?
Whilst some veterans will be well equipped to cope, others may have extra vulnerabilities. Examples of these are:
Pre-existing undiagnosed mental health difficulties
- Mental health symptoms that were not yet problematic enough to prompt help-seeking may have worsened due to increased anxiety, reduction in social contact, loss of routine and potential losses. Mental health symptoms may now have a greater impact on mood and functioning.
Previously unresolved trauma may be triggered by the current situation
- Many former military personnel have endured traumatic experiences as part of their service. The heightened need for hand hygiene and the focus on the virus may worsen health anxiety, panic, obsessive compulsive or generalised anxiety difficulties.
Potential difficulties expressing/dealing with emotional distress
- Veterans can understandably find it difficult to speak about their traumatic experiences and their mental health, and self-medication through use of alcohol or substances is common. The restrictions of COVID-19 may mean veterans are left lacking in the skills or means to deal with emotions in more healthy ways.
The language used to describe the pandemic
- COVID-19 is often referred to as the ‘invisible enemy’ and ‘a battle’ to be fought. Whilst this language can be a helpful to make many act in the best interests of the nation , it can raise particular difficulties for veterans.
Grief and loss
- The widescale loss of life caused by the pandemic, particularly the loss of loved ones, may trigger unresolved grief of lost comrades, especially if there is limited opportunity to say goodbye.
- Being in isolation might reinforce a tendency to avoid people in those who suffer from certain forms of mental health difficulties such as social phobias, health phobias, depression, anxiety and post-traumatic stress disorder. Once restrictions are lifted the veteran might find it much more difficult than otherwise to socialise and might need some help to be part of the team.
- The lack of Personal Protection Equipment (PPE) in front line NHS staff and other groups might re-ignite feelings of moral injury in veterans who fought on the front line knowing their equipment was inadequate. Return to work without adequate safety planning and PPE perceived as adequate by the veteran might reinforce feelings of being let down and undervalued.
Strategies to support the psychological wellbeing of veterans at this time
If you are a member of an organisation employing veterans, you will already have a great deal of knowledge and familiarity with the veteran(s) you support in your workplace. Some of you will already have veterans’ networks within your structures and strong links to HR and Occupational Health, with access to mental health treatment and support that are veteran friendly.
As a result, you will have acquired a strong sense of the conditions which allow your veteran colleagues to thrive. Have confidence in this insight. Reflect on how you can support your veteran employees to do more of what they have found to be helpful and less of what is not, based on prior experiences.
Here are some additional strategies to consider. As this resource is aimed at a wide readership, please pick the strategies that are possible and practical given your unique working relationship with the veterans engaging with your organisation. The terms ‘veteran colleague’ and ‘veteran participant’ have been used to reflect this range of readership.
Step 1: Normalise emotional reactions and provide reassurance and empathy
- Reassure and normalise that the experience and expression of different emotions is a healthy response to the current crisis, either in person or remotely if required.
Here are some suggestions of phrases you can use/adapt to convey these qualities:
- Ask about the support available to the veteran in his home, whether he or she are alone, or sharing a house or have a family with them to support of have support from.
- Talk openly about challenges: “This is uncharted territory…”
- Empathise: “What you’re going through sounds really tough, thank you for sharing this with me”
- Offer your help and support: “How can I/we best support you? What needs to happen for you to feel more at ease? What has helped you in the past?”
- Reassure: “I’m here to support you, we’ll find a way through together”
- Consider and check in regarding confidentiality of information shared and organisational needs regarding employee wellbeing and record keeping
Step 2: Provide information and self-care advice during lockdown
Establish new routines
Military life is very structured, and many report that creating a daily routine is helpful in the transition to civilian life. Life at the moment means that we are all grappling with new demands. Encourage your veteran colleague/participant to establish a new routine that involves a balanced mix of activities, including those that provide:
- A sense of achievement
- Social contact
- A fresh focus on physical health including healthy nutrition, regular sleep, hydration, minimal alcohol use and daily exercise. Time out from screens is also important.
- Time to keep the living environment clean and tidy, in the same way as in military life, is also important when we are spending more time at home.
If your veteran colleague/participant is struggling, encouraging him/her to write a plan every evening for the following day - even it’s only 4/5 things – to provide a purpose upon waking and a sense of satisfaction when completed. Doing this can make the day pass faster and contributes to feelings of wellbeing.
The work environment at home
- Guide your veteran employee to set up a healthy work environment. Assist him/her to aim for a well set-up work-station, with appropriate chair, desk of suitable height, keyboard mouse and monitor if they are using a laptop.
Encourage social interaction with colleagues/peers
- Consider establishing peer support via a buddy system. Regular check-ins using video call, phone, text or email can prevent isolation, allow the opportunity to give and receive encouragement, and reinforce the sense of team working /wellbeing in this challenging time.
- We each choose jobs and adapt our work environment to suit our needs. Some people might be relishing working from home, valuing a greater senses predictability, remote working and less environmental input. In contrast, others may find they miss the work environment with its continuous changes and input from colleagues. They may find it more challenging to stay motivated and productive and find that they become more anxious or low due to the loss of these. Asking your veteran colleague about this aspect can promote a useful discussion.
Focus on what can be controlled
- Much of the current situation is outside of our immediate control. Reorienting attention on to what can be influenced, rather than focussing on what can’t, is a wise strategy for all of us at this time. Developing compassion for ourselves when we don’t achieve as much as we’d like to and talking to ourselves kindly is important. Reminding your team that this crisis will end and encouraging them to make plans for the future after the crisis, can provide a helpful shift in focus.
Step 3: Be alert for possible signs of mental health problems
Do be alert to possible signs of mental health distress, including:
- Appearing more anxious / ‘on edge’
- Seeming more withdrawn than usual
- More prone to irritability or anger
- Lower in mood than usual
- Little interest in doing things
- Reports lethargy/fatigue or trouble relaxing or sleeping
- Greater self-criticism or a sense of hopelessness
- Trouble concentrating
- Reporting using alcohol or substances more often to cope
If your veteran colleague/participant is showing any of these or other signs that cause you concern, aim to have an open conversation. Discuss the advantages of seeking extra support to promote mental fitness at this time. We have developed an extensive library of online self-help resources for veterans to offer specific support for COVID-19 mental health issues. Please do signpost veterans to our website to access these 24/7, free of charge:
Step 4: Signpost to mental health support services
If you have concerns about your veteran colleague/participants’ emotional wellbeing, encourage him or her to speak to their GP and seek a referral for appropriate psychological support.
LOOKING FOR MORE SUPPORT?
For further education about how to better support veterans in your organisation, please contact Dr Jen Bateman, Lead Clinical Psychologist at Combat Stress Jen.Bateman@combatstress.org.uk
Is there someone I can call and talk to?
Our 24/7 free Helpline remains open, so please do not hesitate to call if you need someone to talk to or any guidance during this difficult time.
Combat Stress 24/7 Free Helpline 0800 138 1619.
If you require more urgent help, either yourself or a member of your family, please contact your GP or call 111.
You can also contact the Samaritans on 116 123.