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Article
Publication date: 5 May 2021

Lamia Haque and Robert Rosenheck

While many studies have shown that liver diseases (LD) can be caused or exacerbated by substance use disorders (SUD), few have examined the proportion of adults with LD…

Abstract

Purpose

While many studies have shown that liver diseases (LD) can be caused or exacerbated by substance use disorders (SUD), few have examined the proportion of adults with LD and SUD who receive mental health and addiction treatment or correlates of such use.

Design/methodology/approach

Using national Fiscal Year (FY) 2012 data from the United States Veterans Health Administration (VHA), the authors studied all 43,246 veterans diagnosed with both LD and SUD in FY 2012 and compared those who received mental health treatment (n = 30,456; 70.4%) to those who did not (n = 12,790; 29.6%).

Findings

Veterans who received mental health treatment were less like to be older than 75 years of age, more likely to have served during recent Middle East conflicts (Operation Iraqi Freedom or Operation Enduring Freedom), more likely to have been recently homeless and to have drug dependence as contrasted with alcohol dependence when compared with those who did not receive mental health treatment. Although the majority, 70.4%, received mental health treatment, only 30.6% of the total received specialized addiction treatment, and these veterans were more likely to experience homelessness and have drug dependence diagnoses.

Originality/value

This is the first study as per the authors’ best knowledge that broadly examines mental health and addiction treatment received by veterans with LD and SUD. High rates of mental health treatment in this population likely reflect the integrated nature of the VHA and its emphasis on providing comprehensive services to homeless veterans. Further research is needed to identify barriers to specialized addiction treatment in this population.

Details

Journal of Public Mental Health, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1746-5729

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Book part
Publication date: 8 August 2016

Luma AlMasarweh and Carol Ward

This study aims to provide a better understanding of Native American women veterans’ experiences with Veteran Administration and Indian Health Services. Eighteen…

Abstract

Purpose

This study aims to provide a better understanding of Native American women veterans’ experiences with Veteran Administration and Indian Health Services. Eighteen interviews were conducted with special attention to the quality and quantity of health and mental health care services veterans accessed, the barriers and local contextual factors in accessing and utilizing services, and potential solutions to service gaps for women veterans from two Montana reservations, the Northern Cheyenne Reservation and the Confederated Salish and Kootenai Tribes of the Flathead Reservation.

Methodology/approach

We examine the barriers and needs of Native American veterans in both reservations using qualitative methods. The research analyzed 18 interviews with women veterans from the Northern Cheyenne and Flathead reservations.

Findings

Native American women veterans identified a number of barriers to accessing care, some of which include lack of information regarding eligibility and the types of services available. Women often found the application process to be confusing and difficult. Other barriers included distance, cost of travel, and conflicts with their work schedule.

Research limitations/implications

This exploratory case study served to clarify the challenges and obstacles Native American women veterans experience with accessing health and mental health services. This research revealed several patterns and themes in the experience of Native American women veterans in both reservation communities when attempting to access and seek care at Veterans Administration (VA) facilities and Indian Health Services (IHS). This research calls for policy changes and research to clarify how resources can be more efficiently and effectively distributed to rural veterans.

Originality/value

Little research has addressed the needs of Native American veterans. American Indians and Alaska Natives serve at a higher rate in the U.S. military than any other population. This research provides important information about Native American veterans who are often underrepresented in survey research, yet a rapidly growing segment of the United States military and veteran population.

Details

Special Social Groups, Social Factors and Disparities in Health and Health Care
Type: Book
ISBN: 978-1-78635-467-9

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Article
Publication date: 15 October 2018

Bret Hicken and Kimber Parry

The purpose of this paper is to provide an overview of rural older veterans in the US and discuss how the US Department of Veterans Affairs (VA) is increasing access to…

Abstract

Purpose

The purpose of this paper is to provide an overview of rural older veterans in the US and discuss how the US Department of Veterans Affairs (VA) is increasing access to health care for older veterans in rural areas.

Design/methodology/approach

This is a descriptive paper summarizing population and program data about rural veterans.

Findings

VA provides a variety of health care services and benefits for older veterans to support health, independence, and quality of life. With the creation of the Veterans Health Administration Office of Rural Health (ORH) in 2006, the needs of rural veterans, who are on average older than urban veterans, are receiving greater attention and support. ORH and VA have implemented several programs to specifically improve access to health care for rural veterans and to improve quality of care for older veterans in rural areas.

Originality/value

This paper is one of the first to describe how VA is addressing the health care needs of older, rural veterans.

