Multiple deprivation in help-seeking UK veterans

Transcription

1 Multiple deprivation in help-seeking UK veterans A report compiled by Combat Stress Dr Dominic Murphy, Emily Palmer & Rachel Ashwick

2 Multiple Deprivations in Help-Seeking UK Veterans Contents Executive Summary and Recommendations... 2 Acknowledgements... 7 Chapter 1: Background Information... 8 Chapter 2: Report Methods Chapter 3: Description of UK Help-Seeking Veterans Chapter 4: Exploring Multiple Deprivation of Veterans in England Chapter 5: Exploring Multiple Deprivation of Veterans in Northern Ireland Chapter 6: Exploring Multiple Deprivation of Veterans in Scotland Chapter 7: Exploring Multiple Deprivation of Veterans in Wales Chapter 8: Comparisons across the UK Chapter 9: Strengths and Limitations of this Report Appendices Reference List Page 1

3 Executive Summary and Recommendations Aims: The aim of this report is to provide an overview on the experiences of deprivation in a national sample of veterans with mental health difficulties. As such, we hope that this will aid service development and planning by informing on how to best target specialised military support to veterans. It is also hoped that the overview will serve as a guide to other service providers and charitable organisations working with veterans. The UK Government routinely collects data on a range of deprivation indices which are combined to be called the Index of Multiple Deprivation (IMD). The IMD is a relative measure of the different social and economic types of deprivation; including financial, health, education and crime rates. Being a relative measure allows for an individual s score to be compared nationally. In this study we linked the IMD to a sample of veterans who were engaged with Combat Stress. Combat Stress is the largest provider of community and residential multidisciplinary evidencebased mental health interventions in the United Kingdom, after the NHS. It is the leading specialist clinical service provider for veterans with some services commissioned by the NHS. Method This report explored demographics, multiple deprivation (using the IMD), military history and help-seeking from a national sample of UK veterans who were at all stages of treatment at Combat Stress. The sample comprised of 3,120 veterans who were all active clients of Combat Stress as of 1 February 2016 and had had an appointment with the charity in the preceding year. Page 2

4 Main Findings: 1. The majority of the UK sample was male, with a fairly even age distribution (mean age 48.3 years) and relationship status (48% in a relationship vs 52% single) 2. The majority had served in the Army (87%) compared to the Royal Navy (7%) and Royal Air Force (6%). 3. Nearly one in five (18%) veterans seeking support from mental health difficulties from Combat Stress were Early Service Leavers. 4. On average, individuals took approximately 11 years after leaving the military to seek help. 5. Only 4% of help-seeking veterans were in receipt of a war pension % of the sample resided in England, 17% in Northern Ireland, 11% in Scotland and 9% in Wales. Compared to the relative size of the general population, a greater proportion of the sample than expected was based in Northern Ireland, (17% of the sample compared to 3% of the UK population), Scotland (11% vs 8%) and Wales (9% vs ). 7. Veterans with mental health difficulties are more likely to reside within areas of the UK with higher risks of deprivation. (It should be noted that the IMD gives an overall deprivation score and also an indication of the deciles the score is found in nationally. As such, this allows the deciles score to be an indicator as to how the individual s deprivation score compares to the national population. When looking at the distribution of deprivation scores within this sample, evidence was observed suggesting veterans with mental health difficulties are more likely to reside within areas of the UK at higher risks of deprivation. For example, 4 of the sample resided in areas classified as being the most deprived areas in the UK compare to living in the three least deprived areas.) 8. Veterans living in Scotland appeared to be at the greatest risk of deprivation, followed by English and Welsh veterans. In contrast, veterans living in Northern Ireland were on average at less risk of deprivation. 9. The exploration of associations between demographic and military characteristics revealed that in all four countries, there was an association between higher levels of deprivation and not being Page 3

5 in a relationship. Other variables associated with higher levels of deprivation were being an Early Service Leaver and taking longer to seek help. 10. When exploring associations with deprivation specific to UK countries, it appeared that in England there was a trend towards higher levels of deprivation for those who were in the Army rather than the Royal Navy and RAF. In Scotland and Wales, there seemed to be a greater risk of deprivation in those in the younger age brackets compared to the older ones. 11. The locations veterans resided in were geographically spread across the UK. 12. There were a greater number of veterans residing in urban areas compared to rural locations, and those living in urban areas appeared to be at greater risk of experiencing deprivation. Limitations: 1. The main limitation of the report is that it is restricted to veterans who had sought help from Combat Stress; further research is needed to identify ex-servicemen and women who are unable to access support in order to understand their deprivation risks. 2. Other limitations are considered in more detail within Chapter Nine of this report. Page 4

6 Recommendations and Further Investigation and Research Required: 1. Veterans with mental health difficulties appear to be at an increased risk of residing within more deprived parts of the UK. The findings from this report point to the possible application of using geographic information to help target support to those most at risk. 2. In general there is an increased risk of experiencing multiple deprivations in veterans seeking help for mental health issues compared to the general public. This highlights the importance of not only treating the symptoms of mental illness but also considering the context within which an individual lives. For example, the impact of residing in an area with poor access to local services, or where there are high levels of unemployment. 3. Veterans were spread across the UK. This suggests that there is an ongoing need for a nationally provided service with community-based support to provide easier access to services for veterans. In the context of funding restrictions, the finding that more veterans live in urban areas supports the notion that targeted service delivery in these areas using a clinic based Hub and Spoke model, and other interventions such as setting up a Peer Support framework will reach the majority. However, other means of service delivery such as telemedicine and planned residential admission or targeted home visits in the context of assertive outreach; if clinically indicated, may be appropriate for those whose access may not be comparable because of their geographical rural location. 4. The relative size of the help-seeking veteran populations in England, Northern Ireland, Scotland and Wales differed from what might be expected compared to the general public. Following on from this, funding allocation for the provision of veteran services should not be based on the relative size of each nations population, or even based on geographical boundaries set out by Combat Stress area boundaries, but rather, reflect the regional proportion of help-seeking veterans. 5. Experiences of deprivation for help-seeking veterans differed between the nations. As the risk of deprivation was greatest in Scotland and somewhat greater in England and Wales compared Page 5

7 to Northern Ireland. Specific support for issues related to deprivation should be targeted to these countries. 6. Factors related to individuals service history were found to increase the risk of deprivation. Of particular note was that Early Service Leavers were at increased risk of deprivation. This reinforces the need to highlight those who might be at increased risk during their military service and then provide early intervention support for veterans during transition from service. 7. The finding that almost one fifth of veterans accessing care at Combat Stress are Early Service Leavers is a major finding. Prior to this study the number of ESLs engaged in the clinical services at Combat Stress was unknown and their demographics and location were also unknown. Other researchers in the field had commented that this was a group that probably engaged with few clinical services. This has now been proven to be untrue and valuable data and information has been gathered about this group as a result of this study. The literature has demonstrated that ESLs are most at risk of mental illness and that they display a suicide rate three times higher than their non-veteran counterparts. A separate study is warranted to examine in more depth the demographics, clinical characteristics and need and service design modifications that may be required for this particular group. Other points of investigation should include method of referral, access into clinical services, treatment engagement completion rates and clinical outcomes. 8. Other demographics associated with an increased risk of deprivation included having served in the Army, being of a younger age and being single. These demographics require further evaluation and will probably form part of the further study now planned into the ESLs, as these findings are likely to be linked. 9. Taking longer to seek help was associated with a higher risk of experiencing multiple deprivations. Whilst the cause of this is not known, the association reinforces the need to improve access and engagement in services for those in more deprived areas. Page 6

8 Acknowledgements We would like to thank the Office of National Statistics, Department for Communities and Local Government, Northern Ireland Statistics and Research Agency, the Scottish Government and the Knowledge and Analytical Services, Welsh Government for making the deprivation and postcode data freely available. Appreciation also goes to Ben Weijers, Senior Data Analyst at Combat Stress for his assistance in extracting the client data and producing the maps that appear in chapter eight of this report. In addition, thanks to Rachel Ashwick, Research Assistant at Combat Stress for proof reading and editing the report. Page 7

9 Chapter 1: Background Information Chapter 1 Background Information Chapter highlights: Multiple deprivation is a relative measure of social and economic deficit, encompassing a broad range of domains, including financial, health, education and crime. It is provided by Government departments for each of the countries in the UK by neighbourhood Understanding deprivation in the context of mental health difficulties can be valuable in drawing implications about accessing services, impact on severity of mental health presentations and engagement and effectiveness of treatments. Veterans seeking help for mental health difficulties have a particularly high burden of mental illness, welfare and social care needs. Studies indicate that veterans experience practical and stigma-related barriers to accessing help for mental health difficulties. Studies indicate that deprivation may be associated with poorer outcomes of mental health treatment. This report explored patterns of demographic characteristics and deprivation in UK veterans seeking help for mental health difficulties. Page 8

