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Helping veterans with hearing loss and tinnitus can improve mental health

by Alicia Rennoll

There are around 300,000 veterans living with hearing loss in the UK, according to The Royal British Legion. In addition to being at a greater risk of PTSD, depression, and anxiety, many vets are also battling psychological distress from hearing problems.

“Hearing loss is one of the hidden injuries of conflict which is often forgotten about, and consequently many veterans don’t seek support. I would urge anyone affected from a Service-related hearing problem, however big or small, to contact the Legion for help,” said Steven Baynes, Head of Grants and Social Policy at The Royal British Legion. Getting help quickly is key, because hearing loss can have a big effect on our vets’ quality of life and mental health.

What are the key psychological issues faced by veterans in the UK and how can they be overcome?

The Effect of Hearing Loss on Mental Health

Hearing injuries are the most common service-related medical issue for vets – more so than traumatic brain injuries or PTSD. It is easy to see how failing to get help can exacerbate the isolation that many vets already feel when coming home after a long tour or mission. Many vets who have hearing loss do not seek help. Research undertaken by the American Psychological Society has found that those who battle hearing loss without help are around 50% more likely to face sadness or depression, than those who receive treatment. The case is particularly dire for older vets, since sensorial decline in seniors is common irrespective of age. In their case, normal hearing loss is exacerbated by tinnitus due to noise exposure. The latter can arise from exposure to aircraft, gunfire, bombs etc.

What Help is Available for Vets?

The Veterans Hearing Fund (VHF), launched in 2015, is an excellent option for vets facing hearing loss. Staff at the VHF report that less than 2,000 veterans have applied for help. This means there are hundreds of thousands who are missing out an opportunity to improve their quality of life and ability to interact with friends and family.

The VHF specialises in the type of hearing loss that is common among vets and offers unique solutions to this group. In the case of tinnitus, a treatment called ‘Levo’ relies on an iPod device to treat a patient while they are sleeping – since the sleeping brain is more responsive to this treatment. ‘Levo’ essentially mimics the specific tinnitus sound heard by a patient. Over time, the brain learns to ‘ignore’ the tinnitus sound, significantly improving a patient’s quality of life.

Hearing Loss and Stress

Veterans may need psychological help to deal with the stress of hearing loss and tinnitus. Vets and their partners or spouses can obtain expert help from the NHS Veterans’ Mental Health Transition, Intervention and Liaison Service, or the NHS Veterans’ Mental Health Complex Treatment Service. Both these services are available throughout the UK and are provided by mental health specialists who know about the specific challenges faced by veterans and their families. Not only do these services help with psychological symptoms, but they also provide other needs that can affect mental health and wellbeing, such as social support, housing, substance abuse, etc. Treatment for stress caused by hearing loss and the veteran experience as a whole, ranges from psychotherapy, right through to group therapy for specific needs, such as including anger management and stress.

Stress Relief

Studies have shown that cognitive behavioral therapy (CBT) alongside standard therapy can help patients with tinnitus. An integrative approach that also includes stress reduction has shown to be useful. The British charity Help for Heroes, which provides facilities for British servicemen and women who have been injured, notes the importance of holistic practices such as yoga for stress relief. Veterans receiving treatment for tinnitus and other hearing conditions may find that treatment takes time; in the meanwhile, they can lower stress levels by taking part in natural mindfulness-based practices. Help for Heroes has recovery centres throughout the UK, where veterans can inquire about yoga, found in several studies to reduce symptoms of depression and PTSD.

Where do I start?

Contact details are shown below for services that can help veterans deal with the physical and psychological symptoms of work-related hearing loss. Men aren’t notoriously fantastic at seeking help, but taking control of hearing loss and tinnitus offers so many benefits to veterans, their families, and anyone around them, it seems like taking a risk and taking the first step is a small price to pay for what could be a significant uplift in overall wellbeing.

For further information and help with this issue, contact:

Help for Heroes

Phone 0300 303 9888 – Monday to Friday, 9am – 5pm (calls to this number are charged at your standard network rate)

email getsupport@helpforheroes.org.uk

Contact information for recovery centres around the UK can be found here

 

NHS Veterans’ Mental Health Transition, Intervention and Liaison Service

North of England TIL: phone 0303 123 1145 or email vwals@nhs.net

For other parts of the UK, see contact details here

 

Veterans Hearing Fund (VHF)

For further information on VHF services, call 0808 802 8080 or email medicalfunds@britishlegion.org.uk

 

 

Open post

The other ‘hidden homeless’: autistic men

by Dr John Barry

Around 85% of rough sleepers are men (St. Mungos, 2016). The reasons for homelessness are many and complex, but the most frequently cited reasons for male homelessness are relationship breakdown, substance misuse, or leaving an institution (e.g. prison, care or hospital) (Brown et al, 2019).

At any one time in the UK there are around 5000 rough sleepers (Ministry of Housing, Communities & Local Government, 2017). This isn’t counting the group often called the ‘hidden homeless’, a much larger number of people – at least 250,000 – with no stable accommodation (Shelter 2016). We know that almost half of rough sleepers have mental health needs (Combined Homelessness and Information Network, 2017), but these figures don’t identify the other type of ‘hidden homeless’ – people with autism.

Autism effects 1% of the population (Brugha et al, 2016). Autism exists on a spectrum of severity (Autistic Spectrum Disorder, or ASD). There are some interesting gender differences that might lead to underestimates of ASD in females (van Wijngaarden-Cremers, 2019), but most estimates suggest that more severe cases are four times more common in males, and the less severe form (Asperger Syndrome) is nine times more common in males (Barry & Owens, 2019).

