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Armed Forces: Mental Health Services

Volume 497: debated on Tuesday 13 October 2009

To ask the Secretary of State for Defence (1) how many troops returning from (a) Afghanistan and (b) Iraq have been treated for (i) post traumatic stress disorder and (ii) drug and alcohol dependency in each of the last five years; (289532)

(2) what support is available for (a) soldiers and (b) veterans suffering from (i) post traumatic stress disorder, (ii) drug and alcohol dependency and (c) any other mental illness; and if he will make a statement.

The MOD’s Defence Analytical Services and Advice (DASA) organisation publishes statistics on new attendances to the MOD’s Departments of Community Mental Health (DCMH) in the UK Armed Forces Psychiatric Morbidity reports. Quarterly and annual reports for the whole of 2007 and 2008, and quarterly reports for January to March and April to June 2009, are now available both in the Library of the House and on the DASA website at:

Equivalent verified data prior to 2007 are not available and could be provided only at disproportionate cost.

MOD takes very seriously its responsibility to provide high-quality mental health care to its personnel. Diagnosis and treatment of mental health disorders in members of the armed forces are performed by trained and accredited mental health personnel. In Afghanistan, we deploy uniformed mental health nurses to provide in-theatre care and treatment for our personnel. If personnel need to leave the operational environment, then their care continues either on an out- or in-patient basis in the UK or their permanent base overseas.

In the UK, our mental health services for military personnel are configured to provide community-based mental health care, primarily through our 15 military Departments of Community Mental Health (DCMH) across the UK (plus centres overseas), which provide out-patient mental health care. The DCMH mental health teams, comprising psychiatrists, mental health nurses, clinical psychologists and mental health social workers, have particular expertise in treatments for psychological injury.

For the relatively small number of military patients who need it, in-patient care is currently provided by a group of seven NHS trusts located throughout England and Scotland, led by South Staffordshire and Shropshire NHS Foundation Trust (SSSFT) through a central MOD contract.

The Department has issued guidance to commanders on substance misuse and all three services have robust drug and alcohol policies in place. As such early intervention by the chain of command is likely to occur for disciplinary or welfare reasons before treatment by the Defence Medical Services would become necessary.

Service personnel identified by the chain of command as being at risk of alcohol misuse receive counselling and welfare support, this can include attendance on preventative early intervention programmes designed to alert them to the harm that alcohol can cause to themselves and others. More serious cases are treated through specialist medical and psychological treatment and rehabilitation, including where appropriate as in-patients.

Drug use is seen as being incompatible with military service and as such there is a zero tolerance policy which is reinforced by Compulsory Drug Testing (CDT). In the majority of cases a positive CDT result will lead to an immediate administrative discharge. In very exceptional circumstances service personnel may be retained if their drug use is considered to be uncharacteristic and their retention would be in the interest of the service. In these cases retention is subject to the successful completion of a special programme, which is designed to re-educate and give training in cognitive behavioural therapy.

When personnel leave military service their health care becomes the responsibility of the NHS. Ex-service personnel receive good treatment from their GPs but we recognise that many health professionals have limited experience of dealing with veterans who have mental health symptoms arising from their service experience. The MOD, the four health departments and the Combat Stress charity have been working together with clinical experts and the Health and Social Care Advisory Service (HASCAS) to develop a new model of community based mental health care that will address assessment and treatment of veterans’ mental health problems in the long term.

The community mental health model is NHS-led and reflects NHS best practice. Two-year pilots, tailored to local circumstances, are operating at Staffordshire and Shropshire Foundation Healthcare Trust, Camden and Islington Mental Health and Social Care Trust, Cardiff and Vale NHS Trust, Tees Esk and Wear NHS Trust, Cornwall NHS Partnership, and NHS Lothian (led by the Scottish Executive). Evaluation of the pilot areas is now under way; early results from all six are encouraging, with evidence that veterans feel able to access and use the service with confidence. Informed by the results of the evaluation the service will be rolled out across the UK. In the interim, for areas not yet involved in the pilots, veterans with operational service after 1982 who are concerned about their mental health can attend our Medical Assessment Programme based at St. Thomas’ hospital, for specialist mental health assessment by a consultant psychiatrist with extensive military experience.

To ask the Secretary of State for Defence what steps his Department is taking to ensure the provision of suitable after-care for veterans of the conflicts in Iraq and Afghanistan in respect of post-traumatic stress disorder and other mental illnesses; and if he will make a statement. (290408)

Since 1948, it has been successive Governments’ policy that the NHS should be the main provider of health care for veterans and for the majority of veterans their mental health needs are fully met by current NHS provisions.

The Department of Health and devolved Administrations with support from the Ministry of Defence and Combat Stress have launched six mental health pilots around the United Kingdom. The aim of the pilots is to deliver a service which provides expert assessment and interventions and which is acceptable to veterans.

The early results from all six pilots are encouraging with evidence that veterans feel able to access and use the service with confidence. Evidence suggests that the presence of the pilots is making a difference to the local veterans’ communities.

Veterans who do not live near one of the regional schemes can access the Medical Assessment Programme (MAP) which is available to veterans who were deployed on operations since 1982. The MAP offers comprehensive physical and mental health assessments for veterans who feel that their ill-health may be linked to military service.