In August 2021, the Afghan government collapsed, leading to the resettlement of thousands of Afghan veterans and civilians who supported the British Military or UK government through the Afghan Relocations and Assistance Policy (ARAP) and Afghan citizens resettlement scheme (ACRS) schemes. Some were housed temporarily in bridging hotels by the Home Office, while others found accommodation within the community.
Others also fled to the UK, seeking legal protection, with some granted refugee status and others awaiting asylum decisions. Some have been able to settle in the community, others remain at risk, facing financial destitution, and homelessness. More recently arrived individuals are seeking clarity on their situation considering the new immigration bill.
Mental health needs
Many in this population experienced multiple traumas, have lost loved ones and remain separated from family members who remain at risk in Afghanistan. All have faced challenges common among refugees who have been exposed to long-standing conflict, political upheaval, economic deprivation and forced displacement. This has a profound impact on their mental health.1
Notably, there are Afghans who worked closely with the British Military or UK government, risking their lives and their families' safety. Some were subjected to retaliation, detentions, and torture, as well as combat-related injuries as serving military personnel.
The unique mental and physical health needs of these Afghan individuals, who present with both veterans and refugee-related difficulties, may be easily overlooked or misunderstood.2
Support for veterans and refugees
To address these issues, the OpCourage Warm Welcome Afghan service was launched, offering specialised mental health support to resettled Afghan veterans and civilians. This service is an extension of OpCourage, which supports ex-serving UK Armed Forces members nationwide, including those who are making the transition to civilian life and reservists.
The military-related trauma includes exposure to combat, suicide bombings, witnessing colleagues' deaths, and physical injuries, leading to high risk of developing severe post-traumatic stress disorder and complicated grief reactions. Many also report moral injury responses and difficulties coming to terms with the sudden loss of the country they served.
Despite these challenges, some are hesitant to discuss mental health problems at primary care due to various reasons, including lack of awareness around available support, prioritizing other urgent health needs of family members, and fear of involving social services due to the perceived risk of children being removed from their care.
Specialised treatment and culturally sensitive support, however, can help address past traumas and improve mental health, even in the face of ongoing instability.3
If you have patients in your surgery that you think may benefit from accessing support from the OpCourage Warm Welcome Afghan Service, contact us on 020 3317 7979 or afghanservice@candi.nhs.uk or visit our website. We accept self- and professional referrals from anywhere in England via an online referral form and provide interpreters, where needed.
Other resources for GPs and practices to support veterans and refugees
Become a Veteran Aware surgery
GP practices can gain ‘Veteran Aware GP Practice Accreditation’ through the NHS, which shows that the practice sensitively delivers the best possible care and treatment for patients who have served in the armed forces. https://veteranaware.nhs.uk/
Become a Safe Surgery
GP practices can join the ‘Safe Surgery’ initiative to access support, training, and resources to understand and respond effectively to health inequalities experienced by many migrants in accessing healthcare. https://www.doctorsoftheworld.org.uk/safesurgeries/
OpRestore: Veterans physical health and wellbeing service
GP practices can refer veterans to OpRESTORE, a free NHS service which ensures that those who have served in the UK Armed Forces can access the right NHS treatment for significant, continuing physical injuries and illnesses caused by their employment. Contact imperial.oprestore@nhs.net for a referral form.
OpCourage: Mental health support for veterans, service leavers and reservists
OpCOURAGE is an NHS mental health specialist service designed to help serving personnel due to leave the military, reservists, armed forces veterans and their families. It's important to contact the OpCOURAGE service for your local area.
- Dr Eileen Walsh is clinical psychologist and service manager, Dr Julia Gillard is clinical psychologist, and Heather Ashford is administrator at the Op Courage Warm Welcome Afghan Service
References
- Alemi, Q., et al. Afghan mental health and psychosocial well-being: thematic review of four decades of research and interventions. BJPsych Open, 2023: 9(4); e125.
- De Jong, S.Brokers betrayed: The afterlife of Afghan interpreters employed by western armies. Journal of International Development 2023: 35(3); 445-458.
- Yim, S. H., Lorenz, H., & Salkovskis, P. The Effectiveness and Feasibility of Psychological Interventions for Populations Under Ongoing Threat: A Systematic Review. Trauma, Violence, & Abuse, 2023: 15248380231156198.
