Improving access to service charities for female veterans
To date, considerations of improving access to and quality of care for veterans often emphasise male perspectives. This may not reflect the needs of female veterans, nor anticipate the needs of the increasing numbers of female service personnel as they leave service. In the work reported here we aimed to investigate public and charitable sector (service and nonservice) perspectives on the challenges and enablers female veterans face in accessing service charities, to inform and prioritise recommendations for tangible improvements in access to veteran specific services for female veterans. We achieved this aim by conducting a literature review, followed by a qualitative research study. This qualitative study comprised profiling the evolution of conditions for military service for females in UK Armed Forces, 38 stakeholder interviews, and website analysis. Findings and recommendations were discussed with an expert panel and the Project Advisory Group, and disseminated to a range of stakeholders over the course of the project. This report presents the findings of this research, discusses them in the context of previous work, and makes recommendations for service provision, policy and research.
Abstract: There are a number of treatments that have an emerging evidence base and could be considered in the management of common mental health conditions affecting veterans. Emerging and adjunct treatments are typically considered when an individual’s adherence or response to accepted or conventional treatment/s is poor (i.e., chronic, treatment-resistant, or treatment-refractory mental health conditions). The aim of the rapid evidence assessment (REA) was to identify and critically evaluate the current evidence on emerging and adjunct treatments for posttraumatic stress disorder (PTSD) and common mental health conditions affecting veterans. From the four databases that were searched, 25 studies met the inclusion criteria, including 12 secondary sources: four (4) systematic reviews (SRs) and eight (8) SRs with accompanying meta-analyses (MAs). The studies within these secondary sources (i.e., those contained within SRs and MAs) were extracted to a database containing the primary sources (i.e., randomised controlled trials, RCTs). From this collated set of articles (281 in total), all studies that did not meet the inclusion criteria were excluded (e.g., cohort and case-control studies), and all duplicate studies were removed (i.e., often the same RCT would appear in multiple SRs and MAs; as well as being directly retrieved by the search strategy). The final set of articles included 13 RCTs. The findings from these studies were narratively synthesised, and risk of bias assessments were conducted for each RCT. Strengths of the REA include the focus on peer-reviewed Level I and Level II evidence (NHMRC, 2009) from scientific journals in the fields of health, medicine, psychiatry, and psychology (including a specialist database developed by the US Department of Veterans’ Affairs focusing on literature relevant to veterans with PTSD). Limitations of the REA include the exclusion of potentially relevant papers that were published prior to 2017 and the exclusion of non-English language papers. It is difficult to draw conclusions and recommendations regarding DCS interventions from the body of evidence considered by the REA. DCS is proposed to enhance fear extinction or extinction learning via partial agonism of the NMDA receptor (neurobiological mechanism of action). Thus, most of the included studies examined the effects of DCS administration in combination with exposure-based psychotherapy for anxiety disorders. Some studies appear to indicate that DCS improves outcomes from evidence-based psychotherapy. However, due to the mixed findings across studies, it is difficult to recommend the use of DCS interventions in specific clinical situations. Further high-quality research is required.