Transcript 12.05pm - Turning Point

Welcome to the APPG meeting on the complex needs of
Veterans
Chaired by Lord Victor Adebowale CBE and Baroness Judith Jolly
Follow or link to us on Twitter: @appgcomplexneed, @Voa1234
and @DavidBurrowesMP
Agenda
11.30am – Welcome and introduction
11.40am to 12.05pm – Speakers
12.05pm - Questions and discussion
12.50pm – Closing comments
12.55pm – Next meeting and staying informed
13.00pm – Meeting ends
Today’s Speakers:
• Prof. Neil Greenberg – Professor of Defence Mental Health, Help
for Heroes
• Wing Commander (Rtd) Dr Walter Busuttil - Medical Director and
Psychiatric Consultant, Combat Stress
• Major General (Rtd) Nick Caplin CB – CEO, Blind Veterans
• Kevin Lowe - 1st Btn Royal Regiment of Wales (Served between
1998 -2002)
• Bill Nevill - Royal Engineers (Served between 1969 - 1981)
Combat Stress
24 Hour Helpline
0800 138 1619
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Combat Stress
National Third Sector Charity
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Established 1919:
UK wide
Largest Third Sector Veterans’ Mental Health Provider
Multi-Disciplinary Clinical Staff
National Specialised Commissioning by NHS
Funding: 33% Statutory, 66% Charity
Turn over:
 2007/8: £4 million;
 2014/5 £19 million.
5
6,004
Veterans are
currently being
supported.
2, 328
Total of new
referrals in the
year.
1,168
Number of
Veterans
discharged.
Combat Stress Access & Needs-Led Tiered Clinical Pathways
Access
Community
• Helpline
• Self
referral
• Other
clinician
referral
• Welfare
• Community
clinics and
groups
• Outreach
• Outpatients
• Substance
misuse case
management
service
Triage
Nurse
Case
manage
ment
Residential
Treatment
Programs
Rehabilitati
on
Wellbeing
Breakaway
centre
programs
Research and Audit
 Formal Link into Kings Centre for Military Health Research
(KCMHR) & Academic and International Collaborations
 Research aimed at identifying needs of help-seeking veterans and
service development
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Bio-psycho-social presentation
Stigma and barriers into care
Treatment outcomes
Family and Carers
Brain Injury and PTSD
Help seeking and illness behaviour
Demographics
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Army 84%
Merchant Navy 0%
Royal Air Force 7%
Royal Marines 3%
Royal Navy 6%
Majority - Army and lower ranks
97% male and 3% female
In Under 65s - 50% unemployed
Average Age 41.8 years
Average Length of Service 11.1 years
Interval between discharge and first contact 12.3 years
Demand
• 2014/15 - 5,954 active veterans vs 5,473 end 2013/14 - 9% increase
• 2014/15 2,328 new referrals vs 1,854 end 2013/14 - 28% increase
Access
• 44% self referral ; 4% Families / friends
• 21% other charities/Unknown
• 17% from Helpline
• 7% NHS Community Mental
health,
• 4% GPs,
• 3% from the Website
Theatres of Operation – Active
Veterans (n=6004)
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2.
3.
4.
5.
6.
7.
8.
Northern Ireland 33%
3500
Iraq 13%
3000
Afghanistan 11%
2500
Balkans 10%
2000
Gulf 7%
1500
Falklands 6%
1000
All other conflicts and Wars 13% 500
None 8%
0
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Please note, a veteran may appear in both conflicts
Help Seekers:
Needs Analyses
One Independent study and large
Combat Stress clinical audit dataset
since 2005
Evidence Base:
• For treatment to be effective the following must be satisfied:
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Accessible
Engage
Complete
Efficacious: Improvement of symptoms & function
Maintain improvement long term
• Plus: Skilled qualified; professionally registered staff
Intensive Six Week Programme - Outcomes
British Medical Journal (March 2015)
• Naturalistic study: Successive patients-246 veterans who
accessed Combat Stress between late 2012 and early 2014
for treatment.
• Six week and six month follow-up
 High engagement and high completion rate (94%) – (US studies drop out
rates 22-46%)
 Highly significant reductions in symptoms (87%) and improvement in
function to six month follow up.
 One year FU data - similar findings - about to be submitted for publication.
