Media coverage of the crisis in Gaza may impact our armed forces communities.

The Military Veterans Service (MVS) and Op Courage North West TILS service remain committed to supporting our veteran communities and addressing any mental health difficulties people may be experiencing.

Strong emotional reactions are normal and there is no right or wrong way to feel about the continuing situation. This news may evoke distress, memories and dreams, particularly if you have previously been deployed, served with colleagues who have been deployed or are a family member of someone who was deployed. In uncertain times, it is common to feel unsettled and for some people, news and images may evoke very intense feelings.

If you or someone you know is affected by your time in the military and/or recent events concerning Gaza, and you are located in north west England, the Military Veterans Service and Op Courage NHS Veterans Mental Health and Wellbeing Service (TILS) North West are inviting you to contact them to discuss how they can best support you at this time.

General enquiries/referrals: 0300 323 0707 or the.mvs@nhs.net

Helpful things to do

We also provide a range of local, confidential services, from talking therapies to help with addictions that are provided by experienced and highly trained staff, many of whom are trained in armed forces community awareness or are armed forces community members themselves. You can access our community services page here.

Crisis information:

• At immediate risk of danger to life? Dial 999
• Struggling to keep yourself safe? Call NHS 111 or attend the A&E department at your nearest hospital.

24/7 support is available for you during a mental health crisis from the following:

• Freephone helpline: 0800 145 6570 if you’re a resident of Liverpool or Sefton
• Freephone helpline: 0800 051 1508 if you’re a resident of Halton, Knowsley, St Helens, Warrington
• Text ‘HEAL’ to 85258 if you’re a resident of Liverpool or Sefton and ‘REACH’ to 85258 if you’re a resident of Halton, Knowsley, St Helens, Warrington
• Samaritans: 116 123
• Combat Stress: 0800 138 161

Here is a table showing the hierarchy of roles across all four services. Below this table you will find a presentation giving more information about what the various roles actually involve.

Taking the Army as an example, the presentation below gives information about progression through the ranks and the kind of tasks and responsibilities for each role. Civilians might associate the role of Sergeant Major with a very loud person on the parade ground, but we learn from this presentation that Sergeant Major is a senior management role focussing on the welfare, training and discipline of the company and involving a great deal of project planning and management skills.

British Army Rank structure and roles

By asking specific questions about a veteran’s service career, you can find out useful information which may help when providing support –when they joined and why, and where they served.It is also well recognised by veterans themselves, the voluntary sector and specialist services that some people fabricate or embellish a forces history ( a ‘Walt’ or Walter Mitty’ as they say in the armed forces) and for all of these reasons it can be useful to request a veteran’s service record using the request template below.

Template request for service records

So useful general questions to ask a veteran or reservist are:

• What was/is their service number?
• What was their reason for discharge?
• What agencies (veterans and non-veterans) have they engaged with?
• Do they have a copy of their medical documents?
• Have they been injured due to service in the armed forces?

Some veterans may appear to have very high, or very low expectations of mental health services but their experiences of army health services may mean that they are not as tolerant as some other clients might be of perceived mistakes, lateness to appointments, barriers to treatment or ‘stuck’ points, as they are used to things happening exactly when they are told they will. You may not be able to deliver that but you can adjust their expectations and be careful to let them know if you are going to be late for an appointment, for example. If you can’t do what you said you would, explain this as soon as possible. Trust is likely to be earned and not a given. Be clear about your role and theirs to help manage expectations.

You may be asking them to talk about things that they have ‘pushed away’ for years and to experience difficult emotions which they have avoided at all costs for a long time. Their training supported this and may have been how they were able to continue to function and tackle the next challenge (see ‘BATTLE MIND’ above), not only as a way of coping themselves. Respect this, make sure you can provide the support they will need before they share difficult experiences and take things slowly. Remember that they may also be wary of being judged for things they’ve done or been part of in service and may be judging themselves vary harshly (see ‘Moral Injury’ under ‘Mental Health problems’ above)

As you would with any client, make sure you know your client’s key dates, anniversaries and triggers. Remember that, depending on their experiences whilst serving, your appearance or accent may trigger a trauma reaction. Don’t take it personally.

Don’t pretend to be an expert on everything military. You will be found out or tested further! Be an expert in your field and let them be an expert in theirs. Ask for clarification. Expect military ‘lingo’ (see attachment below). Some knowledge of this may be good but it’s not essential. The first few in particular may be helpful for engaging.

