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Mental Health Frontline: a nurse's view

Our Mental Health Frontline series gives a voice to the people working directly with those facing mental health issues. 

Research into military mental health has been a fascinating area of progress and discovery, with Kings College London’s ‘Centre for Military Health Research’ at the forefront for gaining a better understanding and improving policy and care for the mental health of people who have experienced war.

Mental health nurse Andy Walton works with veterans, he writes about how evidence-based approaches give him confidence in his practice – and the areas where further research is needed. 

It takes great strength and courage to speak openly, often for the first time, about something still so raw, vivid and distressing. As a mental health nurse working with veterans, I appreciate the privileged position I am in when sitting down with people as they go through the deeply personal process of opening up about their unique story of combat and their resulting struggles in civilian life.

Working within a Community Outreach Service for military veterans, I am often the first mental health professional they have seen. I understand that a key responsibility in developing insight, engagement, and inspiring hope of recovery can be down to this first encounter. 

I refer veterans for treatments like mindfulness and trauma-focused Cognitive Behavioural Therapy to help them cope with conditions like Post Traumatic Stress Disorder. It gives me confidence in my practice, knowing that others have benefited from such interventions before. I feel proud and privileged to work and support those who have risked their lives for our country.

Careful monitoring and reporting underpins care delivery for PTSD, making sure we are able to measure the effectiveness of treatment. Producing reports from our cohort of veterans helps to further develop insight into their needs and what treatments work. 

I would like to believe that there is a growing movement towards a more open and real conversation about mental health. And this is something we are seeing with veterans - those deployed in Iraq and Afghanistan are coming forward asking for support quicker than any other military group that has gone before, which is an example of how attitudes are changing. 

In the last 20 years, the amount of time it has taken for veterans to contact the service has reduced from 24 years in 1994 to under 12 years in 2014, and for Iraq and Afghanistan veterans the period is 4 and 2 years respectively. 

This shows that more and more veterans are coming forward earlier to acknowledge things are not quite right. Veterans are often doing their best to manage but may lack proper insight into why they are struggling with symptoms like vivid reliving of combat.

Often instinctive - but destructive - maladaptive coping such as avoidance or substance misuse are developed. These behaviours can then become entrenched as they offer short-term relief but ultimately they only add to the problem. 

We need to raise awareness and insight into early warning signs, educate veterans regarding symptoms, triggers and importantly, provide positive ways of coping at an early stage.

I would like to see more research into the barriers and challenges that exist preventing someone from recovering. We need to develop effective processes for early interventions – having an even stronger evidence base of what works at the early stages of one’s struggle could transform a person’s life for years to come.

Andy is a mental health nurse with lived experience of anxiety. You can read more on his blog nowandafterwards.com, where he writes about anxiety and anxiety management. 

Last updated: 20 April 2017

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