City Health Conference & Paolo Pertica Award Presentation

1. Dave Marsden, - Combat Stress,
Seconded from Newcastle, Tyneside
and Northumberland NHS

2. • 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.
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COMBAT STRESS

3. 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”

4. • 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
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The Challenge.

5. • 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

6. 6
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.

7. 7
Partnerships

8. • 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
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Partnership with NNT NHS

9. • 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.
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Criminal Justice work.

10. • 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.
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Case Study

11. •THE BEST JOB I’VE
EVER HAD!!
• dave.Marsden@combatstress.org.uk
• 24 Hour Helpline – 0800 138 1619
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