How veterans in Northern Ireland can access support from Combat Stress

The Northern Ireland Veterans Support Office (NIVSO) team recently visited the office of  Combat Stress in Belfast. And this is the first of two news pieces to cover the visit.

The aim of the visit was for the NIVSO team to gain an-depth knowledge of Combat Stress services and to find out how to encourage veterans to seek much needed support.

On the day, various Combat Stress experts were on hand. These included, Community Psychiatric Nurse, Brad Bradshaw, Principal Clinical Psychologist, Dr Lauren Quigley and Consultant Forensic Psychiatrist, Dr Adrian East.

How the Support System works

The following insights were shared by  Brad Bradshaw

You’ve made those first steps to reach out for help. What’s next?

There are various routes for veterans to connect with Combat Stress. These include:
– Self-referral via the helpline
– Referral by other organisations.

Once a referral is received/phone call made the veteran’s information is passed to the local hub, and a clinical team member makes a screening. 

Screening explained

 – Screening is a referral on the person’s medical file.
– Questionnaires that have been filled in by veterans are examined
– A call may be made to the veteran for more information. Especially to check that mental health difficulties are related to military service. If they are not this will be made clear to the veteran.
– Issues related to service will result in the offer of an assessment.

Assessment explained

– An appointment letter with information is sent. If they prefer, veterans may be accompanied by a spouse or friend during their first meeting.
– During the assessment the clinician gathers information which is recorded for future reference if needed.
– The assessment covers current struggles, military and personal background, past traumas, and support networks. And may last a couple of hours.
– Optionally, the team may contact someone from the veteran’s life for additional perspective.

Post assessment:

The interdisciplinary team discusses recommended treatment options and shares them with the veteran. Together they create a treatment plan. 

Initial assessments are in person, by phone or online via MS Teams.

As a Community Psychiatric Nurse, Brad plays a pivotal role in the early stages of a veteran’s journey at Combat Stress:

My part of the pathway tends to be typically when the veteran starts their journey with us. So if they need help with stabilisation or building resilience, help to understand their difficulties, I would do that with them.

Brad trained as a mental health nurse after leaving school, joined the Infantry at 18 then after a couple of years, transferred to the Nursing Corps where carried out the rest of his service working in mental health.

My 20 odd years in the Army has all been about military related mental health. I hope that veterans feel more at ease knowing that they are talking to somebody who understands what they’ve gone through. I’ve been there myself, I understand what military training is all about, what it is to serve, been deployed and the issues that come with all that. I like to think that they get a sense that they’re talking to someone who is a fellow veteran.

Utilising both individual and group therapy approaches, Brad tailors support to cater to each veteran’s unique needs:

Asking for help, that first ever step, that is the hardest part of anyone’s journey. Coming to a place and maybe talking to someone about problems, it’s out of people’s comfort zones to do that… Anxiety is high, avoidance is there but the more you carry on and engage, the more that those anxieties will reduce, and you will start to become more comfortable with the process.

Empowering Veterans

Insights from Dr. Lauren Quigley, Principal Clinical Psychologist

Moral injury is one we see a lot. It’s something that’s often difficult, even more difficult than typical PTSD for veterans to talk about because it’s often associated with a lot of shame – they feel forced to do something that goes against their morals. That can have an impact on the person, but it sometimes has an impact on relationships because people will think, well, if they knew what I had done, they would think differently, or they wouldn’t want to spend time with me. ‘You wouldn’t understand’ is another really common experience that veterans have.

Combat Stress has established support groups for veterans to join together to talk about their experiences during treatment. Lauren explained:

One of the things we offer in Combat Stress is groups – they can be so so helpful because veterans are able to talk with other veterans about their experience and that can have a nice, normalising and de-shaming effect.

Lauren understands that seeking help can be challenging, especially for veterans who have faced unique and often difficult experiences, but she reassures:

We have a lot of experience in the team, we’ve got a very good understanding of some of the experiences that veterans have been through, and we’re an entirely non-judgemental and approachable team. Even if you’re not too sure, come for the assessment, see how you get on, you can always change your mind at any point and that’s ok.

The feedback we often get from veterans is that:

I was worried this morning, I almost cancelled, but actually I feel much more comfortable about the process now that I’ve been in, I’ve met you, and I’ve seen the offices. It is often difficult for veterans to ask for help, so taking that first step can feel quite daunting, but generally once people have met us they tend to stick with us.

Lauren’s passion for understanding human behaviour motivated her to pursue a career in mental health. Her expertise lies in trauma and complex PTSD, and she previously worked with the Grenfell Health and Wellbeing Service in London, supporting individuals through trauma and bereavement. 

Driven by a desire to return to Northern Ireland and address the pressing need for mental health services, she found her calling with Combat Stress, where she could work in her area of expertise closer to home. Lauren shared:

I’ve always had it in the back of my mind that I wanted to build up lots of experience working with trauma and then bring it back to Northern Ireland.

I have always been interested in people: how we think, how we feel, why we behave in the way we do, and how we react and respond to life’s challenges. We often talk about veterans being trained to run towards danger, but our bodies want to run away. Often veterans have been in situations that the rest of us would never be put in at all – really dangerous, life or death situations, and sometimes horrific situations, so they really have had some quite extreme experiences that can test human responses.

Lauren uses the items in this sensory kit to help clients feel grounded during their sessions. 

Editor’s note:

The contribution of Consultant Forensic Psychiatrist, Dr Adrian East will be covered in the second piece. This news was adapted from the latest NIVSO newsletter.

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