What helps veterans successfully manage post-traumatic stress?
The following blog summarises my doctoral research thesis which was titled ‘Veterans’ experiences of successfully managing post-traumatic stress disorder’. It took 2 years (the joys of academia…) but we did manage to get the paper published in the Mental Health Review Journal. Hope you find the post interesting and useful.
Key points
It is hard for veterans to accept and talk about mental health difficulties such as post-traumatic stress, due to stigma around problems with emotions and mental health.
If these problems are not addressed this can lead to a downward spiral where veterans continue to get worse until they reach rock bottom.
Accepting that post-traumatic stress is a problem and taking responsibility for replacing unhelpful coping strategies with more helpful ones allows veterans to gain control over symptoms.
Talking about post-traumatic stress is an important step for managing it, but this depends on talking to the right people, i.e. people who understand military related difficulties and how to help.
Talking to other veterans with experience of post-traumatic stress is highly beneficial, as they understand and will not be judgmental.
Mental health services specifically for veterans are a useful resource, as they are more tailored to meeting veteran’s needs than civilian services.
Civilians and civilian services are a source of stress that can make post-traumatic stress harder to manage. This can make it more difficult for veterans to access the help and support that they need.
Having a plan for managing symptoms of post-traumatic stress is essential. It is important to be committed to building a personalised toolbox of strategies that work, as there is no easy ‘cure’ for post-traumatic stress and managing it effectively requires hard work.
The veterans in this study felt it was essential to be open to new ways of expressing emotions that they hadn’t considered previously, for example through art, music and other creative activities.
Being involved in veterans’ organisations in the community was a vital coping resource, as it gave a sense of identity, belonging and purpose that some veterans had not experienced since their military days. This also opened up opportunities to help other veterans with similar difficulties, which was a big factor in helping them manage their own mental health.
Why we did the research
Post-traumatic stress is recognised as a significant problem for military personnel and veterans, particularly during times of active conflict. For some veterans, this makes settling back into civilian life after military discharge harder and affects their health and career prospects for the future. Veterans have reported that they find it hard to get the right help for their mental health, due to stigma around talking about emotions and mental health, and because civilians don’t always understand the military experiences that led to their problems. Not getting the right help and coping with post-traumatic stress alone can have concerning consequences for veterans and their families. This can include avoiding problems and becoming withdrawn, drinking alcohol excessively to cope, aggressive behaviour, relationship problems, breakdown of the family and in some cases suicide.
To provide support and treatment that helps veterans manage post-traumatic stress, it is important to listen to veteran’s views on what helps them the most. This could help other veterans experiencing similar problems to know what to do, and help civilian healthcare professionals understand their problems better to offer them the right support. There is very little research out there currently that covers this from a veteran point of view.
What the research involved
Taking part in the research involved a small number of veterans talking to the main researcher in a lot of detail about their experiences of managing post-traumatic stress. The veterans who participated were contacted through veteran community organisations including Veterans In Communities (VIC) and Dig In North West. These organisations kindly agreed to help the researchers find veterans with experience of managing post-traumatic stress.
The findings
There were three main themes in the findings, which are described below. Where words are in “quotation marks” they are the veterans own words.
Theme 1: Accepting the problem, taking responsibility and gaining control
Difficult transition
Most of the veterans had not planned to leave the military when they did, which made the transition to civilian life harder. One veteran said their mind was “caught somewhere in between the military and civilian world”. The loss of military structure and identity was hard to cope with. Some felt that the military had not offered much support or resettlement to help them transition, which was disappointing after what they had put into their service.
In denial
Initially most veterans didn’t recognise that they had problems with post-traumatic stress or their mental health. Some described being “in denial” for a long time, and did not accept or talk about the strong emotions they were experiencing. They explained this by saying it was the military way of coping with emotions, and they had been taught to “suck it up soldier” and “grit your teeth and carry on”. They felt that coping by talking about emotions and problems would have put them at risk of appearing weak or unable to do their job. Unfortunately this meant that emotions got “bottled up” and some veterans were coping in unhelpful ways, such as by putting themselves and others at risk of serious harm or drinking excessive alcohol, which had a negative effect on their relationships and made their problems worse.