 Optimum outcome predictors paper published.
Collaboration
NHS
• Most Veterans remain unidentified – Stigma; no means to identify
veterans.
• Majority must access statutory NHS services – 80% of CS veterans have
tried to get help from NHS first!
• IAPT - data incomplete – similar to general population in terms of
treatment completion - around 50%. - No long term FU studies of efficacy
• Specialised Services: Veterans’ Mental Health Network:
 10 across England – minority are psychology/therapy led clinical services not truly
multidisciplinary – others are signposting services.
 No long term FU studies of efficacy.
 Many shared patients with CS.
 No standardisation of NHS services – difficult to interface with
Recommendations
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More Joint Working & Collaboration
Simplify accessibility especially Military Charity Sector
Identify veterans within the NHS
Evidence based service planning (remember A,E,C,E,M).
Joined up tiered pathways & programmes – NHS & Third sector
References
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Andrews, B., Brewin, C.R., Philpott, R., Hejdenberg, J. (2009). Comparison of immediate-onset and delayed-onset posttraumatic stress
disorder in military veterans. Journal of Abnormal Psychology, 118, 767-777.
Brooks, E., Novins, D.K., Thomas, D., Jiang, L., Nagamato, H.T., Dailey, N., Bair, B., Shore, J. (2012) Personal characteristics affecting veterans’
use of services for Post Traumatic Stress Disorder. Psychiatric Services 2012; doi: 10.1176/appi.ps.201100444
Brooks, E., Novins, D. K., Noe, T., Bair, B., Dailey, N., Lowe, J W.J., Richardson B., Hawthorne, K., Shore, J.H. (2013) Reaching Rural
Communities with Culturally Appropriate Care: A Model for Adapting Remote Monitoring to American Indian Veterans with Posttraumatic
Stress Disorder Telemedicine and e-Health. Apr 2013, Vol. 19, No. 4: 272-277.
Busuttil, W. (2010) Mental Health Problems in British Veterans. In: Managing Trauma In the Work Place: Supporting Workers and
Organisations. Ed Noreen Teherani. Routledge Taylor and Frances Group pp33-50.
Busuttil, W. (2011) Post-traumatic stress disorder and substance misuse. In Practice in Mental Health Substance Use 109-124; D C Cooper ed.
Radcliffe Publishing Ltd: London.
Busuttil, W (2012) Military Veterans’ Mental Health – the long term post trauma support needs. In: 'International Handbook of Workplace
Trauma Support', eds Rick Hughes, Andrew Kinder and Cary L. Cooper. pp458-474. Wiley- Blackwell: Oxford.
Busuttil, W. (2014) Trauma Related Substance Misuse. In Attorney’s Guide to Defending Veterans In Criminal Court. (Brocton Hunter ed)
Chapter 7. National Veterans Foundation: Minneapolis USA.
Busuttil, W (2014) The Charity Worker’s Tale. In Battle Against Stigma eds M Neville & J Hacker-Hughes - its Role ed Jamie Hacker-Hughes
Bringing War Home. Volume 2, pp 66-79. Wellcome Trust: London.
Creamer, M., Morris, P., Biddle, D., & Elliott, P. (1999). Treatment outcome in Australian veterans with combat-related posttraumatic stress
disorder: A cause for cautious optimism? Journal of Traumatic Stress, 12, 545–558.
Elhers, A., Gene-Cos, N., Perrin, S. (2009) Low recognition of post traumatic stress disorder in primary care. London Journal of Primary Care.
Royal College of General Practitioners, 2, 36-42.
Forbes & Creamer M, (2003) The Treatment of Chronic Post Traumatic Stress Disorder. In: Military Stress and Performance: The Australian
Defence Force Experience (eds G E Kearney, M Creamer, R Marshall, A Goyne) pp206-218, Paul & Co Pub Consortium: Defence Science and
Technology Organisation. Canberra.
Forbes D., Lewis, V., Parslow, R., Hawthorne, G., Creamer, M. (2008). Naturalistic comparison of models of programmatic interventions for
combat-related post-traumatic stress disorder. Australian and New Zealand Journal of Psychiatry 2008; 42:1051-1059
Foa, E. B., Keane, T. M., Friedman, M. J. (2009) eds. Effective Treatments for PTSD: Practice Guidelines from the International Society for
Traumatic Stress Studies. 2nd Edition New York: Guilford Press.
