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Ex-service Personnel (Psychological Welfare)

Volume 554: debated on Thursday 6 December 2012

Motion made, and Question proposed, That this House do now adjourn.—(Nicky Morgan.)

As chair of the Unite the Union group in Parliament and of the all-party group on health and safety, I have spent most of my working life in politics standing up for people who have been disadvantaged because of the career they have chosen. As Major Cameron March MBE, from the Army’s operational stress management team, recently said:

“If we put people into difficult places we’ve got to have something in place to look after them”.

That is true in all walks of life, whether we are dealing with builders exposed to asbestos, lorry drivers travelling over long hours or, as I will speak about this evening, service personnel exposed to traumatic experiences. The issue I have brought to the House today seems to me to be an extreme example of occupational health and safety. As employers, we have a responsibility to those brave individuals to ensure they can live a fulfilling life following their service.

I was delighted to read in one of the tabloid papers today that the Prime Minister has announced £1 million for veterans’ charities. I would like to say, “It was this debate wot done it”, but something inside tells me that another event is taking place tonight that has been organised by one of the tabloid papers. The £1 million is welcome and I am sure the veterans will appreciate it.

Post-traumatic stress disorder, or PTSD as it is now known, is not a new phenomenon. It was first identified during the first world war, and was called “shell shock”. We have moved on since then and correctly recognise that it is a serious condition that in no way undermines the brave work undertaken by our armed forces. Despite that, there is still a significant stigma attached to mental health issues among veterans. Many still consider themselves “weak” if they suffer in the adjustment to civilian life.

A culture change among veterans is needed, but for policymakers that is difficult to achieve. However, if the Government direct more funding to the condition, which is what I shall argue for today, we can give hope to those suffering and help them to recognise that they are not weak and that the condition is a natural reaction to the horrors they have seen.

Will my hon. Friend pay tribute to the work of Dr Ian Palmer and the medical assessment programme at St Mary’s? Until recently it was open to all veterans who could go for individual psychological assessments. That has now been downgraded and moved to Chilwell in Nottinghamshire. Does my hon. Friend share my concern about that and agree that open access, even later in life, is important for veterans?

I am not aware of the precise details, but I am extremely disappointed to hear that. I am sure that the Minister will address that when he gets the opportunity.

My right hon. colleague, the Minister for the Armed Forces, has said that he

“takes the issue of mental health very seriously, and we recognise that operational deployments will inevitably expose personnel to stressful experiences.”—[Official Report, 12 June 2012; Vol. 546, c. 447W.]

Similarly, when he was a Health Minister, the right hon. Member for Chelmsford (Mr Burns), claimed that the coalition Government

“considers the health and wellbeing of…armed forces personnel, veterans and their families to be a top priority.”—[Official Report, 18 June 2012; Vol. 546, c. 801W.]

I agree with these sentiments, as I am sure we all do. Those veterans have put their lives on the line so that we can be safe. They have done a great service for their country and they deserve the top service from their country in return. So why then do the actions of Ministers not speak louder than their words? Their statements are commendable, but their funding commitments are not. I am calling today for more public funding to be directed to the issue and for the psychological well-being of our veterans to be considered a top priority.

The hon. Gentleman referred to the great work done by charitable organisations —for instance, SSAFA Forces Help, the Army Benevolent Fund, the Royal British Legion, Help for Heroes and many others. Would it be more constructive if the Government were to work with those charitable organisations to address the problem?

I thank the hon. Gentleman for that contribution. I will come to that important aspect.

It is important that we tackle the issue now as we are only a few years away from it becoming more serious. The Prime Minister confirmed at the end of November that the combat mission in Afghanistan will end in 2014. With this will come the return of thousands of troops who have been serving abroad so that we can remain safe in our own country. Combat Stress estimates that 7,600 of the 191,000 personnel who have served in Iraq and Afghanistan could develop PTSD, and that 37,600 are suffering from other disorders, such as depression, mood disorders and anxiety. It could be up to 13 years before the problems reveal themselves, so work done now in this area could prove invaluable 10 to 15 years down the line.

However, we should not be alarmist. Most British military personnel do not suffer any mental health problems while in service or afterwards. We also cannot be certain that the numbers of personnel suffering from mental health issues are disproportionate to the population as a whole. There are conflicting views on this. I have spoken to Veterans Aid, which says that there is no problem with ex-service personnel care, yet PTSD Resolution, a charity that gives counselling to veterans, talks about a much larger problem that is not currently acknowledged. The Royal British Legion anticipates a growing number of problems due to the rebalancing of the armed forces towards reservists.

With more and more armed forces coming back from Afghanistan, the possibly low estimate of 4% of personnel with probable PTSD, 19.7% with other mental disorders and 13% with unhealthy relationships with alcohol will become a much larger problem. I say possibly low estimate because the United States’ estimates of its defence personnel with PTSD range from 12% to 20%. Whether our figures are low or not, all personnel suffering from PTSD and other mental health issues deserve the highest quality post-deployment support services.