Hitting rock bottom
Most veterans described being stuck on a downward spiral which eventually reached “rock bottom”. Some felt suicidal at this point and knew they needed to do something about how they felt or they would become “another statistic”. Suicide wasn’t an option, as the veterans felt they couldn’t do that to their families. At this point they were still reluctant to ask for help, but friends or family members encouraged them to do this or contacted mental health services on their behalf.
Accepting the problem
Some veterans reported that a big step in their journey towards managing post-traumatic stress was accepting that it was a problem for them. This was difficult as it meant facing what they had previously denied and taking responsibility for how they were coping with it. Accepting the problem allowed them to learn more about post-traumatic stress and connect how they were feeling to past events in the military. This helped them challenge beliefs that experiencing post-traumatic stress was a weakness and discover new coping strategies that could help with this problem. When they took responsibility for replacing unhelpful ways of coping with more helpful ones, some felt they had more control over the symptoms of post-traumatic stress and the impact it had on their life.
Theme 2: Talking to the right people
Being able to talk to someone about their experiences and how they were feeling was important for learning to manage emotions and symptoms. However, this depended on “talking to the right people” because not all contact the veterans had with others was helpful.
Veterans
Other veterans with similar problems were the ideal people to talk to, as participants could speak without fear of judgement and knew they would be understood. Informal environments that didn’t involve “questions and answers” meant they could talk at their own pace and use “banter” to cope with intense emotions. They also preferred to see ex-military professionals if possible, such as doctors and liaison officers within their local council. This was due to ex-military professionals being calmer, more able to understand their problems and reliable at following through on what they said they would do.
Civilians with military understanding
Most participants of the study were referred to veteran specific mental health services, where they found that practitioners had a good understanding of military experiences and problems. This meant they could relate to practitioners and made the contact helpful for them. Therapists from these teams were patient and relaxed, allowing participants to open up at their own pace and say all they wanted to say. Some said it was helpful that appointments were regular and continued for as long as needed, rather than being limited to a small number from the start like in civilian services. Having military understanding meant practitioners were sensitive when asking about traumatic experiences and potential risks of harm to themselves and others. Once participants had the chance to talk about their difficulties with someone they could relate to, they appreciated being given clear information about their problems and advice on what to do about them.
Civilians who show an interest
Even though most civilians in society were not familiar with veterans’ military experiences, some did show an interest and appreciation for what veterans had done for their country. One veteran had talked to school children about what it was like to be a soldier and some others had contact with mixed civilian and veteran groups, which worked well as it improved civilian understanding of veterans. However not all of the veterans had positive experiences of connecting with civilians.
Civilians with no military understanding
Most of the veterans experienced problems communicating with civilians who lacked understanding of the military setting and post-traumatic stress. Within civilian mental health services some felt rushed and that practitioner’s questions or responses were not sensitive or helpful. Some felt civilian health care systems were not set up to help veterans, as therapy appointments were limited and they couldn’t access therapy if they had physical health problems that also needed attention. Financial and practical support was difficult to access as agencies that arrange this did not have an understanding of veterans’ problems. Some found it hard to trust government agencies such as those who assess people for benefits, due to the stress experienced when contacting them. One veteran commented that this made the Armed Forces Covenant seem like a “rubber stamp activity”.
Participants saw a divide between themselves and civilians, and described contact with civilians in society as a source of stress that made post-traumatic stress harder to manage. They believed that civilians take risks that put others in danger, have no sense or logic in the way they do things and focus too much of their energy on trivial matters. Two veterans felt that civilians deliberately tried to make them angry. In general participants didn’t feel that their military service and what they had endured was recognised or appreciated by civilians, and this made it hard to reintegrate into civilian life.