10 Chapter 1: Background Information Defining Multiple Deprivation Multiple deprivation is a measure of social and economic deficit. It encompasses a broad range of domains such as financial, health, education, services and crime. As such, it describes a multidimensional problem that is broader than affluence or a deficit in a single domain 1. It represents overall quality of life and availability of resources across a range of domains that influence our social and economic experience. In the UK this data has been compiled by relevant government bodies and is based upon a geographic area. Multiple deprivation incorporates a number of quantitative indices that represent different indicators of deprivation. For instance, in England, multiple deprivation is measured based on 37 separate statistical indicators 2. Such measures are used to understand the distribution of social inequalities and can, with caution, be used to allocate resources. In the UK these measures of multiple deprivation are available by geographical areas or neighbourhoods, and are known as Indices of Multiple Deprivation (IMD). These indices give an overall measure of multiple deprivation of the people living in that area. However, experiences of deprivation can vary from person to person within similar areas or even between generations within families. The IMD measures give an overall score which can then be ranked to make comparisons between the most deprived and least deprived areas across the country possible. Multiple Deprivation and Mental Health Understanding multiple deprivation is important to those providing mental health services. First, several aspects of deprivation may lead to barriers in accessing services. These may be low income and related barriers such as the ability to attend appointments or residential care due to travel or childcare costs. Another aspect of multiple deprivation involves physical distances to key services; it may be that areas with greater deprivation experience greater challenges in attending a GP surgery for referral. Lower educational attainment may also influence awareness of mental health, meaning people will be less likely to seek help due to not recognising when there is a need. Page 9

11 Chapter 1: Background Information Secondly, the experience of deprivation may directly or indirectly influence mental health. Historical and current adversities relating to social and economic background have been associated with psychological distress 3. The influence of deprivation on mental health has been found to be significant when considering deprivation at a community level, even after controlling for individual risk factors 4 ; 5. The reasons for this association are not known. One reason could be that those who are experiencing mental health difficulties may be more dependent on collective resources for support, and when these are lacking due to neighbourhood multiple deprivation, problems are exacerbated. Furthermore, deprivation has been associated with a greater likelihood of experiencing a mental health problem as part of a complex co-morbidity, which refers to an individual experiencing several physical and mental health problems concurrently 6. Thirdly, systemic thinking and evidence suggests that the context an individual lives in is highly influential in their treatment success. On a household level, evidence has shown that distress in the home environment has a negative impact on treatment outcomes 7. It is reasonable to suggest that increased deprivation could increase distress in the home environment, as concerns about money, employment or education may be a source of daily stressors. The time, effort and emotional demands therapeutic treatments place on individuals may be difficult to manage when also dealing with the wider demands of deprivation. For example, guidelines for the treatment of PTSD in the UK 8 involve a period of stabilisation and then, following trauma-focused treatment, a period of re-integration. Understanding the social context, particularly regarding multiple deprivation, will help tailor these stages of intervention to the challenges potentially faced by the population, thereby making treatments more accessible and improving adherence rates. Multiple Deprivation and Veteran Mental Health It has been estimated that over 16,000 service personnel leave the UK Armed Forces each year 9. Evidence suggests there has been an increase in referrals of veterans seeking mental health support in the UK over recent years 10. Whilst the reasons for this are not known, it has been suggested that veterans from more recent conflicts in Iraq and Afghanistan are seeking help sooner. However, there is still a Page 10

12 Chapter 1: Background Information significant overall delay between leaving the Armed Forces and seeking help. Furthermore, evidence suggests there may be large numbers of Armed Forces personnel meeting the criteria for PTSD who are not accessing help; one study found that only 23% of those with identified mental health issues were seeking help 11. Studies into barriers for accessing mental health services in military and veteran populations have suggested stigma and logistical barriers to be influential 12, 13. Understanding any patterns in multiple deprivation in the population who have sought help may begin to elucidate areas requiring attention to improve more effective access to services for others in need. UK veterans seeking help present with complex mental health needs, with 8 reporting difficulties for common mental health problems and 73% for PTSD 14. Evidence suggests that not all mental health issues in serving and veteran populations are directly attributable to military experience; when considering PTSD specifically only 5 of cases in current serving personnel are directly attributable to deployments 15. Deprivation may play a role in exacerbating or triggering mental health difficulties in veterans. High education attainment and higher socio-economic background are associated with better mental health 16. For example in the Armed Forces, it has been reported that Officers have lower rates of mental health difficulties compared to other Ranks 17. Whilst research has suggested that veterans in general are not at risk of social exclusion, those who reported symptoms of mental illness were more likely to be unemployed and experience continued mental health difficulties at a 3-year follow-up 18. Directionality of this association is not known, however it does suggest there is a relationship between some aspect of deprivation and lack of mental health recovery in this group of the veteran population. Given the influence that context has on mental health and success of treatments, it is important to understand the prevalence and type of deprivation experienced by help-seeking veterans. This could have implications for the treatment pathway regarding additional support veterans needs prior to, during, or after treatment. Page 11

13 Chapter 1: Background Information What is the Value in Exploring Multiple Deprivation of Help-Seeking Veterans? As discussed earlier in the report, understanding patterns of deprivation in a population of help-seeking veterans could have multiple benefits and implications. In general, exploring the relative deprivation across sub-domains may help identify specific problematic areas of deprivation that are potentially heightened in this group (e.g. health, access to services or income). This may elucidate ways in which to remove barriers to accessing treatment, understand where poor mental health may be exacerbated by deprivation and improve treatment outcomes by further considering context. With on-going pressure on funding for the provision of veteran mental health services, exploring these areas will be valuable in ensuring the efficiency and effectiveness of future investments in services. For example, identifying sub-groups of help-seeking veterans who are at an increased risk of deprivation may provide insight into how to best target cost-effective support to remove help-seeking barriers. Aim of this Report The aim of this report was to explore whether UK veterans seeking help for mental health difficulties are at an increased risk of deprivation. This report summarised the linkage of data from UK multiple deprivation indices and neighbourhoods lived in by population of veterans who have contacted Combat Stress. It will explore the overall picture of relative deprivation experienced by the Combat Stress helpseeking population. It will also explore associations between demographics, such as age, and military history, such as length of service, with deprivation. This analysis will be conducted separately for England, Northern Ireland, Scotland and Wales. A UK-wide comparative summary will also be included. Page 12

14 Chapter 2: Report Methods Chapter 2 Report Methods Chapter highlights: The report linked data for deprivation provided by UK Government departments (known as the Index of Multiple Deprivation) to demographic, military and help-seeking data for a sample of veterans seeking help from Combat Stress. Indices of Multiple Deprivation are statistical measures of deprivation comprised of a range of domains and underlying statistical indicators. For example, the measure in England consists of seven differently weighted domains: income, employment, health, education, crime, access to services, and environment. The sample of veterans comprised all active clients of Combat Stress as of 1 February 2016 who had had an appointment with the service in the preceding year. After linking the data sets, the sample consisted of 3,120 veterans. Patterns of deprivation and demographics were explored using descriptive statistics and graphical presentations. Page 13

15 Chapter 2: Report Methods Study Design The aim of this study was to link a UK population of veterans who have sought help for mental health difficulties to data reflecting multiple deprivation in the geographical area they reside in. The veteran data was provided by Combat Stress, as it is the leading mental health charity that provides clinical services for military veterans throughout the UK. Deprivation data was provided by UK Governmental departments, independently for each of the four countries of the UK. It is referred to as an Index of Multiple Deprivation. Using a sample of clients of Combat Stress ensured the report explored a homogenous group in line with this criterion. Sample The sample comprised of all active clients who had attended at least one appointment with Combat Stress between January 2015 and January Data was cleaned to ensure any duplicate clients were removed. An appointment was defined as attendance at a treatment programme, an outpatient psychiatric appointment, or a community-based appointment. This broad definition ensured that our sample was representative of all veterans who sought help from Combat Stress, encompassing all stages of the treatment pathway. Of the 3,185 clients retrieved from the veterans database, demographic and military data was extracted for the following variables: postcode, gender, age, marital status, employment status, military service type, military service length, and time since leaving the military. Index of Multiple Deprivation Index of Multiple Deprivation (IMD) is a relative measure of deprivation reported by geographical areas, or neighbourhoods, across the four countries of the UK. It is calculated based on seven subdomains of deprivation (eight in Wales) which are broadly represented by the categories of: Income, Employment, Health, Education, Crime, Barriers to Services, and Living Environment. The weightings assigned to each sub-domain vary between countries. IMD is represented by a score based on the underlying statistical indicators for each of the sub-domains. For example, a statistic representing numbers of adults and children in income support families Page 14