Given the fact that most homeless people are male, we would expect a larger proportion of homeless people to have autism. In the first study on this topic published in a peer-reviewed journal, Churchard et al (2019) found that autism is at least 12 times more common in homeless people than the general population (or probably more, if it was possible to identify the ‘hardest to reach’ homeless people). This figure far exceeds the rate you would expect if autism in homeless people was simply due to both autism and homelessness being more common in men. So if gender doesn’t fully explain the over-representation of autism in the homeless population, then why are so many autistic people homeless?

Well, substance abuse does not explain it, because people with autism are less likely to have problems with substance abuse than other people (Butwicka et al, 2017). However Churchard et al (2019) suggest that the greater levels of social isolation experienced by people with autism might be the key; autistic people often have fewer people to turn to if things go wrong in their lives, such as their housing being threatened. People with autism are also less likely to be employed, so might slip into the poverty trap more easily (Calsyn & Winter, 2002). Churchard et al also suggest that because people with autism are more likely to experience sensory difficulties (e.g. finding noise distressing), this makes living in shared accommodation or a hostel virtually impossible. Also for those with cognitive impairments to abilities such as planning, everyday independent living might become virtually impossible.

Although the current level of knowledge regarding homelessness and autism is very basic, there has been some progress by a group called Homeless Link (2015), who have created practical guidelines on how to identify autism in homeless people, and how to communicate in a way that best facilitates support for the homeless person.

This article only scratches the surface of mental health issues in homelessness. Other issues that impact the general population of homeless people include a history of childhood abuse and neglect, seen in 80% of homeless people (Torchalla et al. 2012). This type of history creates special problems for housing homeless people, because they may have learned to associate home with abuse and neglect (Duffy & Hutchison, 2019). Trauma prior to homelessness is also common (e.g. military-related PTSD), as is trauma as a result of life on the street (Buhrich et al. 2000).

More research is needed to identify the scale of the problem of autism in homelessness, and to develop evidence-based methods of helping these vulnerable people. There can be little doubt that homeless autistic people should be one of the key issues for anyone interested in Male Psychology.

 

About the author

Dr John A. Barry is a Chartered Psychologist and Associate Fellow of the British Psychological Society, Honorary Lecturer in Psychology at University College London, clinical hypnotherapist, and author of over 60 peer-reviewed publications on a variety of topics in psychology and medicine. John is a professional researcher and has taken an interest in improving the teaching of research methods and statistics. He has practiced clinical hypnosis for several years and is a member of the British Association of Clinical and Academic Hypnosis. His Ph.D. was awarded by City University London, on the topic of the Psychological Aspects of Polycystic Ovary Syndrome, which is also the topic of his forthcoming book (Palgrave Macmillan, 2019). He is co-founder of both the Male Psychology Network and the Male Psychology Section of the British Psychological Society (BPS).

 

References

Barry JA and Owens B (2019). From fetuses to boys to men: the impact of testosterone on male lifespan development, in Barry JA, Kingerlee R, Seager MJ and Sullivan L (Eds.) (2019). The Palgrave Handbook of Male Psychology and Mental Health (pp. 3-24). London: Palgrave Macmillan. DOI 10.1007/978-3-030-04384-1

Brown, J. S., Sagar-Ouriaghli, I., & Sullivan, L. (2019). Help-Seeking Among Men for Mental Health Problems. In The Palgrave Handbook of Male Psychology and Mental Health (pp. 397-415). Palgrave Macmillan, Cham. DOI 10.1007/978-3-030-04384-1

Buhrich, N., Hodder, T., & Teesson, M. (2000). Lifetime prevalence of trauma among homeless people in Sydney. Australian and New Zealand Journal of Psychiatry, 34(6), 963–966.

Butwicka, A., Langstrom, N., Larsson, H., Lundstrom, S., Serlachius, E., Almqvist, C., … Lichtenstein, P. (2017). Increased risk for substance use-related problems in autism spectrum disorders: a population-based cohort study. Journal of autism and developmental disorders, 47(1), 80-89.

Churchard, A., Ryder, M., Greenhill, A., & Mandy, W. (2019). The prevalence of autistic traits in a homeless population. Autism, 23(3), 665-676.

Combined Homelessness and Information Network. (2017). CHAIN annual report: June 2015. The Greater London Authority.

Duffy, J., & Hutchison, A. (2019). Working with Homeless Men in London: A Mental Health Service Perspective. In The Palgrave Handbook of Male Psychology and Mental Health (pp. 533-556). Palgrave Macmillan, Cham. DOI 10.1007/978-3-030-04384-1

Homeless Link (2015). Autism and Homelessness: Briefing for frontline staff. https://www.homeless.org.uk/sites/default/files/site-attachments/Autism%20&%20HomelessnesOct%202015.pdf

Ministry of Housing, Communities & Local Government. (2017). Rough Sleeping Statistics, Autumn 2017, England. London: Author.

Shelter. (2016). Green book 50 years on: The reality of homelessness for families today. http://www.shelter.org.uk/__data/assets/pdf_file/0003/1307361/GreenBook_-_A_report_on_homelessness.pdf.

St. Mungos. (2016). Stop the scandal: An investigation into mental health and rough sleeping. http://www.mungos.org/documents/7021/7021.pdf.

Torchalla, I., Strehlau, V., Li, K., Schuetz, C., & Krausz, M. (2012). The association between childhood maltreatment subtypes and current suicide risk among homeless men and women. Child Maltreatment, 17, 132–143.

van Wijngaarden-Cremers, P. (2019). Autism in Boys and Girls, Women and Men Throughout the Lifespan. In The Palgrave Handbook of Male Psychology and Mental Health (pp. 309-330). Palgrave Macmillan, Cham. DOI 10.1007/978-3-030-04384-1

 

 

 

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