Veterans in crisis: Describing the complexity of presentations to a mainstream UK Veterans' mental health service.

Introduction: Veterans may delay presentation to mental health services until they near or reach a crisis point. This study sought to understand the profiles of UK Veterans at or near crisis presenting to a Veterans' mental health service, for whom there is a paucity of data. Methods: Patient records for 177 Veterans presenting to and eligible for treatment by a specialist Veterans' mental health crisis service during the first year of its operation were accessed. Clinical presentation, factors contributing to crisis, and demographic data were extracted and analysed. Results: Veteran demographics were reflective of groups identified as being at higher risk for suicide and mental health crisis in the general population, primarily middle-aged (mean = 44.4 y) and male (93.8%). Veterans' reported mental health problems included a high prevalence of symptoms of anxiety and depression (68.4%), disordered sleep (67.2%), and posttraumatic stress disorder (PTSD; 62.1%). Psychosis was indicated to be more prevalent than among the general population. The most common reported crisis factors were suicidal ideation (85.3%), relationship strain (51.4%), and social isolation (49.7%). Reported mental health problems and crisis factors were highly comorbid. Discussion: Veterans at or near point of crisis presenting to Veteran-specific pathways in mainstream health care report a broad range of crisis factors and mental health problems. The range of presenting profiles suggest that broad-spectrum, whole-person wraparound care is suitable for addressing the needs of Veterans in crisis. Further work is required to ensure crisis services reach the whole Veteran community, including those at elevated risk.