Centre for Mental Health REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families

REPORT

Matt Fossey Unsung Heroes of Service families of the emotional support needs of the emotional Developing a better understanding Developing a better

18 19 20 23 24 25 3 4 5 6 7 9 11 12 provides welfare to the whole Armed Forces family - serving, family Armed Forces the whole to welfare provides

is the UK’s leading military charity specialising in the care of Veterans’ Veterans’ of in the care specialising charity military leading the UK’s is

health care, in the right place, at the right time. We provide specialist trauma-focussed trauma-focussed specialist provide We time. the right at place, in the right care, health in the support and clinical and practical centres, treatment short-stay three at treatment 1619). (0800 138 Helpline and a 24-Hour community 160,000 interventions. Standing shoulder to shoulder with all who serve, our mission is to to is who serve, our mission all with shoulder to shoulder Standing interventions. 160,000 for and Remembrance representation comradeship, welfare, of be the number one provider community. the Armed Forces Stress Combat mental the right receive Veterans that ensure to our aim is in 1919, Founded health. mental The Royal British Legion British The Royal Service affecting issues of on a range campaign also We and their dependants. ex-Service the one of and are Appeal Poppy the annual run Remembrance, of the custodian are people, over spends Legion British The Royal On average organisations. membership largest UK’s with community helped our beneficiary In 2010 we work. on our welfare a week £1.4 million Contents The author Acknowlegements References Domestic violence Domestic Mental health Conclusion The evidence family of The importance and families Alcohol Introduction Background position policy The current Foreword from the Royal British Legion British the Royal from Foreword Hughes Jamie Hacker from Foreword Executive summary summary Executive Health. Matt Fossey is an independent healthcare consultant and a Senior Associate at Centre for Mental Mental for Centre at Senior Associate a and consultant healthcare an independent is Fossey Matt

REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 2 Centre for Mental Health 4 Centre for Mental Health REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 3 Until recently, most research has focused on the impact of men being deployed or separated or separated deployed men being of on the impact focused has research most recently, Until women’s of the impact understand to be undertaken to needs Further work families. their from and their children. their families from separation to recovery. As well as addressing the psychological needs of Service personnel recovering from from recovering personnel Service of needs the psychological addressing as well As recovery. to them must for who care on the families impact and emotional the practical injuries, physical consideration. into be taken also it must seek to ensure that IAPT services are able to meet the needs of veterans and their veterans of the needs meet to able are services IAPT that ensure to seek must it families. be integral to been shown has their families from receive personnel service injured The support and further amendments to the Military Covenant must fully reflect the needs of the families of of families the of the needs reflect fully must Covenant the Military and further to amendments serving personnel. (IAPT) programme Therapies Psychological to Access Improving its expands the Government As Similarly, more research is needed into the effect of alcohol misuse among veterans and the veterans among misuse alcohol of the effect needed into is research more Similarly, on their families. impact be recognised should the Armed Forces of capacity the functional to families of The contribution use within the UK Armed Forces. However, there is very little evidence about the impact of of the impact about evidence little very is there However, Armed Forces. the UK within use among misuse alcohol of impact the possible into Research families. on military misuse alcohol required. urgently is and their families veterans and personnel serving Armed Forces developed to meet the specific needs of Service families. Service of needs the specific meet to developed alcohol of the levels about the concern highlights that research of body a substantial is There Little is understood about the psychological impact of deployment on the families and children and children on the families deployment of impact the psychological about understood is Little are services the correct that ensure to required is research personnel. More Service UK of Executive summary Executive

7. 6. 5. 3. 4. 2. 1. on families and the effectiveness of existing family support, the impact on Service families of of families Service on support, the impact family existing of and the effectiveness on families recommendations: seven makes It violence. and domestic misuse alcohol This report looks at the practical initiatives to support service families in housing, health care and care health in housing, families service support to initiatives the practical at report looks This problems health mental of impact the around conducted be to research more for and calls education It examines the services already in place for families and identifies areas where more evidence, evidence, more where areas identifies and families for in place already services the examines It is services, these of and the effectiveness families support to services both the need for about necessary. this report draws together what we know about how the families and children of Service personnel personnel Service of and children the families how about know we what together report draws this and training. deployment of impact and psychological the emotional with deal supported to are As the UK Armed Forces undergo unprecedented restructuring to deliver a new employment model, a new employment deliver to restructuring unprecedented undergo Armed Forces the UK As , Director Health & Welfare, Royal British Legion British Royal Welfare, & Health , Director Foreword from the Royal British Legion Royal British from the Foreword March 2012 March when they reach out. We can not achieve our aims without close and innovative partnerships with with partnerships and innovative close without our aims achieve not can We out. reach when they charity Service and our Champions Department Government the Armed Forces encourage We others. and recognise to solutions find policy to us join report and this of the implications study to partners needs. families’ Armed Forces address Freeth Sue The future outlook for the Legion’s welfare services is to reach out to unmet need in the Armed unmet to out reach to is services welfare the Legion’s for outlook The future individuals enable to want support.We needing people more with engaging community, Forces to live their potential fulfil can families and their time so they the right support at right find the to lives. and successful independent in their lives points at families Armed Forces more support to expanding are services The Legion’s We welcome the recommendation that future research is focused on the Service family and their family Service on the focused is research future that the recommendation welcome We and that needs these meet to commissioned are services the right that ensure to needs healthcare of types familial different the understanding includes also This the picture. of out left not are they ‘man’. Service the as well as ‘woman’ Service and the families veteran Reserve, Service, We thank Centre of Mental Health for carrying out this independent review. Of particular note is the the is note particular Of review. independent this out carrying for Health Mental of Centre thank We that meant has which needs emotional family’s on Armed Forces focused research UK of paucity under the to the need acknowledging despite sufficiently, their needs addressed not has policy Covenant. Military This review reveals the breadth of the emotional support needs of the Service family, including including family, Service the of needs support the emotional of the breadth reveals review This Armed Forces face. they and experiences pressures and the particular families veteran Reserve and of role vital the and celebrate recognise all We our work. to central more become need to families and resilient enabling to a cornerstone is health and mental Their social family. the Armed Forces families. independent, successful The Legion campaigns on evidence based research. When we released our most recent study last last study recent our most released When we research. based on evidence campaigns The Legion and families bereaved personnel, injured of families in particular, that highlighted 2011, we May death of and causes injuries traumatic from arising pressures unique suffer spouses Armed Forces and the often frequent Service; by and parenting on relationships placed the strains age; young a at support family and healthcare schooling, childcare, employment, affecting location of changes networks. organisations that currently support Armed Forces families so effectively. There has been a lot been a lot has There so effectively. families Armed Forces support currently that organisations a further is review This healthcare. mental and health on Armed Forces focused work good of need to charities Service of and the work policy Government else where highlighting contribution disadvantage. encounter do not families Armed Forces that ensure to focus The Royal British Legion and Combat Stress are the Department of Health’s Voluntary Sector Sector Voluntary Health’s of the Department are Stress and Combat Legion British The Royal and Combat 2010 the Legion April Since sector. veteran and the Armed Forces for Partners Strategic needs on identifying the healthcare focusing programme year a three out been carrying have Stress their families. and veterans personnel, Service Armed Forces of those of all and recognise review in this involved those all of the contribution thank to want We

REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 4 Centre for Mental Health 4 Centre for Mental Health REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 5 MSc MPhil (Cantab) PsychD CPsychol CSci FBPsS CSci CPsychol PsychD (Cantab) MPhil MSc Foreword from Jamie Hacker Hughes Hacker from Jamie Foreword March 2012 March Jamie Hacker Hughes Hughes Jamie Hacker University Ruskin Anglia Therapies, Psychological Military of Professor Visiting MoD (Psychology) Advisor Consultant Defence Former recommendations that politicians, government departments, healthcare and third sector providers providers sector and third departments, healthcare government politicians, that recommendations consider. to do well all would and researchers and academics in uniform are serving overseas on operational or other detached terms of duty. of terms detached or other on operational serving are overseas in uniform and practical sensible most a number of making by report concludes Health’s Mental for Centre ‘Unsung Heroes’ also examines the implications of deployment for those serving on the ‘home those for deployment of the implications examines also Heroes’ ‘Unsung and dependants the families describe to allies our NATO some of by used still a term front’, their kinfolk – whilst in our case Cyprus, and Germany Kingdom, behind – in the United remaining issues of housing, healthcare and education through to examining the effects of alcohol, violence violence alcohol, of the effects examining to through and education healthcare housing, of issues and on their lives. and Dependants Families Service on problems health and mental the key literature in this area into this extremely timely brief report: ‘Unsung Heroes’. In addition to to In addition Heroes’. report: brief ‘Unsung timely extremely this into area in this literature the key the broader from the report ranges life, military of and out into transitions of the impact considering and Dependants. some of together drawn has Health Mental for Centre manner, equitable and highly In an insightful less has, to date, been done to address – in a similarly coordinated and structured fashion - the fashion and structured coordinated – in a similarly address been done to date, to has, less of each go through who those of needs psychological and emotional physical, financial, practical, Families Service our namely Servicemen, and Servicewomen our nation’s alongside steps six these In recent years especially, a great deal of effort on project work such as this has gone into promoting promoting into gone has this as such work effort on project of deal a great especially, years In recent and developing and into personnel our Armed Forces of resilience and supporting the emotional rather however, this, to when needed. In comparison and treatment support appropriate offering Life. Later policy developments built upon this ‘6-Step’ model to develop a framework of stress stress of a framework develop to model ‘6-Step’ upon this built developments policy Later Life. stages. these of six all at personnel to be delivered to education and training management or ‘OROSM’, in which I was privileged to be have been able to play a small part, a developed a small play to been able be have to privileged was I in which or ‘OROSM’, Career and Promotion Services; the Entry into life: Service through progression of model ‘6-Step’ Civilian into back Transition and Deployment, and Post-Operational Intra- Pre-, Development; a review of the effects of Service life and of operational deployments on levels of stress in Service Service in stress of on levels deployments operational and of life Service of the effects of a review tri-Service into be translated then would that recommendations making to view a with personnel Management’ Stress Operational of Review the ‘Overarching review, This area. this in policy Nearly 10 years ago, the Ministry of Defence’s Department of Service Personnel Policy (SPPol) began began (SPPol) Policy Personnel Service of Department Defence’s of the Ministry ago, years 10 Nearly Anon. 17th Century God is forgot and the soldier slighted. the soldier and God is forgot “God and our soldiers” is the people’s cry. the people’s is soldiers” our “God and When war is proclaimed and the dangers nigh the dangers and proclaimed is When war But when peace is proclaimed and all things righted, things all and proclaimed is when peace But Introduction in the UK context, international literature is drawn upon. The report also contains a number of a number of contains The report also upon. drawn is literature international context, in the UK This families. of needs the wider meet to adapted have services where showing examples practical be should further where research to as recommendations of a series making by report concludes families. Service of the needs to meet be configured should services and how conducted following physical trauma are enormous, but the psychological impact faced by families has yet yet has families by faced impact the psychological but enormous, are trauma physical following examined. be fully to serving personnel of the families affect that issues the pressing of some at report looks brief This has that research on the reportfocuses The conflicts. recent of those particularly veterans, and available is research little Where available. is evidence UK and what area in this been conducted What do we know about the impact of military life on families, not only in times of conflict, but but conflict, of in times only not on families, life military of the impact about know do we What military of nature pervasive the does impact What and training? preparation of periods through war? of scars the psychological with cope do families How families? of on the lives have culture and integration rehabilitation of veterans and Armed Forces the UK by faced The challenges recent conflicts (from Royal British Legion and Combat Stress Conference Nov 2012). These numbers numbers These 2012). Nov Conference Stress Combat and Legion British Royal (from conflicts recent rise. to continue undoubtedly will every for but, and their experiences personnel Service been on has focus The understandable involved: and emotionally materially who are others also are there our Armed Forces, member of and friends. siblings daughters, sons, fathers, mothers, partners, husbands, wives, Dr. Andrew Murrison MP reported that BLESMA (the national charity for limbless serving and ex serving and ex limbless for charity (the national BLESMA MP reported that Murrison Andrew Dr. conflicts, Afghanistan and the Iraq from amputees 198 has and their dependants) personnel Service 2011). Blind (Murrison, amputees double whom are of and 69 amputees triple whom are 14 of St. formerly impaired, visually who are personnel Service for charity (the national UK Veterans the of a result as blinded personnel Service 20 with referrals, 50 direct over received has Dunstan’s) The demands of these conflicts have placed pressures on the skills and resources of the military. the military. of resources and on the skills pressures placed have conflicts these of The demands possible now is It medicine. in front-line years few the past over advances enormous to led has This in itself This fatal. proved have historically would injuries whose personnel and repatriate treat to voluntary the the military, both within services and support recovery to challenges huge raises Service. Health and the National sector Unfortunately there is a price to pay that is not just material. The lives of some of these young young these some of of The lives material. just not is that pay to a price is there Unfortunately or psychological physical of a result is this whether or not catastrophically, changed are people become not may that conditions debilitating, equally but pervasive, more suffer may Others trauma. the military. after leaving long until evident In recent years, UK Armed Forces have been involved in conflicts around the globe. The wars in wars The the globe. around in conflicts been involved have Armed Forces UK years, In recent the raised have and attention to attract continue in Afghanistan conflict and the on-going the Gulf things extraordinary to do expected women are Men and Forces. Armed the UK of work the of profile most. to unimaginable in situations placed being environments, of hostile in the most

REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 6 Centre for Mental Health 4 Centre for Mental Health REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 7

(Ibid. Para. 85). Added to this this to Added 85). Para. (Ibid. 2003) while stressing the importance of developing the evidence the evidence developing of the importance stressing while 2003) “the absence of an accepted definition of who is a Service child and the child and Service a definition of who is of an accepted “the absence et al., et at the King’s Centre for Military Health Research (KCMHR) and work being being and work (KCMHR) Research Health Military for Centre the King’s at Kids Study Kids Background undertaken by Cardiff University. The KCMHR study is considering the impact of military life on the life military of the impact considering is study The KCMHR University. Cardiff by undertaken (Army) 850 military identified have personnel. Researchers Service UK of the children of being well funded is study This study. longitudinal cohort military the existing from and their families fathers Only a few studies have been funded to promote further research in the area of family impact, impact, family of in the area further promote research to been funded have studies a few Only the notably veterans will rise significantly over the next few years, and they will have the added pressure pressure added the have will and they years, few the next over significantly rise will veterans a time of at especially redundancy, due to the Forces of out transition with cope to having of downturn. economic cuts, it is likely that the numbers of Regular Forces families will be reduced and the numbers of of and the numbers be reduced will families Forces Regular of the numbers that likely is it cuts, of families of the numbers However, increased. Reserve Forces volunteer the with associated those Service child issues suddenly go away. go suddenly issues child Service spending defence of round the current in line with reduced is forces the standing of the size As lack of a mechanism by which data on Service children are collected” are children on Service data which by of a mechanism lack Services. the Armed left have parents after their children Service of track’ in ‘keeping the difficulty is the that mean not does it child’ a ‘civilian becoming themselves find suddenly children because Just of the actual number of Service children. For 2004, an estimate of between 90,000 and 186,000 and 186,000 90,000 between of an estimate 2004, For children. Service number of the actual of in variance wide This (2006). Committee Defence Commons of the House to in evidence given was to attributed was estimates 14% were single (McCafferty, 2012). (McCafferty, single were 14% unsure the MoD is However, schools. in state educated are age school of children Service Most in a relationship. Statistics were slightly different for the Reservist cadre, with 56% indicating they they indicating 56% with cadre, the Reservist for different slightly were Statistics in a relationship. in were time, 17% or subsequent a second for married were group this of though 9% married, were and the remaining or divorced separated were 13% married, though not relationships “long-term” 70% of Regular personnel were married, though a significant 13% of this group had married for a for married had group this 13% of though a significant married, were personnel Regular of 70% term” be a “long to considered they in what were but single were time, 13% or subsequent second and not single were 9% The remaining or divorced. either separated 8% were whilst relationship, many Forces personnel are in relationships or have other dependent family. Surveys conducted conducted Surveys family. other dependent or have in relationships are personnel Forces many the of make-up the current of an indication provide Federation Families RAF the independent by in their 2011 surveys, who participated members family the 3,000 Of status. marital by Family RAF male Regular Army Other Ranks were married compared with 28.9% of female Regular Army Other Army Regular female of 28.9% with compared married were Other Ranks Army Regular male As increases. rank as increases married who are personnel of the percentage In general, Ranks. or how are there children dependent many how us tell do not they are, data these as interesting been published on the marital status of members of the UK Armed Forces since 2007 when 64.2% of of 64.2% when 2007 since Forces Armed the UK of members of status on the marital been published of 43.2% Similarly officers. female of with 32.5% compared married were officers Army Regular male According to the Ministry of Defence (DASA, 2011), as of 1 October 2011 there were 184,010 military military 184,010 were 2011 there 1 October of 2011), as (DASA, Defence of the Ministry to According not have Data reservists. volunteer and a further 37,600 Forces Regular serving in the UK personnel While most of the emphasis has been placed on the needs of the returning Service person or or person Service the returning of on the needs been placed has the emphasis of most While in especially children, or their families of the needs to been paid has attention very little veteran, military. the UK of the context Walker, 2010, Dandeker Dandeker 2010, Walker, delivery. service to approaches different of the effectiveness determine to base interest both politically and in the media, and recent authors have highlighted the need to continue continue the need to highlighted have authors and recent the media, and in both politically interest 2011, Justice, Social for Centre 2010, (Fossey, veterans and personnel Service for services develop to 2006, Research, Health Military for Centre King’s 2010, Research, Health Military for Centre King’s The mental health and wellbeing of veterans and Armed Forces personnel continues to generate generate to continues personnel and Armed Forces veterans of and wellbeing health The mental To date, the focus has been directed at personnel returning from from returning personnel at been directed has the focus date, To The few UK-based studies conducted in this area have shown low reporting low shown have area in this conducted studies UK-based The few There has been a recent focus on the support needs of families of Service Service of families of needs on the support focus been a recent has There The use of alcohol amongst UK Service personnel has been widely reported. However, reported. However, been widely has personnel Service UK amongst alcohol of The use personnel and veterans, and the Government has pledged to help support families through a through families help support to pledged has and the Government veterans, and personnel support of a range Although Covenant. in the Armed Forces out set initiatives practical of range consideration. into taken not are families of needs and psychological the emotional offered, is violence in the military has a raised profile in the US, and more research needs to be undertaken undertaken to be needs research in the US, and more profile a raised has in the military violence services. support appropriate for plan to are we if context in the UK problems: health Mental on the impact research UK of a paucity is There veterans. of health and on the mental operations children. particularly family, personnel’s Service on problems health mental these of Support: Family behind during deployment, and there is no UK research considering the longitudinal impact of of impact the longitudinal considering research no UK is and there deployment, behind during veterans. of on the families consumption alcohol excessive violence: Domestic relied though, studies, cohort. These civilian with a compared differences or no significant rates Domestic the military. across representative be seen as and cannot sizes sample very small on Alcohol: Service of on the families drinking irresponsible of the impact about known is very little left who are members family of habits the drinking about understood also is personnel. Little • • • This paper will look at four areas of particular interest. In all four of these areas, there is a need to a need to is there areas, these of four In all interest. particular of areas four at look will paper This policymaking. inform to research UK-based develop to continue • family, even when the emotional needs of children and parents have been highlighted as an area of of an area as been highlighted have and parents children of needs when the emotional even family, 2007). Group, Funding Charities (Maritime concern Service of the families by faced the issues some of examine to work on going is there Although further research. from benefit would that areas a number of are there veterans, and personnel There remains a significant gap in our knowledge in the UK regarding the impact of Service on Service of the impact regarding in the UK knowledge gap in our a significant remains There (Royal issues the broader highlighted reports have A number of families. of needs the emotional Thomas, 2007, Group, Funding Charities Maritime 2009, Fund, Children’s Marines and Royal Navy mental of and treatment the recognition improving about recommendations made and have 2003) Fund, Children’s Marines and Royal Navy (Royal personnel and ex-Service Service of needs health the for services therapeutic to links better recommending short of fall these Unfortunately, 2009). on the educational needs of specifically Service children (Clifton, 2007, Edwards, 2004, Service Service 2004, Edwards, 2007, (Clifton, children Service specifically of needs on the educational in peer reviewed been published have these none of 2011), but Network, Support Childrens and have 2007) (Clifton, children of needs the emotional considered have studies These journals. peer-relationships form to and the ability on schooling moving frequent of the impact at looked Trust. Schools Caledonian the Royal by been commissioned has and further work 2004) (Edwards, the Forces Children’s Trust. It is hoped that this will help to develop a clearer understanding of how how of understanding a clearer develop help to will this hoped that is It Trust. Children’s the Forces the when required, so that, deployments of the effects experience and families children Service UK and children to be provided can services support based evidence and effective appropriate most 2012a). (Pexton, phase the deployment throughout home and school at families focusing in the UK, predominantly been undertaken have studies scale further small A number of currently in its second year of three waves of data collection. The Cardiff study aims to examine examine to aims study The Cardiff collection. data of waves three of year second in its currently for functioning family of the role consider as well as health mental parent and child between links 2011). (Shelton, adjustment psychological children’s and families children of needs support and well-being the emotional at looking also is study A pilot by and part-funded supported is This participating). families 60 (with deployment mid and post pre, by the US Department of Defence and is expected to report in 2013 (KCMHR, 2011). Cardiff University University Cardiff 2011). (KCMHR, report in 2013 to expected and is Defence of Department the US by children adopted who have personnel Service with study longitudinal a prospective, conducting are is It agency. adoption (SSAFA) Association and Families Airmen Sailors, Soldiers, the through

REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 8 Centre for Mental Health 4 Centre for Mental Health REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 9 “the MOD ensures, wherever wherever “the MOD ensures, (p.17, Ministry of Defence, 2011b). Defence, of Ministry (p.17, 2010). Consequently, the recommendations set out in this report were used to to used were report in this out set the recommendations 2010). Consequently, et al., et The current policy position current policy The agencies enabling children and their families to cope with the experience of geographical mobility mobility geographical of the experience with cope to and their families children enabling agencies the evidence reviewed have Education of The Department members. family of and the deployment 2010) and, although the Education, for (Department on children life Service of the impact about education, including early years education, as their civilian counterparts. Ofsted undertook a survey undertook Ofsted counterparts. their civilian as education, years early including education, 2011). In (Ofsted, people young and children for and outcomes provision of the quality examining and other authorities local schools, of a sample by provided the support at looked it particular, Education for Service children Service for Education to access the same have should children military that aspiration in its clear is The Covenant course of their duty, should be implemented, meeting veterans’ prosthetic needs and ensuring and ensuring needs prosthetic veterans’ meeting be implemented, should their duty, of course 2011a). Health, of (Department veterans for services health in mental improvement and develop Armed Forces Networks to ensure that the principles of the Covenant are delivered delivered are Covenant the of the principles that ensure to Networks Armed Forces and develop that stipulates also Framework The Operating veterans. and their families Forces, the Armed for in the injured been seriously who have those for Protocol, Transition Defence/NHS of the Ministry The 2012 / 13 NHS Operating Framework has also instructed the NHS (in England) to maintain maintain to (in England) the NHS instructed also has Framework Operating NHS The 2012 / 13 fertility treatment. In the case of IVF provision, it is stated that... that... stated is it provision, IVF of case In the treatment. fertility to a different moved not are treatment of IVF a course undergoing families those that possible, completed” is it before location In principle, this means that the pressures placed on families due to mobility (i.e. moving between between moving (i.e. mobility due to on families placed the pressures that means this In principle, they that the care affect not should person), the service of the role by demanded as etc bases to and access care, dental to access lists, on waiting position includes – this the NHS by receive healthcare by local NHS providers, with dedicated military wards and aftercare facilities. In facilities. and aftercare wards military dedicated with providers, NHS local by healthcare an is It resources. NHS local use to be expected would personnel military of families cases, most be disadvantaged. not should community the Armed Forces that Covenant the of principle important Healthcare and secondary Defence of the Ministry by provided is care health serving primary personnel, For Within the 15-point framework, there are number of areas that are particularly relevant to the topic the topic to relevant particularly are that areas number of are there framework, the 15-point Within report, in particular: this of series of aspirations, in the main these rely on state interventions and the voluntary contributions of of contributions voluntary and the interventions state on rely these in the main aspirations, of series organisations. sector voluntary and private communities, that any member of the Armed Forces community should not be treated unfairly or in any way way or in any unfairly be treated not should community the Armed Forces member of any that serve to their commitment member’s their or their serving family of result a as disenfranchised whole a out sets the Covenant Although the Covenant. of the cornerstone is Equivalence country. The Covenant sets out a framework for how the Armed Forces community should expect to be be to expect should community the Armed Forces how for a framework out sets The Covenant Housing Healthcare, from ranging spectrum a broad cover These 15 areas. covering treated, is the document of tenet The basic citizens. as participation and recognition to and education its implementation (Ministry of Defence, 2011b). 2011b). Defence, of (Ministry implementation its a task force to determine how a more robust Military Covenant could be developed and delivered and delivered be developed could Covenant Military robust a more how determine to force a task (Strachan for notes 2011a) and the guidance Defence, of (Ministry Covenant Forces Armed the current develop Families and Veterans” (Ministry of Defence, 2008) and subsequently identified the barriers that that barriers identified the 2008) and subsequently Defence, of (Ministry Veterans” and Families (Service counterparts their civilian as opportunities life the same in getting face can families Service established Government the new Coalition 2010). In 2010, Taskforce, Skills & Employment Families In 2008, the previous Government set out its commitments to the Armed Services community in the community Services Armed the to commitments its out set Government the previous In 2008, their Armed Forces, our to Support Cross-Government Commitment: Nation’s “The Paper, Command Secretary of State to report to Parliament annually on the state of the Armed Forces Covenant. In Covenant. the Armed Forces of on the state annually Parliament report to to State of Secretary in legislation. the Covenant enshrined has this effect, prosthetic support for military amputees (Murrison, 2011). It is regrettable that neither report makes neither report makes that regrettable is 2011). It (Murrison, amputees military for support prosthetic in the nor, the injured, of families by faced complexities the psychosocial about recommendations be aligned to could services how about made recommendations report, any are the second of case personnel. injured severely of needs the psychological manage on the a duty places 2011, on 3 November Assent Royal gained 2011, which Act The Armed Forces civilian life a challenge, this being especially the case for younger, unskilled men and Early Service Service men and Early unskilled younger, for the case especially being this a challenge, life civilian improving to committed is it that said has Defence of Ministry The 2010). (Fossey, (ESLs) Leavers who those for the case particularly is This the Forces. who leave personnel of the experiences by commissioned reviews been two have and there service of a result as been injured have may health mental of review the Murrison First, issues. these addressed have that the Government of the provision of review Murrison’s 2010) and, secondly, Fit” (Murrison, “Fighting provision, Transition and support after service after support and Transition them to for required and abilities the skills with personnel provide the Armed Forces a rule, As to military from some find the transition However, service. of on completion life civilian into move children. Pollock and Van Reken (2011) argue, amongst other things, that for children who move who move children for that other things, amongst (2011) argue, Reken Van and Pollock children. the have do not they because place in one roots down put to finally difficult is a lot, it around not in their new environment children by compounded is This this. with deal to strategies coping (in the case identity cultural the child’s In other words, mobility. of the challenges understanding the civilian by valued and/or understood not is identity’) ‘Service’ their children, Service our of Services. the leaves parent when their community The Covenant states that the special impact of deployment on both personnel and family members members and family on both personnel deployment of impact the special that states The Covenant The available. be made should members family for support welfare and that be recognised should needs health the mental about information 2011c) offers Defence, of (Ministry Service Welfare Army families. to be available should that support about no information is there serving but personnel, of Service for a challenge equally is life civilian into service from transition that maintained also is It health and education needs; and improved communication with personnel on deployment. on deployment. personnel with communication improved and needs; and education health These life. military of facts are deployment for and the potential postings different between Moving between basis a regular on Moving family. on their also but person, Service on the impact only not the most of one and was on the family impact a deleterious have may “mobility”, bases, different Covenant. for the phase consultation the during families military by raised concerns significant for the children’s academic attainment. attainment. academic the children’s for life family and Deployment Service for life family improve to Covenant in the been made have recommendations A number of with helping thus arrangements, mobility better stock; housing improved include These personnel. main experiences are positive, a US RAND corporation study is cited (Science Daily, 2009) which which 2009) Daily, (Science cited is study RAND corporation a US positive, are experiences main behavioural and emotional more from suffer may families in military children that concluded implications has this 1500) and that (around youths other American to compared when difficulties

Centre for Mental Health REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 10 4 Centre for Mental Health REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 11 Army Army

The ., 2007a) but we know so know we but ., 2007a) et al “...the presentation of the Emotional Cycle...in some instances some instances Cycle...in the Emotional of presentation “...the 2010) found that deployment in general and, specifically, longer longer and, specifically, in general deployment that 2010) found , 2009, Segal and Harris, 1993), often referred to as the “unsung the “unsung as to often referred 1993), and Harris, Segal , 2009, et al ( al et et al. et , 2011). Because of the institutional and contextual differences between between differences and contextual the institutional of , 2011). Because , 2011) because of their support for Service personnel before, during and after during before, personnel Service for their support of , 2011) because et al. et et al. et The evidence was simply inappropriate. Army and Families Federation questions whether [Unit Welfare Officers] Officers] Welfare [Unit whether questions Federation Families and Army inappropriate. simply was would information and important very and sensitive this to present training the right have the presentation.” of part this for utilised is Service] Welfare the [Army that recommend conducted by the Army Families Federation (AFF), on the families of soldiers due to be deployed in be deployed due to soldiers of (AFF), on the families Federation Families the Army by conducted although pre-deployment reported that The AFF 2010). Federation, Families 12 (Army Afghanistan families: to offered were briefings of families. of was groups, focus and subsequent respondents) survey (136 pre-deployment smaller A much questionnaire is limited in its reach. Where health care matters are considered in the survey, the in the survey, considered are matters care health Where reach. in its limited is questionnaire of and the impact treatment fertility care, pertinent dental to information on gathering is emphasis needs or emotional the psychological consider not does FAMCAS times. waiting on hospital mobility analysis of this survey considered the views of Service spouses and civil partners (6813 participants participants (6813 partners and civil spouses Service of views the survey considered this of analysis unmarried encompass not does family definition of the MoD’s but 24%), of rate a response with the FAMCAS consequently children, with personnel divorced and those lone parents partners, (FAMCAS) to assess the views of Service families. This is a 37-item questionnaire which considers considers which questionnaire a 37-item is This families. Service of views the assess to (FAMCAS) The 2011d). Defence, of (Ministry and education families, health, housing, domains: in four issues families irrespective of deployment history. deployment of irrespective families survey attitudes continuous families’ tri-Services an annual conducts Defence of Ministry The UK personnel reporting increased problems at home, including perceiving lower support from family, family, from support lower perceiving home, including at problems reporting increased personnel (Rona children with and problems the relationship partner ending for like is life what generally and more Services the between differ whether effects about little acute stress reaction and adjustment disorders. disorders. and adjustment reaction stress acute Service with been associated has the Armed Forces among deployments of In the UK, the duration deployments were associated with mental health diagnoses among military wives. Women whose whose Women wives. military among diagnoses health mental with associated were deployments at remained husbands whose women of group a control to compared deployed, were husbands and anxiety disorders, sleep disorders, depressive of diagnoses more significantly home, received through the Department of Veterans Affairs (US Department of Veterans Affairs, 2011). Affairs, Veterans of Department (US Affairs Veterans of the Department through Mansfield study, One US Hoshmand, 2007, Sayers Hoshmand, 2007, (Gewirtz heroes” service their military completed have they once veterans support their help to and also deployment, also differ greatly, adding to the difficulty of making direct comparisons. comparisons. direct making of the difficulty to adding greatly, differ also and (Hoshmand families Service support the need to of in the USA recognition a growing is There personnel and veterans in the US with the UK. There are particular differences between the between differences particular are There the UK. with in the US veterans and personnel lengths reservists, of numbers to respect with particularly militaries, the different of compositions provision care social and health of Models profile. socio-economic and age service, active of tours of al., 2011, De Burgh al., Burgh De 2011, Service for services of the developments directly compare to problematic is it countries, the two There have been a number of US studies examining the impact of Service deployment on both deployment Service of the impact examining studies US a number of been have There et (White reviews literature recent in two been summarised have and these and children families remember that there are some significant structural and contextual differences between the US and the US between differences contextual and structural some significant are there that remember health to and their access families, and veterans the military, to regard with especially cultures, UK care. and social Most of the evidence cited in this report is based on US literature. There is a general paucity of of paucity a general is There literature. on US based report is this in cited the evidence of Most to the evidence when considering important is the UK. It to relating research published quality

“professional and immediate counselling is on is counselling immediate and “professional “…expecting more time and attention … particularly in terms of family duties… some duties… of family terms in … particularly attention time and more “…expecting (Dandeker et al., 2006). et (Dandeker The importance of the family The importance of the However, as the military has become less institutional, Service wives have become more more become have wives Service institutional, less become has the military as However, independent: support traditional their of tolerant less become have personnel of UK Service spouses that claim role” Montgomery describes families as the “centre of gravity of the moral component of operational operational of component the moral of gravity of the “centre as families describes Montgomery clear are who Federation, Families the Naval by endorsed view 36), a 2012 p. News (Navy capacity” sailor happy equals family the serving Happy person. for work won’t it wrong families get we “if that fundamental. is families military of The support 2012). (Richardson, around” the other way and not numbers will decrease as the Services go through a further period of restructuring and the size of of and the size restructuring a further through period of go Services the as decrease will numbers on deployed are when troops However, reconsidered. is abroad forces UK of contingent the standing behind. left are families service, or active training of and safety health and the comfort, be underestimated cannot families Service of The importance Charles Admiral Vice Lord, Sea Second The serving for personnel. motivators important are families women have followed them as wives, cooks, concubines and in many other guises (Venning, 2005, (Venning, other guises and in many concubines cooks, wives, them as followed have women 1989). Neuberg, the 19th since battle into armies follow to families for been the practice not has it Thankfully, abroad, troops with stationed are families where occasions very few are there Nowadays, Century. these that anticipated is – although it and Gibraltar Cyprus Germany, being exceptions the notable in similar situations) the cultural, institutional and structural nuances of military life undoubtedly undoubtedly life military of nuances and structural institutional the cultural, situations) in similar what families, Service by faced issues distinctive the some of considers paper This a bearing. have help. to been developed have services and what available is evidence have Families years. the over fluctuated has families of the importance views the military How been armies, have there as long as For measure. in equal of and disapproved been tolerated Service families face extended periods of separation coupled with anxieties about the risks that that the risks about anxieties with coupled separation of periods extended face families Service not are circumstances these Although or training. on deployment their loved-ones by faced are areoften zones conflict in workers NGO workers, field fishermen, oil seafarers, (merchant unique non-serving family members did not feel they had sufficient information on the potential impact of of impact on the potential information sufficient had they feel did not members non-serving family of 33% with in their serving partner, symptoms the recognise to and how stress post-operational 2012). (McCafferty, the same saying the serving participants sufficient by the Army and Families Federation. Families and Army the by sufficient of 45% that in 2011, indicated conducted Federation, Families the RAF survey by a small Similarly, appropriate offer did not / MOD the RAF that felt members family non-serving serving 50% of and communication that felt participants the 676 40% of than More deployments. during support 60% of worryingly, More be enhanced. should person and deployed the family between and Families Federation also recommend that: that: recommend also Federation and Families Covenant.” the Military of part as tours to military due injury suffering families military to offer seen as not is the NHS through be available should counselling that response The Government’s

