Pathways into mental health care for UK veterans: a qualitative study

Figures & data

Table 1. Socio-demographic characteristics of the sample.

Participant	Age	Ethnicity	Employment status	Relationship status	Children	Rank at exit	Service	Years in Armed Forces	Years since retiring
1	56	White British	Signed off sick	Single	Yes	Corporal	Army	18	22
2	32	White British	Signed off sick	In a relationship	Yes	Senior Aircraftsman	RAF	9	5
3	43	White British	Retired	In a relationship	No	Sergeant	Army	15	12
4	56	White British	Retired	In a relationship	Yes	Sergeant	Army	13	12
5	48	White British	Signed off sick	Married	Yes	Corporal	Army	14	6
6	53	White British	Self-employed	In a relationship	No	Guards Man	Army	8	29
7	33	White British	Full time	Married	Yes	Private	Army	13.5	3
8	57	White British	Signed off sick	Single	No	Corporal	RAF	22	17
9	47	White British	Unemployed	In a relationship	No	Private	Army	6	24
10	57	White British	Full time	Married	Yes	Lance Corporal	Army	13	25
11	68	White British	Retired	Single	Yes	Corporal	Army	8	40
12	68	White British	Self-employed	Single	Yes	Private	Army	5	47
13	39	White British	Unemployed	Single	Yes	Corporal	Army	7	11
14	43	White British	Full time	Married	Yes	Lance Corporal	Army	6	21
15	57	White British	Unemployed	In a relationship	Yes	Sergeant	Army	15	27
16	53	White British	Unemployed	Single	Yes	Private	Army	5	31
17	60	Black Caribbean	Unemployed	Single	No	Corporal	Army	9	36

Table 2. Scores from standardized measures.

Participant	PHQ-9	GAD-7	PCL-C	AUDIT-C
1	15*	16*	70*	4
2	26*	21*	67*	5*
3	25*	21*	80*	7*
4	19*	14*	71*	12*
5	17*	15*	62*	1
6	15*	18*	46	0
7	9	10*	34	2
8	20*	21*	70*	9*
9	10*	7	20	6*
10	10*	7	37	0
11	10*	5	33	6*
12	9	7	42	7*
13	13*	16*	66*	5*
14	12*	11*	48	7*
15	17*	6	42	12*
16	23*	20*	73*	4
17	20*	10*	48	0

* = clinically significant level of depression and anxiety or above threshold for PTSD or alcohol problems

Table 3. Barriers and enablers to initial help-seeking and pathways through treatment.

Domain	Theme	Number of participants	Supporting quotations
Barriers to help-seeking	a. Insight/readiness to change	17	‘I wasn’t sure that there was something wrong’ [P14] ‘I thought I had irritable bowel syndrome, high blood pressure and stress … but as its transpired over the years … I had Post-Traumatic Stress Disorder’ [P10] ‘I realized there was a problem there, but I didn’t know who to turn to’ [P11]
	b. Self-stigma	13	‘I felt very embarrassed’ [P8] ‘I just thought I was going mad’ [P15] ‘It was a weakness’ [P13] ‘I thought I was a loser … you know I was useless’ [P2]
	c. Public stigma	15	‘You say PTSD and people think you’re a walking time bomb’ [P13] ‘Civilians do not have a clue, they don’t understand and straight away they will judge’ [P3] ‘It worried me that everybody would think that I was bluffing it, even though I wasn’t, so I just carried on and on and on’ [P5]
Enablers to help-seeking	d. Internal resources	14	‘I’m thinking I’m going to give myself a bit of a better chance’ [P6] ‘Laughter does help you get through these kind of things’ [P14] ‘My willpower at the end of the day’ [P10]
	e. Media/advertising	9	‘I literally just kind of googled it’ [P1] ‘I’m still on servicemen networks through Facebook’ [P8] ‘You’ll be amazed what you can learn off the TV’ [P3]
	f. Risk of not help-seeking	17	‘I was putting myself in some very dangerous situations, with some highly dangerous people, and I didn’t care about it’ [P4] ‘I said [to myself] “if you don’t get help here, Mate, you’re going to prison”’ [P8] ‘I tried to take my life’ [P1] ‘I lost my job, um, I lost my flat, and in fact, I was homeless’ [P17] ‘I was trying to commit suicide at least 3–4 times per week’ [P10]
	g. Support from others	14	‘I had a very supportive wife all the way through’ [P10] ‘I’ve had a lot of encouragement off friends, my partner’ [P3] ‘A couple of my best mates that I grew up with just dragged me down there one day and said “look you’ve got to sort this man out”. Interviewer: And would you say that without that support network you probably wouldn’t have got help when you did? Participant: I’d be dead by now, I know that. There’s no ifs and buts about that’ [P6]
Barriers to pathways through treatment	h. Practical	11	‘It took three months to see a nurse, three months to see a psychiatrist by which point things are getting worse’ [P1] ‘When you ring sometimes they don’t ring you back’ [P7] ‘Initially it was a phone call saying what’s the matter … it was very cold, there was absolutely no empathy’ [P4] ‘I sometimes have issues on public transport … I was driving, but I just found I was getting wound up on the way there, so I thought the only other way to get there is the tube which I don’t use during busy hours’ [P13]
	i. Health services and professionals	17	‘He just dismissed those [flashbacks] as night terrors’ [P1] ‘It’s not that they don’t want to help you, it’s that they don’t understand what to do’ [P10] ‘I wasn’t being treated for my problems’ [P9] ‘Uncaring temporary staff, and an absolute lack of any kind of therapy … no occupational therapy, no group therapy, no one-to-one, nothing at all’ [P1]
Enablers to pathways through treatment	j. Diagnosis	15	‘A welcome relief for me, it was absolutely inspiring for me, it changed my life’ [P15] ‘It was like a balloon being let down, all that pressure gone, the weight was lifted’ [P9] ‘It just clarifies things’ [P16] ‘It gave me justification that I wasn’t going completely insane’ [P1]
	k. Health services and professionals	17	‘I went to see my GP, um, who was amazing’ [P1] ‘He looked on the internet at the time’ [P7] ‘They gave me a number to ring up all the time, I kept getting the weekly visits from the regional welfare officer, and probably every couple of months from the community practice nurse … Nothing was too much trouble for them. Absolutely nothing’ [P10] ‘She’s really understanding … they were so quick and straight in’ [P15]
	l. Military environment	17	‘I could take it from him being an ex-major in the Army, and it was the first time I had heard an Army guy say to me “it’s nothing to be ashamed of, it’s not your fault, let X sort it out for you”, and that was sort of easier for me to take on board’ [P11] ‘She seemed to understand a lot of military terms, so she got it where I was coming from’ [P12] ‘It was very eye opening, all of a sudden there were a whole bunch of guys that were just like me, that were human beings that had thought they were indestructible, um, and that for a whole gamut of different reasons, had kind of fallen down … And the staff there were incredible … I realized that I kind of wasn’t alone, and that there was a whole world out there of people that were struggling with similar issues’ [P1]