To help former servicemen and women with mental health problems, Combat Stress have a unique nationwide Peer Support Service.
Led by veterans for veterans, it’s a chance to talk and share experiences, receive support and socialise with others who also served in the military. We spoke to Peter Hoare, National Co-ordinator for the Peer Support Service to find out more.
Civvystreet: We understand that the service is run by veterans for veterans. Do you feel that it works better having a service run by those with experience in the field as opposed to a regular counselor?
Peter Hoare: “Yes I do, we don’t replace clinical services we are not an either or service but where we are, there are a lot of veterans that are reluctant to seek help – it is an acknowledged factor.
“A lot of veterans are reluctant to seek medical/clinical advice and what we do is provide a broad, compliance referral so the first point of contact with us is veterans helping veterans; it is as simple as that really.
“So other veterans provide the emotional practical and social support that the guys miss as they leave the service. From simply discussing with other veterans sometimes that is enough to put somebody’s mind at ease”
Civvystreet: So the service helps them open up more?
Peter Hoare: “I think it does, it is much easier to open up to another veteran than it is to a clinician that you are not familiar with and you feel hasn’t experienced the same or has the same lived experience that you have. So a veteran feels more comfortable discussing their issues with another veteran initially.
“Now that other veteran might say to them that it is entirely normal and we all feel that way or that other veteran (myself included) might be saying I think you need to speak to somebody more qualified in the field. I would then recommend and obviously for us it would be Combat Stress but it might be your GP or local services.
“We would recommend they speak to their GP and refer themselves in for a clinical assessment with either local services or with Combat Stress.
Civvystreet: How does the service work – are there regular meetings each week and do you find that it helps combat loneliness and isolation?
Peter Hoare: “It absolutely does yes and I use my own experience as a 35 Royal Marine Veteran. Most of my friends live in Plymouth, Exeter, Yarbrough but when I left the service I moved back to my home base which is in Lancashire.
“Coming back to West Lancashire I removed myself from my support network of friends. You have your family and civilian friends but the people that understand me best are marine or ex-marine. My former Royal Marine buddies are not here, and that is very true of the guys and girls that we see especially when they move away from what is called the garrison towns: Aldershot, Catterick, Portsmouth and Plymouth where the navel service is based.
“They end up removing themselves from their support network and then that contributes to the isolation so they feel they’ve got nobody that they can discuss their issues with, nobody that is experienced in the transition from military life to Civvy street.
“The transition can cause issues because they think all their friends have left and have set the world on fire and found that fantastic job that pays monopoly money wages and are doing fantastically. They don’t meet up with other guys who are perhaps struggling with the transition out of the military and into Civvy street, so they become isolated and that compounds their issue and the stigma, the isolation of stigma that ‘I am the only guy that’s left and I am struggling with the transition’, or ‘I am the only one that can’t find a job or having relationship issues because of the stress and strain of trying to establish life, family dynamics.’
So what we provide is a forum for veterans to speak to other veterans.
Civvystreet: Do you run group meetings for veterans to attend?
Peter Hoare: “The service is a pilot service run by Combat Stress but supported and funded by the British Legion. So for example in Liverpool we use the British Legion pop in centre and there are a couple of groups a month where veterans can come along and meet other veterans in a safe environment, so it is only veterans.
“The group is run by a veteran, it is only for other veterans and what the guys have the opportunity to do is receive support but also give support to the veterans and that helps to encourage and motivate a veteran.
“If he feels he can give something back, by helping support another veteran then that does wonders for somebody’s self-esteem and reduces that stigma – so sometimes it is very simple.
“The coordinators will give practical advice if somebody has left the service and is struggling with employment where will he go to get support as a veteran. Now you and I know there is Civvystreet Magazine, there is the RFCA and the CTP, but for some guys that have left the service – everybody just wants to get out the gate.
“I myself was well set up and supported but once you get that release date, your focus is on leaving and getting on. So sometimes the guys and girls don’t take notice of what is available to them, especially if they feel they have got something lined up.
“I had a job lined up before I left so my main focus was getting out the gate and starting work in my new job, so I wasn’t quite aware, I didn’t fully focus on some of the support that was available to me whilst servicing and then as a service leader.
Civvystreet: There is so much available and I think sometimes if you are focused on something it is hard to see what is around you and see what is on offer.
