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Military Training: Mental Health Resilience

Volume 606: debated on Tuesday 23 February 2016

I beg to move,

That this House has considered opportunities for mental health resilience in military training.

All of us in this place realise the debt we owe to our armed forces personnel and to their families for the sacrifices they make to keep us safe. It has to be acknowledged that unless we, too, have seen active service, faced danger and death, witnessed carnage and experienced loss we cannot fully appreciate or understand the impact and the price that some pay.

I had second-hand experience of such sacrifice when working in a boarding school. I was in loco parentis to 25 teenage girls whose fathers were serving in Bosnia. I saw something of the impact of protracted periods of lives lived apart and of relationships stretched. I saw something of the fear and anxiety of children for their father, and the loneliness and challenge for the parent left behind. Boarding school often provided the continuity that families need and, for the overwhelming majority, service life is one of purpose, identity and fulfilment, with men and women going on to lead successful lives thereafter. For the estimated one in five who bear the unseen scars, however, every opportunity to build resilience or mental toughness needs to be recognised.

The Ministry of Defence recognises mental illness, including post-traumatic stress disorder, as a serious disabling condition, but—importantly—as one that can be treated. My question today is, can it be prevented? In the US Battlemind programme, mental resilience training has been dubbed “armour for your mind”. Can we put mental health resilience on the same footing as physical fitness or, indeed, physical armour?

This is an important debate and I am sure that the hon. Lady agrees with the importance of having full implementation of the military covenant throughout the whole of the United Kingdom. I am sure she shares my frustration that in Northern Ireland we cannot achieve that. The points she is making are very important.

I absolutely subscribe to the hon. Gentleman’s passionate support for the military covenant. I will say more about that later.

The new and growing recognition for mental health and veterans’ care on returning home is very welcome, and I pay tribute to the work of charities, of hon. and gallant and hon. Members and of the Government for their unswerving commitment to the military covenant. We are living amid a sea change in our understanding and recognition of mental health issues as we strive for parity of esteem between physical and mental health in our NHS. Times are changing.

Our commemorations of the centenary of the first world war remind us of a different time, when mental health issues bore a stigma and the social view was that wounds that could not be seen could not really be there. Veterans did not seek help and many could not even speak of their experience. Henry Allingham, God rest his soul, was an Eastbourne resident and a supercentenarian. He only started to share his story at the age of 105, but between his 110th and 111th birthdays he is reported to have made more than 60 public appearances. I met him the once.

“It’s good to talk”—the time-honoured role of the padre reflects that and initiatives such as the armed forces’ mental health first aid programme recognise it. After operational deployment, decompression is another hugely valuable opportunity to safeguard resilience. Furthermore, the stress and resilience training centre within the Defence Academy at Shrivenham runs a course called “START Taking Control”. Perhaps the Minister will elaborate on whether such training, which was designed for postgraduate and leadership roles, might soon be extended to initial training.

My hon. Friend is making an excellent speech on a subject that is incredibly important, in particular to someone who has a close relative serving in the armed forces. Alcohol misuse is one of the most frequently reported mental health problems for deployed UK troops. It is the only mental disorder to have increased in prevalence. Comparison of alcohol misuse in the same age and gender group shows that armed forces personnel are more likely to misuse alcohol than the rest of the population. Does she agree that the dangers of alcohol misuse must be incorporated into any training to improve the resilience of personnel?

I acknowledge the great wisdom of what my hon. Friend says. It has been recognised for some time that alcohol abuse has too long been part of a work-hard, play-hard culture. Alcohol has also evidently been used to some extent to cope with the inevitable strains of conflict and combat. It is worth noting that young soldiers between the ages of 18 and 24 are three times more likely than their civilian counterparts to be consuming harmful levels of alcohol. The problem is a serious cultural issue that we must consider, in particular in connection with mental health.