Details

Quality in Ageing and Older Adults, vol. 19 no. 4
Type: Research Article
ISSN: 1471-7794

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Article
Publication date: 18 September 2020

Jill Manthorpe and Stephanie Bramley

This purpose of this paper is to review evidence about the barriers and facilitators to ex-service personnel obtaining employment within social care roles. Social care has…

Abstract

Purpose

This purpose of this paper is to review evidence about the barriers and facilitators to ex-service personnel obtaining employment within social care roles. Social care has long-standing, well-recognised problems of staff recruitment and retention. Policymakers and employers are exploring if there are untapped sources of potential employees. Some ex-service personnel may be interested in exploring a move to social care work with older people but may face barriers to such a move which may need to be addressed.

Design/methodology/approach

Databases and grey literature were searched systematically to provide an overview of evidence on this topic. In total, 23 articles were included in the review.

Findings

A narrative analysis revealed barriers to ex-service personnel obtaining employment within social care not only related to their previous occupation, health status and identity but also facilitators related to the sector’s severe recruitment challenges and the transferable skills of ex-service personnel. Evidence suggests that learning from health services may be highly relevant and transferable.

Research limitations/implications

This review was confined to English language studies published between 2008 and 2018. Few mentioned specific user or client groups.

Originality/value

This review identified evidence suggesting that learning from health services may be highly relevant and transferable to the social care sector so as to facilitate the transition of more ex-service personnel into social care work with older people.

Details

Working with Older People, vol. 24 no. 3
Type: Research Article
ISSN: 1366-3666

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Article
Publication date: 16 February 2015

Cory A. Crane, Robert C. Schlauch and Caroline J. Easton

Over the course of their service, veterans are exposed to elevated levels of chronic stress that contribute to a greater prevalence of mental illness than observed in the…

Abstract

Purpose

Over the course of their service, veterans are exposed to elevated levels of chronic stress that contribute to a greater prevalence of mental illness than observed in the general population. When mental illness is present, comorbidity is normative. Convergent evidence suggests that co-occurring substance use and mental illness is among the most prevalent forms of comorbidity within veteran samples. The purpose of this paper is to explore issues associated with dual diagnoses among veterans in the USA.

Design/methodology/approach

Research on dual diagnoses among veterans was reviewed and consolidated for presentation into three substantive content areas consisting of prevalence, associated conditions, and treatment of dual diagnoses.

Findings

Dually diagnosed veterans represent a group at particularly high risk for myriad adverse biopsychosocial and treatment outcomes, including poor health, suicidality, violence or aggressive behavior, arrest, homelessness, and unemployment. A comprehensive strategy has been implemented within the Veterans Health Administration to address dual diagnosis and related problems. Additional research is required to more readily identify co-occurring substance use and mental illness and to refine integrated intervention approaches to minimize burden while improving treatment outcomes for veterans and their families.

Originality/value

The current review includes a wide range of research spanning more than two decades and describing dual diagnosis among combat veterans of all modern eras. Areas in need of further research (e.g. dual diagnosis among female veterans; early detection of psychopathology and fully integrated care among returning veterans) are identified and discussed.

Details

Advances in Dual Diagnosis, vol. 8 no. 1
Type: Research Article
ISSN: 1757-0972

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Article
Publication date: 20 March 2017

Edward Fraser

A significant minority of veterans have poor mental health outcomes but their needs are not always well managed by the NHS. The purpose of this paper is to explore veterans

Abstract

Purpose

A significant minority of veterans have poor mental health outcomes but their needs are not always well managed by the NHS. The purpose of this paper is to explore veterans’ experiences of NHS mental healthcare in Norfolk and Suffolk to identify ways of improving services.

Design/methodology/approach

Interviews were conducted with 30 veterans. Template analysis was undertaken to explore key themes in the interview transcripts.

Findings

Participants were reluctant to seek help but were more likely to engage with a veteran-specific service. Those whose symptoms were military related reported better experiences when accessing treatment that was military sensitive.

Research limitations/implications

This was a local study and the findings do not necessarily reflect the views of the wider veteran community. Most participants who received military sensitive treatment were referred to the study by NHS providers, which could account for their positive feedback.

Social implications

The development of dedicated mental health services may encourage more veterans to seek support, helping to improve patient outcomes. There is a need for further research to determine the effectiveness of dedicated services and identify how they should be deployed.

Originality/value

Where academic interest has generally centred on the aetiology of mental health conditions within the military, this study focussed upon service user experience. The findings contributed to NHS England’s recent decision to extend its network of dedicated services in 12 areas of the country to cover veterans across England from April 2017.

