Focusing on the mental health of treatment-seeking veterans

Military veterans with and without post-traumatic stress disorder: results from a chronic pain management programme

BACKGROUND AND AIMS

There is very little published evaluation of the treatment of military veterans with chronic pain, with or without post-traumatic stress disorder. Few clinical services offer integrated treatment for veterans with chronic pain and PTSD. Such veterans experience difficulty in accessing treatment for either condition: services may consider each condition as a contraindication to treatment of the other. Veterans are therefore often passed from one specialist service to another without adequate treatment. The veteran pain management programme (PMP) in the UK was established to meet the needs of veterans suffering from chronic pain with or without PTSD; this is the first evaluation.

METHODS

The PMP was advertised online via veteran charities. Veterans self-referred with accompanying information from General Practitioners. Veterans were then invited for an inter-disciplinary assessment and if appropriate invited onto the next PMP. Exclusion criteria included; current severe PTSD, severe depression with active suicidal ideation, moderate to severe personality disorder, or who were unable to self-care in the accommodation available. Treatment was by a team of experienced pain management clinicians: clinical psychologist, physiotherapist, nurse, medical consultant and psychiatrist. The PMP was delivered over 10 days: five residential days then five single days over the subsequent 6 months. The PMP combines cognitive behavioural treatment, which has the strongest evidence base, with more recent developments from mindfulness-based CBT for pain and compassion-focused therapy. Standard pain management strategies were adapted to meet the specific needs of the population, recognising the tendency to use demanding activity to manage post-traumatic stress symptoms. Domains of outcome were pain, mood, function, confidence and changes in medication use.

RESULTS

One hundred and sixty four military veterans started treatment in 19 programmes, and 158 completed. Results from those with high and low PTSD were compared; overall improvements in all domains were statistically significant: mood, self-efficacy and confidence, and those with PTSD showed a reduction (4.3/24 points on the IES-6). At the end of the programme the data showed that 17% reduced opioid medication and 25% stopped all opioid use.

CONCLUSIONS

Veterans made clinically and statistically significant improvements, including those with co-existing PTSD, who also reduced their symptom level. This serves to demonstrate the feasibility of treating veterans with both chronic pain and PTSD using a PMP model of care.

IMPLICATIONS

Military veterans experiencing both chronic pain and PTSD can be treated in a PMP adapted for their specific needs by an experienced clinical team.

Understanding the Link Between Traumatic Brain Injury Accompanied by Loss of Consciousness and Well-Being: A Sample of UK Military Veterans

OBJECTIVE

To investigate the association between reported traumatic brain injury plus loss of consciousness (TBI + LOC) and a range of demographic, military, and physical and mental health factors among a sample of UK veterans seeking support for mental health difficulties.

DESIGN

The present study was a cross-sectional study.

PARTICIPANTS

Clinical records were used to identify a sample of treatment-seeking UK veterans (N = 3335), of which a total of 403 took part.

MAIN MEASURES

Information on demographic characteristics, military experiences, and a range of physical and mental health difficulties was collected.

RESULTS

Almost half of the sample (48%) reported a TBI + LOC, which was most strongly associated with drug use and childhood adversity. More modest associations also emerged with earlier service termination, likelihood of unemployment, as well as chronic pain and poor mobility.

CONCLUSION

The findings suggested that TBI + LOC may not specifically be associated with symptoms of posttraumatic stress in a sample of treatment-seeking veterans. The demonstrated links between TBI + LOC and adverse childhood, drug use, physical health, and employment may be useful in improving the assessment and rehabilitation of veterans with TBI + LOC.

Veterans Universal Passport: a pilot of a health and social care record for UK ex-service personnel

BACKGROUND

The transfer of care between different health and social care systems are often associated with poor outcomes and disengagement. Indeed, following the transition from military to civilian life, ex-service personnel report difficulties in navigating civilian health and social care services. Personal healthcare records are associated with a number of benefits, including improved continuity of care and patient empowerment. As such, this pilot project aimed to assess the benefits of the Veterans Universal Passport (VUP) in supporting UK ex-service personnel accessing NHS services.

METHODS

In-depth semi-structured interviews were carried out with eight participants (three ex-service personnel, two carers, three health and social care professionals) who had used the VUP. Interviews explored the benefits, challenges and unmet needs associated with the VUP. A thematic analysis was used to identify themes within this framework.

RESULTS

Participants felt that the VUP improved continuity of care and promoted a feeling of control over care. The military-specific nature of the VUP promoted a sense of identity and provided a 'support scaffold' for navigating the complexities of the civilian healthcare system. Challenges included awareness among health and social care professionals, and engagement of users. All participants suggested development into a digital application.

CONCLUSIONS

Findings suggest that the VUP had a positive impact on veterans' access to civilian health and social care services, highlighting that it provided a much-needed structure to their journey through treatment. Considering the parallels with other health and social care transitions, translation for other populations may be beneficial.