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Title: Experiences of serving personnel and veterans conceptualising their difficulties and accessing mental health services
Author: Gayson, Charlotte
ISNI:       0000 0004 9359 1312
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2020
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This thesis explores various factors that impact accessing services for mental health difficulties within Armed Forces serving personnel and veterans. There are approximately 2.4 million veterans estimated to be residing within Great Britain (Ministry of Defence [MOD], 2019) and 18 million veterans in the United States (US; US Census Bureau, 2018). It is documented that veterans have a higher prevalence of mental health difficulties than the general population (VA Department of Veterans Affairs, 2018). This increased risk of developing mental health difficulties may be due to exposure to traumatic events (Vogt et al., 2014), although the explanation is more complex and there are likely multiple factors. Common mental health disorders (CMDs) are the most prevalent mental health condition (21.9%) in UK Armed Forces personnel, followed by alcohol misuse (10%) and post-traumatic stress disorder (PTSD; 6.2%) (Stevelink et al., 2018). This illustrates an increase in CMD and PTSD compared to a previous representative study which reported CMD and PTSD at 19.7% and 4% respectively (Fear et al., 2010). In US, PTSD prevalence estimates range from between 11% and 30% depending upon service era (VA Department of Veterans Affairs, 2018). However, within a help-seeking veteran population, PTSD is the most reported mental health difficulty (82%, Murphy, Ashwick, Palmer, & Busuttil, 2019). Consequently, a global increase in the diagnosis of military-related PTSD has been documented (Chandra et al., 2011). In addition to the prevalence rates above, within the UK Armed Forces TBI prevalence is estimated to be 4.4%, rising to 9.5% in those with a combat role 9.5% (Rona et al., 2012) and co-morbidity of health outcomes is high within military population (Murphy et al., 2019). Nevertheless, it is estimated that 60-80% of Armed Forces personnel with a mental health difficulty do not seek help (Hines et al., 2014; Sharp et al., 2015), and of those that do, they often experience poorer treatment outcomes than the general population (Murphy et al., 2017). Mental health beliefs and models of health and illness are subjective (Hughner & Kleine, 2008), and are an important predictor to accessing mental health care for this population (Vogt, 2011). Holding negative beliefs about mental health and mental health services, or having normalising beliefs is a barrier to accessing support (Pietrzak et al., 2009; Seigel, Dors, Brants, Schuy, & Rau, 2018; Vogt, 2011). Chapter one is a narrative review of serving personnel and veteran's beliefs and conceptualisations of PTSD. It explores how serving personnel and veteran populations attribute their PTSD experiences and their beliefs and attitudes towards it. This review draws upon quantitative, qualitative and mixed method data published since 2000 to present day to synthesise available data regarding this topic. Chapter two consists of an IPA study exploring how UK veterans experience accessing mental health services, when they have mental health difficulties, alcohol misuse and a traumatic brain injury (TBI) acquired during their time in service. This study aimed to strengthen previous literature on help-seeking, exploring barriers and facilitators within this population. Following on from the narrative review, this study also explores the beliefs and conceptualisations of veterans with these multi-morbidity experiences. The empirical paper will be submitted to the British Journal of Psychology for publication (Appendix A for author guidelines). It is acknowledged that there are debates about the language of understanding traumatic experiences, with differences in medicalisation versus a psychological approach. However, for the purposes of this thesis the term 'PTSD' will generally be used for consistency of language throughout and alignment with the literature base on veteran experiences. Other terms and definitions of understanding may be used when discussing different approaches where necessary.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral