The mental health of serving and ex-Service personnel A review of the evidence and perspectives of key stakeholders A report prepared by the Mental Health Written by Chiara Samele Foundation on behalf of the Forces in Mind Trust May 2013 Contents Acknowledgments ....................................................................................................................................... 4 Forward ........................................................................................................................................................ 5 Forces in Mind Trust .................................................................................................................................... 6 Mental Health Foundation .......................................................................................................................... 7 Executive summary ...................................................................................................................................... 8 Main findings of the review .................................................................................................................... 9 Help-seeking, barriers to care and stigma ............................................................................................ 10 Use of mental health services ............................................................................................................... 10 In-services and support for serving personnel ..................................................................................... 10 Screening for mental health problems ................................................................................................. 10 NHS specialist services .......................................................................................................................... 11 Transition and resettlement to civilian life ........................................................................................... 11 Mental health impact of deployment on families of Service personnel ............................................. 11 Key stakeholder views for further research.......................................................................................... 11 Main gaps in research ........................................................................................................................... 12 Recommended research priorities ........................................................................................................ 12 Conclusion ............................................................................................................................................. 13 Scope of the review ................................................................................................................................... 14 Introduction ............................................................................................................................................... 14 Aim ........................................................................................................................................................ 16 Methods of literature review .................................................................................................................... 17 Overview of the literature ......................................................................................................................... 17 Mental health issues in UK serving and ex-Service personnel ................................................................. 20 Prevalence of mental illness and risk factors ....................................................................................... 20 Alcohol misuse ...................................................................................................................................... 22 Drug misuse ........................................................................................................................................... 23 Post-traumatic Stress Disorder (PTSD) .................................................................................................. 23 Delayed-onset PTSD .............................................................................................................................. 24 Suicide, attempted suicide and self-harm ............................................................................................ 25 Mild traumatic brain injury and post-concussional syndrome ............................................................ 26 Violent behaviour .................................................................................................................................. 26 Help-seeking, barriers to care and stigma................................................................................................ 27 Use of mental health services ................................................................................................................... 28 Services and support for serving and ex-Service personnel ..................................................................... 29 In-service provision ............................................................................................................................... 29 Trauma risk management programmes ................................................................................................ 30 Screening for mental health problems ................................................................................................. 31 NHS specialist services .......................................................................................................................... 32 Voluntary-sector mental health services for ex-Service personnel ..................................................... 33 Medical Assessment Programme (MAP) .............................................................................................. 34 Treatment outcomes ............................................................................................................................ 35 Transition and resettlement to civilian life ............................................................................................... 35 Transition and Resettlement – Definitions and Distinctions ................................................................ 35 Mental health impact of deployment on families of Service personnel ................................................. 37 Impact on children ................................................................................................................................ 38 Impact on spouses/partners ................................................................................................................. 38 contents 3 Mental health needs and services/support for families and carers .................................................... 40 Existing support for families in the UK ................................................................................................. 40 Key stakeholder views for further research .............................................................................................. 40 Gaps in the research evidence .................................................................................................................. 43 Prevalence of mental health problems ................................................................................................ 43 Help seeking and use of mental health services .................................................................................. 43 Services and treatment outcomes ........................................................................................................ 44 Resettlement and transition ................................................................................................................. 44 Impact of deployment in families and children.................................................................................... 45 Previous recommendations for further research ..................................................................................... 45 Recommended research priorities ............................................................................................................ 46 Conclusion .................................................................................................................................................. 47 References.................................................................................................................................................. 48 Appendices ................................................................................................................................................ 57 Appendix 1: Search strategy ................................................................................................................ 57 Appendix 2: Grey literature search ....................................................................................................... 62 Appendix 3: Key stakeholders interviewed .......................................................................................... 63 Acknowledgments I would like to warmly thank Dr Eva Cyhlarova and Dr Andrew McCulloch from the Mental Health Foundation for their invaluable support and comments on early drafts of the report. I owe a great deal of thanks to Meri Mayhew, Ray Lock of the Forces in Mind Trust and Grahame Jones for their advice on early drafts