Peter Hoare: “Absolutely and if another veteran can signpost you to something else and say they were in exactly the same boat as you 6-12 months ago and they went to the British Legion who put them in touch with Civvystreet who got them a placement or RFCA or CTP who found them a course or a placement, or people that they knew who were offering jobs for veterans specifically. That signpost can be a huge help for somebody who is lost in and doesn’t know where to go next or what the next step is.
“All it takes is a few simple steps such as heading down to the front desk of the British Legion and filling out a form for somebody from Poppy Factory to get in touch. That can be a huge boost for the guy who is receiving the help but also a boost if you had gone to that group feeling a bit low and helped somebody out and the next time you meet them at the group they’ve had an interview and found a job.
“We provide that practical and social support, where a veteran can meet another veteran and talk about shared life experience without feeling isolated. Once a guy starts talking in military speech it can become an issue. We all talk in our own code and 3 letter abbreviations. But when the guys talk like that in front of a civilian they simply think ‘what are you talking about?’ Sometimes it is helping guys translate – providing a translation service for transferring your military skills into civilian skills.”
Civvystreet: “Do you in terms of the support that the peer service offers think the veterans are addressing mental health more so than in past decades and the service is going to help propel that forward?”
Peter Hoare:“Yes to both, I think that the armed forces as a whole are definitely more aware and more open and more encouraging about mental health now. I think the acknowledgment is there – mental health is an intricate part of wellbeing so you can’t be well without physical and mental health and the services are very good at supporting and signposting that.
“There is always room for improvement but in my 30 odd year career in the royal marines I have seen a vast improvement in the service attitude to mental health where people can put their hand up and ask for support and receive the appropriate support and return and engage in their career.
“Whereas before there was always that stigma that once somebody had put their hand up and said I am having mental health issues that was almost a career foul, you could never quite be trusted. Given the operation tempo for the last 10-15 years or so it has become more prevalent and people have become more aware. It is a practical thing we have got to get these people well and back into service and doing the job they are paid for.
“So the MOD are a lot better at doing it. Combat Stress have got clear evidence that the gap between incident and request for support is reducing. It used to be around about 14-30 years before they finally asked for support and help, whereas now that gap is reducing to around about 7 years. We are seeing the young men and women coming back from Afghanistan and Iraq asking for help a lot sooner. I think that is because of the attitude of the MOD but also the social attitude towards mental health.”
Civvystreet: In terms of the main issues of veterans coming forward within the peer to peer service do you think the groups help with anything from employment, relationship, education, to social groups and hanging out with people? Do you think there is a whole range of things that the service is able to provide for the veterans?
Peter Hoare: “I think the main thing we provide is that support. We are
not a clinical service but we provide the practical, emotional and social support that the guys and girls can miss once they have left the service.
“I think the difficult thing is we sometimes assume that people know what is wrong with them. For instance look at the broad brush definition based on the Canadian model, ‘OSISS’ which stands for operational stress injury social support. They have a very broad brush definition which they call operational stress. What it means is if a man or a woman leaving the service can articulate a change or if they feel a partner or family member can sense a change as a result of their service, then that is enough to get the ball rolling.
“Which might ultimately lead to a clinical diagnosis, for example, PTSD further down the stream. We also frequently will get a partner or a parent say he or she is not the same person that came back from Afghanistan, they came back from Iraq and I noticed the change in them straight away.
“If they come to a group with other veterans and they say they have been struggling with certain issues and another veteran says so have I, it almost validates the feelings and can provide that support that says I am not alone, it is not just me, which is enough sometimes.
“But other times it’s about saying ‘you know I was the same as you I sought help, I had a clinical assessment and I received residential treatment. I went for residential treatment with Combat Stress and now I am back with the family, I am back at home, I now work full time and I am getting on with my life.’
“So there is the example of hope and meeting somebody further downstream than you which can be a huge motivator. That says they are just like me, they were where I am now so maybe in a year’s time, 18 months or 2 years I can be back to the person I once was.
“For the person that has been through it and is further downstream they can help somebody and say ‘Look I can help! Use me as your example, if I can do it, you can too.’ That example of hope and encouragement really reduces the stigma and motivates people to change because they have met somebody like them, that has made it through.
