Why do they fail? A qualitative follow up study of 1000 recruits to the British Army Infantry to understand high levels of attrition

BACKGROUND: The British Army has over 100 career employment groups to which recruits may apply. The Infantry is one of these career employment groups; it accounts for 25% of the overall strength. It is of concern that Infantry recruit attrition within the first 12 weeks of training remains consistently above 30%. Poor selection methods that lead to the enlistment of unsuitable recruits have negative financial and personal consequences, but little is known about the personal experiences of those who fail. OBJECTIVE: The aim of this research was to understand why infantry recruits choose to leave and explore the personal experiences of those that fail. METHODS: This study draws on qualitative data from the second phase of a larger mixed method study. The foci of this paper are the findings directly related to the responses of recruits in exit interviews and their Commanding Officers' training reports. An exploratory qualitative, inductive method was used to generate insights, explanations and potential solutions to training attrition. RESULTS: What the data describes is a journey of extreme situational demands that the recruits experience throughout their transition from civilian life to service in the British Infantry. It is the cumulative effect of the stressors, combined with the recruit being dislocated from their established support network, which appears to be the catalyst for failure among recruits. CONCLUSION: There are clearly defined areas where either further research or changes to current practice may provide a better understanding of, and ultimately reduce, the current attrition rates experienced by the Infantry Training Centre

Housing Needs of Ageing Veterans Who Have Experienced Limb Loss

Military veterans can experience limb loss as a direct result of conflict, an accident, illness or injury. Whatever the cause, there is a need to recognise the long-term consequences and challenges of limb loss on maintaining independence in one’s home. This study aimed to examine the housing needs of veterans experiencing limb loss, and the impact of limb loss on housing needs and home adaptations of ageing military veterans. Thirty-two military veterans (aged 43–95) participated in this study and up to three life-story interviews were carried out with each participant. Two themes were generated: availability of support and changing housing needs. It is evident from the findings that military veterans are unique in various ways, specifically due to military culture, geographical relocation and the additional support that is available to the Armed Forces Community. This must be considered in long-term support to maintain independence in the home

Management of mental illness by the British Army

Background: The Ministry of Defence has its own hospital for soldiers requiring admission for mental health problems. Aims: To assess the efficiency of the army psychiatric hospital at restoring patients to full active duty. To assess whether a new military training and rehabilitation unit (MTRU) that emphasises military-skills training, improves outcome. Method: A 2-year, inception-cohort outcome study of hospital in-patients. A 12-month, case-matched, ‘before and after’ outcome study compared MTRU patients with hospital in-patients. Results: I (hospital in-patients, n=309): at 2-year follow-up 67 (22%) were fully fit for active duty. Military psychiatrists' success rate at predicting recovery to active duty was 27%. 2: the odds of a soldier in the MTRU cohort (n=35) returning to active duty were 14 times greater than for the hospital cohort (n=35). The odds of remaining in the army while unfit for active duty were 20 times less for the MTRU than for the hospital cohort. Conclusions: The army hospital is inefficient at rehabilitation to active duty. The MTRU significantly increased the odds of returning to active duty and reduced the odds of remaining in the army while still unfit. These findings may be applicable to the emergency services

Understanding Unique Factors of Social Isolation and Loneliness of Military Veterans: A Delphi Study

Social isolation and loneliness are recognised societal issues, and it is estimated that between 5% and 18% of adults in the United Kingdom feel that they are ‘often’ or ‘always’ lonely (Co-Op Foundation and The Red Cross, 2016; Office for National Statistics, 2018). Furthermore, social isolation and loneliness are highlighted as being central to the narratives of military veterans, and the Armed Forces Community (Kiernan et al., 2018; Stapleton, 2018; Wilson, Hill, & Kiernan, 2018). This study aimed to gather expert consensus relating to the cause, impact and ways to tackle social isolation and loneliness of military veterans. It builds on previous research conducted by the Northern Hub for Veterans and Military Families Research, Northumbria University which highlighted that military veterans can experience social isolation and loneliness in a ‘unique’ way (Kiernan et al., 2018; Wilson, Hill & Kiernan, 2018). This ‘uniqueness’ is due to military-related intrinsic and extrinsic factors including number of transitions, military-related trauma such as limb loss, physical health and mobility, and losing touch with comrades (Kiernan et al., 2018; SSAFA, 2017; Stapleton, 2018; Wilson et al., 2018). Using the Delphi method (Helmer-Hirschberg, 1967) to gather expert consensus of military veterans’ social isolation and loneliness, this study aimed to: • Further explore the concept that veterans are considered as being ‘unique’ to adults to the general population, and other members of the armed forces community in their experiences of social isolation and loneliness. • Consider whether older veterans are ‘unique’ to younger veterans in their experiences of social isolation and loneliness. • Examine perceived factors leading to social isolation and loneliness of veterans. • Identify perceptions of how to tackle veterans’ social isolation and loneliness