Some armed forces slang

How do you know you are not disadvantaging someone if you haven’t asked the question? Ask: “Have you or any member of your immediate family ever served in the armed forces?”

Don’t ask: “Are you a veteran?” as people often think about older people, heroes and the Invictus Games when they think about veterans and many ex-armed forces, particularly those who are younger or who have served for only a short period of time, won’t identify themselves with that term. Also remember that ex-armed forces can be any age, male or female and we also need to identify the families of ex-armed forces.

Some may be reluctant to acknowledge that they are ex-armed forces. This may be because they have experienced people reacting negatively or making negative assumptions about ex-armed forces. So it can help to explain that being aware of their veteran status can help you to get them the most appropriate care and support for their needs.​

RiO, CareNotes, IAPTus and PACIS users For mental health services, the Trust is required to submit the Mental Health Services Dataset, and within this there is a section which specifically looks at which of our service users are ex-armed forces or a family member. To help the Trust improve on this recording, the Business Intelligence Team have created reports which pull this data from the clinical recording systems so that for each clinical team we can see how many service users have been asked if they are part of the armed forces community. Your clinical record system asks you to record whether the service user is:

EMIS users For EMIS users the questions about veteran status are part of the Physical Health Data Set. Where the GP has already recorded this information on EMIS it will already be available to you and it is important that you note what has been recorded.

Where the information on veteran status has not yet been recorded, you will need to tick the drop down menu as follows:

Be aware that their GP may only/also have ticked the following:

Mental health problemsOne in four people can experience mental health problems in their lives and those who have been in the armed forces are no exception to this. Military veterans are not at increased risk of mental ill health but they may find it difficult to ask for help in civilian life.

The armed forces have been trained to work in teams and to rely on each other in their team to solve the problem … in order to survive, complete the project or face the danger. In civilian life some find it difficult to ask for help from others, such as health professionals, because it feels as if they are going outside the team and letting the team down. In some cases, they may not even recognise that they are experiencing difficulties.

Service personnel are exposed to events that others are not and so can be at greater risk of experiencing life threatening incidents.

During conflict, service personnel are required to respond rapidly in dangerous situations, to make split second decisions which may save or take a life. But when they are out of danger or out of service, some may question themselves about difficult decisions and actions. (Ref 4)

Research shows that the main problems that armed forces personnel face are common mental health disorders such as anxiety, low mood and problems around adjustment, and the research also tells us that veterans, especially if they have served in combat, are more likely to misuse alcohol. The overall incident rate for post traumatic stress disorder (PTSD) is around 5 percent in the armed forces which is not much different from the general population but this is likely to be higher for those who were in combat roles and the much higher rate of adjustment disorders than the general population may include some whose PTSD has not yet been diagnosed. (Ref 8)

The King’s Centre for Mental Health Research study looked at the incidence of PTSD in armed forces deployed in Iraq in 2003 n= 7700. Of these, 7 percent who had a combat role had probable PTSD and 3 percent of regulars had probable PTSD of which 50 percent were not in a deployed role. Of the reservists in this study, 6 percent had probable PTSD and in the North West as a whole there are approximately 6000 reservists and 6000 cadets.

PTSD does not just come about due to being deployed in combat. Soldiers can struggle with the experience of having a comrade die when they were safely at home or at base. People can be traumatised during peace keeping missions if they are exposed to atrocities and suffering ,or when deployed after environmental disasters, during training, in refugee situations, working in medical field hospitals fighting Ebola or behind the front line, in straightforward accidents or because they have been assaulted or raped. The concept of ‘Moral Injury’ refers to an injury to an individual's moral conscience resulting from an act of moral transgression and has been defined as “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.” (Ref 8)

Veterans’ mental health problems can have a major impact on family members and peers, as well as creating difficulties for the individual. Those veterans who suffer from mental health problems can often delay seeking help for many years after they have returned home from active service. They may become socially isolated and therefore harder for services to reach. If they do decide to seek help, they may find navigating civilian health and support services difficult due to the differences between these services and the support available in the military and may also be facing other issues such as problems with housing and finances.

Military Trauma (Ref 8)Military trauma is different. Being traumatised from being in a car crash is different from being traumatised in a situation where you are trained and required to deal with what may happen and the trauma. In the military the trauma tends to be severe and multiple and may involve IUDs, children and Hazmat suits.

