Doctors prescribe career coaching for ex-Forces patients

A new service offers veterans with health conditions one-to-one career coaching prescribed by GPs and mental health teams.

A report published today praises a ground-breaking programme in the north west of England that has given GPs and mental health teams the opportunity to prescribe career coaching for ex-Forces patients.

The specialist service, delivered by employment consultants embedded within an NHS health centre, was developed by experts at The Poppy Factory charity as part of their programme to overcome barriers to employment that can affect some veterans after they leave the Armed Forces and transition into civilian life.

Being embedded in a community mental health team proved vital to the success of the project, according to the independent report by the Institute of Mental Health at the University of Nottingham. The Poppy Factory’s employment consultant was involved in clinical meetings about patients (with patient consent), providing key information and becoming trusted advisors and colleagues.

The initial programme was funded by Forces in Mind Trust, and it has now been extended and funded by the NHS. It runs in the Wirral, where The Poppy Factory works closely with Cheshire and Wirral Partnership NHS Foundation Trust to support veterans with physical and mental health conditions to find work.

Alongside physical challenges such as musculoskeletal and hearing problems, these veterans may also have an increased risk of experiencing anxiety and depression, alcohol and substance misuse, gambling problems and Post Traumatic Stress Disorder (PTSD).

For the veterans using the service, engaging with The Poppy Factory’s employment service was an opportunity for them to speak openly to someone who understands the differences between military culture and “civvy street”, as well as the barriers to employment they might face especially in the context of their health challenges. Almost every veteran commented on the boost to their overall mental wellbeing as a result of their time spent with The Poppy Factory, with many veterans feeling more confident in themselves after attending the service.

Veterans’ comments included:

“We all talk the same language… we were able to say what we think when we think, whereas if civilians are doing it, you are guarded, you’re not saying how you feel as you will do to someone who has been in the same boat.”

“Just having someone to talk to, someone who understood my situation, someone who didn’t judge, helped a hell of a lot.”

Veterans can struggle to engage with health services and some of them felt more comfortable dealing with their employment consultant, who was then able to update clinical colleagues. Collaboration with clinical teams was particularly straightforward due to the embedded nature of the service within an NHS trust.

As clinicians commented:

“The employment consultant has been usefully updating me when the lines of communication with myself directly with the person haven’t been so great. It’s been useful…a barometer of where they’re at and a mechanism through which I’m able to be kept updated on how they’re doing with their life as well as about their recovery.”

“It would have come to a crisis if no one knew about the client’s state…I don’t think it would have been able to be resolved without collaboratively working together.”

The Poppy Factory’s dedicated employment consultants were also able to understand the mind-set of veterans and how they like to approach things, including the type of work cultures in which they might thrive. They understood the types of skills that veterans had, and how these skills would be transferable in the job market.

One veteran commented:

“It made me realise I was actually a better person for the jobs than I actually realised because half the stuff that they were asking for, I instantly put myself down saying ‘well I haven’t got that qualification, I haven’t done that’ and the employment consultant explained, ‘well you did that when you were in the Services’ and he helped me word it in a sense that I realised actually half the jobs that I was turning down because I didn’t think I was qualified for, I was more than qualified for.”

Evaluation of the programme shows that 48.8% of veterans using the service were in employment at 12 months, and 54.4% had started a job within a year.

Commenting on the results of the initial project, Deirdre Mills, Chief Executive of The Poppy Factory, said:

“We are very pleased with the effect this pilot has had in helping us reach more of the ex-Forces community. There has been positive feedback from the clinicians, who recognise the clear benefits and impact of our partnership. Best of all, there has been very positive feedback from the veterans themselves.

“Employers also benefit from skilled veterans entering the workplace and the corresponding boost to veterans’ mental health should lead to a reduction in the number of NHS appointments needed by those taking part. The pilot and its evaluation provide a strong foundation from which to further develop our employment service and work more formally alongside the NHS in other areas.”

Tim Welch, Chief Executive of Cheshire and Wirral Partnership NHS Foundation Trust said:

“From the feedback received, it is clear this has been a highly effective partnership, with the veterans involved feeling they were supported and in a safe space. They could build trusting relationships built on a foundation of specialist knowledge both within mental health and the veteran experience, which has naturally led to better communication and joined up working to the benefit of veterans.

“We are immensely proud of our involvement in the project and look forward to building on this work for the future.”

Tom McBarnet, Chief Executive of Forces in Mind Trust, which funded the report, said:

“Forces in Mind Trust exists to improve the success of transition to civilian life for ex-Service personnel and their families. Although most experience a successful transition, their lives enriched by their time in the Armed Forces, we know that some face additional challenges. For these individuals, a service like the one provided by The Poppy Factory is invaluable. We were pleased to have been able to fund this important evaluation, which demonstrates the impact the project has had on those who have taken part. We hope this model of support can also be successfully translated to other regions.”  

Recommendations made in the report by the Institute of Mental Health include:

  • Embedding a veteran-specific service within the NHS is highly effective in building the critical partnerships for success. It allows trust to be built between the service and mental health practitioners, leading to better communication and joined up working to the benefit of veterans. Senior level buy-in from the NHS is essential for implementation.
  • The service should accept referrals from a wide range of sources including primary and secondary care, to ensure employment support can be used as an early intervention before health conditions escalate or can be used as part of a veteran’s recovery plan from more serious conditions.
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