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House of Commons Hansard
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Mental Health (Armed Forces Veterans)
14 October 2015
Volume 600

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

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I am pleased to have secured this important debate. Let me initially declare an interest, having previously worked in the NHS with trauma clients, some of whom have been veterans. Also, my husband is a veteran, having served in the Army, including in Bosnia.

The majority of British military personnel do not experience mental health problems while in service or afterwards in civilian life. For a significant minority, however, this transition is brought to the point of failure by mental health issues that range in complexity and severity, and are caused by factors before, during and after military service.

Although the mental health problems experienced by military personnel are the same as those suffered by the general population, the unique risk and experiences faced during service and the transition to civilian life mean that their mental ill health may be triggered by different factors and involve unique complexities.

Service personnel may experience trauma from a variety of situations, such as training incidents, administering medical treatment or other activities in war zones. However, studies in this area have suggested that some groups of service personnel, such as deployed reservists and early service leavers, may be at higher risk from mental health problems.

In 2011, the Ministry of Defence published the tri-service armed forces covenant. The principles underpinning it are that members of the armed forces community should not be disadvantaged by their service and should be provided with specialist treatment where appropriate and based on clinical need. It is important to ensure that there are no gaps in those service provisions.

A report by the Mental Health Foundation commissioned by the Forces in Mind Trust and published in 2013 conducted a comprehensive review of the available literature. It reported that the overall prevalence of mental health problems in the UK armed forces remained fairly stable between 2000 and 2010. It particularly highlighted depression and anxiety disorders as the most common mental health problem among both serving and ex-service personnel, while post-traumatic stress disorder was found to be associated with being a deployed reservist and with individuals experiencing problems at home both during and following deployment. Emerging evidence has also confirmed the existence of delayed onset of PTSD, with one study reporting a prevalence of 3.5%.

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I spoke today to a charity called Go Commando in Taunton Deane, where I come from. It reported exactly what the hon. Lady is saying—that many of the servicemen and women who served in Afghanistan have settled back home, but are now showing many signs of post-traumatic stress disorder and depression, and of requiring anger management. I support the hon. Lady in urging as much support as possible for these people, some of whom have served as long ago as in Bosnia or even in the Falklands.

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I thank the hon. Lady for her intervention, and I concur exactly with her sentiments.

From speaking to an ex-military medical officer in preparation for this debate, it appears that some hold the view that the prevalence of PTSD is much higher than acknowledged. Studies also found that the suicide rate was higher than expected for those under the age of 20, and that there was a two to three times higher risk of suicide in men aged 24 or under who have left the armed forces as compared with their counterparts in the general population and those still serving.

It is also recognised that alcohol misuse among UK military personnel is a significant health concern. I understand from Combat Stress that that presents as a significant issue among the clients with whom it works. It describes issues related to the culture of alcohol use in the forces, and the use of substances as a maladaptive coping strategy to manage symptoms of mental health problems.

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I congratulate the hon. Lady on raising this matter. Everyone who is in the Chamber tonight is here for a purpose, because we have constituents who suffer from this condition. His Royal Highness Prince Harry said recently that we needed to do more to help those with what he described as unseen injuries. Only by talking about this and helping more can we make the necessary changes.

I want to make a brief point about people who live in the Republic of Ireland but served in the British forces. Some of those people are not receiving the help that they should be receiving, financially and in terms of benefits relating to mental issues and disabilities. For the record, will the hon. Lady ask the Minister to look into that?

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I thank the hon. Gentleman. I should be pleased if the Minister would comment on those matters, which are very specific to Northern Ireland.

Problems arising in the current system appear to relate to a number of issues, including help-seeking, referral, assessment, and access to appropriate treatments. One study reported that only a quarter of those with diagnosed mental health problems had accessed medical help. It has also been reported that stigma and lack of trust or confidence in providers of mental health services represent some of the main barriers preventing service personnel and veterans from seeking help. Stigma concerning mental health problems is particularly problematic for military forces who are required to be physically and psychologically resilient. It has been emphasised to me that the attitudes of the Ministry of Defence are also important in that regard, and that there is a need to be upfront in acknowledging the mental health issues that can arise from military service, as well as the physical risks, in order to prevent such barriers.

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I wonder whether my hon. Friend is aware of reports of drone pilots experiencing higher levels of post-traumatic stress disorder than those flying conventional aircraft. Issues of stress are causing some concern, and questions relating to recruitment and retention are beginning to emerge. Will my hon. Friend join me in urging the Minister to commit himself to more research and support for service personnel and veterans in that context?

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I thank my hon. Friend for a very well-made point. I certainly urge the Minister to commit himself to research on that issue.

In the context of referral and assessment, it has been suggested that there are still problems caused by a lack of understanding and awareness among many mainstream health care professionals of how to deal with the issues that veterans present. There is a tendency to rely on prescribing medication, and, according to Combat Stress, there is a problem of low rates of referral to its service by GPs and community mental health teams. The British Medical Association has drawn attention to the chronic undermanning of Defence Medical Services, which is reported to have had a detrimental effect on morale, motivation, and the retention of doctors. The association says that adequate resources are a key factor in ensuring the best quality and consistency of mental health care in the long term. It believes that the issue should be addressed as a matter of urgency, given the need for appropriate and sustained long-term funding.

The Royal College of Psychiatrists has highlighted the need for better trauma-related treatment from the NHS. It reports that many veterans rely on small charitable providers that sometimes do not have the resources to be trained in evidence-based therapies, which should be consistent with the current evidence-based practice. The Royal College has also raised the need to evaluate the effectiveness of current follow-up service. The Murrison report recommended a telephone or face-to-face check on how someone was doing a year after they had left service. Currently, however, all that happens is that a letter is sent to the last known address of the service leaver, telling them that they can phone or see their GP if they have an issue. It is suggested that there may be a need for investigation into the uptake of this service and whether this correspondence is in fact being received.

The Government therefore need to address issues of help-seeking, stigma, referral processes, assessments and availability of appropriate treatments. There are also issues of co-morbidity and the requirement for integrated approaches across services including health, criminal justice, forces and social care. There is, in addition, a reported lack of service provision for partners and children of service personnel, who may also suffer mental health issues owing to the nature of their family member’s job. I am pleased that the Scottish Government have put in place a veterans commissioner for Scotland to begin to address some of these issues, but I would like to see similar credence given across the rest of the UK.

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I congratulate the hon. Lady on securing this debate on such an important subject. I have Army headquarters in my constituency and strong services links in Hampshire. So desperate were a group of veterans in my constituency that they started their own organisation, Veterans in Action, who have just this month launched PTSD awareness month. I am wearing their little badge, which looks not dissimilar to an SNP badge, I have been told. The hon. Lady put her finger on the problem earlier in her speech when she said that there is not enough awareness out there about these issues, particularly among medical staff. I hope, therefore, that she might support an initiative such as awareness month in the future.

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I do indeed support awareness month, and I very much like the hon. Gentleman’s wee badge.

To conclude, veterans are individuals who would have put their lives on the line for their country. The least we can do is prioritise their care and treatment to support them in their recovery. I welcome the Prime Minister’s comments today regarding prioritisation of this issue, and I welcome the Minister’s reply.

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I call the Minister, Alistair Burt.

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I think, Madam Deputy Speaker, there is another colleague who is going to intervene.

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Madam Deputy Speaker, I was going to share the time with the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron).

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In order to do so, the hon. Gentleman must have the permission of the person whose debate it is, the Minister and the occupant of the Chair. He clearly has the agreement of the Minister and of Dr Cameron. He has my agreement, too.

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Thank you, Madam Deputy Speaker. I apologise—I spoke to Mr Speaker before you took the Chair.

I thank the hon. Member for East Kilbride, Strathaven and Lesmahagow for giving me a few minutes of her allocated time, and offer my sincere thanks to her for bringing what the Prime Minister rightly described today as “this very important issue” before the House. He correctly identified the strategic defence and security review as an opportunity to get our approach right in the future, and I fully support him in that intention.