Centre for Mental Health REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 12 4 Centre for Mental Health REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 13 when families known to them who have lost loved loved lost them who have to known when families indirectly, more than 1,200 people in all three Services, the Army accounting for 60% of referrals. The majority The majority referrals. 60% of for accounting the Army Services, three in all 1,200 people than more life major stress, to in relation 30% being with and children families to relate referrals SSAFA’s of 2012) (McRedmond, and bereavement. changes, provided more than 20,000 hours of community support, of which 13,000 hours were given by by given were hours 13,000 which support, of community of hours 20,000 than more provided support volunteers 1,400 than More Volunteers. Support Victim and Support Carer Community, Other voluntary sector organisations are also providing support for their specific constituents, constituents, their specific for support providing also are organisations sector voluntary Other the Royal Service, of branches the different to connected Federations Families Service the notably SSAFA In 2010, (SSAFA). Association Airmen and Families Sailors, Soldiers, and the Legion British children themselves. In this context, some families may require additional support at these times times these at support additional require may some families context, In this themselves. children 2012b). (Pexton, home and at school both at community on the wider impact may and this coping” than about the deployed parent. (McCafferty, 2012) (McCafferty, parent. the deployed about than coping” home and for at or carers parents for and strains stresses additional place can anxieties These RAF FF in 2011, of the 113 children aged 10-17 who participated, 13% said they were “very worried” “very worried” were they said 13% who participated, 10-17 aged children the 113 in 2011, of FF RAF or work school their sleep, affected it “so worried were they 8% said parent, a deployed about home was at the family how about worried “more were they and 5% said behaviour” general Children are very sensitive to parental anxieties and will also have their own feelings and concerns and concerns feelings their own have also and will anxieties parental to sensitive very are Children been who have family the of friends of be aware also may Children tours. forthcoming regarding the by survey conducted youth In a small tours. in action on previous been killed or have injured greater strains when facing issues of uncertainty when families are preparing for future operational operational future for preparing are when families uncertainty of issues when facing strains greater deployment. the period of with and indeed coping tours For those families who are grieving grieving who are families those For of the risks serve make can to this partner, Service injury their to a serious or experienced ones to lead can and grief loss indirect of experience This and acute. real more and injury far death Federation indicates that awareness of the Big White Wall initiative is very low in family members members in family very low is initiative Wall White Big the of awareness that indicates Federation 2012). (McCafferty, Wall (2011). Although essential services, they do not meet all of the psychological needs faced by by faced needs the psychological of all meet do not they services, essential (2011). Although Wall Families the RAF from Evidence people. young and children of the needs especially families, military unique conditions? The current UK Government answer is, in part, through addressing support support in part, addressing is, through answer Government UK The current conditions? unique organisation sector voluntary the by provided service, crucial - an undeniably after bereavement White the Big via support online of the provision (2011) - and through Care Bereavement Cruse A focus on practical approaches to meeting the challenges faced by Service families is important, is families Service by faced the challenges meeting to approaches on practical A focus these under living of stressors and psychological the emotional addressing we are how but education or physical healthcare needs. healthcare or physical education in the UK families for Support addressed as the Covenant is delivered. However, there is no Ministry of Defence-led initiative to to initiative Defence-led of no Ministry is there However, delivered. is the Covenant as addressed absent is this anything, If families. Service of needs wellbeing psychological the broad address housing, meeting as such the practical, for preference a with developments and practice policy from There has been concern about the conditions of Service family accommodation, and the and accommodation, family Service of the conditions about concern been has There be will the inequalities of some Hopefully, mobilise. to when forced face they that discrimination Families of Injured Service Personnel Service Injured of Families Personnel Service Injured of Siblings Families Bereaved Siblings Bereaved Forum and Disability Needs Additional Forces

SSAFA is the UK’s oldest Armed Forces charity, providing practical help and assistance to to assistance help and practical providing charity, Armed Forces oldest the UK’s is SSAFA day. single a for only was it served, ever if even serving or has currently who is anyone health, of a range provides SSAFA staff work and social health volunteers, its Through and children spouses, personnel, service to services work and social support personal requirements to According needs. health and mental emotional with those and for families Gibraltar, Cyprus, Europe, Western in provided are services and non-statutory both statutory and the UK. Canada Nepal, Brunei, from services of range a wide helped through are worldwide people 50,000 of In excess for holidays to personnel, injured of families for accommodation short to stay Forcesline, and mentoring responsibilities carer young or disability needs, an additional with children going befriend those Volunteers life. civilian to and returning the services leaving those for and provide or bereavement depression illness, and loneliness, isolation of periods through additional an with members one or more have that and families families adoptive to support need or disability. groups: support the following facilitates also SSAFA the MoD, of the request At Practice Example 1: Soldiers, Sailors, Airmen and Families Association (SSAFA) Association and Families Airmen Sailors, Soldiers, 1: Example Practice For military families facing marital difficulties SSAFA also provide “Stepping Stone” homes, homes, Stone” “Stepping provide also SSAFA difficulties marital facing families military For either with time and assisting and emotional be a stressful can in what support offering the families giving breakdown, relationship a reconciling home or a permanent finding start. a fresh make to chance or http://www.ssafa.org.uk 975 1300 on 0845 office central SSAFA Contact:

Centre for Mental Health REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 14 4 Centre for Mental Health REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 15 et Emotional Emotional Disorganization Stabilization Recovery and Recovery , 2011). et al. et and Withdrawal Detachment Detachment Cycle Return Deployment Deployment Anticipation of of Anticipation Anticipation Anticipation of Departure of Return Return Renegotiation and Adjustment and Adjustment Stabilization Reintegration Reintegration 2011) identified the different coping strategies that are needed at each stage of the model. of stage each needed at are that strategies coping identified the different al, 2011) et Pincus (From Model Cycle Stage Seven The 1. Diagram Education of health care providers, military leaders, service personnel and family members to to members and family personnel service leaders, military providers, care health of Education familial minimize and to return safe person’s the service ensure to crucial is stages these anticipate have and 1 below) (see Diagram deployment of stages identified seven have al et Pincus trauma. of every 10 are married to a member of the Armed Forces (Pincus (Pincus Forces the Armed of a member to married every 10 are of US Military. 60% of US Soldiers are now married and deployments are now longer than those those than longer now are and deployments married now are Soldiers US 60% of Military. US are soldiers male Active-duty times. shorter turn-around with campaigns, in previous experienced 4 out nearly married, who are females those for but soldiers, female than be married to likely more The US has developed a psychological model of deployment (see diagram 1 below), as it has been has it as 1 below), (see diagram deployment of model a psychological developed has The US on deployment of trauma the emotional “experiencing are Families Military US that recognised the to concern increasing of is separations long these of The impact scale.” an unprecedented physical health and wellbeing of their armed services (U.S. Army Office of the Surgeon General General Surgeon the of Office (U.S. Army armed services their of and wellbeing health physical al., In the US Military, there is an increased recognition of the importance of the Service family, and family, Service the of importance the of recognition increased an is there Military, In the US the meeting to approach a comprehensive fostering to and research resources dedicated have they and the emotional address to work of programme a broader part of is This families. Service of needs Support for families in the US in families for Support 2006) et al., et (Dandeker (Dandeker (2006) reported that the majority the majority (2006) reported that et al al et study may show that UK Service Families are potentially potentially are Families Service UK that show may study et al., et “…in the context of living in an Army garrison town, wives favour informal social social informal favour wives town, garrison in an Army of living the context “…in Federation, 2011). In their Annual Report 2011, the RAF Families Federation also reported increased reported also increased Federation Families 2011, the RAF Report 2011). In their Annual Federation, and closures base with associated the uncertainty from arising members family among concern many, some – for by “fragile” as described is “Morale stating: the Chairman with redundancies, (RAF redundancy”. or personal closures base of news the unwelcome by been shattered has morale 2011). Federation, Families have been identified by the Tri-Service Families Continuous Attitude Survey (FAMCAS) (Ministry of of (Ministry Survey (FAMCAS) Attitude Continuous Families Tri-Service the by been identified have 2011d). Defence, be well may life on family deployment of on the effects the focus that consider to important is It an area as been identified has and this in the MoD, redundancies of issue the looming by eclipsed Families (Army Reports Concerns quarterly Families’ Federation Families the Army by concern of There are differences between the individual Services. For instance, families with a parent in the a parent with families instance, For Services. the individual between differences are There that means families of and the dispersal in the Army those as mobile be as not may or RAF Navy differing also are There different. be quite may groups these by faced and challenges the issues support welfare own its developed has Service and each Services the between separation of levels These and their families. personnel their of the needs meet best to and services mechanisms It is important that the differences in cultures between the UK and US forces are taken into into taken are forces and US the UK between in cultures the differences that important is It a relatively Although be appropriate. may that support of a model when considering consideration the Dandeker size, sample small fully be needed to would Further research counterparts. their US than or stoic independent more Families. Service UK of strategies coping the appreciate that their career, and especially deployments, puts on their families.” families.” their on puts deployments, especially and career, their that the mother if family, the whole for the pivot was wife Service the that found (2007) Clifton Similarly, then posting, a different to house or moving her spouse, of the deployment with cope to able was 2007) (Clifton, and be successful. well adapt also would the children that was the likelihood support from their own family (95.7%), and other military wives (85.1%). Interestingly, support support Interestingly, (85.1%). wives and other military (95.7%), family their own from support et Dandeker utilised. not were the regiment of outside families military for and charities services that concluded al or expect not do and of deployment; stressors the against a buffer to provide support of networks pressures the of tolerant more much are wives support. Army of line first their as the military choose think they the pressures with happy less who are soldiers the than them on place the military that families, is there the need to develop such interventions in the UK context? context? in the UK interventions such develop to the need there is families, Dandeker spouses, and their wives 50 military of In a study their of a result on them as placed demands additional the about worry did not (65.9%) wives of or the Regiment help from for asked had they 20% reported that than Less deployed. being spouse informal seeking the majority with departure, their spouse’s for in preparing sources other military Implications for UK Services UK for Implications Service American of needs the psychological meet to done in the USA been has work much Although

Centre for Mental Health REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 16 4 Centre for Mental Health REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 17 0161 253 6638 or visit the website the website visit or 6638 253 0161 Pennine Care Veteran’s service on service Veteran’s Care Pennine

Contact: www.penninecare.nhs.uk/military-veterans encourage them to self-refer to the service, which has proven to be very useful. be to proven has which the service, to self-refer them to encourage the service. evaluate to partner an academic with working is Care Pennine The service has established strong links with the existing Mental Health and Substance Substance and Health Mental the existing with links strong established has The service associations and family charities The military the NorthWest. across services misuse or directly the service into and their families veterans refer can and they it support Family members are able to self-refer to the service, which will work with the whole family, family, the whole with work will which the service, to self-refer to able are members Family children. young including systemic/family therapy as an integral component of the service model. the service of component an integral as therapy systemic/family engaging veterans in a therapeutic process. Families also indicated that help was needed help was that indicated also Families process. in a therapeutic veterans engaging a family and the need for problems relationship post-deployment complex with cope to and psychotherapy introduced has Care Pennine veterans. with when working approach As part of the service development, a consultation was undertaken with veterans and their veterans with undertaken was a consultation development, the service part of As are services while support direct offered being of the importance of spoke Families families. mental health needs of veterans also impacted on their families. Some of these issues can can issues these Some of on their families. impacted also veterans of needs health mental common to violence and domestic management anger from and range very complicated be life. civilian to back good transition a make to difficult it make that problems health mental Access to Psychological Therapies services (Department of Health, 2011b). It aims to provide provide to aims 2011b). It Health, of (Department services Therapies Psychological to Access and their families veterans military for Therapies Psychological based evidence accessible the that soon recognised service Care The Pennine England. of the NorthWest across Practice Example 2: Military Veterans Service, Pennine Care NHS Foundation Trust Foundation NHS Care Pennine Service, Veterans Military 2: Example Practice Improving of expansion the Government’s part of as established originally was service This because so many families are housed in MoD properties. This raises all sorts of issues such as as such issues sorts of all raises This MoD properties. in housed are families so many because and the increased places school new finding another town/city, to moving homelessness, of threat 2012). (Shelton, behaviour a coping as alcohol, particularly substances, of use harmonious and adaptive relationships at home. Families where one or both parents are Service Service are one or both parents where home. Families at relationships adaptive and harmonious redundancies, and threat job of in the context pressure additional under be also may personnel and employer the primary the MoD is where the UK of in areas located are they if particularly stress and overload exerts effects on children indirectly via impacts on the quality of the couple and the couple of on the quality impacts via indirectly on children effects exerts and overload stress serve may stress/pressure work parent’s 2001). One and Bumpus, (Crouter relationship parent-child maintain to ability both parents’ impeding by health mental children’s for problems compound to Community-based research in the US and the UK show that economic pressure and work stress stress and work pressure economic that show the UK and in the US research Community-based work parents’ instance, For term. shortin the both and long health mental children’s on effects exert

., (2007) used the Alcohol the Alcohol used ., (2007) et al 2007). 2007). 2005). et al., et et al., et (2007b) has also shown an increased use of alcohol amongst Service women women Service amongst alcohol of use an increased shown also has (2007b) et al., al., et Alcohol and families Alcohol

