Avances en Psicología Latinoamericana ISSN: 1794-4724 [email protected] Universidad del Rosario Colombia GALE, JOHN; SAFTIS, ELEFFTHERIOS; VIDAÑA MÁRQUEZ, INMACULADA; SÁNCHEZ ESPAÑA, BEATRIZ A psychological treatment programme for traumatised ex military personnel in the UK Avances en Psicología Latinoamericana, vol. 26, núm. 2, julio-diciembre, 2008, pp. 119-134 Universidad del Rosario Bogotá, Colombia Available in: http://www.redalyc.org/articulo.oa?id=79926202 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative A psychological treatment programme for traumatised ex military personnel in the UK Un programa de tratamiento psicológico para personal exmilitar traumatizado en el Reino Unido JOHN GALE*, ELEFFTHERIOS SAFTIS INMACULADA VIDAÑA MÁRQUEZ, BEATRIZ SÁNCHEZ ESPAÑA Community Housing and Therapy, United Kingdom Abstract Resumen A large proportion of homeless people in the UK Una gran proporción de personas sin hogar en el Rei- are former members of the armed services and no Unido corresponde a ex-miembros de las fuerzas suffer from a mental illness. In fact, homelessness armadas, quienes sufren además de enfermedades itself can be considered a symptom or manifesta- mentales. El hecho de no tener un hogar se puede, en tion of other underlying psychological difficulties. sí mismo, considerar como un síntoma o una mani- For these reasons Community Housing and The- festación de otras dificultades psicológicas inheren- rapy (CHT) considers that providing psychologi- tes. Por esta razon, Community Housing and Thera- cal therapies to treat the homeless population is py considera que dando terapias psicológicas para a more effective way of tackling the problem of tratar el hecho de no tener un hogar es una forma más homelessness, as it addresses the roots of the pro- efectiva de enfocar el problema, debido a que trata blem. This approach is one which is beginning to su raíz. Este enfoque se está empezando a reconocer be recognised by leading agencies in the field. At por agencias líderes en el área en el Reino Unido. the same time, the provision of psychological the- Al mismo tiempo, la provisión de terapias psicoló- rapies for symptoms such as depression and anxiety gicas para tratar síntomas tales como la depresión has become accepted through the Department of y la ansiedad ha sido aceptada por la iniciativa del Health’s (DoH) Increased Access to Psychological Departamento de la Salud (DoH) denominada ‘In- Therapies ( IAPT) initiative. Depression is the most creased Access to Psychological Therapies’ (IAPT). common psychiatric disorder that homeless people La depresión es el desorden psiquiátrico más común suffer and it is well documented that psychological que la población sin techo sufre, pero también está treatments for depression can be extremely effec- documentado que los tratamientos para la depresión tive. As well as approaching homelessness from pueden ser muy efectivos. Además de enfocar el the angle of psychological therapies, CHT in its problema de la población sin hogar desde un punto work with the ex-service community has become de vista psicológico, CHT en su trabajo con la co- increasingly aware that there are a large number munidad de ex-militares se ha conscienciado cada of non statutory homeless that do not get the same vez más de que hay un gran número de personas sin attention as rough sleepers. hogar que no están reconocidas por las autoridades Key words: homelessness; ex-military; psycho- y que no reciben la misma atención que las personas therapy; therapeutic communities; treatment. efectivamente clasificadas como sin hogar. Palabras clave: población sin hogar; exmilita- res; psicoterapia; comunidades terapéuticas; tra- tamiento. * Correspondence to: John Gale, Community Housing and Therapy, 24/5-6 The Coda Centre, 189 Munster Road, London SW6 6AW, United Kingdom. E-mail: [email protected] Avances en Psicología Latinoamericana/Bogotá (Colombia)/Vol. 26(2)/pp. 119-134/2008/ISSN1794-4724 < 119 <John Gale, Elefftherios Saftis, Inmaculada Vidaña Márquez, Beatriz Sánchez España Introduction a quarter of homeless people had served in the armed forces - 25% and 22% respectively. Ex-service men and women can find it difficult to • The Alcohol Recovery Project found that 9% adjust to civilian life. Those with psychological of clients attending its London walk-in centres difficulties often develop symptoms including al- had a services background, demonstrating the cohol or drug abuse and homelessness, and need risks posed by the drinking culture in the armed support and assistance. According to the Mental forces. Health Foundation, there are five million veterans • Other factors may