16 Chapter 2: Report Methods combines with other statistics to give a numerator for the Income sub-domain; this combines with the other domains to give an IMD score for that area. These IMD scores are used to give a rank and decile for each neighbourhood, which gives a level of deprivation relative to other neighbourhoods. Whilst there is substantial overlap in sub-domains, the specific definitions and indicators underlying each vary between countries. Details of the indicators used for each country can be found in the appendices. The weightings given to each sub-domain across the four countries are presented in Table 2.1. Table 2.1: Sub-domains and weightings that comprise the indices by country. Income Employment Education Health Crime Barriers Environment England % 9.3% 9.3% NI ** Scotland 28% 28% 14% 14% 9% 2% # Wales % * # ## * Referred to as Community Safety; ** Referred to as Proximity; Referred to as Geographic Access; Referred to as Access to Services; # Referred to as Housing; ## Referred to as Physical Environment. IMD is organised by small geographical areas, with averages of 800 to 2000 residents per area. In England, the Index of Multiple Deprivation is organised by Lower-layer Super Output Area (LSOA). A LSOA has an average of 1,500 residents, there are 32,844 LSOA s in England. In Northern Ireland, the Multiple Deprivation Measure is organised by Super Output Area Geography (SOA). A SOA has an average of 2,000 residents, there are 890 SOA s in Northern Ireland. In Scotland, the Index of Multiple Deprivation is organised by Datazones. Datazones have an average of 800 residents, there are 6505 datazones in Scotland. In Wales, the Index of Multiple Deprivation is organised by Lowerlayer Super Output Area (LSOA). A LSOA has an average of 1,600, there are 1,909 LSOA s in Wales. IMD is an overall measure of deprivation experienced by people living in these specified geographical areas, or neighbourhoods. Page 15

17 Chapter 2: Report Methods Data Linkage Methods Veterans in our population were linked to the Index of Multiple Deprivation (IMD) for the neighbourhood they lived in, based on their postcode. This was done by matching veteran postcode to the code for their neighbourhood by which the deprivation data was organised by. This in turn was matched to the IMD for that area. Two per cent of the original sample were not found as part of these matching processes, yielding a final sample size of 3,120. This process is shown in Figure 2.1. Figure 2.1: Linking veteran data to the Index of Multiple Deprivation Database 1 Veteran Database (Demographics and veteran postcode) N=3,185 Database 2 Postcode Directory (Matched veteran postcode to neighbourhood) Database 3 Index of Multiple Deprivation Reports (Matched veteran neighbourhood to IMD data) Report Database Veteran sample, each client matched to IMD data N=3, veteran postcodes were not found (1.4%) 19 veteran small neighbourhood areas were not found (0.6%) Further, when linking the veteran postcode to neighbourhood in the postcode directory, data referring to the urban versus rural classification of that area were also extracted. In line with the Office of National Statistics definition of rural and urban for England and Wales, urban is classed as living within a settlement of 10,000 or more. This criteria was also applied to the data for Scotland. There was no rural versus urban data available for Northern Ireland. Data sources The data for Combat Stress clients were extracted from the electronic patient database (CareNotes, provided by Advanced Health and Care). This system holds a single electronic patient record for each client and is a UK-wide database. Data was anonymised during extraction. The Postcode Directory was sourced from the Office of National Statistics (ONS). It was the ONS Postcode Directory, February Page 16

18 Chapter 2: Report Methods 2016 edition. It provides postcode data coverage for the whole of the UK. There were 2,573,419 postcodes in this directory. The English Index of Multiple Deprivation was released by the Department for Communities and Local Government in September The Northern Ireland Multiple Deprivation Measure was released by the Northern Ireland Statistics and Research Agency in May The Scottish Index of Multiple Deprivation was released by The Scottish Government in December The Welsh Index of Multiple Deprivation was released by Knowledge and Analytical Services, Welsh Government in November Analysis methodology We explore characteristics of the sample in chapter three. The separate analyses regarding deprivation for each country were are explored in chapters four to seven. Finally, we compare the data from the four countries in chapter eight. Frequency statistics for all demographic, military and help-seeking characteristics were calculated and reported as percentages, for the UK and each of the four countries individually. To explore whether there were any differences in frequencies in these variables across the countries, a Pearson s chi-squared analysis test was used. To explore distributions of deprivation, bar graphs by decile were plotted for each country. Then for each country, this distribution was plotted by the demographics and other variables, in order to explore any potential associations with these. How to interpret these graphs is depicted in chapter three. Analysis was conducted using IBM SPSS Statistics version 22 and Microsoft Excel To explore any potential geographical patterns, geographical spread of veterans by deprivation, relationship status, length of service and time to contact CS were plotted on maps of the UK using software provided by Bing, the online search engine by Microsoft. Page 17

19 Chapter 3: Description of Help-Seeking Veteran Sample Chapter 3 Description of UK Help-Seeking Veterans Chapter highlights: The sample consisted of 3,120 UK veterans, with an over-representation for Northern Ireland and an under-representation of England (although to a lesser extent). Scotland and Wales were also over-represented compared to the general populations of the UK. The sample was majority male (97%), and had a fairly even spread across age groups and roughly even split between those in a relationship and those who were not (51% to 47% respectively). The sample comprised of a majority of Army veterans (87%) and the majority did not have a war pension granted (96%). Nearly one in five veterans had left service after fewer than four years (18%) and nearly half the sample took 11 years or more to contact Combat Stress for support (46%). Veterans residing in Northern Ireland appeared to differ in terms of demographics and military characteristics compared to the other nations. There were fewer males, more veterans aged over 65 years old and more in a relationship as opposed to single. There were more veterans who served in the Army and more who served for over 15 years. There were no significant differences between countries for time to contact Combat Stress for help after leaving the military. There were more veterans in the sample living in the most deprived deciles than the least deprived deciles (4 in the most three deprived deciles, compared to in the three least deprived deciles). This suggests a higher level of deprivation in this sample compared to the general UK population. Page 18

20 Chapter 3: Description of Help-Seeking Veteran Sample Distribution of Sample across the UK The sample of help-seeking veterans used in the production of this report had a sample size of 3,120. Table 3.1 shows the distribution of the sample of help-seeking veterans across the four countries of the UK. Table 3.1: Distribution of veteran sample by country Country Number of veterans Distribution of Distribution of sample general population England % 84% Northern Ireland % 3% Scotland % 8% Wales 271 9% General population data extracted from the 2011Census, published by the Office of National Statistics 2011 In comparison with UK population, England is under-represented in our sample. Northern Ireland, Scotland and Wales are over-represented 19. Page 19

21 Chapter 3: Description of Help-Seeking Veteran Sample Demographic Characteristics of the Sample Table 3.2 shows the demographic characteristics of the overall sample. Table 3.2: Demographic characteristics of the veteran sample Demographic Percentage Sex Female 3% Male 97% Age < % % % Relationship status In a relationship 51% Not in a relationship 47% Widowed 2% The sample consisted of a large majority of males compared to females. Currently the UK Armed Forces consists of only female personnel 20. Whilst we would expect a majority of the sample to be male, females did appear to be under-represented. Less than a third of the sample were under 40 years old. Just over half of the sample were in a relationship. Page 20

22 Chapter 3: Description of Help-Seeking Veteran Sample Table 3.3 shows the comparative proportions of demographic characteristics across the four countries of the UK. Statistical tests (chi-squared) were carried out to explore whether there were statistically significant differences between any of the four countries along each of the variables. Where these have a p-value less than or equal to 0.05 there is some significant difference between the countries in the categories of that variable. Table 3.3: Demographic characteristics of the veteran sample across UK countries Demographic England NI Scotland Wales P value Sex Female 3% 7% 3% 1% Male 97% 93% 97% 99% Age <30 12% 3% 11% % 54% 47% % 44% 3 34% 65+ 9% 23% 7% 7% Relationship status In a relationship 5 66% 38% 48% Not in a relationship 48% 31% 61% 51% Widowed 1% 3% 1% 1% There are statistically significant differences between the countries in all three of the demographic variables (sex, age and relationship status). Northern Ireland appear to have a greater representation of females and Scotland have proportionately more males. The Northern Irish sample was weighted more heavily towards the older age brackets, with very few in the under 30 years bracket and proportionately more in the over 65 years bracket. In Scotland, fewer were in a relationship, whilst in Northern Ireland more were in a relationship, in comparison to England and Wales which had approximately half in a relationship. More Northern Ireland veterans were widowed, possibly linked to the older age of this group. Page 21

23 Chapter 3: Description of Help-Seeking Veteran Sample Military and Help-Seeking Characteristics of the Sample Table 3.4 shows the military and help-seeking related characteristics of the overall sample. Table 3.4: Military and help-seeking characteristics of the veteran sample Demographic Percentage Military service Royal Navy 7% Army 87% Royal Air Force 6% War Pension No 96% Yes 4% Yrs in service <4 18% % Yrs to contact Combat Stress <2 27% % % The majority of the sample were Army veterans. This is an over-representation compared to the current employment statistics from the UK Armed Forces which reports the Army to make up 62% of military personnel 9. Less than 1 in 20 had been granted a War Pension. There was a relatively even spread of service duration across the sample. Nearly 1 in 5 had left service after fewer than four years, classified as early service leavers. Nearly half served for ten years or more. Just over quarter of the sample contacted Combat Stress for help within two years of leaving the Armed Forces. In contrast, nearly half (4) sought help by contacting Combat Stress over ten years after leaving the Armed Forces. Page 22