Nevertheless, excessive alcohol use is detrimental to both health and family cohesion and the and cohesion and family both health to detrimental is use alcohol excessive Nevertheless, further research. requires that an area is families military UK among use alcohol excessive of impact amongst military wives (Henning, 1986) found that alcohol consumption increased in relation to to in relation increased consumption alcohol that found 1986) (Henning, wives military amongst cultures in drinking the differences However, who drank). the sample in those (for stress separation conclusions. direct any to draw be difficult may it that so profound are and the UK the USA between A study by Rona men. Service non-deployed to compared Wars or Gulf the Iraq to deployed not who were It is very difficult to draw conclusions about alcohol use in the military and the impact of dangerous dangerous of and the impact use in the military alcohol about conclusions to draw very difficult is It area. in this and research evidence of the lack due to primarily is This families. on military drinking of Partners issue. this at when looking be considered should other factors that possible is It a as be used may Alcohol facilities. military behind, often in isolated left are personnel deployed consumption alcohol at looking study US A small-scale tool. bonding or social mechanism coping used alcohol prior to the offence, and that 48% were “alcohol dependent” (Gilchrist et al., 2003). al., 2003). et dependent” (Gilchrist “alcohol 48% were and that the offence, prior to alcohol used (Brookoff in U.S. literature been shown also has offenders amongst use alcohol of high level This the perpetrator if than victim injury the to serious in more result can drinking Heavy al., 1997). et Martin and Bachman, 1996, Senchak, and Leonard al., 2004, et Graham 2002, (Brecklin, sober. was 1997). abuse (Jewkes, 2002), but the relationship is a complex one and the responses by different agencies agencies different by one and the responses a complex is the relationship but 2002), (Jewkes, abuse (Humphreys and ineffective often disjointed are and use on alcohol research UK-based reliable been little has there (2006) reports that Galvani 73% showed offenders violence on domestic research Office Home However, women. to violence consumption on military families, particularly the impact on partners and children. There is also also is There and children. partners on the impact particularly families, military on consumption Services. the Armed left have they once veterans of behaviour on the drinking evidence UK little Studies, Alcohol of (Institute types, offence different of range a wide with associated is Alcohol in 2009 committed offences million one nearly in that identified has 2010) and the Home Office with domestic associated been long has abuse Alcohol 2010). (Home Office, an issue was alcohol 20-24 year olds this was 32% compared to 14% (Fear (Fear 14% to 32% compared was this olds year 20-24 motivator, an important remains it excesses, drinking curb tried to has the military much However on use alcohol of on the impact been conducted has research Although agent. and bonding reward Henderson al., 2007, et Iversen al., 2007, et al., Fear 2008, et Hughes (Hacker personnel Service alcohol excessive of the impact on literature UK published of a paucity al., is 2008) there et among serving personnel, age and gender matched to the UK general population. The researchers The researchers population. general the UK to matched and gender age servingamong personnel, their than alcohol of amounts harmful more drank consistently in the Armed Forces those that found age with ameliorate to tends Services in the Armed alcohol of use Excessive counterparts. civilian age, with decrease the rates though even However, population. the general seen in also is and this Armed in the males old year 18-19 36% of that showed study The the military. higher in still are they and for population 8% in the general with compared alcohol of amounts harmful drank Services Excessive alcohol use in the UK Armed Forces is not a new phenomenon. Drunkenness, its impact on impact its Drunkenness, a new phenomenon. not is Armed Forces UK in the use alcohol Excessive the higher troubled has liquor, cheap to access personnel’s Service tackle to how and performance, excessive of A culture 1996). (Kopperman, the 18th Century since command of the chain of echelons are consumption alcohol of and the levels 2010) (Fox, troops UK among continues use alcohol Fear population. matched and gender age higher than considerably consumption alcohol harmful of rates compare to scale (AUDIT) Test Identification Disorders Use

Centre for Mental Health REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 18 4 Centre for Mental Health REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 19 ., 2005, ., 2005, et al et al (2006) could draw no draw (2006) could ., 2000, Marshall Marshall ., 2000, et al et al ., 2003, Sadler Sadler ., 2003, et al ., 2006, Williamson, 2011). Williamson highlights research focusing on focusing research highlights Williamson 2011). Williamson, ., 2006, ., 2006, Rosen ., 2006, Rosen ., 2003, Heyman and Neidig, 1999, Bradley, 2007, Marshall Marshall 2007, Bradley, and Neidig, 1999, Heyman ., 2003, et al et al t al (2001) have shown that experiences of combat and trauma during deployment were were deployment during and trauma combat of experiences that shown (2001) have Dr Anne Fox et al www.galahad.co.uk Director, Galahad SMS Ltd. SMS Galahad Director, 712401 01883 [email protected] programmes have also been delivered in a variety of civilian workplace settings. workplace civilian of variety in a been delivered also have programmes Contact: Programme (EIP) for soldiers who test positive for drugs or who misuse alcohol. The EIP alcohol. misuse or who drugs for positive who test soldiers (EIP) for Programme rate The EIP success and counselling. education provides and risk a soldier’s assesses misuse substance Galahad’s 87%. period) is a 4-year over re-offending by (measured Galahad SMS Ltd has supplied the Ministry of Defence with drug and alcohol educational educational drug and alcohol with Defence of the Ministry supplied has Ltd SMS Galahad Intervention Early a 5-day running 1999 since research and interventions programmes, Practice Example 3: Galahad Substance Misuse Solutions Ltd Solutions Misuse Substance 3: Galahad Example Practice Domestic violence attributed this mainly to the differing research methodologies, sample types and sources of data in data of and sources types sample methodologies, research the differing to mainly this attributed within identified are problems when severe that commented also They examined. they the studies abuse, drug and alcohol problems, health mental conduct, criminal e.g. cohort military the US however the link with domestic violence was not explored. Rentz explored. not was violence domestic with the link however in the violence and domestic service military between a link was whether there to as conclusions The authors cohort. a civilian with be drawn could comparisons whether any and literature US MacManus MacManus personnel, military in UK homecoming following behaviour violent with associated significantly Forgey and Badger, 2006), and the relationship between military culture and violent behaviour behaviour violent and culture military between 2006), and the relationship and Badger, Forgey Rentz 2003, (Adelman, 2003). and Bach, Erez from US literature (Rentz (Rentz literature US from military by perpetrated violence domestic with associated factors and risk prevalence the impact, e (McCarroll personnel camp between 2002 and 2004 (Smith, 2009). and 2004 2002 between camp predominantly drawing violence, and domestic on the military the literature of reviews two are There six-week period. Three of these cases involved Special Operations soldiers who had served who had in soldiers Operations Special involved cases these of Three period. six-week particular this at violence domestic of victims reported a further Army 832 The US Afghanistan. by 5,200 serving personnel (Wolfowitz, 2001). (Wolfowitz, 5,200 serving personnel by in a or ex-partners their partners by killed were wives four base military in one large In 2002, soldiers were charged with the murder of their wives in Fort Campbell, Kentucky. In a subsequent In a subsequent Kentucky. Campbell, in Fort their wives of the murder with charged were soldiers set Defense, of Secretary Deputy the then Wolfowitz, Paul officials, military high ranking memo to perpetrated violence domestic of incidents 10,500 were there in 2000, reporting that the issue out Domestic violence in the US Military has been reported widely in the media. In 2000, three US army army US three In 2000, the media. in been reported widely has Military in the US violence Domestic use in the military is not only tolerated, but encouraged (Fox, 2010), achieving these aims within the within aims these 2010), achieving (Fox, encouraged but tolerated, only not is the military in use very challenging. prove may Forces Armed UK The Government’s recent alcohol strategy clearly states the intention to make irresponsible and and irresponsible make to the intention states clearly strategy alcohol recent The Government’s alcohol excessive where 2012). However, (HM Government society in intolerable drinking dangerous 2010). In other words, 2010). In other words, et al., et , 2010). This is quite dissimilar to the US the US to dissimilar quite is This , 2010). et al. et who examined self-harm amongst 166 Service personnel attending an A&E an A&E attending personnel Service 166 amongst self-harm who examined . 2010). et al., et (2009) et al (2009) also concluded that of a study of 9990 participants (8278 regulars, 1712 reservists), reservists), 1712 regulars, (8278 participants 9990 of a study of that concluded also (2009) Mental Health the development of a tri-Service DVD to raise awareness of this issue in Service communities and to and to communities Service in issue this of awareness raise to DVD a tri-Service of the development agencies. support to victims signpost violence in a military versus civilian cohort (Browne, 2011). (Browne, cohort civilian versus in a military violence in research paucity is there that concludes Williamson study, the Hampshire of In her analysis deliver to seeks the Government as that and highlights forces and UK violence domestic regarding both the how consider to be important will it strategy, (VAWG) and Girls Women against Violence its on working The MoD is 2011). (Williamson, engaged fully are communities veterans and military A small scale online study ( of 192 participants, 187 partners and 5 military personnel) undertaken in undertaken personnel) and 5 military partners 187 participants, 192 ( of study online scale A small amongst abuse and violence domestic self-reported of levels find high not did England, Hampshire, areas on all reintegration regarding concern and anxiety of levels did find high but families military unpublished an earlier Similarly 2011). Williamson, 2009, and Price, (Williamson life family of no significant found also Nottingham, of the University at Browne, Kevin Prof by undertaken study reported domestic between in prevalence differences 7% high risk) vs. higher 9% marginally (but about this issue within the UK Armed Services? Armed the UK within issue this about report on the do not (DASA) and Advice Services Analytical and Defence Defence of The Ministry the to determine difficult is and it Armed Forces, the UK within violence domestic of incidents issue. the of or nature degree The US Congress set up a task force to examine the issue of domestic violence in the military. in the military. violence domestic of the issue examine to force up a task set Congress The US have recommendations subsequent its and and 2003, 2001 reported between force The task on Centre (National Military the US of procedures operational and the training into been adopted 2011). Violence, Domestic and Sexual know do we What seriously. and abuse violence domestic of issue the taken has Military The US service personnel are often discharged from the military (Raiha and Soma, 1997), skewing the the skewing 1997), Soma, and (Raiha the military from discharged often are personnel service research. more the need for stress the authors In conclusion, picture. Relationship problems associated with poor mental health presentations have been identified by by been identified have presentations health poor mental with associated problems Relationship Hawton had a partner and 18.8% with problems relationship had 62% examined, those Department. Of the examine on to go did not this studies, most Like their family. within problems relationship on the family. behaviour the self-harming of impact pervasive personnel compared to UK forces, which have reported approximately 5% using the same screening screening the same 5% using reported approximately have which forces, UK to compared personnel (Pinder tools and personnel Service of the families of resilience and emotional health the mental though of What veterans? the impact of fighting doesn’t appear to have a significantly deleterious effect on UK troops. Fear troops. UK on effect deleterious significantly a have to appear doesn’t fighting of the impact et al reported frequently the most remain misuse and alcohol disorders mental common of symptoms probable of the prevalence and that personnel, Armed Forces in UK conditions health mental (Fear low was disorder stress post-traumatic combat 20% of i.e. PTSD of the prevalence 4 times approximately is there where experience The mental health of members of the Armed Forces and veterans continues to have a high profile. a high profile. have to continues veterans and the Armed Forces of members of health The mental was problems health mental of the prevalence on operations, that concluded has work Recent (Mulligan samples military non-deployed of that to dissimilar not