Theme 3: Strategies to manage symptoms
The veterans reported that there was no easy cure for post-traumatic stress and it was not always possible to predict when symptoms would be triggered. However having a plan in place could help manage symptoms when they happened and make them feel more prepared.
Practical coping strategies
The plan for managing symptoms was made up of practical strategies that veterans had been taught or had discovered over time. They needed to be open to trying different ways of coping and practicing them consistently to find out what worked for them. The strategies that were helpful are summarised in the following diagram.
Creative ways of managing emotions
Most of the veterans also found it helpful to try ways of expressing emotions that they would not have considered previously. This involved creative methods of expressing feelings without talking, such as art, gardening, song writing and metal work. Some said this helped them challenge the idea that emotions were a weakness, as they could make use of their emotions to gain something new and positive in their life. This was so valuable that one veteran said “art to me is better than any medication. In fact since I started doing it I’ve come off a lot of medication”. Another veteran said that using creative ways to manage emotions was an “antidote” to the problems they were experiencing.
Getting involved in veteran communities
Most of the veterans felt that attending community organisations and groups with other veterans was an essential part of their recovery. Although it was hard to go along initially, they quickly found that it gave them a sense of belonging that compared to their military days. In time some veterans took on paid or voluntary roles within these organisations, which allowed them to use what they had learned to help other veterans. They found this therapeutic and it gave a sense of identity, purpose and responsibility that made their life more meaningful.
What happens next?
This study was written up as a formal report and published in an academic journal. The report contains recommendations for changes that would help veterans access better help in future. These include:-
Encouraging veterans who leave the military with post-traumatic stress to access support before they hit “rock bottom”. There are several ways this can be done, including:-
1. Better links between the military and veteran community organisations, so that on discharge veterans can be pointed towards these organisations. Then they could meet other veterans who can help them adjust to civilian life and identify if they may need help with their mental health.
2. When veterans register with GP surgeries on discharge, being asked about military service and mental health at this point is essential. GP surgeries need to be aware of resources for veterans within the community and mental health services. This could be done through providing training to GP’s and other medical professionals that veterans may have contact with.
The NHS and Royal College of GPs have introduced a programme to accredit GP practices as ‘veteran friendly’ to facilitate recognition of veterans and military attributable difficulties within a given practice. This includes online training, support and advice around veteran issues and referrals. More information on this, including a list of veteran friendly GP practices here.
3. It would be helpful if the NHS England veteran’s webpage had details of community peer support services that veterans can access as an alternative or in addition to accessing NHS mental health service treatment.
Considering the value of speaking to other veterans about problems such as post-traumatic stress, offering group treatment to veterans within NHS services would be valuable. It may be especially useful if these groups are ran by veterans who are trained for this purpose, and are held in informal settings within the community.
It would be beneficial for a guide to be produced by veterans for other veterans who leave the military, letting them know how to manage difficulties such as adjusting to civilian life and managing post-traumatic stress. This could be done in collaboration with NHS services or veteran community organisations.
Acknowledgements
Thank you to the veterans who took part in this study. Their honesty, courage and strong desire to help other veterans with similar difficulties was beautiful to see. Thanks also to Bob Elliott and Liz Davies at Veterans In Communities (VIC), Donna Rowe-Green at Dig In North West and Dr Jen Pomfret from the Peer Mentoring Group at the Military Veteran’s Service for helping the researchers find veterans who were willing to take part. Finally thank you to my supervisors and co-authors for the paper – Dr Suzanne Hodge and Dr Alan Barrett.
More information
I have more information about veterans’ mental health on my veterans page here.
Reference
Parry, G., Hodge, S. M., & Barrett, A. (2021). Veterans’ experiences of successfully managing post-traumatic stress disorder. Mental Health Review Journal.
Full paper here.