24 Chapter 3: Description of Help-Seeking Veteran Sample Table 3.5 shows the comparative proportions of military and help-seeking characteristics across the four countries of the UK. Table 3.5: Military and help-seeking characteristics of the veteran sample across UK countries Demographic England NI Scotland Wales P value Military service Royal Navy 9% 1% 7% 7% Army 84% 97% 86% 88% Royal Air Force 7% 1% 7% War Pension No 96% % Yes 4% 1% Yrs in service <4 19% 14% 17% 22% % 46% 6 54% % 4 22% 24% Yrs to contact Combat Stress <2 27% 28% 26% 24% % 28% 24% % 43% 5 46% There are statistically significant differences between the countries in three of the variables. There were a greater proportion of veterans residing in Northern Ireland who were in the Army, compared to the Navy or RAF. Veterans residing in England had the highest proportion of those who served in the Navy. Those residing in Wales had the lowest rate of receiving a war pension compared to the other three countries. Wales also had the highest proportion of early service leavers. Northern Ireland had the highest proportion of veterans who had served for 15 years or more. There were no significant differences between countries in the years to contact Combat Stress after leaving the service, suggesting this is consistent across the four countries. Page 23

25 Chapter 3: Description of Help-Seeking Veteran Sample Rural and Urban Distribution of Help-Seeking Veterans in the UK Figure 3.1 shows the distribution of the help-seeking veteran sample between rural and urban areas. This data was not available for Northern Ireland. Figure 3.1: Distribution of help-seeking veterans across urban and rural areas England Scotland Wales Rural Urban All three country s samples consisted of a majority of veterans living in urban areas. There was a greater proportion of urban dwelling veterans in England (79%) compared to Scotland and Wales (71% and 69% respectively), however the differences were modest. Page 24

26 Chapter 3: Description of Help-Seeking Veteran Sample Multiple Deprivation of Help-Seeking Veterans in the UK Figure 3.2 shows the distribution of the veteran help-seeking sample across the deciles of deprivation for the whole of the UK. The first decile represents the most deprived neighbourhoods relative to the rest of UK, and the tenth decile signifies the least deprived. Figure 3.2: Distribution of help-seeking veterans across deciles of deprivation in UK 1 A large proportion of the veteran sample (4) resided within the three most deprived deciles in the UK. In contrast, half this proportion () of the veteran sample lived in the three least deprived deciles in UK. The mean of the deciles for the veteran sample was 4.7, below the median point for the general population of UK. Page 25

27 Chapter 3: Description of Help-Seeking Veteran Sample How to interpret the deprivation graphs Deprivation is a relative measure. It is provided in deciles. Deciles represent the deprivation data ranked in sections of, thus there are ten deciles. The first decile is the most deprived neighbourhoods. The tenth decile is the least deprived neighbourhoods. If we were to plot the whole population of the UK on a graph, it would appear flat with in each, just like this: 1 Any variation from this flat graph indicates there is a different pattern of deprivation in the sub-group represented by the graph in comparison to the general population. If the graph is skewed towards the most deprived (the 1 st decile) this suggests there are more people living in deprived areas in this group than in the general population. For example: 1 Comparing graphs of sub-groups can give an indication whether those variables have some potential association with deprivation. We cannot draw definitive conclusions about statistical significance from such graphs. Remember we are looking at the deprivation measure of the neighbourhood each veteran lives in. So, the measures of deprivation are not of each veterans specific circumstances, but rather those that they reside within. Page 26

28 Chapter 4: Exploring Multiple Deprivation for Veterans in England Chapter 4 Exploring Multiple Deprivation of Veterans in England Chapter highlights: The demographic characteristics for help-seeking veterans in England were similar to those of the UK. The majority were male (97%), there was an even spread across age groups and half were in a relationship (5). The military and help-seeking characteristics of help-seeking veterans were also similar to the UK, with a majority in the Army (84%) and not having a war pension (96%). 19% were classed as early service leavers and only 27% sought help fewer than two years after leaving service. Nearly double the number of veterans resided within the three most deprived deciles (41%) compared to the three least deprived deciles (21%). A greater proportion of veterans who are not in a relationship were in the three most deprived deciles (47%) compared to the three least deprived (17%), suggesting an association between not being in a relationship and an increased risk of deprivation. Veterans who had served in the Army appeared to be at an increased risk of deprivation compared to those who had been in the Royal Navy or Royal Air Force. Longer service length appeared to be negatively associated with deprivation. For example, early service leavers appeared to be at increased risk of deprivation compared to individuals who had longer service engagement. Taking longer to seek help seemed to be associated with higher levels of deprivation. For those who had taken more than 11 years to seek help, 44% resided in the three most deprived deciles compared to 37% of those who sought help within two years of leaving the Armed Forces.

29 Chapter 4: Exploring Multiple Deprivation of Veterans in England Index of Multiple Deprivation for England Multiple deprivation data for England is referred to as the Indices of Deprivation and is published by the Department for Communities and Local Government. It was last released in The indices consist of seven domains of deprivation, based on 37 separate statistical indicators. Details of these indicators can be found in the Appendix of this report. These domains and how each is weighted to calculate the Indices are shown in Figure 4.1. Figure 4.1: The domains and weightings of the English Indices of Deprivation Environment 9.3% Barriers 9.3% Income 22. Crime 9.3% Health 13. Employment 22. Education 13. Page 28

30 Chapter 4: Exploring Multiple Deprivation of Veterans in England Demographic, Military and Help-Seeking Characteristics for England The demographics and military characteristics of the veteran sample for England were explored. Table 4.1 outlines the demographic characteristics and Table 4.2 outlines the military characteristics. Each table also shows the percentages for the overall UK sample of help-seeking veterans for comparison. Table 4.1: Demographic characteristics of the veteran sample in England Demographic England Sample UK Sample Sex Female 3% 3% Male 97% 97% Age <30 12% % % 32% 65+ 9% 11% Relationship status In a relationship 5 51% Not in a relationship 48% 47% Widowed 1% 2% The demographic characteristics of the England sample are similar to those for the wider UK sample. That is, the majority are male, a fairly even spread across age ranges clustered around the 30 to 49 and 50 to 64 years brackets and roughly half are in a relationship. A similarity to the UK sample could be expected as England makes up the largest proportion of the whole sample (63%). Page 29

31 Chapter 4: Exploring Multiple Deprivation of Veterans in England Table 4.2: Military and help-seeking characteristics of the veteran sample for England Demographic England Sample UK Sample Military service Royal Navy 9% 7% Army 84% 87% Royal Air Force 7% 6% War Pension No 96% 96% Yes 4% 4% Yrs in service <4 19% 18% % % 26% Yrs to contact Combat Stress <2 27% 27% % 27% % 46% The military and help-seeking characteristics of the England sample are similar to those for the wider UK. The majority were in the Army (84%) and did not have a war pension (96%). 19% were classed as early service leavers and only 27% sought help fewer than two years after leaving service. As with the demographic characteristics, this similarity is to be expected as England makes up the largest proportion of the whole sample. Page 30

32 Chapter 4: Exploring Multiple Deprivation of Veterans in England Multiple Deprivation of Help-Seeking Veterans in England Figure 4.2 shows the distribution of the veteran help-seeking sample across the deciles of deprivation. The first decile is the most deprived neighbourhoods relative to the rest of England, and the tenth decile is the least deprived. Figure 4.2: Distribution of help-seeking veterans across deciles of deprivation in England 1 The largest proportion of the veteran sample (1) resides within the most deprived neighbourhoods in England. Nearly double (41%) the amount of veterans reside in the three most deprived deciles, compared to the three least deprived (21% of the sample). The mean of the deciles for the veteran sample was 4.7, below the median point for the general population of England. This suggests that in England, help-seeking veterans are residing in areas with higher levels of deprivation. Page 31

33 Chapter 4: Exploring Multiple Deprivation of Veterans in England Multiple Deprivation of Help-Seeking Veterans by Demographic Characteristics The link between deprivation and demographics was explored. This provided additional insight into the patterns of deprivation in this group, and indicated any sub-groups that may be at higher risk of deprivation. Figure 4.3 shows the distribution of deprivation by age, Figure 4.4 shows the distribution by sex, and Figure 4.5 shows the distribution by relationship status. Figure 4.3: Distribution of help-seeking veterans across deciles of deprivation by age group Under 30 years old Between 30 and 49 years old 1 1 Between 50 and 64 years old 65 years old and above 1 1 The pattern of deprivation between different age groups in England were similar. In the older age category of 65 years old and above, compared to the other three age categories, there were fewer veterans in the most deprived decile. However, the proportions of veterans in the three most deprived deciles in each of the age categories was similar, ranging from 39 to 42%. It would appear that there is no notable pattern between age group and deprivation for help-seeking veterans in England. Page 32

