The MOD uses the Medical Employment Standard (MES) as the main measure of outcome of its medical treatment including for mental health. The MES gives an indication of the employability of Service patients from the beginning (diagnosis) through to the end of their care pathway. The MES is derived from a medical assessment of the patient’s illness, the treatment course required and various occupational factors. The MES indicates whether the Service person can carry out full service, serve in some restricted form/role for a temporary period or, in some cases, a permanent basis or whether they should be discharged from the Service on medical grounds.
With regard to outcomes, in the majority of cases, personnel treated at the MOD's Departments of Community Mental Health are able to return to Service. Medical discharge rates for mental health conditions are low—out of 2000 personnel medically discharged annually from the UK armed forces, only about 150 will have a mental health problem. Of these, 20-25 will meet the criteria to be diagnosed with Post Traumatic Stress Disorder (PTSD).
With regard to veterans, upon leaving the armed forces or on demobilisation for reservists it is the long established practice that responsibility for medical care passes to the NHS. This has been the case since 1948 under successive Governments. Responsibility for assessment of mental healthcare for veterans provided by the NHS rests with the UK Health Departments.
For veterans who are also war pensioners, under the War Pensions Scheme the MOD has a discretionary power to meet the cost of any necessary expenses in respect of the medical, surgical or rehabilitative treatment of ex-members of the armed forces that arise wholly or mainly arise as a result of the disablement due to service, before 6 April 2005. It cannot be used to fund treatment provided under other UK legislation. Where appropriate “remedial treatment” at homes run by the Ex-Services Mental Welfare Society (Combat Stress) is funded by this route for pensioned psychological conditions.
Over the last few years research evidence of effective best practice treatment and interventions for mental health disorders has been published and officials of MOD, the UK Health Departments and Combat Stress are currently working to develop and implement a new community mental health service for veterans. This will involve public, private and charitable providers working together to deliver evidence based interventions and will be subject to appropriate clinical governance.
In addition, the department recently announced that reservists demobilised since January 2003 will be entitled to a mental health assessment by Defence Medical Services personnel, and out-patient treatment if appropriate. A further announcement will be made later this year to confirm the details of the service that will be provided including the location(s) at which the assessments will be provided, and the date on which the service will commence.