Investigating the Moral Challenges Experienced by UK Service Police Veterans

Previous research has explored the negative effects of exposure to potentially morally injurious events among armed forces veterans and active-duty military personnel generally. However, this current pilot research provides a unique contribution to the extant research literature by examining the specific moral challenges experienced by a potentially at-risk and under-researched sub-group of military personnel. Semi-structured interviews were conducted with 10 United Kingdom (UK) Service Police veterans to identify any moral challenges encountered during their military service and to investigate the experience of moral dissonance underlying these events. Using Interpretative Phenomenological Analysis (IPA), four main themes (with sub-themes) emerged from the data: (a) violation of a moral code, (b) experience of disillusionment, (c) attempted resolution of moral dissonance, and (d) risk and protective factors for moral dissonance. Evidence of the types of moral challenges encountered by Service Police veterans during their military service and the negative consequences of moral dissonance was explored for the first time. Some of these findings overlap with existing evidence from non-Service Police research, although novel insights were also identified, such as the attempts of Service Police veterans to resolve moral dissonance through acting with moral courage, self-preservation, or seeking acceptance. The current research therefore provides a rationale for further investigation into the experience of moral dissonance and impact of exposure to morally injurious events in this sub-population of veterans. Potential implications for advancing conceptual understanding of moral injury and informing interventions to prevent the development of morally injurious outcomes are discussed

Social Isolation and Loneliness of UK Veterans: A Delphi Study

Background Evidence increasingly acknowledges the impact of social isolation and loneliness on the lives of military veterans and the wider Armed Forces Community. Aims The study gathered expert consensus to (i) understand if veterans are considered ‘unique’ in their experiences of social isolation and loneliness; (ii) examine perceived factors leading to social isolation and loneliness of veterans; (iii) identify ways to tackle veterans’ social isolation and loneliness. Methods This study adopted a three-phase Delphi method. Phase 1 utilized a qualitative approach and Phase 2 and Phase 3 utilized a mixed-methods approach. Results Several outcomes were identified across the three phases. Transition out of the military was viewed as a period to build emotional resilience and raise awareness of relevant services. It was also concluded that veterans would benefit from integrating into services within the wider community, and that social prescribing services could be a vehicle to link veterans to relevant services. Furthermore, access to, and the content of, programmes was also of importance. Conclusions These findings illustrate various important interventional aspects to consider when funding and implementing programmes focussed on tackling social isolation and loneliness

Developing an Integrated Model of Care for Veterans with Alcohol Problems

Introduction: Veterans often do not present with alcohol problems in isolation, they may have a wide range of social, physical, and sociological needs. The aim of this study was to facilitate the development of a co-designed integrated model of care for veterans with alcohol problems. Methods: Following the development model by the Agency for Clinical Innovation, a planning symposium was held in North East of England to engage health and social care planners, public health leads, clinical commissioning groups and providers. Service users were empowered in discussions to provide insights and look for solutions (N=43). Results: Using diagramming techniques, three examples of health and social care provision were created demonstrating the current commissioning landscape, one veteran’s experience of accessing services and a proposal for a new integrated model of care for veterans with alcohol problems. Discussion: By engaging stakeholders and service users, the model proposed a potential solution to reducing the number of veterans ‘falling through the gaps’ or disengaging from services. The collaborative approach highlighted the difficulties in navigating the current complex health and social care systems. The co-designed hub and spoke model aims to enable alcohol misuse services to adapt and evolve so that they better fit the needs of veterans