Along with the many good things that the Government are doing to support mental health—I have touched on only some of those—I urge us not to overlook the most effective support system of all, which is the family. The UK Government implemented an operational mental health needs evaluation for those serving in the field during operations in Iraq and Afghanistan. Despite obvious operational difficulties in ensuring a full rate of participation, evaluation of a statistically significant 15% of all serving personnel in Iraq and 16% in Afghanistan greatly aided our understanding of the mental health challenges faced by our servicemen and women. The fact that 99% of those asked to participate did so suggests to me that the military has been successful in breaking down barriers to the point that armed forces personnel want to share their experiences, albeit anonymously.

The results of the survey, as broken down in The British Journal of Psychiatry, also showed the prevalence of the most common mental health disorders, with an incidence rate of about 20%. That, too, is significant. The results were used to match the correlations between family stress and the development of mental health disorders, further underlining how vital it is for us to support military families.

The past 15 years have been a time of strain for many armed forces personnel, given the extended interventions in Iraq and Afghanistan. We know that the mental scars of conflict can emerge many years after people are relieved of active duty. Many trigger points can be completely unrelated events that take place in the home, far from the field of battle. Problems at home such as financial trouble, relationship breakdown or even child-related stress can all trigger mental health issues. It is therefore imperative that we equip our soldiers and, crucially, their families with all the mental resilience skills necessary to hurdle the challenges of military life and beyond. Family is the best support system, as soldiers themselves testify. How we promote and protect the military family will be defining for mental health outcomes.

Mental health is likely to be a ticking time bomb. According to Combat Stress, the veterans’ mental health charity, 13 years is the average length of time between service discharge and a veteran seeking help. Next month marks the 13th anniversary of the US-led invasion of Iraq, so the demand for mental health services for veterans is likely to increase in the short term. Combat Stress has already seen a 28% increase on 2013-14 in the number of veterans seeking assistance in 2014-15.

I am pleased that we are making it easier for our armed forces personnel to get the support that they need and to come forward in the first place, although a report this week suggests that a significant number of them—perhaps up to 40%—are still not seeking such support. Is there a case for more training, particularly in initial training? The received wisdom is still that prevention is better than cure. Do we need to offer more specific training and dedicate time to building mental resilience, just as we push physical speed, strength and stamina? Does that need to be universally rolled out and not hostage to self-awareness, self-selection or self-referral?

I am a patron to the Military Preparation College. As I shake those graduates’ hands and see them walking off into the sunset, I need to know that we are doing everything in our power to mitigate what is certain occupational hazard, looking overseas for best practice, looking at initial training and training at every stage of military service and beyond. We are looking to change culture by lifting up mental health awareness and we will need to have that as a focus for the foreseeable future.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I remind the House of my interest as a serving member of the Army Reserve. I start by congratulating my hon. Friend the Member for Eastbourne (Caroline Ansell) on securing the debate to discuss mental health resilience in military training.

The Government are committed to maintaining and improving the mental health of members of our armed forces. According to research, the armed forces generally show similar rates of common mental health disorders to the civilian population. Deployment on operations does not in itself appear to be a factor in mental health problems overall, although exposure to combat is associated with an increased risk of more serious conditions such as post-traumatic stress disorder.

We are extremely grateful to our armed forces for the work that they do. It is our duty in return to provide care and treatment for them if they become ill. Evidence shows that most mental health disorders can be successfully treated and we have a range of trained medical personnel and facilities to do that, but it is clearly much better to provide our people with the knowledge, training and support that will enable them to build up both their physical and mental resilience before they deploy on operations.

It is important to look at health and wellbeing together, because overall they involve both the mind and the body. Mental wellbeing is very much enhanced by feelings of self-esteem and people having belief in their ability to do the things that they want to do. Good relationships—confidence in leaders and trust in friends and colleagues—are also vital. Good mental health does not mean never experiencing difficult feelings or situations, but it does mean having the strength and resilience to cope when things become difficult.

To that extent, building resilience is one of the principles that underlies all our training programmes, which are designed to be robust, challenging and realistic enough to prepare our people to carry out their operational roles effectively and efficiently, under inspirational and caring leadership. The Defence Academy is a world leader in the provision of military training. It has its own stress and resilience training centre, which is responsible for managing stress and resilience training and educational requirements within the armed forces. Its aim is to build psychological resilience in defence personnel and ensure that compatible training is delivered across the three services.