Details

Journal of Public Mental Health, vol. 16 no. 1
Type: Research Article
ISSN: 1746-5729

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Article
Publication date: 5 June 2017

Richard E. Nelson, Adi Gundlapalli, Marjorie Carter, Emily Brignone, Warren Pettey, Thomas H. Byrne, Ann Elizabeth Montgomery, Randall Rupper and Jamison Fargo

Several risk factors have been identified in ongoing efforts by the US Department of Veterans Affairs (VA) to mitigate high rates of homelessness among veterans. To date…

Abstract

Purpose

Several risk factors have been identified in ongoing efforts by the US Department of Veterans Affairs (VA) to mitigate high rates of homelessness among veterans. To date, no studies have examined the relationship of rurality and distance to nearest VA facility to risk of homelessness. Due to challenges in accessing available services, the hypothesis was that rural-residing veterans are at greater risk for homelessness. The paper aims to discuss these issues.

Design/methodology/approach

The cohort consisted of veterans who had separated from the military between 2001 and 2011. The authors used a forwarding address provided by the service member at the time of separation from the military to determine rurality of residence and distance to care. The authors examined differences in the rate of homelessness within a year of a veteran’s first encounter with the VA following last military separation based on rurality and distance to the nearest VA facility using multivariable log-binomial regressions.

Findings

In the cohort of 708,318 veterans, 84.3 percent were determined to have a forwarding address in urban areas, 60.4 and 88.7 percent lived within 40 miles of the nearest VA medical center (VAMC), respectively. Veterans living in a rural area (RR=0.763; 95 percent CI=0.718-0.810) and those living between 20 and 40 miles (RR=0.893; 95 percent CI=0.846-0.943) and 40+ miles away from the nearest VAMC (RR=0.928; 95 percent CI=0.879-0.979) were at a lower risk for homelessness.

Originality/value

The unique data set allowed the authors to explore the relationship between geography and homelessness. These results are important to VA and national policy makers in understanding the risk factors for homelessness among veterans and planning interventions.

Details

Housing, Care and Support, vol. 20 no. 2
Type: Research Article
ISSN: 1460-8790

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Article
Publication date: 1 March 2007

Dana A. Forgione, Melony J. Goodhand and John A. Wrieden

We present a legislative background and assessment of approaches to financing the US Department of Veterans Affairs (VA) healthcare services, and focus on issues related…

Abstract

We present a legislative background and assessment of approaches to financing the US Department of Veterans Affairs (VA) healthcare services, and focus on issues related to beneficiaries eligible for both VA and Medicare benefits. We refer to a large, VA Medical Center (VAMC) hospital and healthcare complex as a case for comparison of financing approaches. Several legislative proposals had been made to grant the VA funding transfers from Medicare. To date, none has passed in the Congress. Our analysis shows that payments from Medicare would need to be adjusted for the specialized characteristics of VAMC patients, as well as for higher capital costs related to the federal VAMC mandate to maintain reserve capacity for national health emergencies, in order to appropriately apply Medicare payments.

Details

Journal of Public Budgeting, Accounting & Financial Management, vol. 19 no. 3
Type: Research Article
ISSN: 1096-3367

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Article
Publication date: 1 April 2021

Gemma Parry, Suzanne Margaret Hodge and Alan Barrett

Prevalence of post-traumatic stress disorder (PTSD) among UK veterans is higher than in the general population. However, prevalence figures do not reflect the complexity…

Abstract

Purpose

Prevalence of post-traumatic stress disorder (PTSD) among UK veterans is higher than in the general population. However, prevalence figures do not reflect the complexity of this phenomenon and ways in which it may be bound up with veterans’ experiences of adjusting to civilian life. The purpose of this study is to explore veterans’ experiences of successfully managing PTSD.

Design/methodology/approach

Semi-structured interviews were conducted with six veterans who had served in the UK armed forces and analysed using interpretative phenomenological analysis.

Findings

Three themes were developed: accepting the problem, taking responsibility and gaining control; talking to the right people; and strategies, antidotes and circling back around. Managing PTSD appeared to be bound up with veterans’ experience of renegotiating their identity, where positive aspects of identity lost on leaving the military were rebuilt and problematic aspects were challenged. Participants sought to speak about their difficulties with others who understood the military context. They felt that their experiences made them a valuable resource to others, and they connected this with a positive sense of identity and value.

Practical implications

The findings suggest the importance of wider provision of peer support and education for civilian health services on veterans’ needs.

Originality/value

This study adds to the understanding of what meaningful recovery from PTSD may involve for veterans, in particular its potential interconnectedness with the process of adjusting to civilian life.

Details

Mental Health Review Journal, vol. 26 no. 2
Type: Research Article
ISSN: 1361-9322

Keywords

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Abstract

Details

Soldiers on International Missions
Type: Book
ISBN: 978-1-78973-032-6

1 – 10 of over 2000