When traumatised on peace keeping missions, soldiers may be traumatised associated with feelings of intense disgust, nightmares and flashbacks yet may never have felt their life was at risk. When dealing with the aftermath of a Tsunami soldiers again may never have felt that their life was at risk but were carrying out body recovery work and seeing horrific sights. They were also working outside their job role and expertise which may have made it particularly difficult.

Triggers can be very varied but for example:

• Fireworks and loud bangs
• Battenburg cake – smells like Semtex
• Barbecue smells – smells like burning flesh
• Screaming and crying from children – very common in war zones and has been used as an interrogation technique.

When triggered, soldiers can get ‘antagonised’ so that their body goes into flight, fight, freeze mode, cortosol is pumped into the blood stream and through the body and so heart rate goes up. They will get hot, breathe shallowly and rapidly and feel as if they can’t breathe. The armed forces are trained to eliminate the flight response. The freeze reaction is more likely to be evident if the veteran has also experienced childhood trauma when freezing was most appropriate.

Transition problemsSkills and competencies essential to combat and battle-ready alertness can cause difficulties for ex-armed forces or reservists making the transition home. Below are some of the issues which can arise:

‘Battle Mind’ – Combat skills making the transition home (Ref 9)

Addiction problemsDrug use is 17 percent compared with 1 percent in the general population and alcohol abuse is 30 percent compared with 26 percent in the general population. Incidences of problem gambling and risky thrill seeking behaviour are high possible due to the loss of high adrenaline experiences.

Physical health problems

• Musculoskeletal problems are higher in veterans than in the general population
• Hearing loss is common due to proximity to ordinance firing in spite of ear protectors
• Ex-armed forces also have a significantly higher incidence of mesothelioma than the general population
• Mild traumatic brain injury (mTBI) is common due to soldiers getting blown off their feet and getting concussion and there is a danger that this can go undiagnosed or be misdiagnosed as PTSD as there is no obvious sign of physical trauma. It presents similarly to PTSD as people have problems with sleep, managing emotions, memory, cognitive and functional impairment, so questions about whether they have had a known head injury, ever been knocked unconscious or if they struggle with impulsivity are important to ask.

The census of 2017 showed that there were 2.4 million ex-armed forces living in households across the UK. In 2018 a further 14,400 trained and untrained men and women left the armed forces followed by a further 15,230 by 31 December 2019. Despite the armed forces being 11% UK population, 20% of recruitment from the North West and 25% of the army infantry who are likely to experience combat. 6000 ex-military personnel return to the North West region every year.

People leaving the regular armed forces can leave under a range of very different circumstances, however, and these can be grouped into three categories:

1. Normal service leavers who are discharged when they have given notice to leave and have completed their term of service, or when they have been made compulsorily redundant.
2. Medically discharged leavers who have developed physical or mental health problems caused by, or made worse by, their service to the extent that it has affected their future in the services and a medical board have decided they need to leave. Some will be happy with the decision taken, others will not. Those who are unhappy with the decision may struggle to trust community support agencies when they return to civilian life and can sometimes avoid or delay seeking their help.
3. Early service leavers who have either:
   • been discharged compulsorily (as a result of alcohol/drug misuse, criminal acts, inefficiency, temperamental unsuitability – not ‘fitting in’) and therefore lose their entitlement to any resettlement provision
   • or leave at their own request, having completed less than four years’ service. Early service leavers leaving at their own request have the same discharge procedures as normal service leavers but often leave at extremely short notice without having the opportunity to plan their transition to civilian life.

Those in the volunteer reserve forces, formerly known as the Territorial Army, (Army Reserves, Royal Naval Reserves, Royal Auxiliary Air Force and Royal Marine Reserves) will have signed up for a set period of time when they joined the forces but can leave voluntarily at any time unless they have been mobilised and are on full time active service.

Support available to service leavers service leavers can access resettlement support up to two years before the date of discharge and each branch of the armed forces offers this. It usually begins months before their final day and includes advice about housing, education, finances and employment and the armed forces work with a number of agencies who provide advice .For some, however, their appreciation of why they might benefit from this can come too late but these agencies can also be contacted directly after discharge and include:

The Career Transition Partnership (CTP) delivers free resettlement services to all ranks of Her Majesty’s Armed Forces with the aim of easing the transition from military to civilian life. They help service leavers produce a CV, learn interview techniques, research the employment market and apply for jobs. Mersey Care is registered as an employer with CTP and posts non-clinical vacancies on the site.Website: www.ctp.org.uk/ctp or phone: 0207 469 6661.