The subject before us this evening refers to that great stain on this nation of ours, which I mentioned when I first spoke in this House. I regret to say that, aside from some excellent individual practice and charitable work, the way we look after our veterans’ mental health in this country remains poor. Many of our young men and women, who by good training and fortune walked away from battle without any physical scars, have been stricken in later years by an underlying sickness that can tear at the very core of the strongest and most enduring individual. I speak as a Conservative Member of Parliament. I work hard to support all the efforts of Government to produce and implement the exciting and progressive agenda so clearly laid out by the Prime Minister a week ago, but on this issue, while it remains in its current state, I am afraid I will not be silenced.

I have no personal agenda to drive here. I have never had the misfortune to need to use one of our tremendous military charities. I will forever be the soldiers’ voice in this debate, crafted from much time spent on operations with our young men and women, and now in my privileged position as a Member of this House and attracting a great deal of correspondence on this issue it is incumbent upon me to speak out and I will do so. I feel embarrassed at my fellow man sometimes as we stand here again tonight in 2015 in the seat of the world’s most advanced democracy and talk yet again about the stigma of mental health.

The stigma results from a basic lack of education and understanding about a human condition that affects one in four of us—a condition as medically valid as a broken leg or a fractured arm, but because it occurs in our heads, its treatment has historically been subjected to unacceptable social, political and financial disadvantage. That stigma ends in this Parliament, and I will not rest until it has.

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I had the honour of chairing a disability employment session at the TUC today and a young man with autism came out with what I thought was a fantastic phrase about mental health issues in the workplace: “There is no normal.” We all have mental health; sometimes it is good and sometimes it is not. Maybe instead of us thinking about a certain percentage having a problem, we should acknowledge that we all have different problems at different times. That might make it easier for people to come forward.

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Absolutely, and when we have more time, we might discuss specific projects looking at what normal is and that process. That is an important part of this.

I could inevitably speak all night on this issue, but I will not. In preparation for tonight, I stayed up most of last night and read as much as I could of a couple of books I have on my desk in my office here in Westminster. One is called “Aftershock” by Matthew Green and another is called “The Battle against Stigma” by Mark Neville. We have got better in this area as a nation over the last few years. I would ask however that before any of us enter into an exercise of back-slapping on how far we have come on mental health, we all read those two books and reflect on both what we ask of our servicemen and women and how we look after them when they come back.

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The issue in the north-east is that large numbers of young men go to war on our behalf and come back, but there is not the support for them. Many of them fought in Northern Ireland and 20 years on they have gone back to normal life and are struggling. There is just no support for them or their families. It is a particular crisis in my region because it has a large former military population.

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Mental health and the time lag involved is increasingly well publicised, and people are becoming more aware of it, but we have a long way to go on that and we see that on a daily basis.

Our British public have in the latter part of the last decade been the knight in shining armour flying over the horizon and rescuing some of our most war-scarred individuals. They have given millions upon millions of pounds, and donated time, effort, blood, sweat and tears to looking after our boys and girls. They are, quite simply, what makes Britain great, and what make us, when we are away, so proud, and fight so hard for the country we love.

Similarly, now this Government have for the first time been elected on a manifesto that explicitly stated a parity between mental and physical health—the first time in history that has occurred. Similarly, we now have waiting time target lists for mental health, again for the first time in history. This Government get it, and I am proud to be a part of it, and I thank the Minister personally for his valiant efforts in this regard. There is so much further to go, however, to win what I would call part of an internal “generational struggle” of ours in veterans care.

Finally tonight I wanted to guard against a misunderstanding of the problem. The vast majority of servicemen and women in this country make a stable and successful transition back to civilian life. They are cornerstones of our communities—directors of companies, nurses, doctors, shopkeepers, lawyers and manufacturers.

Our job in this place is to look after the 10%, those who through no fault of their own find life a daily struggle, those who with a bit of bad luck or a couple of poor decisions could be any one of us and, in particular tonight, that refers to those who have often given their best years in the service of the nation, but have found returning to a civilian life the hardest fight of all.

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We should always mention the families because they are often deeply affected and we need to support them.

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I agree.

So let us now win this fight and take our place as a country at the vanguard of contemporary veterans care. In five years’ time it will be too late. The momentum in the battle will be lost, and we will simply be fighting fires. The politics of good intentions and at times tokenism is finished; we must get this right, and I look forward to it being prioritised as such in the forthcoming strategic defence and security review.