I find it a huge cause for concern that these services are at present undertaken, by and large, by charities. They rely on the generosity of the public and in the current environment, where donations to charities are down by 20%, according to the Office for National Statistics, we cannot go on in this way. Let me provide some examples. The Big White Wall online support network is propped up by a £100,000 commitment from Help for Heroes. That is almost a third of its total funding. Combat Stress, a veterans charity, is currently supporting over 5,000 veterans aged from 20 to 101 and it says it

“simply couldn’t do what we do without the generosity of the great British public.”

PTSD Resolution provides counselling to UK veterans, with a 78% success rate, but gets no recognition for its work from the MOD. Erskine hospital in my constituency provides vital care to veterans suffering from mental health issues, among others, and relies on donations to cover a large part of the £7 million a year that it needs to keep going.

It is unfortunate that those charities have to rely on fundraising to undertake work that provides a lifeline to those suffering after service. Veterans are clearly not a priority for this Government; they were not for the previous Government either. They are a priority for the charities, but it is a sad fact that in our society it is charities that are caring for our war wounded. More funding should be directed to the psychological welfare of ex-service personnel, and it should come from the public purse.

The funding issue will only get worse. The Government are planning to double the number of reservists, from 15,000 to 30,000, by 2018. That raises a key question, because reserve personnel are more likely than regular soldiers to suffer from PTSD. Therefore, we need a strategy for the future to tackle that invisible consequence of service.

Funding has been allocated for those brave personnel, but we do not know whether any of it will cover increased mental health provision. I have a few precise questions about the Government’s plans to care for those additional members of the armed forces, who take on the responsibility alongside their day jobs. Since reservists are going to be more exposed to the front line, will there be a change to the pre-deployment training to reflect that, and will there be any additional provision for reservists and their families?

On that point, let me underline the importance of including families in any post-deployment care. PTSD and other mental health problems do not have individual victims; their effects permeate the lives of sufferers’ friends and family, and often that effect is overlooked. It is perhaps more pertinent for reservists, as they return to environments where their experience is not particularly well understood. They can find it hard to readjust to civilian life, and their friends and family find it hard to see the person they loved change into someone new.

As an MP with a long history of standing up for rights in the workplace, I am also interested to hear how reservists’ rights will be protected. Will the Minister be looking to change post-deployment rest and recuperation, given that it is a key factor, cited by many experts, for why they do not recover? That seems a sensible suggestion to help mitigate the effects of traumatic experiences in the field. If that was the case, how much extra time away from work would that imply? Will reservists be given guarantees by the Government that their involvement will not hinder their job applications or relationships with employers?

Reservists, as with all other armed forces personnel, make a great sacrifice for their country and should not be penalised for that. They face specific issues on return, such as a lack of understanding from friends and family and more open criticism of the war in Iraq. They are also usually called upon to fill gaps in the regulars, becoming out of sync with the rest of their unit and, therefore, lacking the comradeship that can be such an important part of service. As such, they should be given the proper prevention and intervention strategies they need to readjust to civilian life and prevent any mental health issues from manifesting themselves.

I am sure that the Minister agrees with me on many of these issues. He might be searching desperately in his limited budget for spare cash to spend on mental health care for veterans. Perhaps I can help him in that regard. We have called for deeper cuts to the number of one-star officers and those above, the highest paid, in order to correct the top-heavy imbalance across our services. I am not usually in favour of redundancy policies, but the number of the most senior officers in the MOD has risen by a third since 1990. We have more admirals than ships. We have a higher number of officers across all three services than do the French and US air, maritime and land forces. Although 20% of more junior ranks look set to lose their jobs, just one in 20 of the most senior officers in all three services have been made redundant. The money spent employing senior officers could be much better spent helping to ease the burden of veterans’ charities. The £1 million could be spent on a fund that would focus research on mental health issues and charities could bid for funds to support their own policy research.

It is estimated that by 2020 1.8 million people in the armed forces community will be living with a long-standing illness. I have spent much of my political career fighting for people who have been injured or made ill as a result of their job. Serving in a combat zone where their life is constantly imperilled places unique burdens on our service personnel. It is imperative that the Government recognise the need to ensure that our armed forces are afforded not only the best physical care but the best mental health care while serving and after returning to civilian life. We cannot rely on charities to do this vital work any longer. I sincerely hope that this debate has managed to bring some of the issues to the table, and I will be interested to hear the Minister’s plans to ensure the mental well-being of our respected veterans.

Finally, it would be inappropriate in the context of this debate not to mention the Christmas Island veterans, who are still looking for compensation after almost 40 years. I hope that the Minister will say something about them as well.