Centre for Mental Health REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 20 4 Centre for Mental Health REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 21 : Wright Andy Practice Example 4: Vulnerable Veterans and Adult Dependants (VVADS) Dependants Adult and Veterans Vulnerable 4: Example Practice 01748 873156 01748 [email protected] VVADS Programme Manager Programme VVADS Barracks Kent of Duchess Garrison Catterick designed to promote wellbeing and resilience within the local armed forces community. armed forces the local within and resilience wellbeing promote to designed Contact to develop new and creative ways of working. This has resulted in a much more responsive responsive more in a much resulted has This working. of ways new and creative develop to it as and expertise knowledge share to opportunities for looked constantly has that service been specifically have that projects of a series overseeing currently is VVADS evolved. has rapidly within the garrison and transform primary care mental health services locally. services health mental care primary transform and the garrison within rapidly MOD and the NHS by commitment been a real has project pilot VVADS the of the heart At collaboration that has seen an NHS mental health service co-located within an active active an within co-located service health mental seen an NHS has that collaboration in experienced therapists recruiting with combined This, team. health mental military itself establish to VVADS allowed has families, and armed forces veterans with working Catterick Garrison, the largest garrison in Europe. It specialises in working with Veterans Veterans with in working specialises It in Europe. garrison the largest Garrison, Catterick based evidence to access improve to and aims serving personnel of and Dependants unique a is VVADS difficulties. health mental experiencing who are those for treatment Vulnerable Veterans and Adult Dependants (VVADS) is a bespoke IAPT service based at at based service IAPT bespoke a is (VVADS) Dependants Adult and Veterans Vulnerable to an evaluation and we are awaiting details of its reach and effectiveness. and effectiveness. reach its of details awaiting are and we an evaluation to Following the Murrison recommendations a national helpline addressing mental health needs needs health mental addressing helpline a national recommendations the Murrison Following is helpline This 2011. in March established was and their families veterans personnel, service for subject is service This Stress. and Combat Illness Mental Rethink between in partnership delivered practice in this area (Royal British Legion and Combat Stress, 2010, Royal British Legion and Combat and Combat Legion British Royal 2010, Stress, and Combat Legion British (Royal area in this practice 2011b). Stress, Murrison is the inclusion of a partnership between the Royal British Legion and Combat Stress on Stress and Combat Legion British the Royal between a partnership of the inclusion is Murrison Legion British (Royal Programme Partnership Strategic Sector Voluntary Health’s of the Department and both policy forward drive to partnership this of 2011a) and the potential Stress, and Combat problems. by made the recommendations forward drive to commitment the Government’s of Further evidence health needs of veterans the NHS has been required (Department of Health, 2011a) to develop develop 2011a) to Health, of (Department been required has the NHS veterans of needs health has There recommendations. the Murrison deliver to and services Networks Armed Forces health mental with veterans for in the services development been a national consequently The Government has pledged to improve the provision of mental healthcare for regular forces, forces, regular for healthcare mental of the provision improve to pledged has The Government the mental 2010) into (Murrison, Report Murrison the recent Following veterans. and reservists via www.bigwhitewall.com www.bigwhitewall.com via a population accustomed to viewing itself as mentally and physically robust. and physically mentally as itself viewing to accustomed a population Contact: using art by creating ‘Bricks’ to say how they feel in images and words. in images feel they how say to ‘Bricks’ creating art by using least not vital, is distress psychological experiencing anyone for stigma of Avoidance by highlighted as offline services existing use not who may veterans, and serving personnel to acceptable interventions of the importance flagged 2010), who also (Murrison, Murrison charge, since its launch to the Armed Forces community in mid Sept 2011. Sept in mid community the Armed Forces to launch its since charge, through gone have who may others to anonymously talk members Wall, White On Big (professionally Guides Wall from support counselling brief and get experiences, similar the community, with on their mind in ‘Talkabouts’ is what share can Members staff). trained themselves express also can They Guide. Wall another member or with or in a one-to-one Practice Example 5: Big White Wall Wall White Big 5: Example Practice a safe, with people provides It 24/7. available community an online is Wall White Big 1,800 over Well stigma. of no fear them, with troubling is what share to space anonymous of free www.bigwhitewall.com joined have and their families veterans serving personnel, of the Big White Wall might be limited. The Big White Wall is, though, currently only available for for available only though, currently is, Wall White Big The be limited. might Wall White the Big of the of because audience younger a for be applicable not 16 and may of the age over people young children younger for in services gap a significant leaves This content. the online some of of nature service. military their parent’s of a result as distress psychological from be suffering who may places being made available for Service personnel, their families and veterans. It is hoped that hoped that is It veterans. and their families personnel, Service for available made being places of analysis Early effectiveness. and take-up utility, its show will programme this of the evaluation the service, using people 1,500+ the of that shows the pilot of months 3 the first for usage service a study (of and 23% veterans 559) of a study 37% ( of personnel, Service are 604) of a study 40% (of 2012). (Makin, women were (87%) the majority members, the family Of members. 348) family of awareness that indicated Federation Families the RAF by conducted poll straw very small a However, The broader mental health needs of families have been recognised as an imperative within the within an imperative as been recognised have families of needs health mental The broader for intervention service early support an online Wall, White and Big Covenant, Services Armed 2,400 free with year, one over and evaluated piloted being is distress, psychological in people

Centre for Mental Health REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 22 4 Centre for Mental Health REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 23 et et al., al., et “Soldiers and and “Soldiers (Para 67) However, it is unclear unclear is it However, 67) (Para (BBC, 2006). 2011a) and results do not suggest that being a veteran is associated with adversity in terms in terms adversity with associated is veteran a being that suggest do not 2011a) and results Conclusion Excessive and dangerous drinking is associated with domestic abuse and violence. Very little is is little Very violence. and abuse domestic with associated is drinking and dangerous Excessive abuse domestic although military context, military the UK phenomenon within this about known reporting on the issues. Taskforce Congress a US to led have scandals health problems (including heavy alcohol use) than longer-serving veterans (Woodhead (Woodhead veterans longer-serving than use) alcohol heavy (including problems health 2011b). al., the general with compared treatment seek to or reluctance disadvantage social health, mental of mental more experience may leavers service early that implies some evidence However, population. Research has shown that community-dwelling Armed Service veterans are at no greater risk of of risk no greater at are veterans Service Armed community-dwelling that shown has Research (Woodhead controls population than health or behavioural physical mental, adverse current There is now an accepted body of research that highlights the concern about the levels of alcohol alcohol of the levels about the concern highlights that research of body an accepted now is There excessive of the impact about evidence little is there However, Armed Forces. the UK within use families. on military use alcohol transferable to the experiences of the UK military because of the institutional and contextual and contextual the institutional of because military the UK of the experiences to transferable issues. these at looking in the UK work limited is There countries. the two between differences A growing body of research is developing about the impact of military life on families and children. and children. on families life military of impact the about developing is research of body A growing be easily not may and the research in the USA colleagues by been driven has this However, whether this will be acted upon at this time of austerity and general cuts in the Armed Services Services in the Armed cuts and general austerity time of this upon at be acted will whether this budget. home that bear the brunt of the difficulties caused by deployment, it is time that the Department the Department that time is it deployment, by caused the difficulties of the brunt bear that home it services support the at again to look it urge we action, and into acknowledgement that turned personnel.” Forces of Armed children and the families for provides Defence Committee, 2011) have encouraged the MoD to address the needs of families: families: of the needs address the MoD to encouraged 2011) have Committee, Defence at behind left the families often is it that acknowledge circumstances other in does the MoD “while taking into account the psychological needs of Service families. families. Service of needs the psychological account into taking Commons of (House Committee Defence Commons of the House the evidence of a review Following constructed Armed Forces Covenant (Ministry of Defence, 2011a). The Covenant is an important an important is Covenant The 2011a). Defence, of (Ministry Covenant Armed Forces constructed and their families veterans our Armed Forces, for services equitable in the delivery of forward move not provision, service practical on applied, focus the Covenant within the deliverables – however Over recent years, successive governments have taken great strides to raise issues and challenges challenges and issues raise to strides great taken have governments successive years, recent Over and the 2008) Defence, of (Ministry veterans and personnel Service to relating Whitehall across the recently report on to State of Secretary on the a duty in law enshrined has Government Coalition their families, and in giving the 2006 Richard Dimbleby lecture, was very clear that, that, clear very was lecture, Dimbleby the 2006 Richard and in giving their families, valued” be properly must families their during the recent conflicts in Afghanistan and Iraq, but also by the revelations about the poor the poor about revelations the by also but and Iraq, in Afghanistan conflicts the recent during former Jackson, Sir Mike General 2007). (Hickley, live families Service some in which conditions and soldiers of treatment Defence’s of the Ministry of been scathing has Staff, the Defence of Chief There remains a political and public interest in how the nation treats those who serve those Armed in the treats the nation in how interest and public a political remains There made sacrifices the of profile media the raised in part, by been fuelled, has interest This Forces. Centre for Mental Health The recent raised profile about mental health problems within the UK Armed Forces and veterans has led to a series of policy intentions, to improve the availability of appropriate mental health services. However, the recommendations made (Murrison, 2010) and the policy commitments (Ministry of Defence, 2011b) have fallen short of providing appropriate and evidence-based mental health support to families and children.

Where there is work in the UK on the impact of the military experience on the lives of families, it falls into a number of categories:

REPORT • Academic research in progress, not due to report for a number of years - as in the cases of the KCMHR and the Cardiff studies;

• Small-scale studies that have sample sizes limitations, which may not be representative across Unsung Heroes: Developing a better understanding of the emotional support needs Service families the tri-Services e.g. domestic violence studies and studies looking at the impacts of deployment and mobility on education; • Unpublished literature and undergraduate and postgraduate dissertations; • Policy and position pieces.

Where UK work has been undertaken the following factors are apparent. Firstly, there is paucity in the research literature, very little is understood about the impacts of isolation, deployment, mobility or military culture on the families and children; secondly, where policy and practice is developed to meet the requirements of military personel or veterans the psychological needs of the family and children are rarely considered; and, thirdly, what little work that has been done in the UK has only considered the Service “man”. As we move into a more flexible and mobile 21st Century military, with greater emphasis on gender equality, more women, and indeed mothers, will be deployed. Understanding the unique impact of maternal separation in this context must be worthy of further research.

Recomendations

1. Little is understood about the psychological impact of deployment on the families and children of UK Service personnel. More research should be commissioned and conducted to ensure that the correct services are developed to meet the needs of Service families and that any resources are appropriately directed. To ensure transparency, research findings should be made publicly available. 2. There is currently no published UK research that considers whether alcohol or other substance misuse in the UK Armed Forces has an impact on Service families. Given the high levels of harmful alcohol consumption among service personnel and the concerns about alcohol’s links with domestic violence, further research needs to be commissioned urgently in these areas. 3. Similarly, there is no UK research that considers the effect of excessive alcohol use among veterans and the impact on their families. If this proves to be a problem then the potential devastating psychosocial effects of alcohol abuse in this population need to be understood, the culture of alcohol use in the military needs to be challenged, and services need to be improved to help both serving personnel and veterans with substance misuse problems. 4. As the Government drives to expand its improving access to psychological therapies programme (IAPT) and its commitment to the Armed Forces Covenant, more attention needs to be paid to ensuring that IAPT services are able to meet the needs of both veterans and their families. The use of family therapy and multi-systemic approaches should be considered. These services should also be schooled in working with veterans and understanding military culture. 5. As more Service personnel are recovering from traumatic physical injuries, consideration needs to be made both to the psychological needs of the injured person, and also the psychological impact on the families – who may be required to cope with exceptional levels of distress and care. It is universally recognised that families are integral to recovery in all aspects of healthcare. 24 Centre for Mental Health REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 25

Violence Violence London: Army Families Federation. Families Army London: Survey of Families. Survey , 22, 197-209. , 17, 185-197. , 17, , 9, 1118-1152. , 9, Journal of Family Violence of Family Journal Universally, most research has focused on the impact of men being deployed or separated or separated deployed men being of on the impact focused has research most Universally, women’s of impact the understand to undertaken be to needs Further work their families. from context. in this separation is laudable in its aims, in its current form it does not fully recognise the stresses placed on placed the stresses recognise fully not does it form current in its aims, in its laudable is capacity the functional on impact potentially could this and how personnel and civilian families Armed Forces. the UK of Government policy needs to be more reflective of the needs of the whole Armed Forces Forces Armed whole the of the needs of reflective be more to needs policy Government the Covenant Although workers. civilian and personnel, of the families – including population

References

Acknowledgements Brecklin, L. R. 2002. The role of perpetrator alcohol use in the injury outcomes of intimate assaults. assaults. intimate of in the injury outcomes use alcohol perpetrator of The role L. R. 2002. Brecklin, Violence of Family Journal Bradley, C., , 2007. Veteran status and marital aggression: does military service make a make service military does aggression: and marital status Veteran C., , 2007. Bradley, difference? Big White Wall. 2011. Big White Wall: The Support Network [Online]. Available: http://www. Available: [Online]. Network Support The Wall: White 2011. Big Wall. White Big 2011]. November 23 [Accessed bigwhitewall.com In The 21st Century [Online]. Available: http://www.bbc.co.uk/pressoffice/pressreleases/ Available: [Online]. Century The 21st In 2011]. 30 November [Accessed stories/2006/12_december/07/dimbleby.shtml www.aff.org.uk/linkedfiles/aff/familiesconcerns2011.pdf [Accessed 3 May, 2012]. May, 3 [Accessed www.aff.org.uk/linkedfiles/aff/familiesconcerns2011.pdf The Realm Of - Defence Jackson Sir Mike General Lecture: Dimbleby The Richard BBC. 2006. Army Families Federation 2010. Op Herrick 12: Op Herrick 2010. Federation Families Army reports. http:// Online. concerns Families’ Federation Families 2011. Army Federation Families Army Adelman, M. 2003. The military, militarism, and the militarization of domestic violence. violence. domestic of militarization and the militarism, The military, M. 2003. Adelman, Women Against 7. 6. contributions. and Dr Anne Fox for their expert opinion on the text. The author also wishes to thank Capt Peter Peter Capt thank to wishes The author also their expert opinion on the text. for and Dr Anne Fox Federation, Families Navy Royal SSAFA, BLESMA, Legion, British the Royal at RN, staff Coulson and their thoughts for Wall White and the Big Federation Families Army Federation, Families RAF the Centre for Mental Health for their assistance and comments on various drafts of this manuscript. manuscript. this of drafts various on and comments their assistance for Health Mental for the Centre Dr Maguire, Claire Hughes, Jamie Hacker Prof Fear, Nicola Dr thank to like also The author would Olusanya Dr Olaoluw Wright, Andy Wood, Nick Shelton, Dr Katherine Pexton, Sharon Clifton, Grace The author would like to thank Andy Bell, Dr Graham Durcan, Michael Parsonage and Gael Scott, of of Scott, and Gael Parsonage Michael Durcan, Dr Graham Bell, Andy thank to like The author would Centre for Mental Health Brookoff, D., O’brien, K. K., Cook, C. S., Thompson, T. D. & Williams, C. 1997. Characteristics of participants in domestic violence: Assessment at the scene of domestic assault. Journal Of The American Medical Association, 277, 1369-1373.

