Learning From America ...

My career, working with Veterans who have multiple complex needs started in 2017, with a specific focus on developing a specialist and holistic service to meet the needs of women who served in the military.

At the time of commencing my employment with Forward Assist, the organisation was in the process of developing their services which meant I was able to take a hands on, strategic approach to build upon pre-existing service provision. Before starting in my role as the ‘Salute Her UK’ women veterans lead, I had held many positions within a variety of mental health trusts, voluntary sector organisations and private practice. I worked with individuals, suffering from addictions, mental health difficulties, including bipolar disorder, personality disorder or depression, and with those in acute crisis at risk from self-harm or ending their life. I specialised in working with those who were most at risk, using a ‘think family’ model of engagement. So, working with those who had suffered trauma was no stranger to me. However, I would come to learn that the sexual trauma experienced by women in the military and the life long impact such trauma had on their lives as veterans was both shocking and and appalling. I thought I’d seen it all. How wrong I was!

I have learned so much from the founder of Forward Assist, Tony Wright about the many unique challenges that Women Veterans face, the fact they are a hidden invisible population was a revelation to me and I had never considered that they would simultaneously be struggling and suffering from a range of mental health problems as a result of traumatic experiences.

There is virtually no research in the UK that looks into the needs of women veterans, past and present. The reality is that once military service is complete, women personnel embark on a long, lonely , arduous journey back to civilian life, a journey fraught with difficulties.  Women are the fastest growing cohort within the armed forces and I would argue that this transition can be more traumatic than that of their male counterparts.

Given there wasn’t a template to work from or research to reference, I carried out a ethnographic data analysis and mapping exercise and was both surprised and shocked to find so many women veterans struggling with adjustment issues and poor mental and physical health problems. There is lots of research in the USA that suggests that women feel uncomfortable in male-dominated veteran environments, and that they prefer to access support and treatment that is gender specific and sensitive to the needs of women.

I was given the opportunity by our CEO along with a women veteran volunteering with Salute Her, to travel to America in 2019 to research and learn everything I could about the needs of Women Veterans. I have brought back this knowledge and examples of good practice and aim to raise awareness of the currently unmet needs of women veterans so that we can all take a collective responsibility to improve services to women in the United Kingdom.

My trip involved visiting several women centric organisations, including meetings at the Department of Veterans Affairs, where I met Andrea Goldstein - senior policy advisor for the Women Veterans Task Force. Andrea talked openly about her experience as a woman who served in the Navy. While serving as a troop commander in Special Operations Forces, Andrea was instrumental in developing best practices to integrate women into previously all-male teams.  Her work includes cross-sector collaboration to facilitate organisational culture change from within, and a focus on incorporating a gender perspective into policy, plans, and operations in the defence and security sector. Andrea visited the UK a few months later and visited Forward Assist to hear about our work and kindly facilitated the opening night of the Salute Her Women Veterans Art Exhibition at Newcastle University.

Carrie Ann Alford, Director of Policy & Planning, Virginia Department of Veterans Services facilitated numerous visits to grassroots services that supported women and their families after service. I wanted to meet with those who had strategic insight and that had built a service from the beginning so I could learn about the challenges they faced and how to overcome them. It was also important to meet other mental health therapists who could speak the same professional language.

Running like a gold thread, through all the organisations I visited was the fact that they all worked in collaboration with each other, they all supported each other and shared resources. This is in direct contrast to my experience in the UK where it appears organisations compete for funding, recognition and sometimes veterans!

Evidence shows that collaborative working is essential for good treatment outcomes, both clinical and holistic. If the needs of all Veterans are to be met in an effective, sustainable way, organisations in the UK need to find a way that they can work together collaboratively.

The Department of Women Veterans provide community-based trauma centres specifically for women veterans. The centres provide a wide range of social and psychological services, including readjustment and transitional therapy.  Individual, group, marriage and family therapy sessions are available and what excited me the most was to see the use of Dialectical Behaviour Therapy (DBT)

In UK, DBT is typically used with those who have a diagnosis of Personality Disorder, so it was refreshing to see it adapted for use within military trauma settings .  What impressed me most was the vast array of services that what were dedicated to women’s health care needs, such as gynaecology and maternity alongside multi disciplinary mental health services and gender specific inpatient units. The VA also use electronic health records to closely track physical health care including breast and reproductive care in order to produce better health care outcomes for women.   All VA staff use a ‘care coordination’ model of care. Many Veterans in both the UK and USA present with multiple complex needs so I would argue that we should adopt this model. The principles and practicalities of care coordination should be taught and adapted for use in the United Kingdom by all services including the voluntary sector.

I was delighted to meet with two trauma therapists and two Social Workers from the Virginia Department of Veterans Services and visited one of the specialist centres for Women Veterans. During my visit they presented the different aspects of their work and explained their roles in relation to the various programs they deliver. In the VA, social workers support trained mental health therapists in all patient care areas. Unlike, the UK social workers are responsible for ensuring continuity of care through the admission, treatment, and discharge processes of military veterans.

The trip was also educational, and I was deeply moved when we visited The Women's Military Memorial Centre at Arlington Cemetery. The sheer size of Arlington Cemetery took my breath away. We were honoured to visit the part of the cemetery that is dedicated to women who have served in the military and learn that there is a place to learn about the extraordinary servicewomen who have stepped forward to defend America. For more than 30 years, the Memorial has been permanently documenting military women’s experiences and their impact on American, military and women’s history.  If you get the chance do visit.

Working Together

Forward Assist and Salute Her work in partnership with Boulder Crest Retreat and have funded two women veterans from the UK to take part in their retreat programme. Boulder Crest Retreat is a not for profit organisation that offers transformative retreats for combat veterans and their families. The Warrior PATHH programme is a lifelong, posttraumatic growth-based training programme. The week long training consists of intensive workshops, that is then followed up by 18 months of connection and training from both peers and psychologists via the online PATHH platform. Boulder Crest Retreat is based in Virginia and Arizona and no expense has been spared. Veterans stay in beautiful, luxurious log cabins and eat nutritious meals, yoga , exercise and meditation to boost wellness. The UK veterans that have accessed this programme describe it as a life transforming experience.

I have to say that wherever I went in America I met the most warm hearted friendly and helpful people, the trip was amazing and insightful. As a therapist I am used to reflective practice and do so daily, and as my trip came to an end I was grateful I was able to learn from so many, especially the strong women who had took it upon themselves to develop much needed services. I remain both humbled and inspired.

In my experience many male professionals in the UK find it difficult, or have a resistance, to identifying the unique impact trauma has on women. The fact that women veterans are a hidden, marginalised and frequently ignored forgotten population creates real difficulties for practitioners and especially women who report feeling not valued and their military service doesn’t seem to matter.

This has to change and the UK Government should accept responsibility and provide and contribute to the development of specialised gender specific, trauma informed, mental health services. Organisations need to come together and assist in the design of gender specific services for women veterans and help identify hidden women veterans living in the community, whilst proactively targeting them with information on specialist support services, entitlements, employment opportunities, health information and benefits.

We all have a collective, moral responsibility to ensure that trauma in women, especially Military Sexual Trauma (MST) is acknowledged and screened for to ensure that women get the service they need at the time they need it most.

Paula Edwards Salute Her Project Lead