“I think that is a big thing that we do which encourages hope and a solution. Sometimes it is a practical solution. For instance, ‘There is no way I will get a house because I am a single veteran.’ But if somebody can say ‘look if you speak to the local veteran charity, you can receive more housing points, go up in banding and get a priority allocation.’
“That information can be life-changing for someone. To be able to say ‘You can get a house’, or ‘You can get your children into the same school when you move back into the area’ simply because they spoke to the local veteran charity or the Council Veterans Coordinator. That information can make a huge difference to a family and a huge reduction in somebody’s stress level when they are leaving the service.
Civvystreet: That is amazing! So in total do you know how many veterans come through your door with the peer to peer service? I know currently, you have 28 groups established in towns and cities across the UK. What are your plans for the future? Are you planning to expand?
Peter Hoare: “We are definitely expanding due to being so successful. We have seen over 600 individual veterans in 1 to 1 sessions. The 5 regional coordinators carry out the first part of the process as a 1 to 1 interview with the veteran. So if somebody contacts the Combat Stress helpline and says ‘I am interested in peer support’, the first thing that happens is one of our regional coordinators will carry out a telephone call. It is not an assessment more of a chat, talking about what we do. We highlight that we are not a clinical service and don’t advise medication, we are essentially about social support.
“From the individual telephone referrals, our coordinators will then arrange to meet somebody on a 1 to 1. We will speak to them on the phone and if they say yes they are interested, we will find a suitable location and meet them in a Costa Coffee downtown. We will buy them a cup of coffee and have a chat about peer support, and any other issues that we can help with, or give advice on. Then if the guy is suitable and interested we will then establish a group.
“That is where we are now. We have 28 groups and are currently establishing further groups. We have just established a second Liverpool group, are looking to establish a Preston group, and a group in Scotland. We are a national service and the idea is when we get enough people to justify putting a group together we establish.
“We have just established a group in Leicester using Leicester Tigers Rugby club. So once the group is established the next thing is to identify a veteran volunteer who is willing to run the group. The volunteer does some facilitation and coordination training and then they then run the group.
“So a veteran commits to say 2-3 hours a month to run a group. They will coordinate and book a room and facilitate the group for 2 hours. That allows the regional coordinator to move onto the next cluster, work with the guys there and establish a group, plus find a volunteer that is willing and suitable to facilitate the group and then move on.
“Our ambition is just to keep growing, we have got established groups, probably nearly a thousand individual attendances. The groups are running on a regular monthly basis around the veterans needs. If the veteran wants to attend a morning or evening session they can arrange this. It is a veterans group run by veterans for veterans so they decide their own group rules and decide and how often it runs. We at the moment have got another 20 groups across the country that are in various stages of planning.
“I think our groups give our veterans a voice, a lot of time the guys almost feel like they’ve lost control, whereas here they can choose to come to a group, they can choose conversation or simply listen. We have a very good, robust clinical supervision, within our peer support service, applying very strong robust national standards across the whole of England, Ireland, Scotland and
Wales. We have rules and procedures around boundaries, they are very professionally managed, but essentially run by veterans for veterans.
“I am really passionate about it. I have a 35-year career as a royal marine and towards the end of my career I was involved in what is called ‘Operational Stress Management’ and ‘Trauma Incidence Managment’. It is in-service peer support for those involved in potentially traumatic incidents.
“It’s important to give something back, and I think that is the other thing that we do. Veterans help themselves by helping others and that is very important. If someone feels they have contributed and are supporting another veteran it helps increase their self-esteem and reduces the stigma. They believe they are good for something, they have been there and helped somebody that is in a worse situation showing an improvement. They want to motivate them to help them get better, by becoming the example of hope for the veteran.
“We have got a volunteer coordinator running one of the Scottish groups now called Robert. Robert was struggling and went through Combat Stress, receiving residential treatment. Joining the group as a peer he received the training and is facilitating the group, an example of somebody who was struggling to seek professional clinical assistance via residential treatment and come out the other side.
“The way we describe it is we say we walk alongside. We don’t walk behind pushing people to somewhere they are reluctant to go and we don’t walk in front pulling people, it is up to them but we will support them on their
For more information on the Peer Support Service click here.
Call the free 24-hour Helpline for veterans and serving military personnel and their families: 0800 138 1619