Browne, K. 2011 Information relating to research on domestic violence [Email] (Personal communication, 19 August 2011)

Centre for Social Justice 2011. Completing the revolution: Transforming mental health and tackling poverty. A policy report by the mental health working group. REPORT

Clifton, G. 2007. The experience of education of the army child. Doctor Of Philosophy, Oxford

Brookes University. Unsung Heroes: Developing a better understanding of the emotional support needs Service families Crouter, A. C. & Bumpus, M. F. 2001. Linking parents’ work stress to children’s and adolescents’ psychological adjustment. Current Directions in Psychological Science, 10, 156-159.

Cruise Bereavement Care. 2011. Supporting The Military Family [Online]. Available: http://www. cruisebereavementcare.org.uk/mfveterans.html [Accessed 1 December 2011].

Dandeker, C., French, C., Birtles, C. & Wessely, S. 2006. Deployment experiences of British Army wives before, during and after deployment: satisfaction with military life and use of support networks. In Human Dimensions In Military Operations - Military Leaders’ Strategies For Addressing Stress And Psychological Support Meeting Proceedings Rto-Mp-Hfm-134, Paper 38. Ed. Neuilly-Sur- Seine, France: Rto.

Dandeker, C., Wessely, S., Iversen, A. & Ross, J. 2003. Improving the delivery of cross-departmental support and services for veterans: A joint report of the department of war studies and The Institute Of Psychiatry, Kings College, London.

DASA. 2011. Defence Analytical Services and Advice [Online]. Available: http://www.dasa.mod.uk/ [Accessed 2 January 2012].

De Burgh, H. T., White, C. J., Fear N.T. & Iversen A.C. 2011. The Impact of Deployment to Iraq or Afghanistan on partners and wives of military personnel. International Review of Psychiatry, 23, 192-200. Department for Education 2010. The educational performance of children of service personnel.

Department of Health 2011a. The Operating Framework for the NHS in England 2012/13. London: Department of Health.

Department of Health 2011b. Talking Therapies: A four-year plan of action. London: Department of Health.

Edwards, L. 2004. Service children’s education: An exploration of the strategies employed to mitigate the adverse effects of pupil mobility on social and academic progress. B.Ed, University of Exeter.

Erez, E. & Bach, S. 2003. Immigration, domestic violence, and the military: The case of “Military Brides”. Violence Against Women, 9, 1093-1117.

Fear, N., Iversen, A., Meltzer, H., Workman, L., Hull, L., Greenberg, N., Barker, C., Browne, T.,

Earnshaw, M., Horn, O., Jones, M., Murphy, D., Rona, R., Hotopf, M. & Wessely, S. 2007. Patterns of drinking in the UK Armed Forces. Addiction, 102, 1749-1759.

26 Centre for Mental Health REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 27 Journal of Journal , University , University Occupational Occupational , 5 January 2007. Journal Of Family Of Family Journal rofessional Psychology: Psychology: rofessional , 12, 641-662. Mail Online Mail Doctor of Philosophy Doctor y, 12, 385-401. y, Violence Against Women Against Violence , 375, 1783-1797. , 375, The Lancet Addiction Research And Theor And Addiction Research , 194, 266-272. , 194, 35, 171-180. , 42, 56-62. , 173, 534-538. , 173, , 59, 25-31. , 59, , 21, 369-80. , 21, House of Commons Defence Committee 2006. Educating service children: Eleventh report of session session of report Eleventh children: service Educating 2006. Committee Defence Commons of House 2005-06. Hoshmand, L. T. & Hoshmand, A. L. 2007. Support for military families and communities. families military for Support A. L. 2007. & Hoshmand, T. L. Hoshmand, Psychology, Community Home Office 2010. A new approach to Fighting Crime. London: The Home Office. The Home London: Crime. to Fighting A new approach 2010. Home Office Hickley, M. 2007. Backlash grows over troops’ squalid living conditions. conditions. living squalid troops’ over grows Backlash M. 2007. Hickley, Heyman, R. E. & Neidig, P. H. 1999. A comparison of spousal aggression prevalence rates in US army army in US rates prevalence aggression spousal of A comparison H. 1999. R. E. & Neidig, P. Heyman, 239-242. 67, Psychology, And Clinical Consulting Of Journal samples. representative and civilian Henning, N. L. 1986. Military wives: stress, strain and alcohol use. use. and alcohol strain stress, wives: Military N. L. 1986. Henning, Pittsburgh. of Henderson, A., Langston, V. & Greenberg, N. 2008. Alcohol misuse in The Royal Navy. Navy. The Royal in misuse Alcohol N. 2008. & Greenberg, V. A.,Henderson, Langston, Medicine Hawton, K., Harriss, L., Casey, D., Simkin, S., Harrison, K., Bray, I. & Blatchley, N. 2009. Self-harm in Self-harm N. 2009. I. & Blatchley, K., Bray, S., Harrison, Simkin, D., L., Casey, K., Harriss, Hawton, presentations. hospital general of study and case–control Descriptive personnel: armed forces UK of Psychiatry The British Journal Wessely, S. 2008. The use of psychological decompression in military operational environments. environments. operational in military decompression psychological of The use S. 2008. Wessely, Medicine Military Population Study Of British Adults. Adults. British Of Study Population M. & C., Deahl, French, T., N. R., Fear, N., Eldridge, M., Greenberg, J., Earnshaw, Hughes, Hacker Offenders: Characteristics and offending related reeds (Findings 217). London: The Home Office. London: 217). (Findings reeds related and offending Characteristics Offenders: A General Aggression: Gender And Partner Alcohol, 2004. M. M. & Plant, K., Plant, Graham, Research and Practice and Research Violence Domestic M. 2003. A. & Kebbell, S., Beech, Weston, R., Takriti, R., E., Johnson, Gilchrist, Gewirtz, A. H., Erbes, C. R., Polusny, M. A., Forgatch, M. S. & Degarmo, D. S. 2011. Helping military military S. 2011. Helping D. S. & Degarmo, M. A., M. Forgatch, Gewirtz, A. C. R., Polusny, H., Erbes, P parenting. support to Strategies process: the deployment through families Galvani, S. 2006. Alcohol and domestic violence. domestic and Alcohol S. 2006. Galvani, Fox, A. 2010. Drink and duty: Alcohol use and the British Army. Phd, Imperial College, University Of Of University College, Phd, Imperial Army. and the British use and duty: Alcohol A. Drink 2010. Fox, London. Fossey, M. 2010. Across The Wire : Veterans, Mental Health And Vulnerability, London, Centre For For Centre London, Vulnerability, And Health Mental Veterans, : Wire The Across M. 2010. Fossey, Health. Mental Forgey, M. A. & Badger, L. 2006. Patterns Of Intimate Partner Violence Among Violence Partner Intimate Of Patterns L. 2006. M. A. & Badger, Forgey, And Consequences. Directionality Level, Type, Military: The In Women Married Violence S. 2010. What are the consequences of deployment to Iraq and Afghanistan on the mental health of of health on the mental and Afghanistan Iraq to deployment of the consequences are What S. 2010. study. A cohort Armed Forces? the UK Fear, N. T., Jones, M., Murphy, D., Hull, L., Iversen, A. C., Coker, B., Machell, L., Sundin, J., Sundin, L., B., Machell, A. C., Coker, L., Iversen, Hull, D., M., Murphy, Jones, T., N. Fear, Wessely, M. & J., Hotopf, R. C., Rona, S., Dandeker, Landau, N., N., Greenberg, Jones, C., Woodhead, Centre for Mental Health House of Commons Defence Committee 2011. The Armed Forces Covenant in action? Part 1: Military Casualties Seventh Report of session 2010–12 Volume I: Report, together with formal minutes, oral and written evidence. Published 15 December 2011.

Humphreys, C., Regan, L., River, D. & Thiara, R. K. 2005. Domestic violence and substance use: Tackling Complexity. British Journal of Social Work, 35, 1303-1320.

Institute of Alcohol Studies 2010. Alcohol and Crime. St Ives, Cambs.: Ias.

REPORT Iversen, A., Meltzer, H., Workman, L., Hull, L., Greenberg, N., Barker, C., Browne, T., Earnshaw, M., Horn, O., Jones, M., Murphy, D., Rona, R., Hotopf, M. & Wessely, S. 2007. Patterns of drinking in the

UK Armed Forces, Addiction, 102, 1749-1759. Unsung Heroes: Developing a better understanding of the emotional support needs Service families Jewkes, R. 2002. Intimate partner violence: causes and prevention. The Lancet, 359, 1423-1429. Kcmhr. 2011. Children of military fathers [Online]. Available: http://www.kcl.ac.uk/kcmhr/research/ kcmhr/kidsstudy.aspx [Accessed 21 November 2011].

King’s Centre For Military Health Research 2006. King’s Centre for military health research: a ten year report. What has been achieved by a decade of research into The Health Of The UK Armed Forces And UK?. London: King’s College, London.

King’s Centre for Military Health Research 2010. King’s Centre for Military Health Research: A Fifteen Year Report. What has been achieved by fifteen years of research into the health of the UK Armed Forces? London: King’s College, London.

Kopperman, P. E. 1996. “The Cheapest Pay”: Alcohol Abuse In The Eighteenth-Century British Army. The Journal Of Military History, 60, 445-470.

Leonard, K. E. & Senchak, M. 1996. Prospective Prediction of Husband Marital Aggression within Newlywed Couples. Journal of Abnormal Psychology, 105, 369-380.

Macmanus, D., Dean, K., Al Bakir, M., Iversen, A. C., Hull, L., Fahy, T., Wessely, S. & Fear, N. T. 2011. Violent Behaviour in UK Military Personnel Returning Home After Deployment. Psychological Medicine, Firstview, 1-11.

Makin, S. 2012 Information about the Big White Wall Project [Email] (Personal Communication, 23 February, 2012

Mansfield, A. J., Kaufman, J. S., Marshall, S. W., Gaynes, B. N., Morrissey, J. P. & Engel, C. 2010. Deployment And The Use Of Mental Health Services Among U.S. Army Wives. The New England Journal Of Medicine, 362, 101-109.

Maritime Charities Funding Group 2007. Supporting Seafarers And Their Families: Challenges For The Future. The Report Of The Maritime Charities Funding Group Research Programme On The Needs Of UK Seafaring Community. Southampton: Maritime Charities Funding Group.

Marshall, A. D., Panuzio, J. & Taft, C. T. 2005. Intimate Partner Violence among Military Veterans And Active Duty Servicemen. Clinical Psychological Review, 25, 862-76.

Martin, S. E. & Bachman, R. 1997. The Relationship of Alcohol to injury in Assault Cases. In: Galanter, M. (Ed.) Recent Developments in Alcoholism. New York: Plenum.