34 Chapter 4: Exploring Multiple Deprivation of Veterans in England Figure 4.4: Distribution of help-seeking veterans across deciles of deprivation by sex Male Female 1 1 The pattern of deprivation for males was skewed to the most deprived deciles, with a steady reduction in proportion as deprivation decreased. Females had a more varied pattern of deprivation. This suggests that being female in a help-seeking veteran sample may be less associated with deprivation. However, this may have been due to the small number of females in the sample, meaning a lack of the power needed for a trend to emerge. Figure 4.5: Distribution of help-seeking veterans across deciles of deprivation by relationship status In a relationship Not in a relationship 1 1 The pattern of deprivation for veterans who are not in a relationship was more skewed towards the most deprived deciles. In contrast, there was less variation for those in a relationship. A greater proportion of veterans who are not in a relationship were in the three most deprived deciles (47%) compared to three least deprived (17%). This is compared to 34% of those in a relationship in the three most deprived deciles. It appears that not being in a relationship had some association with greater deprivation. Page 33

35 Chapter 4: Exploring Multiple Deprivation of Veterans in England Multiple Deprivation of Help-Seeking Veterans by Military and Help-Seeking Characteristics The distribution of veterans across relative deprivation was also explored by military characteristics. Figure 4.6 shows the distribution of deprivation by military service employer, Figure 4.7 shows the distribution by war pension status, Figure 4.8 shows the distribution by length of military service and Figure 4.9 shows the distribution by the time since leaving the military taken to contact Combat Stress for help. Figure 4.6: Distribution of help-seeking veterans across deciles of deprivation by military service Royal Navy Army 1 1 Royal Air Force 1 The pattern of deprivation for those help-seeking veterans who were in the Army was skewed towards the more deprived deciles. The Royal Navy and Royal Air Force are more varied in their pattern of deprivation, suggesting less of an association with deprivation in these sub-groups. Page 34

36 Chapter 4: Exploring Multiple Deprivation of Veterans in England Figure 4.7: Distribution of help-seeking veterans across deciles of deprivation by war pension status War Pension granted No War Pension 1 1 The pattern of deprivation for those who have no war pension granted showed a skew towards the more deprived deciles. Individuals who have had a war pension granted showed a less clear pattern of deprivation, with a more varied spread across the deciles. However, for those in receipt of a war pension there still seemed to be a greater proportion of veterans in the three most deprived deciles (36%) compared to the three least deprived (22%). Page 35

37 Chapter 4: Exploring Multiple Deprivation of Veterans in England Figure 4.8: Distribution of help-seeking veterans across deciles of deprivation by length of service Few than 4 years (early service leavers) Between 4 and 14 years years or more 1 The pattern of deprivation for those veterans who were classed as early service leavers (having left before four years of service) was skewed towards the more deprived deciles, with 21% in the most deprived decile and 4% in the least. This is in contrast to those who served for 15 years or more, where 9% were in the most deprived decile and 7% in the least. These patterns suggested that leaving service early is associated with residing in areas of greater deprivation. Page 36

38 Chapter 4: Exploring Multiple Deprivation of Veterans in England Figure 4.9: Distribution of help-seeking veterans across deciles of deprivation by time to contact CS Fewer than 2 years Between 2 and 10 years 1 1 More than 11 years 1 As time between leaving the military and seeking help from Combat Stress increases, there seems to be increasing proportions of veterans in more deprived areas. In those who sought help after 11 years or more, there were 44% in the three most deprived deciles and 19% in the three least deprived deciles. In both those who sought help after fewer than two years and between two and ten years, there was 37% in the three most deprived deciles. This seems to suggest that as time to seek help increased, individuals were at a greater risk of residing in more deprived areas. Page 37

39 Chapter 5: Exploring Multiple Deprivation of Veterans in Northern Ireland Chapter 5 Exploring Multiple Deprivation of Veterans in Northern Ireland Chapter highlights: The demographic characteristics for Northern Ireland appeared to differ from the UK. There were proportionally fewer males (93% compared to 97%). There were more veterans over 65 years old in Northern Ireland (23%) compared to the overall UK (11%) and more veterans in relationships (66%) compared to the overall UK sample (51%). In Northern Ireland, there were more veterans who served in the Army (97% compared to 87%), and consequently fewer in the Navy and RAF. There were more veterans who had served for 15 years plus (4 in Northern Ireland compared to 26% in UK overall). More veterans reside within the three most deprived deciles in Northern Ireland (31%) compared to the three least deprived (21%). However, the overall pattern of deprivation in Northern Ireland help-seeking veterans was more varied than the other UK countries, with a greater proportion in the mid-ranges. A greater proportion of veterans who are not in a relationship were in the three most deprived deciles (4) compared to the three least deprived (14%), suggesting some association between not being in a relationship and deprivation in Northern Ireland. More veterans who were classed as early service leavers (before four years of service) resided in the three most deprived deciles (4) compared to those who left the service after 4 to 14 years (34%) or after more than 15 years (22%). These patterns suggested that leaving service early is associated with residing in areas of greater deprivation in Northern Ireland. In those who sought help after 11 years or more, there were more in the three most deprived deciles (38%). This is compared to those who sought help within fewer than two years (27%) and between two and ten years (24%). This seems to suggest that as time to seek help increased, individuals may have been at a greater risk of residing in more deprived areas. Page 38

40 Chapter 5: Exploring Multiple Deprivation of Veterans in Northern Ireland Multiple Deprivation Measure for Northern Ireland Multiple deprivation data for Northern Ireland is referred to as the Multiple Deprivation Measure and is published by the Northern Ireland Statistics and Research Agency. It was last released in The indices consist of seven domains of deprivation, based on 52 separate statistical indicators. Details of these indicators can be found in the Appendix of this report. These domains and how each is weighted to calculate the Indices is shown in Figure 5.1. Figure 5.1: The domains and weightings of the Northern Ireland Multiple Deprivation Measure Proximity Environment Income 2 Crime Health 1 Education 1 Employment 2 Page 39

41 Chapter 5: Exploring Multiple Deprivation of Veterans in Northern Ireland Demographic, Military and Help-Seeking Characteristics for Northern Ireland The demographics and military characteristics of the veteran sample for Northern Ireland were explored. Table 5.1 outlines the demographic characteristics and Table 5.2 outlines the military characteristics. Each table also shows the percentages for the overall UK sample. Table 5.1: Demographic characteristics of the veteran sample in Northern Ireland Demographic NI Sample UK Sample Sex Female 7% 3% Male 93% 97% Age <30 3% % 47% % 32% % 11% Relationship status In a relationship 66% 51% Not in a relationship 31% 47% Widowed 3% 2% The demographic characteristics for Northern Ireland had some notable distinctions from those of the overall UK. Whilst there was still a large majority of males, this was 93% compared to 97%. There was a greater number of older veterans in Northern Ireland, for example with 23% in the over 65 year age bracket, compared to 11% in the overall UK. There were more veterans in relationships (66%) compared to the overall UK sample (51%). Page 40

42 Chapter 5: Exploring Multiple Deprivation of Veterans in Northern Ireland Table 5.2: Military and help-seeking characteristics of the veteran sample for Northern Ireland Demographic NI Sample UK Sample Military service Royal Navy 1% 7% Army 97% 87% Royal Air Force 1% 6% War Pension No 9 96% Yes 4% Yrs in service <4 14% 18% % % Yrs to contact Combat Stress <2 28% 27% % 26% % 4 As with the demographic characteristics, there were some notable differences between Northern Ireland and the wider UK sample. There were more veterans who served in the Army (97% compared to 87%), and consequently fewer in the Navy and RAF. There were more veterans who had served for more than 15 years (4 in Northern Ireland compared to 26% in UK overall). Frequencies for war pension status and time to contact Combat Stress were fairly similar to the overall UK sample. Page 41

43 Chapter 5: Exploring Multiple Deprivation of Veterans in Northern Ireland Multiple Deprivation of Help-Seeking Veterans in Northern Ireland Figure 5.2 shows the distribution of the veteran help-seeking sample across the deciles of deprivation. The first decile is the most deprived neighbourhoods relative to the rest of Northern Ireland, and the tenth decile is the least deprived. Figure 5.2: Distribution of help-seeking veterans across deciles of deprivation in Northern Ireland 1 A large proportion of the veteran sample (31%) resided within the three most deprived deciles in Northern Ireland, in contrast to the three least deprived (21%). However, the overall pattern of deprivation in Northern Ireland help-seeking veterans was more varied than the other UK countries, with a greater proportion in the mid-ranges (48% in the middle four deciles). The mean of the deciles for the veteran sample was 5.12, above the median point for the general population of Northern Ireland. Page 42

44 Chapter 5: Exploring Multiple Deprivation of Veterans in Northern Ireland Multiple Deprivation of Help-Seeking Veterans by Demographic Characteristics The distribution of veterans across relative deprivation was explored by demographic characteristics. This provided additional insight into patterns of deprivation in this group, and indicated any sub-groups that may be at a higher risk of deprivation. Figure 5.3 shows the distribution of deprivation by age groups, Figure 5.4 shows the distribution by sex, and Figure 5.5 shows the distribution by relationship status. Figure 5.3: Distribution of help-seeking veterans across deciles of deprivation by age group Under 30 years old Between 30 and 49 years old 1 1 Between 50 and 64 years old 65 years old and above 1 1 There were no notable patterns of deprivation in different age groups in Northern Ireland. Three of the four age brackets had more veterans residing in the three most deprived deciles than the three least deprived, with the exception of the lower middle aged bracket of 30 to 49 years. Overall, it would appear that there is no notable pattern between age group and deprivation for help-seeking veterans in Northern Ireland. Page 43

