| | Improving The Delivery Of Cross Departmental Support And |
| | 0,68 | | MB | Services For Veterans |
| | 189 | | stron |
| | 3841 | | ID | King’s College |
| | 2003 | | rok |
| | List of contents |
| | List of contributors.i |
| | List of contents.. ii |
| | List of tablesvi |
| | List of figures ..vi |
| | Executive Summary .. vii |
| | 1 Introduction.. 1 |
| | 1.1 Aims 1 |
| | 1.2 Objectives . 2 |
| | 2 Analytic strategy and methodology.. 5 |
| | 3 Policy context and strategic questions . 7 |
| | 3.1 The Policy context in international perspective 7 |
| | 3.2 Strategic approaches to veterans issues. 8 |
| | 3.3 Strategic questions confronting veterans’ policy: . 12 |
| | 3.4 Definitions advantages and disadvantages:.. 14 |
| | 3.5 Why care for veterans? 16 |
| | 3.6 What should veterans get?. 17 |
| | 3.7 How to develop strategic change in partnership with veterans: a question of trust. 18 |
| | 3.8 Working for the future? .. 18 |
| | 3.9 Approaches to veterans issues: the international dimension 19 |
| | 3.9.1 National culture and approaches to veterans .. 19 |
| | 3.9.2 Veterans policy, research and analysis: based in or outside MoD? .. 22 |
| | 3.9.3 Monitoring and caring for troops . 23 |
| | 4 A Systematic UK literature review on outcome for veterans . 31 |
| | 4.1 Method 31 |
| | 4.2 Introduction.. 31 |
| | 4.3 Mental Health.. 32 |
| | 4.3.1 World War Two 32 |
| | 4.3.2 The Korean War 32 |
| | 4.3.3 The Falklands War .. 32 |
| | 4.3.4 Persian Gulf War .. 33 |
| | 4.3.5 UK Peacekeepers.. 35 |
| | 4.4 Tours of duty in Northern Ireland . 35 |
| | 4.5 Mortality/Suicide 36 |
| | 4.6 Alcohol 37 |
| | 4.7 Crime 38 |
| | 4.8 Homelessness .. 38 |
| | 4.9 The Transition Process 41 |
| | 4.10 Employment . 42 |
| | 4.11 Conclusion. 42 |
| | 5 Overview of world literature on veterans: mental health and social outcomes 45 |
| | 5.1 Introduction .. 45 |
| | 5.2 Method 45 |
| | 5.3 Combat related psychiatric injury. 46 |
| | 5.3.1 US studies: Second World War: long term outcomes 46 |
| | 5.3.2 Vietnam veterans .. 50 |
| | 5.3.3 Comparison studies . 56 |
| | 5.3.4 Gulf war veterans: initial follow-up 58 |
| | 5.3.5 Gulf war veterans: Later follow-up . 59 |
| | 5.3.6 Israeli Veterans .. 61 |
| | 5.4 General outcomes: non-combat related .. 64 |
| | 5.4.1 European Veterans .. 64 |
| | 5.4.2 Peace Keeping Operations .. 65 |
| | 5.4.3 Other psychiatric outcomes of serving.. 67 |
| | 5.4.4 Delayed PTSD: does it exist?. 67 |
| | 5.4.5 Chronicity of post-combat symptoms/syndromes 69 |
| | 5.4.6 Health Outcomes for Female Veterans . 70 |
| | 5.4.7 Mental Health Outcomes for Special Groups 71 |
| | 5.4.8 Attrition. 71 |
| | 5.4.9 Transition . 72 |
| | 5.4.10 Suicide: Introduction.. 72 |
| | 5.4.11 Suicide rates in Nordic countries . 73 |
| | 5.4.12 Suicide: Canada . 74 |
| | 5.4.12 Suicide: US .. 74 |
| | 5.4.13 Suicide: Italy .. 75 |
| | 5.4.14 Alcohol and Drug use: US .. 76 |
| | 5.4.15 Alcohol and Drug use: Norway. 77 |
| | 5.4.16 Homelessness: US 78 |
| | 5.4.17 Homelessness: Australia .. 80 |
| | 5.4.18 Crime and Prison: US . 80 |
| | 5.4.19 Family life: Context 82 |
| | 5.4.20 The family dynamic and children. 83 |