Iversen A C, Van Staden L., Hacker Hughes, J Greenberg N Hotopf M., Rona RG Thornicroft J Wessely S, Fear, NT (2011) The Stigma of mental
health problems and barriers to care of UK Armed Forces. BMC Health Services Research, 11, 31.
References
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Klein, S., Alexander, D., & Busuttil, W. (2013) Scoping review: A Needs-Based Assessment and Epidemiological Community-Based Survey of Ex-Service
Personnel and their Families in Scotland Robert Gordon University. Aberdeen December 2012 www.scotland.gov.uk/Resource/0041/00417172.pdf
MacManus, D., Dean, K., Al Bakir, M., Iversen, A. C., Hull., L., Fahy, T., Wessely, S., Fear, N.T., (2012) Violent behaviour in UK military personnel
returning home after deployment Psychological Medicine 42(8):1663-73.
MacManus, D., Dean, K., Jones, M., Rona, R.J., Greenberg, N., Hull, L., Fahy, T., Wessely, S., Fear, N.T., (2013) Violent offending by UK military
personnel deployed to Iraq and Afghanistan: a data linkage cohort study Lancet 2013; 381: 907–17
Murphy, D.& Busuttil, W. (2014). Reviewing PTSD, stigma and barriers to help-seeking within the UK Armed Forces. Journal of the Royal Army
Medical Corps, 0:1–5. doi:10.1136/jramc-2014-000344.
Murphy D, Hodgman G, Spencer-Harper L, Hinton M, Wessely S, Busuttil W. (2015) Mental health and functional impairment outcomes following a
six week intensive treatment programme for UK military veterans with post traumatic stress disorder (PTSD): a naturalistic study. BMJOpen. Open
2015;5:e007051. doi:10.1136/bmjopen-2014-007051
Murphy, D., & Busuttil, W. (2015). Exploring factors that predict treatment outcomes in UK veterans treated for PTSD. Psychology Research, 8(5).
Murphy, D., Weijers, B., Palmer, E., Busuttil, W. (2015) Exploring patterns in referrals to Combat Stress for UK veterans with mental health difficulties
between 1994 and 2014. International Journal of Emergency Mental Health, 17, 652-658.
Murphy, D., Palmer, E., Busuttil, W., & Oddy, M. (In press) Exploring the prevalence of traumatic brain injury (TBI) and associations between TBI and
mental health difficulties within UK veterans accessing support for mental health difficulties. Psychology Research
Scheiner, N.S. (2008) Not ‘at ease’: UK Veterans’ perceptions of the level of understanding of their psychological difficulties shown by the National
Health Service. Doctoral Thesis. City University London: Department of Psychology.
Wood, S., Jones, C., Morrison, S., Kitchner, N., Dustan, F., Fone., Fear, NT., Bisson, J. (2011) Mental health, social adjustment, perception of health
and service utilisation of three groups of military veterans living in Wales: a cross-sectional survey. Cardiff University. Unpublished study; synopsis on
Welsh Committee Website Wales
van Hoorn, LA., Jones, N., Busuttil, W., Fear, NT., Wessely, S., Jones, E. Hunt, E.,Greenberg, N. (2013). Iraq and Afghanistan veteran presentations to
Combat Stress, since 2003. Occupational Psychiatry. doi: 10.1093/occmed/kqt017
Today’s Speakers:
• Prof. Neil Greenberg – Professor of Defence Mental Health, Help
for Heroes
• Wing Commander (Rtd) Dr Walter Busuttil - Medical Director and
Psychiatric Consultant, Combat Stress
• Major General (Rtd) Nick Caplin CB – CEO, Blind Veterans
• Kevin Lowe - 1st Btn Royal Regiment of Wales (Served between
1998 -2002)
• Bill Nevill - Royal Engineers (Served between 1969 - 1981)
Our next meetings will be on:
 Tuesday 2nd February 2016 – on MEAM’s Solutions from the Frontline
report
You can find more information on the APPG or contact us via:
WEBSITE: www.turning-point.co.uk/whoarewe/appg
TWITTER: http://twitter.com/APPGcomplexneed
EMAIL: [email protected]