Concerns have been raised about the level of support available to those families who provide unpaid care for wounded, injured or sick (WIS) personnel in the UK. In this opinion piece, support services for families of WIS personnel in the UK and their associated evaluations are reviewed. Support services are found to be provided by government-led initiatives, third sector organisations and the Service Family Federations. A minority of interventions for families of WIS personnel in the UK have been evaluated and a culture of service evaluation is encouraged within the field.
- SOCIAL MEDICINE
- PUBLIC HEALTH
- HEALTH SERVICES ADMINISTRATION & MANAGEMENT
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The military environment presents the possibility of injuries and fatalities due to arduous training and high-intensity, hostile, combat operations.1 Wounded, injured or sick (WIS) personnel may experience injuries attributable to combat operations, including wounding as a result of hostile action, non-battle injuries attributable to an injury that is not caused by hostile action such as training, prior injuries and traffic accidents and illnesses.2 Families can play a pivotal role in the reintegration of Service personnel after combat3 and family members providing unpaid care for WIS personnel can be considered informal caregivers.4 Research has shown that if a caregiver is well supported, then the recovery of the care recipient can improve.5
The Armed Forces Covenant Report and House of Commons Defence Committee report have raised concerns about the care and support available to families of WIS Service personnel in the UK and have highlighted a need for research into the interventions that are available to families of WIS Service personnel.6–8 To the best of our knowledge, until now, there has been limited evaluation of the support and services provided for the families of WIS personnel in the UK. In order to address these concerns and limitations, this opinion piece explores and appraises the support services available to families of WIS personnel in the UK and any associated service evaluations.
According to the Directory of Social Change (DSC) Armed Forces Charities Database,9 there are 1818 Armed Forces charities registered with the Charity Commission for England and Wales (CCEW), 419 Armed Forces charities registered with the Office of the Scottish Charity Regulator (OSCR) and 25 Armed Forces charities in Northern Ireland.10
The key support services available to families of WIS personnel in the UK are provided by government-led initiatives, third sector organisations and the Service Family Federations (Table 1). Governmental support is predominantly provided via the Defence Recovery Capability (DRC), a Ministry of Defence (MoD)-led initiative launched in February 2010, in partnership with Help for Heroes and the Royal British Legion (RBL). The Veterans Welfare Service, provided by Veterans UK, aims to support veterans (who may be WIS) and their dependants via one-to-one caseworker support.11 Third sector organisations offer a spectrum of support, including advocacy, advice and signposting, financial support, peer support, respite, psychoeducation, counselling and psychological therapies. The three Service Family Federations (Naval Families Federation (NFF); Army Families Federation (AFF) and Royal Air Force Families Federation (RAFF)) act as advocates on behalf of the families and the Services they represent. Despite the array of support services available, there appears to be no up-to-date port of call specifically designed and made accessible to families of WIS personnel in the UK.
The authors made contact with the key service providers listed above to discuss the interventions they offer to families of WIS personnel and to request information regarding any evaluations that had been conducted thereof. Until now, there have been only a limited number of evaluations of support services provided to families of WIS personnel in the UK. We are aware, via our personal communications, of evaluations conducted by Help for Heroes who conducted an in-house evaluation of a pilot of its Family Psychological Education Workshops, SSAFA (Soldiers', Sailors' and Airmen's Families Association) collected anecdotal feedback from the families of WIS personnel from two national Families of Injured Service Personnel (FISP) Support Group meetings and The Warrior Programme who conducted an evaluation of their ‘family sessions’ in partnership with the University of Southampton and King's Centre for Military Health Research (KCMHR).12 In 2014, Combat Stress was scoping the mental health needs of the partners of help-seeking veterans and was planning to offer additional support to these partners via a pilot study. In 2014, BLESMA commissioned the Veterans and Families Institute at the Anglia Ruskin University to conduct a study on the impact that limb loss has on the families.13 The researchers of the BLESMA report were unable to locate any studies, based in the UK, concerning the impact of traumatic limb loss on families and highlighted the need for such research.13
Organisations can use monitoring and evaluation to learn about the impact and effectiveness of their interventions and this can support further service development.14 It may be constructive if interventions offered to families of WIS personnel in the UK were tailored to the needs of their service users using specific, observable and measurable indicators such as participation rates and changes in behaviour or attitudes.
Until now, the majority of the support services offered by third sector organisations in the UK have not been independently evaluated. Several organisations recognise that they need to evaluate the support they offer to families of WIS personnel and have forthcoming evaluations. Since much service provision for families of WIS personnel in the UK has been set up within the last decade in response to the UK's involvement in Iraq and Afghanistan, there may have been limited time for evaluations to be conducted. Nevertheless, it may be of benefit to the families of WIS personnel and the wider Armed Forces community if frequent, thorough evaluation of support services for families of WIS personnel were undertaken. We encourage a culture of service evaluation within the sector to ensure that interventions being offered are tailored to and meet the needs of service users.
Contributors NF was the principal investigator in the study. MK was the project lead. AV and GT carried out a literature review. SS was involved in advising on all study materials, data collection and in the writing up of the manuscript. AV drafted the manuscript. All authors read and approved the final manuscript.
Funding MoD UK (TIN 2.025 (B)).
Competing interests AV, MK, GT, SS and NF are/were employed by King's College London, which receives funding from the UK MoD.
Ethics approval Ministry of Defence Research Ethics Committee (MODREC).
Provenance and peer review Not commissioned; externally peer reviewed.