| | 5.4.21 Service Wives. 85 |
| | 5.4.22 Marital Relationship 86 |
| | 5.4.23 War and Service Widows . 87 |
| | 5.4.24 Employment and Education: World War Two Germany. 87 |
| | 5.4.25 Employment and Education: World War Two US.. 88 |
| | 5.4.26 Employment and Education: World War Two Japan. 89 |
| | 5.4.27 Influence of psychiatric injury on occupational attainment 89 |
| | 5.4.28 Military service: benefits and influence on the life course . 90 |
| | 6 Stakeholders views .. 93 |
| | 6.1 Stakeholder interviews 93 |
| | 6.2 The ‘dependency culture’ .. 94 |
| | 6.3 Alcohol use 94 |
| | 6.4 Civilian- military understanding . 95 |
| | 6.5 Modern day veterans 95 |
| | 6.6 Veterans’ perceptions of themselves 96 |
| | 6.7 Medical problems .. 96 |
| | 6.8 Number of veterans organisations . 96 |
| | 7 In-depth qualitative veteran interviews. 97 |
| | 7.1 Introduction.. 97 |
| | 7.2 Identity issues .. 97 |
| | 7.3 Positive attitudes and a concern about resettlement. 98 |
| | 7.4 The Second World War generation.. 99 |
| | 7.5 Problems for personnel discharged for medical reasons . 100 |
| | 7.6 Housing, employment and related problems. 100 |
| | 7.7 Wives of service personnel in employment .. 101 |
| | 7.8 Veterans and veterans’ organisations 102 |
| | 8 Data from existing KCL Military Cohort: a study of leavers . 103 |
| | 8.1 Introduction 103 |
| | 8.2 Method . 105 |
| | 8.2.1 Initial survey (phase 1) .. 105 |
| | 8.2.2 Follow-up 2001 (phase 3) 105 |
| | 8.2.3 Measures (Phase 1 and 3) . 106 |
| | 8.3 Design 106 |
| | 8.4 Statistical analysis .. 107 |
| | 8.5 Results .. 109 |
| | 8.6 Characteristics of leavers at phase 1 . 109 |
| | 8.7 Predictors of leaving.. 109 |
| | 8.8 Associations and predictors of employment . 110 |
| | 8.9 What happens to symptoms after leaving?. 110 |
| | 8.10 Discussion .. 111 |
| | 8.11 Limitations of study .. 112 |
| | 9 Telephone follow- up survey of ‘at risk veterans’ . 113 |
| | 9.1 Introduction 113 |
| | 9.2 Areas of enquiry:. 115 |
| | 9.3 Qualitative data 116 |
| | 9.4 Materials and Methods. 116 |
| | 9.5 Population and sample . 116 |
| | 9.5 Methods 117 |
| | 9.6 Measures used .. 118 |
| | 9.7 Statistical Treatment of Results 118 |
| | 9.8 Emerging Findings . 119 |
| | 10 Conclusion I Next steps: interim suggestions for policy.. 129 |
| | 10.1 The Veterans Agency 129 |
| | 10.2 The 'Dependency Culture' .. 130 |
| | 10.3 Resettlement .. 131 |
| | 10.4 Targeting at Transition. 132 |
| | 10.5 Public Relations 133 |
| | 10.6 Mental Health 133 |
| | 10.7 Cross-Departmental Education 134 |
| | 10.8 Local Authorities and Veterans 134 |
| | 10.9 Housing 135 |
| | 10.10 Communication with Veterans 135 |
| | 11 Conclusion II Researchable questions 137 |
| | 11.1 Introduction 137 |
| | 11.2 Research and policy .. 137 |
| | 11.3 The architecture of research.. 138 |
| | 11.4 Why is there so little to go on? . 140 |
| | 11.5 A research agenda for veterans 141 |
| | 11.5.1 A life course approach 141 |
| | 11.5.2 Related questions .. 144 |
| | 11.5.3 Sub groups 145 |
| | 11.6 Screening. 145 |
| | 11.7 Improving outcomes.. 146 |
| | 11.8 Mental health treatment 148 |