Today [June 25, 2022] will see the UK mark its annual Armed Forces Day, an event which serves to commemorate the service of Armed Forces personnel.
The latest edition of Armed Forces Day comes at a difficult time for some ex-servicepeople. The Covid-19 pandemic has had a drastic impact on the mental health and wellbeing of veterans, an issue which has only been exacerbated by the ongoing cost-of-living crisis.
Nikki Markham MBE is the founder and director of Battling On, an organisation that supports people in gaining confidence, new skills and help with their personal development. Battling On specialises in supporting Armed Forces veterans, helping them transition from military to civilian life following their time in service.
Based at Merryhue Farm on the border between Devon and Cornwall, Battling On operates in a catchment area where a lot of serving Armed Forces personnel are based, and where some 37,000 veterans reside.
In early 2021, the government and the NHS sought to provide better mental health support services for veterans in the face of the Covid-19 pandemic by launching “Operation Courage”. The scheme sees doctors, nurses and other NHS staff work closely with military charities to provide therapy, rehabilitation services and, in extreme cases, inpatient care to hundreds of former soldiers, sailors and RAF personnel per year.
However, Markham told The Leaders Council that despite this initiative, there remain gaps in the service provision for ex-servicepeople and organisations such as Battling On are left trying to plug the gap, with minimal resourcing.
Markham explained: “In the mental health support services set-up to support veterans, there’s a gap in provision. The NHS mental health service for veterans dubbed ‘Operation Courage’ can help veterans access initial counselling and medication but the follow-up steps aren’t there for that longer-term support veterans need. So, there’s nowhere for veterans facing major problems to access rehabilitation services other than us.
“We currently have about 120 complex cases of veterans on our books and we’re having to help these people basically without any funding. Much work we do is done on a voluntary basis or we do it by getting grant funding, and this isn’t sustainable in the long-term. Post-pandemic, much of the funding we would have received pre-Covid isn’t available because a lot of charities are struggling, and the bigger organisations tend to be first in line for the funds.”
Over the course of the first Covid-19 lockdown and since social restrictions have been lifted, Battling On has seen its service provision stretched by a huge surge in the number of veterans presenting themselves with a range of complex issues. A significant driver behind this development was that Armed Forces charities the Royal British Legion and Help for Heroes both chose to close their centres in Plymouth during the first lockdown, which have since been permanently closed. This has left Battling On as the only local provider whose doors are open for veterans to receive in-person services.
Markham said: “During Covid in the first lockdown, the Royal British Legion and Help for Heroes both closed their centres and have subsequently shut them permanently. All the services they offer are now telephone consultation based and many veterans won’t engage with this form of support. So, we’re the only local provider whose doors are open to veterans. Some veterans won’t engage with the Royal British Legion and Help for Heroes at all anymore either, because they feel let down by them and there’s a lot of mistrust. That means more demand is being placed on us.
“It is very difficult, and we are having to balance service provision with not inflicting burnout on our volunteer workforce. Many volunteers working for us are veterans themselves so we do need to be especially careful of their wellbeing. Meanwhile, services are being stretched to the limit. To get one of our veterans before a specialist counsellor here, it takes 11-to-12 months. Elsewhere, it is a two-year wait to get a veteran here in front of a clinical psychiatrist. These are staggering timescales.
“We have now got our own counsellors in place and support mechanisms in place because we’ve pulled them in ourselves, but we are running to standstill with the demand. It isn’t just mental health support that is needed but sometimes acute pain clinics are required to help veterans who come to us with trauma-related injuries sustained on active duty. With the cost-of-living crisis meaning some can’t afford to fuel their cars, we’ve also had to provide for bus services and car shares to physically get our service users into the centre.”
Markham went on to say that she felt there was a disparity in the rhetoric around what the government says it is doing to support veterans by putting funding into Operation Courage, and what is actually happening on the ground.
“Because of the gap in provision, the funding going into NHS services isn’t filtering through properly to the cold face where the veterans are. As a result, we are seeing many veterans going into A&E with severe mental health issues who have suffered breakdowns, have self-harmed or overdosed. The lockdown and Covid are factors, but a major trigger right now is also the cost-of-living crisis, because many of these veterans are unemployed and they’re concerned about being able to afford the basic necessities.”