I congratulate the hon. Member for Paisley and Renfrewshire North (Jim Sheridan) on securing this debate on the mental health of our former service personnel. I thank him for his courtesy in giving me some idea of the issues that he intended to raise.

This is a vital subject in which cross-Government working is having a real impact. Although the four UK Health Departments hold primary responsibility for the issue, I naturally take a very close interest in it given my veterans portfolio. I hope that in the previous debate on armed forces personnel I was able to persuade the House that in the three months in which I have been doing the job I have taken a very close interest particularly in the medical issues that affect personnel and veterans.

That said, I must regretfully disagree with the charges that the hon. Gentleman laid against this Government. We are investing in mental health at every juncture of a service career. From recruitment, to deployment, to discharge and transition into civilian life, the Ministry of Defence and the Department of Health have made funding available for extensive support to serving personnel and veterans who encounter mental health problems.

Let me also say that the Government very much welcome the role played by service charities. It is entirely appropriate that we should look to harness their niche capability and expertise to maximise the quality of support given to the service community. In many cases, this support is provided by a partnership with Government, and that should be celebrated rather than regretted.

As the former Defence Secretary, my right hon. Friend the Member for North Somerset (Dr Fox), announced on 6 October last year, the Government accepted all the recommendations in “Fighting Fit”, the report by the Under-Secretary of State, my hon. Friend the Member for South West Wiltshire (Dr Murrison), which now forms the backbone of the work being done across Government to improve mental health care for service personnel and veterans. I can report good progress in delivering those recommendations. The hon. Member for Paisley and Renfrewshire North specifically talked about veterans, but I will briefly set out the context of our overall strategy for mental health.

While serving, all personnel, including reservists, are encouraged to report distress or mental health concerns. We have introduced a process called trauma risk management, or TRiM—a peer group support system that is helping to identify those at risk and provide support to them.

From what I have heard, there is extremely good counselling in the field after incidents have occurred. People zone in on those affected, immediately and without delay, and check them out as best they can.

I am grateful to my hon. Friend for that important intervention.

TRiM was initially developed by the Royal Marines. It involves training non-specialists in military units to lead discussions about traumatic events and spot those who may need additional help. We make sure that we have mental health professionals forward deployed in theatre, exactly along the lines that my hon. Friend the Member for Beckenham (Bob Stewart) mentioned, to deal with such eventualities if and when they occur. We deploy uniformed mental health teams to provide care on the front line. Regular psychological health assessments are conducted to ensure that support in theatre is sufficient and, if needed, a UK-based team of a psychiatrist and mental health nurse can deploy to theatre at short notice if an incident warrants it.

At the end of an operational tour, units undergo decompression—an opportunity to unwind and talk about their experiences. At this point, personnel also receive a series of briefings designed to help them adapt to their return from deployment, and mental health is one of the specific issues raised.

Specific measures are also in place for those leaving the service. After a successful regional pilot, structured mental health assessments were rolled out nationally in July 2012 as part of routine and discharge medicals. We hope they will be useful in highlighting mental health problems at an early stage.

To ease transition from military to civilian life, personnel with identified mental health issues can access military departments of community mental health up to six months after discharge. There are 15 such departments across the United Kingdom, providing specialist mental health support to military personnel. In addition, GP registration forms in England, Scotland and Wales now enable those who have served to declare this when registering with a doctor’s practice, providing an opportunity to discuss their unique needs, if they so wish.

On the specific steps that we are taking for veterans, the Department of Health, working with South Staffordshire and Shropshire mental health trust, has put in place a national veterans mental health network. This brings together NHS clinicians, the Ministry of Defence, Combat Stress and others to assess the implementation of the recommendations made by the Under-Secretary. The network’s first full meeting was in Stafford on 29 October and a national conference will take place in March 2013. I also take this opportunity to place on the record our appreciation for the valuable work done by Combat Stress, and I am looking forward to a meeting with its chief executive, Mr Andrew Cameron, in the next few days.

Armed forces networks, whose role is to provide links between the forces and the wider community on health issues, are beginning to implement veterans mental health projects in each former strategic health authority area. I am delighted to report that there are now more than 50 extra veterans mental health professionals in the NHS across the various armed forces networks in England, which is 20 more than originally recommended by my hon. Friend. I do not, therefore, accept the point made by the hon. Member for Paisley and Renfrewshire North about lack of resources, although I accept that he made it in good faith.

In his report, my hon. Friend acknowledged the value of the medical assessment programme, which offers assessments to ex-service personnel suffering mental health problems. On 29 October, the MAP was relocated with the reserves mental health programme at Chilwell, Nottingham, to form the veteran and reserves mental health programme. This more central location in the middle of the country will, we believe, make for easier access and ensure that high standards of clinical oversight are maintained.