The exploration of the dispersal of British military families in England following the Strategic Defence and Security Review 2010

Strictly relying on publicly available data, this study depicts and quantifies the spatial pattern of England’s military families with dependent children. England’s Service Pupil Premium for the financial years between 2011 and 2019 is used as a proxy variable to estimate the density of service children at the parliamentary constituency level. Methodologically, the approach allows an assessment of spatial movements of a population or a cohort. The results inform policy makers by providing evidence-based findings about the location of England’s military families and how the distribution has changed between 2011 and 2019. The results show empirical evidence supporting the hypothesis that, at a macro scale, beyond commuting distance, England’s military families are becoming increasingly dispersed. We argue that the findings unveil spatial dynamics that have practical issues of housing, employment, and education regarding military families

The Map of Need: Identifying and predicting the spatial distribution of financial hardship in Scotland’s Veteran Community

Introduction: During military service, many household costs for both married and single service personnel are subsidised, and transition can leave veterans unprepared for the financial demands of civilian life. Armed Forces organisations such as Sailor, Soldier, Air Force Association (SSAFA) play a central role in understanding the financial challenges that UK veterans face and provide an insight into the financial hardship experienced by veterans. The aim of this study was to use SSAFA beneficiary data as a proxy to identify the nature of financial benefit, the spatial distribution of financial hardship in the Scottish SSAFA beneficiary community and explore factors that might predict where those recipients are located. Methods: Using an anonymised dataset of Scottish SSAFA financial beneficiaries between 2014 and 2019, this study used a geographical methodology to identify the geospatial distribution of SSAFA benefit recipients and exploratory regression analysis to explore factors to explain where SSAFA beneficiaries are located. Results: Over half of benefit applicants (n= 10,735) were concentrated in only 50 postcode districts, showing evidence of a clustered pattern, and modelling demonstrates association with area level deprivation. The findings highlight strong association between older injured veterans and need for SSAFA beneficiary assistance. Conclusion: The findings demonstrate that beneficiaries were statistically clustered into areas of high deprivation, experiencing similar challenges to that of the wider population in these areas. Military service injury or disability was strongly associated with areas of high SSAFA benefit use and in those areas high unemployment was also a significant factor to consider

Eye Movement Desensitisation Reprocessing as a Treatment for PTSD in Conflict Affected Areas

Objective: One recommended psychological intervention for trauma treatment in Western countries, including Post-Traumatic Stress Disorder (PTSD), is Eye Movement Desensitisation Reprocessing (EMDR). However, there is a paucity of data regarding treatment interventions in low-to-middle income countries. This study examined the efficacy of EMDR for treating post-traumatic stress (PTS), Anxiety and Depression among a cohort of individuals with low-socio economic status in a conflict-affected middle-income country as well as a smaller refugee cohort. Methods: 268 adults residing in Lebanon (Male=65, Female=203, SD gender =0.43; µ age = 30.5, SD age =10.49; 85 Lebanese, 15 refugees (9.3 from Syria, and 5.7 from Iraq, Palestine, Philippines or other) received EMDR Therapy. Measures of PTS, Anxiety and Depression were taken at three points: Before Treatment (T0); Post-Treatment (T1); 6-Month Follow-Up (T2). Results: Reduction in PTS symptoms from T0 to T1 (F (1,208) =412.3, p<0.01) and T1 to T2 (F (1,46) = 136.1, p<0.01). Reduction in Anxiety symptoms from T0 to T1 (F (1,208) =387.0, p<0.01), and T1 to T2 (F (1,46) = 153.7, p<0.01). Similarly, for Depression, a reduction of symptoms from T0 to T1 (F (1,207) =309.5, p<0.01) and T0 to T2 (F (1,46) = 96.0, p<0.01). Conclusion: EMDR is an effective treatment for reducing PTS, Depression and Anxiety symptoms in individuals with low socio-economic status and refugees, thus contributing to the research base for populations that are under researched. Mental health services, especially in conflict affected settings, would benefit from using EMDR therapy to target these pathologies in these populations