The stress and residence training centre has developed an all-inclusive stress and resilience training package called “START taking control”. Its purpose is to assist students in gaining the knowledge and practical skills to manage everyday experiences of mild to moderate stress and build psychological reliance to prepare them better to meet the physical, emotional and psychological challenges in defence.

In addition to the stresses encountered in everyday life, service personnel are often required to undertake extremely hazardous duties, which potentially expose them to traumatic and life-threatening situations, risking both physical and psychological damage. Psychological resilience is considered to be an essential component of military fitness. Personnel are taught how to spot potential indicators of a problem both in themselves and in their colleagues such as changed behaviour patterns, isolation and increased use of alcohol.

In particular, concerted efforts are being made to de-stigmatise the issues around mental health and to promote awareness of the professional care and support available. Stigma is one of the biggest obstacles facing those with a mental illness. It prevents many people from seeking help, which results in a worsening of the symptoms to a point where significant damage can be caused to their health, wellbeing and relationships. In many ways, the stigma associated with mental illness can be more disabling than the condition itself. The Army has been running a major campaign called “Don’t bottle it up”, which aims to break down stigma and encourage personnel to seek help earlier as well as signposting the support and treatment available.

A specially designed project known as mental health first aid has been developed for the armed forces community, which provides the basis for increased mental health resilience among serving personnel and their families. It trains individuals to recognise the signs of problems and offer non-judgmental listening as well as offering help in accessing professional assistance. By making all personnel aware of the services available and by making clear to them that no stigma will be attached to them owing to their illness, we hope to encourage them to seek help as soon as they feel that they might have a problem. That will enable us to provide rapid diagnosis followed by appropriate and effective treatment.

One programme that has proved to be successful, both in the operational environment and back in the UK, is TRiM, which stands for trauma risk management. It is a method of peer-group assessment, mentoring and support for use in the aftermath of traumatic events. Trained TRiM practitioners are usually non-medical staff who are given the skills to enable them to identify those who might have been affected by traumatic events. That enables people’s comrades and leaders to provide them with appropriate support and refer them for specialist help if necessary. A key element of TRiM is that it aims to reduce the stigma associated with mental health problems and its roll-out across the services has certainly made people more aware of the importance of nurturing the mental wellbeing of those on deployment.

Personnel returning from operations normally go through a process known as decompression. Indeed, I experienced it on my return from Afghanistan. It consists of a short period—usually a couple of days—between leaving the operational theatre and return to the UK in which personnel can begin to unwind mentally and physically and talk to their colleagues and superiors about their experiences. That can give them an opportunity to discuss any issues of concern about their mental health and those of their colleagues, which can be followed up as appropriate. People are also provided with a stress brief, which aims to highlight normal reactions to traumatic events and give some strategies to help with readjustment. They are also given advice about risk-taking behaviours and the homecoming experience in general.

To sum up, the overall aim of those training, educational and support packages is to ensure that our personnel are ready both mentally and physically to carry out their duties, however potentially hazardous and traumatic they may be. Our personnel can be confident that any concerns will be treated seriously and sensitively and that a high quality of medical treatment will be provided if required.

My hon. Friend mentioned the importance of the family and the support we should offer service families so that they in turn can support service personnel. She may be aware that, over the next two years, we will allocate £4 million of covenant funding to support families in stress, which is a major step forward. Equally, she will be aware that, at the end of last year, we launched our family strategy, which is specifically designed to begin to address some of the concerns that families face, while they are spouses of serving personnel, in an effort to support them so that they in turn can support members of our armed forces.

I congratulate my hon. Friend again on securing the debate. We are proud of the work that we have done to date, but we are equally mindful that much more work needs to be done in the future. I assure her and hon. Members across the House that this subject is at the forefront of my mind.

Question put and agreed to.

Sitting suspended.