More than 2,500 members of the armed forces community are now registered to use the Big White Wall, which the hon. Gentleman mentioned. It is a website that allows users to talk anonymously about mental health issues. Early indications suggest that it is proving a valuable means of interaction without the stigma sometimes attached to mental health. User surveys are reporting significant reductions in stress and anxiety, not least because individuals can raise issues anonymously, if they so choose.

Plans are also maturing for the veterans information service, a means of providing advice to veterans on accessing services and support for health issues related to their military service. When launched, all veterans who leave the armed forces will be contacted by letter or e-mail after 12 months, so that we can check how they are getting on.

On work in the nations and regions, I recently met Keith Brown MSP, the Scottish Minister for Transport and Veterans, to discuss the steps the Scottish Government are taking on veterans’ issues. In addition to maintaining support for specialist mental health services for the next three years, they will fund and seek to expand the Veterans First Point service, an advice centre designed to help veterans and their families during the transition to civilian life.

In Wales, the all Wales veterans health and wellbeing service is providing access to specialist outpatient care and signposting veterans and their families to other support that they may require. It offers access to therapists with expertise in veterans’ mental health to provide assessment, treatment and referral. Treatment options include commissioning the services of Combat Stress, which works in partnership with the service to provide nurse-led community support groups.

In Northern Ireland—I should place on the record that the hon. Member for Strangford (Jim Shannon) was present for part of this debate—a specialist aftercare service was established in 2007 to address the unique requirements of veterans of the Ulster Defence Regiment and the Royal Irish Regiment home service, and their dependants. Each year, that widely praised aftercare service deals with about 4,500 cases, providing welfare support and medical services, including mental health support.

Is the Minister aware that a significant number of veterans are serving prison sentences or are on parole? The American system is different because it tracks the crimes of ex-service personnel. I am not suggesting for a minute that people should be able to commit crimes and get away with them, but is there something that we could do in Britain to copy the American system?

I have looked into this matter and am advised that the proportion of veterans in prison is no higher than the proportion of the civilian population that is in prison. We need to do what we can through rehabilitation and other means to help those people, just as we would help others.

The Department of Health in England has extended its funding of the Combat Stress and Rethink 24-hour mental health helpline for service personnel, families and veterans. In addition, the Department of Health, in partnership with the Royal College of General Practitioners, has put in place training packages for GPs to raise awareness of the unique needs of armed forces families and veterans.

On a broader point, in line with the principles of the armed forces covenant—we launched the report on that today—the Government have reaffirmed that veterans in England should be given priority NHS treatment for conditions related to service, subject to the clinical needs of others. The Scottish and Welsh Governments accord the same priority to veterans. That is important, given that one in 10 adults in the United Kingdom is now a veteran, going right back through the second world war, Northern Ireland and other conflicts up to the present day. A high proportion of our population have served their country in uniform in one way or another.

The hon. Gentleman referred specifically to post-traumatic stress disorder. I was delighted to be able to visit King’s College London recently, not least because some time ago that was where I completed my master’s degree in war studies. To some extent, I was going back to my alma mater. While there, I met Professor Simon Wessely and his internationally renowned team in the King’s centre for military health research. Mental health issues, particularly PTSD, have been a key focus of his research, which the MOD continues to fund. I was reassured by Professor Wessely that comparatively low rates of PTSD are being recorded in the service community. The evidence indicates that the mental health of the armed forces remains robust, but naturally we will do our utmost to help the minority who develop PTSD or other mental illnesses.

In addition to the measures that are already in place, we have made provision for the training for primary health care staff to raise awareness of PTSD. Defence Medical Services has more than 200 mental health professionals who provide specialist support to service personnel and, as I have mentioned, additional personnel are available in the NHS to augment the existing capability. I have also mentioned the veterans and reserves mental health programme, which the MOD continues to fund. The Department of Health has agreed to fund the provision of acute PTSD services by Combat Stress with £3.5 million a year for five years. As I have said, I shall be meeting Andrew Cameron shortly to discuss how that money can best be deployed.

The hon. Gentleman asked about the Christmas Island veterans. I hope that he will forgive me, but I have concentrated my remarks on mental health. The fairest thing that I can say is that I will write to him about that issue. I hope, under the circumstances, that he regards that as acceptable.

I think that what I have said gives an indication of the importance the Government attach to the treatment of the mental health problems of our service personnel and veterans. Although we have long been aware of the implications of physical injury to our armed forces personnel, it is fair to say that for a long period there has been a stigma surrounding mental health. We are starting fully to recognise and deal with the impact on the lives of those who suffer from such issues. It is to the credit of the previous Government that work was done to begin to address these issues on their watch. The House can rest assured that the current Government will continue to do all that we practically can to look after service personnel and veterans who develop mental health issues. These people are important to our country and we must do our best for them.

Question put and agreed to.

House adjourned.