include the consequences (with eight million dependants) in the UK, along of the strain of making the transition from an with around 180,000 serving personnel. Although institutional life in the services to the life of a only a minority of serving personnel and veterans civilian. experience mental health problems, they still form a large group of people. Homelessness The mental health problems experienced by military personnel are the same as the general Homelessness in London was a problem that es- population, although experiences during service calated to a very large proportion in the 1990’s. and the transition to civilian life mean that their Efforts by the Government’s Rough Sleepers’ Unit mental ill health may be triggered by different decreased the number of people sleeping rough in factors. Post Traumatic Stress Disorder (PTSD), London by over 50% from 621 in 1998 to 264 in depression, anxiety and substance abuse affect a 2001 (Homeless Link, 2002). The Department of significant minority of service personnel and ve- Health strategy has been effective in targeting the terans. There has been little research into mental most entrenched rough sleepers with severe men- health in the UK armed forces compared to the tal illness and has drastically reduced the numbers United States. However, various UK studies have (CLG, 2008). It is estimated that 30%-50% of the indicated links between active service and mental homeless population suffer from some form of health problems: mental illness (Homeless Link, 2006). Increased at- tention has been given to the value of psychological • 22% of a sample of Falklands War veterans therapies for the homeless. The underlying causes showed symptoms of PTSD – a much higher of homelessness, and its associated problems such percentage than in the general population. as substance misuse, depression and anti-social • Troops deployed to the first Gulf War in 1991 behaviour should be addressed as people will con- were suffering higher than normal levels of psy- tinue to become homeless even when adequate chological distress and fatigue many years after provision is offered to them. the conflict. The Homeless Link document Ending Home- • A study of body handlers from the Gulf showed lessness: from Vision to Action (2006) identifies that 50% were experiencing PTSD symptoms. three key strategic elements to end homelessness. • Psychological difficulties in a sample of British These are (1) prevention (2) support and (3) ac- troops increased by 50% after return from duty commodation. in Northern Ireland during the conflict there. • By June 2006, 1,897 British service personnel Homelessness and the ex-service community had been treated for mental health problems thought to be related to their deployment to Current estimates of homelessness within the ex- Iraq. service population are at approximately 6% (Rho- • Ex-service personnel are also vulnerable to des et al, 2006). This percentage is similar to the social exclusion and homelessness, both risk one reported by the CLG (Communities and Local factors for mental ill health. Both Crisis and Government, 2008) which estimated that the per- the Ex-Services Action Group found that about centage of ex-service rough sleepers is 5%. There 120<Avances en Psicología Latinoamericana/Bogotá (Colombia)/Vol. 26(2)/pp. 119-134/2008/ISSN1794-4724 A psychological treatment programme for traumatised ex military personnel in the UK < remains a very high number of single non statutory recognises psychological therapies as effective ex-service homeless in London on any given day, and safe treatments, both in the short term, and for current projections estimate up to 1,100 indivi- preventing relapse in the long term. duals. The term non statutory homeless refers to Although health authorities claim to look after those to whom the state does not consider it has a former soldiers, most GPs and consultants have litt- duty to house, either because they are deemed in- le or no experience of this area, and many ex service tentionally homeless or because they are not viewed personnel drop out of treatment programmes becau- a priority. It includes the ‘single homeless’ many se they believe staff cannot understand the traumas of whom are young people of both sexes (Rhodes they have been through. Additionally, there is a et al, 2006). scarcity of statutory provision of psychological ser- In their report Rhodes et al. (2006) identified vices available. Dr Andrew McCulloch Chief Exe- that the main difficulties that ex- service personnel cutive of the Mental Health Foundation has com- face are psychological disorders, drug and alcohol mented that, ‘people suffering