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It is standard to congratulate the hon. Member who has secured the debate, but I really do congratulate the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron). This has been a very interesting 18 minutes, and my only criticism is that we should have had at least an hour and a half, or maybe three hours somewhere else, but I suspect that might happen. I also congratulate the hon. Lady on raising this subject at Prime Minister’s questions today. If she permits, may I thank her for her service to the NHS and those in difficulties and thank her husband for his service to the country?

I am delighted to be joined by the Under-Secretary of State for Defence, my hon. and gallant Friend the Member for Milton Keynes North (Mark Lancaster), who has also seen active service and we have just heard from my hon. and gallant Friend the Member for Plymouth, Moor View (Johnny Mercer). I say to them that there are times when their Minister feels very humble in that their collective experiences outrank mine very considerably. So I will do my best to respond to the debate. Because of the length of the initial speeches, I have slightly less time in which to do that, but that is all right because I want to make some changes to what I was going to say.

I should like to set out what the Government are doing. In doing that, I do not intend to suggest that what has come forward up to now is not valid, relevant, important or challenging to the Government. It would, however, be fair of me to put on record what is going on, although it is palpably not enough. If the hon. Member for East Kilbride, Strathaven and Lesmahagow, with her experience, needs more and if my hon. Friend the Member for Plymouth, Moor View, with his experience, needs more, then it is clear that whatever we are doing—good though it is, and better than it was—is not yet meeting the demands and the needs. It is also clear from the comments of other Members tonight that it is not yet meeting the demands of the House. My hon. and gallant Friend from the Ministry of Defence and I have listened carefully and there will be more to be said.

The Government are fully committed to continual improvement in the treatment of mental health conditions for veterans and the general public alike. We are rightly proud of the courage and dedication of our armed forces. For those who have been injured either physically or mentally, it is our duty to ensure that they continue to receive the very best possible care. As Members have already said, the vast majority of those leaving the armed forces do so fit and well, having benefited from their time in the forces. Members of the armed forces are not significantly more likely to develop mental health issues than those in other professions, but support and clinical care that are geared to the specific needs of veterans need to be available.

Armed forces and veterans mental health provision has vastly improved since the publication of the landmark report “Fighting fit” in 2010. The report was produced at the hands of my hon. Friend the Member for South West Wiltshire (Dr Murrison), who recommended that there should be 30 mental health professionals across England to provide services to veterans. With 10 veterans mental health teams in place across England, we now have significantly more than the 30 professionals recommended.

In deference to the position of the hon. Member for East Kilbride, Strathaven and Lesmahagow, let me now say a bit about Scotland’s provision. Scotland is proud of its commitment to improving mental health, including for veterans and their families. Visibility and awareness of mental health issues have substantially risen in the nation over the past decade. That echoes something that my hon. Friend the Member for Plymouth, Moor View said. There is greater awareness following long-standing campaigns against stigma. We have not gone as far as we need to go, but it is easier for people to talk now. For those with very difficult conditions, however, those are easy words, and it is still very difficult for them.

There is better public awareness of mental illness, suicide prevention and faster access to NHS services and other sources of help. Veterans and their families have unhindered access to all NHS services, enhanced by priority treatment where that applies. Evidence-based care and treatment are provided across community-based settings through support from primary care, with specialist or hospital in-patient services provided as appropriate.

In partnership with NHS Scotland and Combat Stress, the Scottish Government recently renewed funding for the provision of specialist mental health services at the Hollybush House Combat Stress facility in Ayr, for veterans resident in Scotland. The sum of £1.22 million a year over the three years to 2018 will fund a range of specialist clinical, rehabilitation, social and welfare support at the facility. Evidence-based treatment programmes include an intensive post-traumatic stress disorder programme; trans-diagnostic and stabilisation; and anger management programmes.

NHS Lothian secured £2.5 million of armed forces covenant LIBOR funding to support the commitment, and established Veterans First Point Scotland to work with local partnerships to explore how the strengths of the Lothian service could be delivered in other localities. Over the past year, work has been taken forward in 10 health board areas across Scotland to assist each local area to establish key partnerships, identify premises, plan requirements and recruit and select staff. This work continues, with the service in Tayside now open with others to follow.

