Editorial
| DOI | https://doi.org/10.1108/JPMH-12-2016-0059 |
| Published date | 20 March 2017 |
| Pages | 1-3 |
| Date | 20 March 2017 |
| Author | Woody Caan |
| Subject Matter | Health & social care,Mental health,Public mental health |
Woody Caan
This special issue on veterans’mental health is fortunate to have a Guest Editorial by an
authoritative writer, Matthew Green. The issue includes both European and American research,
on the population defined by the department for work and pension as “ex-service personnel”,
in terms of care for mental illness and also related problems like drug addiction, social isolation or
poverty. For anyone involved in public health, I would highlight the work here of Megan Kelly and
her Veterans Health Administration colleagues on smoking. In terms of “stolen years”of life,
people with mental health conditions die on average 10-20 years earlier than the general
population and smoking is the single largest factor accounting for this difference (http://ash.org.
uk/information-and-resources/reports-submissions/reports/the-stolen-years/). Since the effects
of the Vietnam War first raised professional awareness of post-traumatic stress disorder (PSTD),
PTSD has been the focus of much research with ex-service personnel. Kelly et al. describe one
deadly interaction between mental illness and smoking: half the US veterans with PTSD smoke at
least 20 cigarettes a day, but few accept help for their entrenched tobacco use.
There is always public health concern about specific populations at risk of illness, such as
refugees who have endured trauma or loss (Caan, 2015). In this editorial, I will focus on how our
“special issue”came about. From my work on addictive behaviours, I knew vaguely that certain
occupational groups were at increased risk of dependence on alcohol or heroin. For example,
alcoholism used to be one of the most common health problems reported among doctors
(Stanton and Caan, 2003). In my public health role, I began to encounter local veterans, their
families and professional carers where their post-conflict drinking was a problem, often amplified
by domestic violence and difficulties with employment or housing, and sometimes ending in
suicide or imprisonment (Caan, 2012). A revelation came to me on 6 March 2012 at a national
conference on Health and Wellbeing initiatives. The responsible minister in the department for
work and pensions gave the keynote address. Back in 1918 and 1945, the post-war ministers
for pensions realised the need for comprehensive and sustained support for veterans. Of the
millions returning from the World Wars, many needed mental health care or employment
support, and a period of social re-inclusion. In 2012, the numbers were much smaller but the
minister seemed to believe that the existing civilian jobseeker services, including the new welfare
to work programme, would fit the needs (and assets) of survivors returning from recent trauma in
Afghanistan and Iraq. As it happened, I had recently done some research with Job Centre
advisors and their local Customers struggling with a routine range of mental illness. I saw the
Minister’s beliefs were, at best, implausible.
Why might veterans need services any different from people with routine employment histories?
In comparison to other professions studied, the Jubilee Centre for Character and Values has
identified that armed forces (on both sides of the Atlantic) expect that “all ranks should display
courage, discipline, respect, integrity and loyalty”and ultimately “soldiers may be required to give
their lives for their country”(Walker, 2016). Some problems begin during service, for example,
self-harm in young soldiers aged less than 24 years (News, 2016). Different personnel experience
different levels and likelihoods of danger, but typically being a veteran doubles the risk of
depression, and in one Australian study of people who had served in Vietnam, the odds ratio for
depression increased to 13.1 (Bonde et al., 2016). Among veterans of working age, SSAFA
(the Armed Forces charity) identifies a group growing in size “who are living in pretty desperate
circumstances”(Gregory, 2016). The NEL Commissioning Support Unit (2016) found that
working-age veterans were more likely to be suffering from depression than the UK population as
a whole. Among the men that have been in combat, there are specific increases in PTSD and
alcohol problems (Greenberg et al., 2016). The combination of PTSD with alcohol is especially
linked to violence (Greenberg et al., 2016).
DOI 10.1108/JPMH-12-2016-0059 VOL. 16 NO. 1 2017, pp. 1-3, © Emerald Publishing Limited, ISSN 1746-5729
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JOURNAL OF PUBLIC MENTALHEALTH
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Editorial
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