The Career Transition Partnership Future Horizons Programme Future Horizons was developed specifically in response to the need to improve resettlement provision to early service leavers. The programme is open across all services, regardless of how long they have served or their reasons for leaving. The programme has been designed and is delivered by the RFEA, The Forces Employment Charity with the support of the CTP. Website: https://www.ctp.org.uk/futurehorizons

All early leavers should be registered with the programme automatically when they are discharged by their military unit discharge staff but can contact their CTP Future Horizons Employment Advisor closest to Merseyside at RRC Catterick. Phone: 01748 872900/01748 872949.

All ESLs should be registered with the programme automatically when they are discharged by their military unit discharge staff but can contact their CTP Future Horizons Employment Advisor closest to Merseyside at RRC Catterick: Tel 01748 872900/01748 872949

Jobcentre Plus Armed forces champions provides Jobcentre Plus support to veterans, service leavers, serving personnel within their resettlement period, spouses and civil partners of serving and ex-service personnel and can be accessed via their local job centre. Champions maintain close contact with Jobcentre Plus staff, who make the champion aware of armed forces issues and raise issues with them if requested. Champions are not always based in the jobcentre.

Defence Transition Services (DTS) is run by the MOD’s Veterans UK and provides information and support for those service leavers and their families who are deemed most likely to face challenges as they leave the armed forces and adjust to civilian life. By this is meant with severe physical or psychological disablement or those considered as having an enduring welfare need. DTS liaise with other government departments, local authorities, the NHS or trusted charities until the point of discharge and will continue to provide support into civilian life as needed on a case by case basis.

Ex-armed forces who are diagnosed with diffuse mesothelioma may be eligible to claim a one off lump sum or weekly/monthly war pension along with professional help, guidance and support to veterans and their dependants. Further information at https://www.gov.uk/guidance/help-for-veterans-diagnosed-with-diffuse-mesothelioma#how-to-claim

Veterans Welfare Service The Veterans Welfare Service is run by the Ministry of Defences’ Veterans UK and provides free one-to-one support to veterans or anyone supporting a veteran, their families and dependants and has a network of welfare managers across the UK. They work with the Royal Navy, British Army, Royal Air Force, local authorities, voluntary organisations, service charities and Veterans Advisory and Pensions Committees. See leaflet below for further information.

Veterans Welfare leaflet.pdf

Step into Health Step into Health provides a dedicated pathway for the Armed Forces community to access the numerous career opportunities available in the NHS. The armed forces community can create a profile on the system giving potential NHS employers information about the careers they are interested in and in what part of the country and they have access to work placements and information days put on by NHS employers. Mersey Care is a registered NHS employer with Step into Health and offers placements and apprenticeships: https://www.militarystepintohealth.nhs.uk/

Op COURAGE is an NHS mental health specialist service designed to help serving personnel due to leave the military, reservists, armed forces veterans and their families.

This service can help if you’re finding life difficult after leaving the military. Working together with Armed Forces charities, Op COURAGE will help you get the right type of specialist care, support and treatment for your specific needs.

Find out more on the NHS website.

Presentations from Training sessions provided to Mersey Care staff.

1. Creating a Military Veteran aware inpatient ward
2. The MVS and TILS – working with military veterans

1. Veterans IAPT Service
2. Op COURAGE

1. Veterans IAPT ServiceThese services are funded by CCG s and were set up across the country as specialist IAPT services providing psychological support for veterans who were unable to engage successfully with a generic IAPT service due to the nature of their service related difficulties. These veterans tend to be at the upper end of the severity level that an IAPT service would work with and often have multiple difficulties in their living and social situations so that veterans IAPT services also have social workers in their teams .

   Veterans in MindVeterans in Mind is the veterans iapt service for Cheshire and Merseyside apart from Liverpool and is delivered by Greater Manchester Mental Health NHS Foundation Trust (GMMH) in partnership with Combat Stress, Support and Management Solutions (S.A.M.S), the Armed Forces Community Support Hub and Veterans in Sefton.