45 Chapter 5: Exploring Multiple Deprivation of Veterans in Northern Ireland Figure 5.4: Distribution of help-seeking veterans across deciles of deprivation by sex Male Female 1 1 There was no notable patterns of deprivation for males and females. This suggests gender in a Northern Irish help-seeking veteran sample may not be associated with deprivation. There were more veterans in the three most deprived deciles compared to the three least deprived in both males and females (4 compared to 21% and 47% compared to 18% respectively). Figure 5.5: Distribution of help-seeking veterans across deciles of deprivation by relationship status In a relationship Not in a relationship 1 1 The pattern of deprivation for veterans who are single was more skewed towards the most deprived deciles. A greater proportion of veterans who are single were in the three most deprived deciles (4) as opposed to the three least deprived (14%). This is compared to 27% of those in a relationship in the three most deprived deciles and 24% in the least. It appears that not being in a relationship had some association with greater deprivation, whereas being in a relationship was less likely to be associated with deprivation. Page 44

46 Chapter 5: Exploring Multiple Deprivation of Veterans in Northern Ireland Multiple Deprivation of Help-Seeking Veterans by Military and Help-Seeking Characteristics Figure 5.6 shows the distribution of deprivation by military service employer, Figure 5.7 shows the distribution of deprivation by war pension status, and Figure 5.8 shows the distribution by length of military service and Figure 5.9 shows the distribution by the time since leaving the military taken to contact Combat Stress for help. Figure 5.6: Distribution of help-seeking veterans across deciles of deprivation by military service Royal Navy Army Royal Air Force The pattern of deprivation for those who were in the Army was clustered around the middle deciles, suggesting a lack of association between being in the Army and deprivation in NI. However there were more veterans in the three most deprived deciles (3, in line with general population distribution) compared to the three least deprived (21 st ). The Royal Navy and Royal Air Force sub-groups did not have any pattern, likely due to small sample sizes lacking the power for a trend. Page 45

47 Chapter 5: Exploring Multiple Deprivation of Veterans in Northern Ireland Figure 5.7: Distribution of help-seeking veterans across deciles of deprivation by war pension status War Pension granted No War Pension 1 1 Of both veterans who were granted a war pension granted and those who were not, there was a less clear pattern with deprivation, with a varied spread across the deciles compared to the overall UK population. Page 46

48 Chapter 5: Exploring Multiple Deprivation of Veterans in Northern Ireland Figure 5.8: Distribution of help-seeking veterans across deciles of deprivation by length of service Fewer than 4 years (early service leavers) Between 4 and 14 years years or more 2 1 There were more veterans who were classed as early service leavers (having left before four years of service) residing in the more deprived deciles. This was in comparison to those who left service after 4 to 14 years or in more than 15 years. 4 of early service leavers resided in the three most deprived deciles (in contrast to 34% and 22%, respectively). Leaving service after 15 years in particular seemed to be less associated with low or high deprivation (with 22% in the most deprived deciles and 24% in the least). These patterns suggested that leaving service early is related to residing in areas of greater deprivation in Northern Ireland. However, there is no significant effect on deprivation of leaving the service after 15 years. Page 47

49 Chapter 5: Exploring Multiple Deprivation of Veterans in Northern Ireland Figure 5.9: Distribution of help-seeking veterans across deciles of deprivation by time to contact CS Fewer than 2 years Between 2 and 10 years 1 1 More than 11 years 1 As time between leaving the military and seeking help from Combat Stress increases, there seems to be increasing proportions of veterans in more deprived areas. In those who sought help after 11 years or more, there were 38% in the three most deprived deciles and 19% in the three least deprived deciles. In those who sought help sooner; after fewer than two years and between two and ten years, there were 27% and 24% in the three most deprived deciles respectively. This seems to suggest that as time to seek help increased, individuals may have been at greater risk of residing in more deprived areas. Page 48

50 Chapter 6: Exploring Multiple Deprivation of Veterans in Scotland Chapter 6 Exploring Multiple Deprivation of Veterans in Scotland Chapter highlights: The demographic characteristics for Scotland were similar to those of the overall UK. This similarity had an exception in relationship status, where there were more veterans not in relationships (61%) compared to the overall UK sample (47%). The military and help-seeking characteristics of the Scotland sample were similar to those for the overall UK sample. 5 of veterans resided within the most deprived three deciles. In contrast, 16% of the veteran sample live in the three least deprived deciles in Scotland. Veterans aged 65 or older appeared to be at less risk of deprivation than younger individuals. The pattern of deprivation for veterans who are not in a relationship was more skewed towards the most deprived deciles. In contrast, there was a little less variation for those in a relationship. A greater proportion of veterans who are not in a relationship were in the three most deprived deciles (5) compared to 41% of those in a relationship. The pattern of deprivation for those veterans who were classed as early service leavers was skewed towards the more deprived deciles, with 63% in the three most deprived deciles. This is in contrast to those who served for 15 years or more, where 32% were in the three most deprived deciles. In those who sought help after 11 years or more, there were 54% in the three most deprived deciles. In those who sought help after fewer than two years, there was some skew towards the more deprived deciles, though less severe (39% in the three most deprived deciles). This seems to suggest that as time to seek help increased, individuals were at a greater risk of residing in more deprived areas. However, the association between time to seek help and deprivation in Scotland was less than in the other UK countries. Page 49

51 Chapter 6: Exploring Multiple Deprivation of Veterans in Scotland Index of Multiple Deprivation for Scotland Multiple deprivation data for Scotland is referred to as the Scottish Index of Multiple Deprivation Measure and is published by The Scottish Government. It was last released in The indices consist of seven domains of deprivation, based on 38 separate statistical indicators. Details of these indicators can be found in the Appendix of this report. These domains and how each is weighted to calculate the Indices is shown in Figure 6.1. Figure 6.1: The domains and weightings of the Scottish Index of Multiple Deprivation Geographic access 9% Housing 2% Crime Income 28% Health 14% Education 14% Employment 28% Page 50

52 Chapter 6: Exploring Multiple Deprivation of Veterans in Scotland Demographic, Military and Help-Seeking Characteristics for Scotland The demographics and military characteristics of the veteran sample for Scotland were explored. Table 6.1 outlines the demographic characteristics and Table 6.2 outlines the military characteristics. Percentages for the overall UK sample are also shown for comparison. Table 6.1: Demographic characteristics of the veteran sample in Scotland Demographic Scotland Sample UK Sample Sex Female 3% 3% Male 97% 97% Age < % 47% % 65+ 7% 11% Relationship status In a relationship 38% 51% Not in a relationship 61% 47% Widowed 1% 2% The demographic characteristics for Scotland were similar to those of the overall UK. There was the same large majority of males (97%). There were also similar proportions across the age brackets, with a majority in the category (54%). This similarity had an exception in relationship status; there were more veterans not in relationships (61%) compared to the overall UK sample (47%). Page 51

53 Chapter 6: Exploring Multiple Deprivation of Veterans in Scotland Table 6.2: Military and help-seeking characteristics of the veteran sample for Scotland Demographic Scotland Sample UK Sample Military service Royal Navy 7% 7% Army 86% 87% Royal Air Force 7% 6% War Pension No 9 96% Yes 4% Yrs in service <4 17% 18% % 26% Yrs to contact Combat Stress <2 26% 27% % 26% The military and help-seeking characteristics of the Scotland sample were similar to those for the wider UK. There were proportionately slightly fewer veterans in Scotland who had served more than 15 years and slightly more who took longer than 11 years to contact Combat Stress for help. Page 52

54 Chapter 6: Exploring Multiple Deprivation of Veterans in Scotland Multiple Deprivation of Help-Seeking Veterans in Scotland Figure 6.2 shows the distribution of the veteran help-seeking sample across the deciles of deprivation. The first decile is the most deprived neighbourhoods relative to the rest of Scotland, and the tenth decile is the least deprived. Figure 6.2: Distribution of help-seeking veterans across deciles of deprivation in Scotland 1 A large proportion of the Scottish veteran sample (5) reside within the most deprived three deciles. In contrast, 16% of the veteran sample live in the three least deprived deciles in Scotland. The mean of the deciles for the veteran sample was 4.2, below the median point for the general population of Scotland, showing veterans in Scotland are more likely to live in deprivation compared to civilians. Page 53

