How new service helps veterans 'suffering in silence', says Leeds psychiatrist

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Social stigma and difficulties engaging with health services continue to act as a barrier for veterans who are seeking support while battling mental health issues, a Leeds psychiatrist has warned.

Lawrence Atkins, who works as a specialty doctor in psychiatry at Leeds and York Partnership NHS Foundation Trust, served as a civilian medical officer with the Army Reserve for more than 15 years alongside his day-job.

Leeds psychiatrist Lawrence Atkinson

Leeds psychiatrist Lawrence Atkinson

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Uniquely placed with an insight into military life, the 43-year-old is now part of a team spearheading the national Veterans’ Mental Health Complex Treatment Service for the North of England, a new community-based service launched in April in partnership with the Combat Stress charity, and commissioned by NHS England.

“We aim to provide a bespoke mental health service to military veterans with complex mental health needs, which have arisen as a result of some difficulties they have had within the military,” Dr Atkins said.

The service, which is flanked by a similarly commissioned scheme covering the south of England, is now being rolled out across the North from South Yorkshire to the Scottish borders and aims to treat veterans close to their own homes who are struggling with - but not exclusively - post traumatic stress disorder (PTSD).

Dr Atkins, who grew up near Cardiff in Wales, said PTSD numbers in the general population are estimated at one or two per cent, while the approximate number of veterans suffering with the disorder is between four and six per cent of ex-servicemen and women.

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“They are relatively small numbers, but several times higher than the rates of PTSD in the general population,” he warned.

“One of the difficulties with PTSD in veterans is the fact that these individuals tend to present late to the services that are able to support them.

“In the general and military populations, there continues to be a stigma with mental health.

“Although things are gradually changing for the better, there are still large numbers of people who are presenting later.”

Dr Atkins, who moved to Leeds in 1993 to train as a doctor, also underlined that there can be tragic consequences for those who do not get the help they need.

“I think that’s a sad truth - that people often suffer in silence for many months or even years. “They feel unable, unwilling or ashamed to seek help.

“Sadly, people often suffer in silence or they are reluctant to engage with support.

“The longer people remain isolated without help and support, they increase the risk that sadly they feel life is no longer worth living.”

One difficulty that mental health staff face, Dr Atkins said, is that many veterans can struggle to engage with support services after transitioning back into civilian life.

“Many of those people have spent a long time with military services; they then enter back into the civilian population and often have confidence issues,” he said.

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“Anecdotally, veterans say to me that civilian health services would struggle to understand their experiences because they are so far removed from anything civilians could relate to.

“Sometimes, part of their experience is that NHS services struggle to understand them. If a veteran sits in front of a health professional and their experiences relate to conflict, war and aspects of military life, it can potentially be difficult for them to be able to communicate that, and for them [the healthcare professional] to understand what a veteran is talking about.”

The role of supporting servicemen and women after they leave the Armed Forces has traditionally been taken on, in part, by military charities and veterans groups. Dr Atkins said that the shared understanding military life between fellow veterans is often why they turn to Armed Forces charities before accessing NHS services.

“If you have none of those shared experiences, that can be a barrier to the engagement of veterans,” he said. “In a nutshell, veterans sometimes feel that they are simply not understood, which is often part of the explanation of why veterans are more likely to approach military charities, rather than traditional health services.”

Part of the Leeds mental health trust’s new veterans service, which it is now in the process of rolling out and co-ordinating for the whole of the North of England, utilises support workers and volunteers from the Combat Stress charity, who work with ex-servicemen and women and encourage them to engage or access help.

“Combat Stress volunteers are often veterans themselves,” Dr Atkins said. “There is an arrangement where veterans are supporting other veterans. That might be through one-to-one conversations, engaging them in group-based activities in the community, or supporting them in attending appointments with health professionals.”

The service already has a Leeds-based team, covering Yorkshire and part of Lincolnshire. Dr Atkins said the roll-out for the remainder of the North - stretching from South Yorkshire and Cheshire to the Scottish borders - will now be phased in during the coming months.

Service bosses hope that a team, likely based in Newcastle and responsible for the North East, and another on the M62 corridor responsible for the North West, will be operational within the next two or three months.

It was introduced, Dr Atkins said, because NHS and support services for military veterans were too sporadic, largely dependant on where they lived in the country.

“NHS England commissioned this because they recognised that there was a relative lack of local, available, veteran-specific mental health services across the country, which is one of the drivers of this service,” he said.

“There were specific services, but often they were run by charities rather than the NHS. It’s fair to say that provision of NHS services - prior to the commissioning of this - were varied, patchy and sporadic.”

“NHS England wants to provide an England-wide service, irrespective of people’s addresses, across the country. I hope, ultimately, that the service can become a part of the NHS, that military veterans have confidence in and feel able to engage with.”

The service, which the Leeds NHS trust is commissioned to provide until March 2020, will support up to 130 veterans per year.