Examining Veterans’ Interactions with the UK Social Security System through a Trauma-Informed Lens
Abstract: This paper uses the principles of trauma-informed care – safety, collaboration, choice, trustworthiness, and respect – to reflect on the quality of veterans’ treatment within the UK social security system. Drawing upon new data from qualitative longitudinal research with veterans in four geographical locations across England, UK, it explores their experiences within the social security system, highlighting specific issues relating to their interactions with the Work Capability Assessment (WCA) but also the conditionality inherent within the UK benefits system. Overall, it is evident that there is a lack of understanding of the impact of trauma on people’s psychosocial functioning and, as a result, veterans are treated in ways which are variously perceived as disrespectful, unfair or disempowering and in some cases exacerbate existing mental health problems. We propose that the application of traumainformed care principles to the UK social security system could improve interactions within this system and avoid re-traumatising those experiencing on-going or unresolved trauma. The paradigm of trauma-informed care has been used internationally to examine health, homelessness, prison and childcare services, but ours is the first exploration of its application to the delivery of social security.
Abstract: Objectives: Increasing numbers of older adults are reentering community following incarceration (i.e., reentry), yet risk of incident neurodegenerative disorders associated with reentry is unknown. Our objective was to determine association between reentry status (reentry vs never-incarcerated) and mild cognitive impairment (MCI) and/or dementia. Methods: This nationwide, longitudinal cohort study used linked Centers for Medicare & Medicaid Services and Veterans Health Administration data. Participants were aged 65 years or older who experienced reentry between October 1, 2012, and December 31, 2018, with no preincarceration MCI/dementia, compared with age-matched/sex-matched never-incarcerated veterans. MCI/dementia was defined by diagnostic codes. Fine-Gray proportional hazards models were used to examine association. Results: This study included 35,520 veterans, mean age of 70 years, and approximately 1% women. The reentry group (N = 5,920) had higher incidence of MCI/dementia compared with the never-incarcerated group (N = 29,600; 10.2% vs 7.2%; fully adjusted hazard ratio [aHR] 1.12; 95% CI 1.00-1.25). On further investigation, reentry was associated with increased risk of dementia with or without prior MCI diagnosis (aHR 1.21; 95% CI 1.06-1.39) but not MCI only. Discussion: Transition from incarceration to community increased risk of neurocognitive diagnosis. Findings indicate health/social services to identify and address significant cognitive deficits on late-life reentry. Limitations include generalizability to nonveterans.