55 Chapter 6: Exploring Multiple Deprivation of Veterans in Scotland Multiple Deprivation of Help-Seeking Veterans by Demographic Characteristics The distribution of veterans across relative deprivation was explored by demographic characteristics. This provided additional insight into patterns of deprivation in this group, and indicated any sub-groups that may be at higher risk of deprivation. Figure 6.3 shows the distribution of deprivation by age groups, Figure 6.4 shows the distribution by sex, and Figure 6.5 shows the distribution by relationship status. Figure 6.3: Distribution of help-seeking veterans across deciles of deprivation by age group Under 30 years old Between 30 and 49 years old 1 1 Between 50 and 64 years old 65 years old and above 1 1 In the 65 years old and above category, compared to the other three age categories, there were fewer veterans in the three most deprived deciles (36% compared to between 48 and 5). It seems that older veterans (65 years and above) were at less risk of residing in areas of higher deprivation, within helpseeking veterans in Scotland. Page 54

56 Chapter 6: Exploring Multiple Deprivation of Veterans in Scotland Figure 6.4: Distribution of help-seeking veterans across deciles of deprivation by sex Male Female 1 1 The pattern of deprivation for males was skewed to the most deprived deciles, with a steady reduction in proportion of veterans as deprivation levels decreased. No pattern emerged for female veterans. Figure 6.5: Distribution of help-seeking veterans across deciles of deprivation by relationship status In a relationship Not in a relationship 1 1 The pattern of deprivation for veterans who are not in a relationship was more skewed towards the most deprived deciles. In contrast, there was a more even distribution across deprivation levels for those in a relationship. A greater proportion of veterans who are not in a relationship were in the three most deprived deciles (5) compared to three least deprived (12%). This is compared to 41% of those in a relationship in the three most deprived deciles. Page 55

57 Chapter 6: Exploring Multiple Deprivation of Veterans in Scotland Multiple Deprivation of Help-Seeking Veterans by Military and Help-Seeking Characteristics Relative deprivation and military characteristics were explored for Scottish Veterans. Figure 6.6 shows the distribution of deprivation by military service, Figure 6.7 shows the distribution by war pension status, Figure 6.8 shows the distribution by length of military service and Figure 6.9 shows the distribution by the time taken since leaving the military to contact Combat Stress for help. Figure 6.6: Distribution of help-seeking veterans across deciles of deprivation by military service Royal Navy Army 1 1 Royal Air Force 1 The pattern of deprivation for those help-seeking veterans who were in the Army was skewed towards the more deprived decile, with 53% in the most deprived three deciles and 14% in the least deprived three deciles. This is in contrast to the Royal Navy which has 29% in the three most deprived deciles, almost in line with general population. The RAF has an above average proportion of veterans in the most deprived decile, with less of a pattern across the other deciles. Page 56

58 Chapter 6: Exploring Multiple Deprivation of Veterans in Scotland Figure 6.7: Distribution of help-seeking veterans across deciles of deprivation by war pension status War Pension granted No War Pension 1 1 The pattern of deprivation for those who have had no war pension granted appeared skewed towards the more deprived deciles with 5 of this sub-group in the three most deprived deciles. A similar pattern was observed for those in receipt of a war pension. There were no veterans with war pensions granted in the two least deprived deciles and there were a greater proportion of veterans in the three most deprived deciles (53%) compared to the three least deprived (7%). Page 57

59 Chapter 6: Exploring Multiple Deprivation of Veterans in Scotland Figure 6.8: Distribution of help-seeking veterans across deciles of deprivation by length of service Fewer than 4 years (early service leavers) Between 4 and 14 years years or more 1 A similar trend emerged in Scotland compared to the other countries between service length and deprivation. Short service length was associated with increased risk of deprivation. For early service leavers, there were 63% in the most three deprived deciles. For those who left after 4 and 14 years of service there were 53% and for those who left after 15 years or more there were 32%. Page 58

60 Chapter 6: Exploring Multiple Deprivation of Veterans in Scotland Figure 6.9: Distribution of help-seeking veterans across deciles of deprivation by time to contact CS Fewer than 2 years Between 2 and 10 years 1 1 More than 11 years 1 As time between leaving the military and seeking help from Combat Stress increases, there seems to be an increase in the proportion of veterans in more deprived areas. In those who sought help 11 years or more after leaving service, 54% resided in the three most deprived deciles and 1 in the three least deprived deciles. In those who sought help within two years of leaving, there was 39% in the three most deprived deciles. This seems to suggest that as time to seek help increased, individuals were at a greater risk of residing in more deprived areas. However, there appears to be less of an association with this variable in Scotland compared to the other UK countries. Page 59

61 Chapter 7: Exploring Multiple Deprivation Data of Veterans in Wales Chapter 7 Exploring Multiple Deprivation of Veterans in Wales Chapter summary: The demographic characteristics for Wales were similar to those of the overall UK. 99% of the sample were males. There were also similar proportions across the age brackets. However, there were slightly more veterans not in a relationship, whereas in the UK, more veterans are in relationships. The military and help-seeking characteristics of the Welsh sample were similar to those for the wider UK. There were proportionately more early service leavers and fewer sought help less than two years after leaving the military. A large proportion of the veteran sample (4) resided within the most deprived three deciles. In contrast, 21% of the veteran sample lived in the three least deprived deciles in Wales. There may be some association between greater deprivation and younger age in Wales with a greater proportion in the three most deprived deciles in the less than 30 years and 30 to 49 years category (47% and 4) than the same in the two older age categories (33% and 3). Early service leavers were skewed towards the more deprived deciles (63% in the three most deprived deciles). This is in contrast to those who served for 15 years or more (32% were in the three most deprived deciles). As time between leaving the military and seeking help from Combat Stress increased, there seems to be an increase in the proportions of veterans in more deprived areas in Wales. 39% of veterans who took less than two years to seek help resided in the three most deprived deciles. This increased to 53% for those who took 2 to 10 years to seek help and 54% in those who took longer than 11 years to seek help. Page 60

62 Chapter 7: Exploring Multiple Deprivation Data of Veterans in Wales Index of Multiple Deprivation for Wales Multiple deprivation data for Wales is referred to as the Welsh Index of Multiple Deprivation and is published by Knowledge and Analytical Services, within the Welsh Government. It was last released in The indices consist of eight domains of deprivation, based on 35 separate statistical indicators. Details of these indicators can be found in the Appendix of this report. These domains and how each is weighted to calculate the Indices is shown in Figure 7.1. Figure 7.1: The domains and weightings of the Welsh Index of Multiple Deprivation Access to Services Housing Physical environment Income 23% Community Safety Health 14% Employment 23% Education 1 Page 61

63 Chapter 7: Exploring Multiple Deprivation Data of Veterans in Wales Demographic, Military and Help-Seeking Characteristics for Wales The demographics and military characteristics of the veteran sample for Wales were explored. Table 7.1 outlines the demographic characteristics and Table 7.2 outlines the military characteristics. Each table also shows the percentages for the overall UK sample. Table 7.1: Demographic characteristics of the veteran sample in Wales Demographic Wales Sample UK Sample Sex Female 1% 3% Male 99% 97% Age <30 11% % 47% % 32% 65+ 7% 11% Relationship status In a relationship 48% 51% Not in a relationship 51% 47% Widowed 1% 2% The demographic characteristics for Wales were similar to those of the overall UK. There was a large majority of males (99%). There were also similar proportions across the age brackets with 81% between 30 and 64 years of age and a minority below 30 or above 65. A slightly greater proportion of Welsh veterans were not in a relationship, than were. This is the opposite of the overall UK sample, where slightly more veterans were in relationships. Page 62

64 Chapter 7: Exploring Multiple Deprivation Data of Veterans in Wales Table 7.2: Military and help-seeking characteristics of the veteran sample for Wales Demographic Wales Sample UK Sample Military service Royal Navy 7% 7% Army 88% 87% Royal Air Force 6% War Pension No 99% 96% Yes 1% 4% Yrs in service <4 22% 18% % % 26% Yrs to contact Combat Stress <2 24% 27% % % 4 The military and help-seeking characteristics of the Wales sample were similar to those for the wider UK. There were slightly more early service leavers and slightly fewer veterans who sought help less than two years after leaving the military. Page 63

65 Chapter 7: Exploring Multiple Deprivation Data of Veterans in Wales Multiple Deprivation of Help-Seeking Veterans in Wales Figure 7.2 shows the distribution of the veteran help-seeking sample across the deciles of deprivation. The first decile is the most deprived neighbourhoods relative to the rest of Wales, and the tenth decile is the least deprived. Figure 7.2: Distribution of help-seeking veterans across deciles of deprivation in Wales 1 A large proportion of the veteran sample (4) reside within the most deprived three deciles. In contrast, 21% of the veteran sample live in the three least deprived deciles in Wales. The mean of the deciles for the veteran sample was 4.6, below the median point for the general population of Wales. Page 64

66 Chapter 7: Exploring Multiple Deprivation Data of Veterans in Wales Multiple Deprivation of Help-Seeking Veterans by Demographic Characteristics The distribution of veterans across relative deprivation was explored by demographic characteristics. This provided additional insight into patterns of deprivation in this group, and indicated any sub-groups that may be at higher risk of deprivation. Figure 7.3 shows the distribution of deprivation by age groups, Figure 7.4 shows the distribution by sex, and Figure 7.5 shows the distribution by relationship status. Figure 7.3: Distribution of help-seeking veterans across deciles of deprivation by age group Under 30 years old Between 30 and 49 years old 1 1 Between 50 and 64 years old 65 years old and above 1 1 In the younger age category of less than 30 years old, there were proportionately more veterans in the most deprived decile (47%) compared to the other categories. The 30 to 49 years category had only slightly fewer (4) but the older age categories of 50 to 64 years and over 65 years (33% and 3 respectively) had notably fewer. There may be some association between greater risk of deprivation and younger age in Wales. Page 65

