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Veterans Substance Misuse Case Management Service
CITY HEALTH CONFERENCE &
Paolo Pertica Award
Presentation
Dave Marsden, - Combat Stress, Seconded from Newcastle, Tyneside
and Northumberland NHS
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• Veterans’ Mental Health Charity• Founded 1919 – WW1 Shell Shock• 3 residential PTSD treatment services• Community Outreach Teams (Welfare, Mental Health,
Occupational Therapy).• High numbers unable to access PTSD (and other MH) treatment
due to substance use.• Exacerbated by role of alcohol in the culture of the armed forces.
• How to fill that gap?• National Lottery and LIBOR funding.
COMBAT STRESS
The Challenge in CJ work. • Veterans are widely considered to be the largest
occupational group in the UK prison system.• Estimates vary between 5 - 17% of the population• Probation figures also patchy• No clearly targeted/funded interventions (VIC etc)– Home Office, HMIP and Forces in Mind Probation study
trying to clarify the situation.• “The Veteran Question”
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• In the Armed Forces, some 13% of those deployed to operations in Iraq and Afghanistan are thought to suffer from significant alcohol disorders.
• More likely than the general public to be– Homeless– In prison– Isolated– Having undiagnosed mental health conditions, including PTSD– Unaware of, or not engaged with services– Poor transitional support historically– Shame– Identity challenges– 12 years
The Challenge.
• Signpost Recovery-Forth Valley
• Glasgow Addiction Services NHS
• Newcastle, Tyneside and Northumberland NHS
• Warrington-NHS• St Helens• Salford-NHS• Trafford-NHS• Lancashire-HMP• Wiltshire-Turning
Point• Portsmouth-NHS
and A&E
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Case Management not Treatment
• Assertive outreach and inreach• Overcoming pride and stigma• Advocacy• Access to psychiatrists and psychologists• Negotiating Pathways• Raising Awareness of Veteran issues – getting
them to ask the question• Hard to reach services, not hard to reach service
users.
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Partnerships
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• One of the first pilots• Drawing on my experience of the Tower
Project in Blackpool, but adapting the approach to veterans
• Equal focus on case management and awareness raising/education/care pathway development
• Real Assertive Outreach – never give up. • “Warrior Down” mentality• Many veterans involved with the CJ system
Partnership with NNT NHS
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• Build links with CJ Services– Probation– CRC’s– Police– Courts– Prisons
• Attendance at Mappa• More informed sentencing packages/sentence management• The veteran question• Increased attendance• Less escalation• Substance Misuse and MH improvements• Prison based service• Still a long way to go.
Criminal Justice work.
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• Veteran on Licence and Public Protection Order• Disengaged from Substance Misuse Services (opiate dependent and homeless)• Discharged from I/P MH services (PTSD and Self Harm)• Frequent non attender at probation – hence referral• Engaged by our service• Housed• Reinstated by Substance Misuse – with considerable support• Regular 4 way meetings at probation• Engaged with Finchale College (Veteran specific)
• Escalation (and prison) avoided• Re engaged with Services• PTSD and MH issues being addressed• Undertaking apprenticeship.• Back in touch with family.
Case Study
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•THE BEST JOB I’VE EVER HAD!!
• 24 Hour Helpline – 0800 138 1619
