Improving Access Report 2017: Understanding Why Veterans Are Reluctant To Access Help for Alcohol Problems

This project arose from two frequently stated perceptions of clinical practitioners working within the field of alcohol misuse services: - Why is it so difficult to engage ex-servicemen (and women) in treatment programmes, - Once they engage, why is it so difficult to maintain that engagement? The aim of this project was to explore why veterans are reluctant to access help for alcohol problems and the extent to which they may be different from other substance misuse service users within the general population. Research was conducted through a sequential process over four phases. The initial three phases consisted of interviews and focus groups with service planners, commissioners, providers, substance misuse service users and veterans from the wider community. The fourth phase was a planned symposium where findings from the first three phases were presented to substance misuse service planners, commissioners and service providers with input from veterans and service users. Findings from this project suggest that veterans with alcohol problems have unique difficulties that set them apart from other substance misuse service users within the general population. From both Phase Two and Phase Three, it was clear that there is a normalisation of excessive alcohol consumption during military service that often remains on discharge. Veterans in Phase Three provided further insight into the difficulties experienced on discharge through the transition to civilian life. It was noted that looking in from the outside, a successful transition appeared the norm, however the focus group participants suggested that transition experiences provided a further warrant for alcohol consumption and continuation of alcohol-based coping mechanisms established during military service. This normalisation of alcohol consumption was found to contribute to a delay in engagement with substance misuse service. A delayed engagement in accessing care lead to complex presentations where all aspects of the veterans’ lives (physical, psychological and social) were impacted. Consequently, when veterans did engage in substance misuse services, they were often referred for alcohol treatment through other services such as social housing, unemployment and mental health. Service providers’ lack of understanding of the unique needs and experiences of veterans, was consistently identified as a main barrier to care in the first three phases. Focus Group participants expressed a certain degree of antipathy towards civilian life and civilian culture, further reinforcing this barrier. Complex care pathways and the lack of integrated health and social care was cited as contributing to a disengagement with care. Support for this was found in Phase Four where a diagram showed that the current care pathway for veterans with alcohol misuse was extensive and convoluted. This was in contrast to service commissioners, planners and providers limited and over-simplified view of the current provision. Successful engagement in care was associated with service providers who had veteran workers within their provision. 81 PROJECT CONCLUSIONS Phase Four facilitated the development of a model from which to evolve current services. Utilising findings from the first three phases, it was proposed that a ‘hub and spoke’ approach would be potentially the most cost effective and beneficial means of engaging veterans in healthcare services. Veterans will be assigned a multi-agency worker who will assist in accessing and engaging in relevant services. An initial assessment will ascertain the veteran’s status on physical health, mental health, social situation and substance misuse. Essentially, the hub and spoke model has the potential to reduce the number of veterans who disengage/disappear from services due to difficulties in navigating complex services.