67 Chapter 7: Exploring Multiple Deprivation Data of Veterans in Wales Figure 7.4: Distribution of help-seeking veterans across deciles of deprivation by sex Male Female 1 1 The pattern of deprivation for males was skewed to the most deprived deciles, with a steady reduction in proportion as deprivation decreased. Females had no pattern of deprivation. Figure 7.5: Distribution of help-seeking veterans across deciles of deprivation by relationship status In a relationship Not in a relationship 1 1 The pattern of deprivation for veterans who are not in a relationship was skewed towards the most deprived deciles. A greater proportion of veterans who are not in a relationship were in the three most deprived deciles (5) compared to three least deprived (12%). This is compared to 41% of those in a relationship in the three most deprived deciles. Page 66

68 Chapter 7: Exploring Multiple Deprivation Data of Veterans in Wales Multiple Deprivation of Help-Seeking Veterans by Military and Help-Seeking Characteristics The distribution of veterans across relative deprivation was also explored by military characteristics. Figure 7.6 shows the distribution of deprivation by military service employer, Figure 7.7 shows the distribution by war pension status, and Figure 7.8 shows the distribution by length of military service and Figure 7.9 shows the distribution by the time since leaving the military taken to contact Combat Stress for help. Figure 7.6: Distribution of help-seeking veterans across deciles of deprivation by military service Royal Navy Army 1 1 Royal Air Force 1 The pattern of deprivation for help-seeking veterans who were in the Army was skewed towards the more deprived deciles (53% in the three most deprived deciles). Trends were less clear for the Royal Navy and Royal Air Force. Page 67

69 Chapter 7: Exploring Multiple Deprivation Data of Veterans in Wales Figure 7.7: Distribution of help-seeking veterans across deciles of deprivation by war pension status War Pension granted No War Pension 1 1 The pattern of deprivation for those who have no war pension granted was skewed towards the more deprived deciles, with 5 in the three most deprived deciles. However, the sample lacked sufficient size to conduct meaningful analysis for the distribution of deprivation for Welsh based veterans in receipt of a war pension. Page 68

70 Chapter 7: Exploring Multiple Deprivation Data of Veterans in Wales Figure 7.8: Distribution of help-seeking veterans across deciles of deprivation by length of service Fewer than 4 years (early service leavers) Between 4 and 14 years years or more 1 Early service leavers appeared to be at a higher risk of deprivation, with 63% in the three most deprived deciles and 14% in the three least. This is in contrast to those who served for 15 years or more, where 32% were in the three most deprived deciles and 17% in the three least. Page 69

71 Chapter 7: Exploring Multiple Deprivation Data of Veterans in Wales Figure 7.9: Distribution of help-seeking veterans across deciles of deprivation by time to contact CS Fewer than 2 years Between 2 and 10 years 1 1 More than 11 years 1 As time between leaving the military and seeking help from Combat Stress increases, there seems to be increasing proportions of veterans in more deprived areas in Wales, from waiting 2 years upwards. In those who sought help after 11 years or more, there were 54% in the three most deprived deciles and 1 in the three least deprived deciles. Similarly, in those who took 2 to 10 years there were 53% in the three most deprived deciles. In contrast, in those who sought help after fewer than two years, there were 39% in the three most deprived deciles. Page 70

72 Chapter 8: Comparisons across the UK Chapter 8 Comparisons across the UK Chapter highlights: Whilst there is some variation in how the indices of multiple deprivation were constructed in each of the four countries, there is sufficient similarity to make comparisons. The patterns of deprivation in the four separate countries showed more veterans living in the most deprived areas in England, Scotland and Wales. This pattern was not replicated in Northern Ireland where more veterans lived in the middle ranges of deprivation. Veterans were spread across a wide range of geographical areas. It appears that the veterans who lived in more deprived areas were more likely to live in and around large cities. In England, Scotland and Wales, where data was available to classify postcodes into rural and urban, there was evidence that living in urban areas increased the risk of deprivation. This chapter also shows the mapped geographical spread of the key variables of relationship status, length of service and time to seek help across the UK Page 71

73 Chapter 8: Comparisons across the UK Comparing Multiple Deprivation across UK countries The underlying statistics and construction of the measures of deprivation vary between the four countries of the UK, as outlined in each country chapter and the Appendices. This means that detailed statistical comparison between the countries is not feasible. However, as there is a significant overlap in the domains underlying the measures, the patterns of deprivation can be considered to give an indication of possible differences in deprivation for help-seeking veterans between the countries. It should be noted that what is being compared is relative levels of deprivation within each country, not between the countries. Figure 8.1 presents the bar graphs that appear in each country chapter in order to compare the distributions. Figure 8.1: Distributions of help-seeking veterans across deciles of deprivation in the UK England Northern Ireland 1 1 Scotland Wales 1 1 The pattern of deprivation shows a majority of help-seeking veterans in England, Scotland and to a smaller extent Wales, in the most deprived deciles with a decreasing proportion as deprivation reduces. Page 72

74 Chapter 8: Comparisons across the UK The pattern differs in Northern Ireland where the larger proportions of veterans reside in the mid-range deciles of deprivation, with fewer in the most deprived and least deprived areas. This corresponds to medians of the deciles as follows: England at 4.7, Northern Ireland at 5.1, Scotland at 4.2 and Wales at 4.6. Each veterans home location was plotted on Figure 8.2, coded as per the range of deprivation of their neighbourhood. The blue dots represent those living within the three most deprived deciles of neighbourhoods in the UK, the red dots represent the three least deprived deciles, and those in yellow represent the four mid-range deciles. Mapping in this way could indicate any geographical patterns that should be explored further when planning service provisions. Figure 8.2: Geographical spread of help-seeking veterans across deciles of deprivation in the UK Page 73

75 Chapter 8: Comparisons across the UK Deprivation is geographically disparate across the UK, so as expected there is little distinct pattern to locations of veterans seeking help and deprivation levels. However, those in the most deprived areas (blue dots) may appear to gather around large conurbations such as London, Birmingham, Manchester and Glasgow. This may be linked to the greater proportion of veterans living in urban areas, as reported in chapter 3. However, the data shows that the sample of help-seeking veterans is not only limited to urban areas and includes some remote locations. To further explore this, patterns of deprivation by rural and urban classification were explored for England, Scotland and Wales, where this data was available. Figure 8.3 shows the proportions of veterans living in each of the ten deciles of deprivation by rural versus urban classification in England. Figure 8.4 shows Scotland and Figure 8.5 shows Wales. Figure 8.3: Distributions of help-seeking veterans across deprivation by rural vs urban in England 18% 16% 14% 12% 8% 6% 4% 2% Rural Urban Page 74

76 Chapter 8: Comparisons across the UK In England, an interaction effect between deprivation and urban or rural classification was observed. A greater proportion of those residing in urban areas were in deprived neighbourhoods. On the other hand, a greater proportion of veterans in rural areas were in the least deprived neighbourhoods. Figure 8.4: Distributions of help-seeking veterans across deprivation by rural vs urban in Scotland 2 1 Rural Urban As in England, there are greater proportions of veterans who live in urban areas in the most deprived deciles in Scotland. There is a slightly more even spread in those who live in rural areas. This suggests, as in England, there is some greater risk of deprivation in urban dwelling help-seeking veterans. Page 75

77 Chapter 8: Comparisons across the UK Figure 8.5: Distributions of help-seeking veterans across deprivation by rural vs urban in Wales 18% 16% 14% 12% 8% 6% 4% 2% Rural Urban In Wales, though they were less pronounced, similar interactions between urban areas and higher levels of deprivation were observed. Page 76

78 Chapter 8: Comparisons across the UK Mapping Demographics and Other Characteristics across UK countries Those characteristics which appeared to show particularly notable patterns and associations throughout the preceding chapters were mapped onto each veteran s location in the UK. Figure 8.6 shows the distribution by relationship status, Figure 8.7 shows the distribution by length of service and Figure 8.8 shows the distribution by time since leaving the military to contact Combat Stress. Figure 8.6: Geographical spread of help-seeking veterans by relationship status To an extent, those not in relationships (yellow dots) were clustered more densely around larger cities. Otherwise, there seemed to be a fairly even distribution of those both in a relationship and not. The greater proportions of veterans in a relationship in Northern Ireland and greater proportion of those not in Scotland could be clearly seen. Page 77

79 Chapter 8: Comparisons across the UK Figure 8.7: Geographical spread of help-seeking veterans by length of service Early service leavers appeared to be more prominent in the rural areas through central England. However, no clear pattern emerged between service length and location across the other UK countries. Page 78