I want to demonstrate that England, too, is recognising and trying to respond to the needs of veterans. Before I say a bit about that, may I thank the hon. Member for Strangford (Jim Shannon) for raising the issue in relation to the Republic? I do not know the answer, but I will find out. I recognise the point that he makes.

Underpinning all that I am saying is the demand for more research. There is some good research. The King’s Centre for Military Health Research has done some good work in identifying the categories of those who might be more at risk. Reservists and their particular issues came up, as did the other groups of veterans, particularly those who have been back for some time. There are ways of picking up those issues, and I will say a little more about that.

NHS England spends £1.8 million a year on mental health services for veterans including the 10 veterans’ mental health teams. Up to £18 million funding is in place to provide the Combat Stress six-week intensive post-traumatic stress disorder programme for veterans, with an additional £2 million of LIBOR funding being provided to Combat Stress to help veterans with alcohol problems, which is a key indicator of problems. Help for Heroes has received £2 million of LIBOR funding for its “hidden wounds” work, offering low-level improving access to psychological therapies services to veterans. Subject to the spending review, a further £8.4 million will be provided over the coming five years to help the most vulnerable veterans who have mental health problems.

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The Minister mentioned LIBOR funding, and that is something that I have been pursuing through the Defence Committee and other ways. We have been seeking to have some of that LIBOR funding available for Northern Ireland to provide a rehabilitation centre for the many people who have served and who will continue to serve. None of that has been forthcoming to the Province so far. I understand that the Minister cannot give me an answer today, but perhaps he can look at the matter and come back to me.

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My hon. and gallant Friend from the Ministry of Defence says that there is money available in a bidding programme and he will write to the hon. Gentleman and see what more can be done in relation to that.

I want to say two things as we run towards a conclusion. Many of the servicemen affected will of course be treated by the NHS in the course of ordinary medical treatment. The so-called talking therapies from the IAPT programme have been particularly successful. It is important to ensure that the particular needs of veterans are catered for in this programme. Work has been under way to ensure that that is done. The IAPT programme has been very successful. For the first time, we have standard waiting times and access targets. That will help veterans too.

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Will the Minister give way?

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I only have a couple of minutes left, but if the hon. Gentleman must intervene, I will give way.

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I am very conscious of the time, and I am grateful to the Minister for giving way. We have heard much talk about service personnel, and I completely agree with it, but there seems to be little discussion about the impact of service personnel’s mental health issues on children. Given that the strategic defence and security review is coming up, will there be some commitment to investigations and discussions with the children’s commissioners of the United Kingdom of Great Britain, Northern Ireland, Scotland and Wales to see how they can inform that debate?

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I note the hon. Gentleman’s remarks. I cannot say anything about the review, but I take his point. It is recognised that anything that affects the mental health of an individual can impact on the family. I hope that the veterans’ work involves that.

May I just say a little more as I have something specifically to say about that? Additional services include: a 24-hour veterans’ mental health helpline that receives more than 800 calls per month; an online peer support, well-being and counselling service called the Big White Wall, which provides support and services to armed forces, their families and veterans 24 hours a day all year round; Combat Stress, of which people are aware; and Help for Heroes’ “hidden wounds”, which is a psychological well-being service offering support to veterans and their families. It is important that these veterans’ services are both sustainable and fully embedded in the mainstream of the NHS so that veterans can move to other mental health services if necessary and at the right time.

In view of what colleagues have said, let me conclude by returning to my original point. There are services in place. They have clearly improved. We have recognised the good work of my hon. Friend the Member for South West Wiltshire some time ago and the demand that has come back, but it is plain from what colleagues are saying that they want us to do more. I do not think that there is a finite limit that we can go beyond in recognition of what has been done for us. I am absolutely certain that the commitment that the Prime Minister made this afternoon in his answer to the hon. Member for East Kilbride, Strathaven and Lesmahagow in which he demonstrated his own deep awareness of the situation is one that we can all rely on. We will continue to meet the commitments of the armed forces covenant and to work closely with all those relevant organisations in the best interest of veterans and their mental health. That is the best way in which we can say thank you.

Question put and agreed to.

House adjourned.