Mc Caffery D. 2012 Information from The RAF Families Federation [Email] (Personal Communication, 16 March, 2012)

28 Centre for Mental Health REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 29 , 197, 405-410. , 197, Journal Of Nervous And Mental Mental And Of Nervous Journal The British Journal of Psychiatry The British Journal 175, 805-810. 175, Military Medicine, Military one for a soldier: A history of life in the British Ranks from 1642 London, Cassell Cassell London, 1642 from Ranks British in the life of A history a soldier: one for G , 191, 3-9. , 191, Pinder, R. J., Fear, N. T., Wessely, S., Reid, G. E. & Greenberg, N. 2010. Mental Health Care Provision Provision Care Health Mental N. 2010. G. E. & Greenberg, S., Reid, Wessely, T., N. R. J., Fear, Pinder, The U.K. Armed Forces. In a military family perspective [Online]. Available: http://hooah4health.com/deployment/ Available: [Online]. perspective family a military 2012]. 3 May [Accessed familymatters/emotionalcycle2.htm January, 2012 January, deployment: of cycle The emotional L. E. 2011. J. & Adler, R., Christenson, S. H., House, Pincus, families. Dpsych, City University, London. University, City Dpsych, families. 9 Communication, (Personal [Email] Thesis D.Clin.Psych to relating 2012 Information Pexton, school service children and their families separated during active service. A psychological A psychological service. active during separated and their families children service school 8-11) and their (Aged children service aged in school deployment of the impact of assessment and skills (OFSTED). and skills primary of needs and support wellbeing emotional; The welfare, : study S. 2012a. A pilot Pexton, OFSTED 2011. Children in Service Families: The Quality and Impact of Partnership Provision for for Provision Partnership of and Impact The Quality Families: Service in 2011. Children OFSTED services children’s in education, standards for The office Manchester: Families. Service in Children Neuberg, V. 1989. V. Neuberg, Ltd. Publishers National Centre on Domestic and Sexual Violence. 2011. The Military’s Response to Domestic and Domestic to Response The Military’s 2011. Violence. Sexual and on Domestic Centre National 1 [Accessed http://www.ncdsv.org/ncd_militaryresponse.html Available: [Online]. Violence Sexual 2011]. December Murrison, A. 2011. A Better Deal for Military Amputees, London: Department of Health. of Department London: Amputees, Military for Deal A. 2011. A Better Murrison, Murrison, A. 2010. Report to Government on Armed Forces Mental Health ‘Fighting Fit’ London: Fit’ London: ‘Fighting Health Mental Forces on Armed Government to A. Report 2010. Murrison, Defence of Ministry Mulligan, K., Jones, N., Woodhead, C., Davies, M., Wessely, S. & Greenberg, N. 2010. Mental health health Mental N. 2010. S. & Greenberg, Wessely, M., C., Davies, Woodhead, N., K., Jones, Mulligan, in Iraq. on deployment while personnel military UK of Ministry Of Defence 2011d. Tri-Services families continuous attitude survey (FAMCAS) Report 2011. Report survey (FAMCAS) attitude continuous families Tri-Services 2011d. Defence Of Ministry Defence. Of Ministry London: Ministry of Defence. 2011c. Army Welfare Service [Online]. Available: http://www.army.mod.uk/ Available: [Online]. Service Welfare Army 2011c. Defence. of Ministry 2011]. November 23 [Accessed welfare-support/ Ministry of Defence 2011b. The Armed Forces Covenant: Today and Tomorrow. London: MOD. London: Tomorrow. and Today Covenant: The Armed Forces 2011b. Defence of Ministry Forces, Their Families And Veterans. London: Ministry of Defence. of Ministry London: Veterans. And Families Their Forces, Defence. Of Ministry London: Covenant. Armed Forces The 2011a. Defence of Ministry [Email] (Personal Communication, 15 March, 2012) 15 March, Communication, (Personal [Email] Our Armed To Support Cross-Government Commitment: The Nation’s 2008. Defence Of Ministry Disease Association Families Airmen’s And Sailors Soldiers, the from 2012 Information P. Mcredmond Mccarroll, J. E., Ursano, R. J., Newby, J. H., Liu, X., Fullerton, C. S., Norwood, A. E. & Osuch, E. A. S., Norwood, A. Osuch, E. & C. X.,Liu, Fullerton, J. H., Newby, R. J., J. E., Ursano, Mccarroll, Soldiers. Army In Us and Deployment Violence Domestic 2003. 335, 335, BMJ, Violence Against Against Violence , 96, 473-480. Online]. , 36, 319-326. Obstetrics and Gynecology and Obstetrics Journal Of Clinical Psychiatry [ Psychiatry Of Clinical Journal International Journal Of Epidemiology Journal International 9, 1045-1071. 9, Service Families Employment & Skills Taskforce 2010. Taskforce Report March 2010. London: London: 2010. March Report Taskforce 2010. Taskforce Skills & Employment Families Service Office. Equalities Government Segal, M. W. & Harris, J. 1993. What we know about military families. US Army Research Institute for for Institute Research Army US families. military about know we What J. 1993. & Harris, W. M. Segal, Sciences. And Social the Behavioural http://www.servicechildrensupportnetwork. 2011. Available: Network. Support Children’s Service com/research.html. Sayers, S. J., Farrow, V. A., Ross, J. & Oslin, D. W. 2009. Family problems among returned military military returned among problems Family 2009. W. D. J. & Oslin, A., Ross, V. S. J., Farrow, Sayers, evaluation. health a mental for referred veterans parental as challenges emotional more face children Military 2009. Daily. Science http://www.sciencedaily.com/ Available: [Online]. finds study longer, grow deployments 2011]. November 23 [Accessed releases/2009/12/091207095503.htm Portsmouth: Royal Navy Navy Portsmouth: Royal fund. Children’s Marines and Royal of consequences Health-related B. N. 2000. & Doebbeling, A. D. G., Booth, B. M., Nielson, Sadler, in the military. Women violence: and sexual physical Partners: SP SP Partners: Legion British Royal London: Summary. 1 Outcomes Year Reporting End Of Conflict. Of Casualties The Overlooked 2009. Fund Children’s Marines And Royal Navy Royal mental health. mental [Online]. Partnership. Health The Armed Forces 2011a. Stress. & Combat Legion British Royal 2011]. 4 November [Accessed http://www.armedforceshealthpartnership.org.uk/ Available: Strategic Health Of – Department Unit Policy Public 2011b. Stress & Combat Legion British Royal Rosen, L. N., Kaminski, R. J., Parmley, A. M., Knudson, K. H. & Fancher, P. 2003. The effects of peer of The effects 2003. P. A. Fancher, K. H. & M., Knudson, R. J., Parmley, L. N., Kaminski, Rosen, soldiers. army US male married among violence partner on intimate climate group Women, veterans and – Report: Armed Forces Unit Policy Public 2010. Stress & Combat Legion British Royal Rona, R. J., Fear, N. T., Hull, L., Greenberg, N., Earnshaw, M., Hotopf, M. & Wessely, S. 2007a. Mental Mental S. 2007a. Wessely, M. & M., Hotopf, N., Earnshaw, L., Greenberg, Hull, T., N. R. J., Fear, Rona, study. a cohort of phase First Forces: Armed in the UK overstretch of consequences Health 603. mental roles: occupational in novel Women S. 2007b. Wessely, L. & Hull, T., N. R. J., Fear, Rona, Forces. Armed in the UK trends health Rentz, E. D., Martin, S. L., Gibbs, D. A., Clinton-Sherrod, M., Hardison, J. & Marshall, S. W. 2006. 2006. W. S. Marshall, J. & M., Hardison, A., Clinton-Sherrod, D. L., Gibbs, S. Martin, D., E. Rentz, 93-108. 7, And Abuse, Violence, Trauma, The Literature. of The Military: A Review In Violence Family 2012 26 March Correspondence Personal Federation, Families 2012 Rf: K Richardson, RAF Families Federation 2011 RAF Families Federation: Annual Report 2011 [Online] Available at: Available [Online] 2011 Report Annual Federation: Families 2011 RAF Federation Families RAF J. 1997. D. Soma, N. K. & Raiha, http://www.raf-ff.org.uk/meettheteam-ourannualreports.asp, 759-768. 21, & Neglect, Abuse Child army. in the US and neglect abuse child of Victims

Centre for Mental Health REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 30 4 Centre for Mental Health REPORT Unsung Heroes: Developing a better understanding of the emotional support needs of Service families 31

, 23, , 23, , 17, 790-796. , 17, The Independent on Sunday The Independent International Review of Psychiatry Review International , 46, 559-566. , 46, Journal of Psychiatric and Mental Health Nursing Health Mental and of Psychiatric Journal Social Psychiatry And Psychiatric Epidemiology Psychiatric And Psychiatry Social Brugha, T., Jenkins, R., Wessely, S. & Fear, N. 2011a. Health of national service veterans: An analysis An analysis veterans: service national of N. 2011a. Health S. & Fear, Wessely, R., Jenkins, T., Brugha, Survey of Morbidity Psychiatric Adult the 2007 from data using sample a community-based of England. Woodhead, C., Rona, R., Iversen, A., Macmanus, D., Hotopf, M., Dean, K., Mcmanus, S., Meltzer, H., S., Meltzer, K., Mcmanus, M., Dean, Hotopf, D., A., R., Iversen, Macmanus, C., Rona, Woodhead, Wolfowitz, P. 2001. Domestic Violence. In: US Department of Defence (Ed.). Online. (Ed.). Defence of Department In: US Violence. Domestic 2001. P. Wolfowitz, Williamson, E. & Price, N. 2009. Pilot Project: Domestic abuse and military families, Research Research families, and military abuse Domestic Project: Pilot N. 2009. E. & Price, Williamson, Bristol. Of University Bristol: Forum. Violence Domestic Hampshire The North East by Commissioned Williamson, E. 2011. Domestic abuse and military families: The problem of reintegration and control. and control. reintegration of The problem families: and military abuse 2011. Domestic E. Williamson, Work. of Social British Journal White, C. J., De Burgh, H. T., Fear N.T. & Iversen A.C. 2011. The Impact of deployment to Iraq or Iraq to deployment of The Impact 2011. A.C. & Iversen N.T. Fear T., H. Burgh, C. J., De White, the literature. of A review children: on military Afghanistan 210-217. Walker, S. 2010. Assessing the mental health consequences of military combat in Iraq and Iraq in combat military of consequences health the mental Assessing S. 2010. Walker, Review. A Literature Afghanistan: Venning, A. 2005. Following The Drum: the lives of Army wives and daughters, past and present, and present, past and daughters, wives Army of The Drum: the lives A. 2005. Following Venning, Headline. London, US Department Of Veterans Affairs. 2011. Family Support [Online]. Available: http://www.oefoif. Available: [Online]. Support 2011. Family Affairs. Veterans Of Department US 2011]. 1 December [Accessed va.gov/FamilySupport.asp Reserve. 2011. Hooah4health [Online]. Available: http://hooah4health.com/default.htm [Accessed 1 [Accessed http://hooah4health.com/default.htm Available: [Online]. Reserve. 2011. Hooah4health 2011]. December U.S. Army Office Of The Surgeon General, The Army National Guard & The Office Of The Chief Army Army The Chief Of Office The & Guard National The Army General, Surgeon The Of Office U.S. Army Thomas, M. 2003. Lost at sea and lost at home: The predicament of seafaring families. Cardiff: Cardiff: families. seafaring of The predicament home: at and lost sea at Lost M. 2003. Thomas, University. Cardiff Centre, Research International Seafarers Strachan, H., Armour, T., Healy, P. & Smith, M. 2010. Report on The Task Force on The Military The Military on Force Task The on Report M. 2010. Smith, & P. Healy, T., H., Armour, Strachan, Covenant. Smith, J. 2009. The soldiers who can’t help bringing their work home. their work help bringing who can’t The soldiers Smith, J. 2009. September 27 2009. Shelton, K, 2012 Comments on the role of parental work stress on the mental wellbeing of children children of wellbeing the mental on stress work parental of the role on Comments K, 2012 Shelton, 2012) 6 January, Communication, (Personal [Email] Shelton, K, 2011 Information about University of Cardiff research on Service families [Email] [Email] families Service on research Cardiff of University about Information K, 2011 Shelton, 2011) 14 November, Communication, (Personal Unsung Heroes Developing a better understanding of the emotional support needs of Service families

Published May 2012 © Centre for Mental Health, 2012 Photograph: iStock

Recipients (journals excepted) are free to copy or use the material from this paper, provided that the source is appropriately acknowledged.

Register for our monthly email bulletins at www.centreformentalhealth.org.uk.

Centre for Mental Health 134 - 138 Borough High Street, London SE1 1LB

Tel 020 7827 8300 Fax 020 7827 8369

www.centreformentalhealth.org.uk

Charity registration no. 1091156. A company lim- ited by guarantee registered in England and Wales no. 4373019.