Veterans in crisis: Describing the complexity of presentations to a mainstream UK Veterans mental health service

Abstract: Armed forces Veterans often delay seeking help for mental health problems until a crisis point is reached. However, the clinical presentation of UK Veterans in mental health crisis is poorly understood. This study explored the presenting demographics, mental health problems, and factors that contributed to the current mental health crisis of UK Veterans who were referred to a Veterans' crisis service, delivered as part of the mainstream health system. It showed that Veterans in crisis were similar in age and gender to the wider population at higher risk of crisis. Veterans presented with a broad range of symptoms of mental ill health and factors that were driving their current crises. Findings suggest that crisis services that address a broad range of symptoms and factors may be best positioned to address Veterans' needs. It also suggests that these services need to ensure they are responsive to the needs of the whole Veteran population, including younger Veterans and women. Introduction: Veterans may delay presentation to mental health services until they near or reach a crisis point. This study sought to understand the profiles of UK Veterans at or near crisis presenting to a Veterans' mental health service, for whom there is a paucity of data. Methods: Patient records for 177 Veterans presenting to and eligible for treatment by a specialist Veterans' mental health crisis service during the first year of its operation were accessed. Clinical presentation, factors contributing to crisis, and demographic data were extracted and analysed. Results: Veteran demographics were reflective of groups identified as being at higher risk for suicide and mental health crisis in the general population, primarily middle-aged (mean = 44.4 y) and male (93.8%). Veterans' reported mental health problems included a high prevalence of symptoms of anxiety and depression (68.4%), disordered sleep (67.2%), and posttraumatic stress disorder (PTSD; 62.1%). Psychosis was indicated to be more prevalent than among the general population. The most common reported crisis factors were suicidal ideation (85.3%), relationship strain (51.4%), and social isolation (49.7%). Reported mental health problems and crisis factors were highly comorbid. Discussion: Veterans at or near point of crisis presenting to Veteran-specific pathways in mainstream health care report a broad range of crisis factors and mental health problems. The range of presenting profiles suggest that broad-spectrum, whole-person wraparound care is suitable for addressing the needs of Veterans in crisis. Further work is required to ensure crisis services reach the whole Veteran community, including those at elevated risk. Introduction : Les veteran(e)s attendent parfois le declenchement ou l'imminence d'une crise pour se presenter aux services de sante mentale. Cette etude cherche a comprendre les profils des veteran(e)s britanniques qui sont en crise ou sur le point de l'etre au moment de se presenter a un service de sante mentale pour veteran(e)s. Methode : Les dossiers medicaux de 177 veteran(e)s admissibles a un traitement s'etant presente(e)s a un service specialise en sante mentale au cours de sa premiere annee de fonctionnement ont ete consultes. Le tableau clinique, les facteurs de crise et les donnees demographiques ont ete extraits et analyses. Resultats : Les donnees demographiques des veteran(e)s etudies correspondent aux groupes a risque plus eleve de suicide et de crise de sante mentale de la population generale : les personnes d'age moyen (moyenne = 44,4 ans) et les hommes (93,8 %). Parmi les problemes de sante mentale rapportes, les symptomes d'anxiete et de la depression (68,4 %), les troubles du sommeil (67,2 %) et les troubles de stress posttraumatique (TSPT ; 62,1 %) ont une prevalence elevee. La prevalence de la psychose est plus frequente que dans la population generale. Les facteurs de crise les plus frequemment signales sont les idees suicidaires (85,3 %), les tensions relationnelles (51,4 %) et l'isolement social (49,7 %). La comorbidite est elevee entre les problemes de sante mentale et les facteurs de crise signales. Discussion : Les veteran(e)s en situation de crise qui accedent aux soins qui leur sont reserves dans le systeme general de sante presentent divers facteurs de crise et problemes de sante mentale declares. L'eventail des profils suggere que les soins holistiques a large spectre et a l'echelle de la personne repondent aux besoins des veteran(e)s en crise. D'autres travaux demeurent necessaires pour s'assurer que les services d'intervention d'urgence rejoignent l'ensemble de la communaute veterane, y compris les personnes a risque eleve.