   Referring to Veterans in Mind

   • You can refer directly to Veterans in Mind if they live in any borough covered by Mersey Care including Warrington, St Helens and Knowsley, excluding Liverpool as Liverpool CCG opted out of this service when it was last recommissioned. For Liverpool veterans who meet the criteria for IAPT, you should refer to Talk Liverpool  OR 
   • refer to the Transition, Intervention and Liaison Service (TILS) (see below) who will assess and direct your referral to where is most appropriate for the veterans needs.

Veterans in Mind

Tel: 0151 908 0019

Email: military.veterans@gmmh.nhs.uk

Web: www.gmmh.nhs.uk/military-veterans-services

If people don't feel they need a specialist service to help manage their mental health and wellbeing, the IAPT services are also available and will give ex-armed forces with a service related problem priority access to therapy.

NHS Talking Therapies offers free NHS therapy for people with common mental health problems like anxiety or depression, to help you change the way you feel by changing the way you think.

When you have your first assessment appointment with a member of our team, you will have plenty of time to talk through the treatment options in more detail to help you decide which one is right for you.

Most people find that online therapy or a wellbeing course is all they need to feel better, but if you still need extra help after completing these, we will then discuss further options that may be available to you.

Our easy to access, flexible therapy options are designed to suit your lifestyle.

Find out more about Talking Therapies at Mersey Care or refer here: https://www.merseycare.nhs.uk/talking-therapies

For Talking Therapies in Warrington call : 01925 401 720

2. Op COURAGE: Veterans Mental Health and Wellbeing Service

All ex armed forces community living in the North of England can access Op COURAGE through a single phone number and email: 0300 373 33 32 or by emailing OpCourageNORTH@cntw.nhs.uk (available 8am to 8pm, 7 days a week). For more detail, see the attached document.

Service life involves frequent deployments both home and abroad, and in 2019, eight percent of the armed forces were currently deployed abroad in 14 countries including peacekeeping, training, the Falklands etc., and the frequency of deployments and the disruption this causes to family life is the most cited reason given for leaving.

This picture shows the deployments around the world as of November 2019. 

People often sign up to the armed forces as a career expecting to do 20+ years but in the Army, only 1 percent will serve the full 22 years and the average age of a service leaver is just 29 years. Those service leavers may have been in the armed forces since they were 18 years old, however, and have had no experience of adult life outside the armed forces.

All service leavers face a big adjustment when they return to ‘Civvy Street’ and it can have a huge impact. Most negotiate this with few problems but for others it can be more of a challenge and can contribute to the development of mental health problems.

Why does leaving the services require such a big adjustment?Although frequent deployments affect family life, service life also means that accommodation, medical and dental care are provided, there is free access to fitness and sports facilities, and a job which brings good pay, self esteem and pride in the unit and its achievements.

Service men and women have a clear chain of command and a wide range of support for healthcare, spiritual needs, money concerns and all aspects of life and welfare. Welfare is a leadership responsibility and a chain of command function, so although each service has its own welfare organisations and structure, all commanders at every level are responsible for the welfare and wellbeing of the service personnel they command. They are part of a much bigger team who work together, often in difficult and dangerous situations. They are surrounded by comrades who share a common language and values and who they can always rely on for support and advice, to an extent that can seem incomprehensible to a civilian.

Most will negotiate the adjustment well but for others the return to Civvy Street can mean the loss of role and income which can lead to a loss of self-esteem. They may have had difficulty finding a job, somewhere to live and adapting to the whole process of paying bills, for example, rent, council tax and electricity for the first time. Even when they find a job they may find that they are earning less and are not used to having to budget carefully to pay for services that used to be provided for them without getting into debt. Even negotiating the health care system can be very different and some may not have registered with a GP.

Without their team around them sharing common goals and ways of working, the characteristics that were highly valued when they were in the services such as having a ‘can do’ attitude, not letting your mates down, stoicism and pride, can, for some people, all get in the way of seeking and accepting help, particularly for psychological and mental health problems, and studies have shown that when they do finally find their way to help, it can be many years after they have left the forces.

For some, joining the armed forces was an escape from a difficult and chaotic family life or circumstances and on leaving and losing the structure and support of their armed forces ‘family’, these early challenging experiences can make coping with the transition all the harder.