Markham revealed that the issue is also intensified by the fact that when veterans are going into hospital and processed, they are not identified as veterans at the point of crisis; a development which means they are not being directed to the appropriate support pathways.
Markham said: “The problem is worsened by the fact that in hospitals, there is no way of tracking veterans that are going into the system. So, we’ve had several cases of veterans having breakdowns and under a section 136 order, police have had to take them into custody for their own safety pending psychiatric evaluation.
“It is a failure in the system that veterans going into hospital aren’t being identified. Veterans don’t want special treatment or to be fast-tracked through, but what hospitals need to acknowledge is that for many who’ve served in the Armed Forces and have PTSD, certain triggers which can be as simple as the beeping of medical machines and the loud banging of trollies can cause bad mental reactions. If we aren’t asking the right questions to patients coming in, to gauge where these risks are, we aren’t going to be giving them the right support to recover.
“What should happen is that veterans should be identified at the point of crisis. So, when a nurse or consultant opens their chart, it flags up that they’re dealing with an individual who has additional or unseen issues that need to be considered. The fact this is not happening means that veterans with these issues aren’t being referred to the right people or support pathways. They then undergo the wrong form of treatment and go back into the community no better off than when they started their treatment because their complex issues have not been addressed.”
For Markham, this disconnect goes beyond healthcare provision and even filters through into the justice system where veterans who suffer from complex mental health issues find themselves in trouble with the law.
She elaborated: “If for instance somebody is arrested and goes to a custody suite, the first thing they should be asked by the custody sergeant is whether they are a veteran or not. This is outlined in the Armed Forces Covenant.
“If someone declares that they are a veteran, then they are to be sent down a different custodial pathway which recognises that the justice system is dealing with someone who is likely to have underlying mental health issues. But this doesn’t happen. So, many veterans who are ill with severe mental health problems that do run into trouble with the police end up being criminalised, rather than getting the support they need. This can damage their long-term prospects of finding alternative employment, puts them through more undue stress and ultimately puts them at greater risk.
“The systems are in place under the Armed Forces Covenant to deal with this accordingly, but it is not being used correctly. I have had these conversations with the police, but they simply say they are not paid to be counsellors. However, what they should be doing nonetheless is protecting the vulnerable. We are working in a very challenging environment.”
Yet, although the conditions on the ground have proven challenging, Battling On has made remarkable progress in its work. It has made significant strides in reaching isolated veterans in need of support, but also demonstrated a new model of pooling local third sector organisations together which has been recognised even by a Royal Family member as a route forward.
Markham highlighted: “We’ve done a lot of engagement work and have a proven methodology of engaging with even the hardest-to-reach veterans. We send outreach mentors out and do a lot of walks with them out on Dartmoor, provide one-to-one support and then pull them into the centre to engage with the wider group.
"Further to this, after the closures of the Royal British Legion and Help for Heroes locally during Covid, we have seen a positive in that it has brought local organisations closer together and stopped them working in silos. As a result, we’ve built a consortium comprised of us and other local organisations we work with and have pooled together food banks, IT companies and more. We’re applying for grants and funding for each other to keep providing these resources in the community, and this working together is really helping make service provision better. This approach is now being recognised as the new way forward.
“When Anne the Princess Royal came to open our Veterans Community Hub during her visit of the 'Together We Can Succeed' project, she commented on how interesting it was that all the local organisations were pulling together and collaborating. Because his doesn’t just happen in the third sector. Everyone competes for funding. But this is now being seen as a model for the way forward and really works at community level.”
For the future, Markham hopes that when ministers begin to set out the levelling-up strategy locally, due attention will be given to organisations like those in the new consortium to ensure that more funding is being provided to grassroots organisations and services that are making a difference on the ground.
“It is great that these smaller organisations are pulling together and it’s opening new funding doors for us also. When the government starts to look at distributing levelling-up funding, I’m hoping that in its strategy it starts to consider the likes of us with our collaborative approach and emphasis on getting money to grassroots organisations and services.”