Circumstances that seem to make an unsuccessful transition more likely are:

• A difficult or impoverished childhood where joining the armed forces was an opportunity for not only survival, but economic mobility
• Childhood trauma experiences which can exacerbate a failure to seek help
• Unplanned or involuntary departure from the armed forces
• Experiencing leaving the armed forces without support as abandonment
• Immediate or delayed reactions to service-related mental health problems complicated by a level of avoidance or rejection of symptoms
• A feeling of loss of identity or self esteem
• Lack of employment and service skills which have not easily transferred to civilian employment

The challenges for families during armed forces serviceAlthough many civilian families experience separation due to work, for example, lorry drivers, oil rig workers, service families can experience unique challenges compared to their civilian counterparts.

Life for families in the armed forces can mean frequent moves and disruption to career, schooling and friendships. Although long periods of time without a family member is not unique, service families have to cope with the added elements of uncertainty and risk that come with service life, as well as the potentially challenging emotional consequences of both their serving member’s departure and return and whatever that brings with it as a consequence of their active service. (Ref 11)

The diagram shows the ‘Emotional Cycle of Deployment’ which was originally developed for naval families and is a helpful tool in understanding some of the common feelings and behaviours that are experienced by family members.

In practice, however, service family life encompasses a broad spectrum of experience, from families who enjoy the benefits service life has to offer, those who struggle with the challenges of relocation and separation, through to those who have to cope with injury, illness and bereavement. The majority of service families will operate somewhere in the middle of these experiences, depending on the service person’s career or their family’s circumstances.

When the serving family member leaves the armed forcesThis also involves a huge adjustment for their family who may also be leaving support networks behind and have to find their way in Civvy Street, and it is not just the serving member who has to negotiate the unfamiliar territory of renting or buying accommodation, finding work, new schools, finding health care and budgeting.

The stresses and strains of finding their way in the world again means that relationship difficulties and marriage breakdown within former armed forces families is not unusual and is a major cause of veterans becoming homeless. (Ref 4) Many armed forces families, particularly Navy families, now remain in the community and don’t live on base although not being surrounded by other families going through the same experiences has its down side.​

​​

“The first duty of Government is the defence of the realm. Our armed forces fulfil that responsibility on behalf of Government, sacrificing some civilian freedoms, facing danger and, sometimes suffering serious injury or death as a result of their duties. Families also play a vital role in supporting the operational effectiveness of our armed forces. In return, the whole nation has a moral obligation to the members of the Naval service, the Army and the Royal Air Force, together with their families”.

In whatever capacity they served, for however long, all members of the armed forces gave their willingness to die for their country.

“In return they deserve not only our respect and gratitude but also our constant attention to how they are treated and the impact that service life has on them and on their families.”

“Veterans … should receive priority treatment where it relates to a condition which results from their service in the armed forces, subject to clinical need.”

This means that unless there are people on the waiting list whose condition is more serious and need more pressing, a veteran with a service related problem, mental or physical, must go to the top of the list.

“Those injured in service, whether physically or mentally, should be cared for in a way that reflects the nations’ moral obligation to them whilst respecting the individual’s wishes. For those with concerns about their mental health, where symptoms may not present for some time after leaving service, they should be able to access services with health professionals who have an understanding of armed forces culture.”

One of the most common responses from veterans is “You are a civilian, you won’t understand.” Armed forces culture can act as a barrier to veterans needing help, and through our efforts to understand and appreciate the experience of ex-armed forces we can make it easier for them to accept help when they need it.

1. Armed Forces Covenant
2. The Armed Forces Covenant, Today and Tomorrow 2011
3. UK Armed Forces Quarterly Service Personnel Statistics, 1 January 2020, Ministry of Defence, Published 20 February 2020
4. SAMH (2009) Life Force: A Practical Guide for working with Scotland's Veterans
5. ‘The Overlooked Casualties of Conflict’ Report, (2009) The Royal Navy and Royal Marines Children’s Fund Ministry of Defence UK Armed Forces Families Strategy 2016 https://nff.org.uk/wp-content/uploads/2017/01/Homeport-pull-out-Making-Sense-of-the-Emotional-Cycle-of-Deployment.pdf
6. Creating a Military Veteran aware inpatient ward (November 2019) Dr Alan Barrett, Consultant Clinical Psychologist, Clinical Lead for TILS, Pennine Care NHS Foundation Trust
7. Military Veterans Service: Introduction to the Transition, Intervention and Liaison Service (2018) C Barry, Pennine Care NHS Foundation Trust
8. Armed Forces Awareness Training 2019
9. Gov.UK – Jobcentre Plus services for the armed forces and their families.