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Mental Health of Veterans

Volume 673: debated on Wednesday 11 March 2020

I beg to move,

That this House has considered the mental health of veterans.

It is a pleasure to serve under your chairmanship, Mr Stringer. I thank you and the Members who have turned up for the debate on what is probably rather a slow news day.

Since I introduced my Bill to ring-fence NHS spending for veteran mental health services, military personnel from across the UK have been in touch to confirm the worst: veterans are struggling to access mental health support and, sadly, we are all letting them down. We have only half an hour for this debate, so I cannot cover all the complex reasons why we are where we are today. I will focus on three areas: the importance of peer-led support, the funding problem and the need for a more holistic approach to ensure we look after veteran mental health in every aspect of life.

In addition to speaking to veterans up and down the country, my office has engaged with amazing charities such as the Forces in Mind Trust, the Ripple Pond, the Royal British Legion, PTSD Resolution—that organisation works with people who have post-traumatic stress disorder—and, of course, Combat Stress. Together with our NHS, these groups work hard with volunteering veterans to do what they can, but my fear is that without the Government’s help, they will struggle to continue the fight for improved mental health support.

I congratulate the hon. Gentleman on securing such an important debate. He is absolutely right to praise the work of a number of different charities in this area. Does he agree that we need a strategic approach to ensure that once veterans leave service, they are signposted in the right direction, and the support that they seek is properly funded?

The hon. Gentleman is absolutely correct, and I will come to that point later. I will deal first with the importance of peer-led support. One veteran, Mark Lister, who is a volunteer for Combat Stress in the highlands and who served as a forward observer in the Royal Artillery for 18 years, called me yesterday and relayed his personal experiences, which were most interesting. One thing he said that stood out was that there is a stark difference between the combat trauma experienced by a soldier or a service person, and the trauma experienced by a civilian.

In his classic, wonderfully frank highland manner, Mark said, “Jamie, only a veteran is going to know how to help another veteran. We don’t want to get bogged down in the trivia of military maps. We don’t want to go through explaining all that stuff. We just want to speak about our trauma with someone who knows and gets what it’s like”. He is absolutely right, because most of us will never understand what our veterans have been through. That is why some of the best care available comes in the form of peer-to-peer support. Alas, cuts to the NHS have made it harder for such services to exist, never mind to be set up in the first place.

I congratulate the hon. Gentleman on bringing this debate to Westminster Hall. We are all here for the same purpose. Does the hon. Gentleman agree that the recent witch hunt of our armed forces who served in Operation Banner has put additional strain on the mental health of those who served? We have a duty of care to those men and women to assure them that we will not allow them to be persecuted, when their only crime was to serve Queen and country. They need every assurance—not just mentally, but emotionally and physically—and the support of this place as they fight to overcome what they have seen and been subjected to in service.

The hon. Member for Strangford makes a point that I know is close to his heart. He has spoken about it with eloquence in the past, and he does so again today.

In constituencies such as mine, which is vast and remote, accessing healthcare is already difficult. That makes it particularly hard for veterans like Mark to reach out and share what they have been through with people who have also risked their lives for their country. The Government should be making it easier for veterans, service personnel and their families to connect with one another and access peer-led mental health support. Time and again, the evidence—both numerically, and in people’s personal experience—suggests that peer-to-peer treatment is the most effective form of mental health support for people who are affected by combat trauma. Accessing this kind of mental health support is a battle for those who have risked their lives for their country, and they should not be asked to fight that battle.

I turn to funding. It is the custom in this place to cite lots of statistics, so here are a few. The Care Quality Commission rated two out of four Ministry of Defence mental health centres as inadequate or needing improvement between April 2017 and January 2019, and there were shortfalls of at least 50% in uniformed and civilian psychiatric posts in 2017-18. Those are not good figures. Charities that provide support for veterans, service personnel and their families often receive no Government funding whatsoever. They rely solely on donations and pay no salaries. For example, in the last 11 years, PTSD Resolution treated more than 2,700 veterans, reservists and families.

I declare an interest: PTSD Resolution is run by my old commanding officer, Colonel Tony Gauvain. It is the most brilliant charity, and it takes very little money from Government. It has more than 200 counsellors and a 78% success rate. It is the sort of charity that we want to encourage and, indeed, give some more resources to, if we can.

The hon. and gallant Member speaks with great knowledge and authority, and I welcome his words.

PTSD Resolution prides itself on delivering a prompt, local, brief and effective treatment, at an average cost of £650 per case. If untreated, the social cost can amount to tens of thousands of pounds; it manifests itself in lost jobs, broken families or perhaps, most tragically of all, suicide. Since Combat Stress had to stop taking referrals from Wales and England because of a reduction in funding, PTSD Resolution has seen a 60% increase in referrals. It tells me that it needs the Government to co-operate in funding, according to demand and outcomes.

The chief executive of Combat Stress, Sue Freeth, said to me:

“82% of the veterans treated by Combat Stress have tried to engage with NHS services but their needs have not been met. The government needs to ring-fence funding for specialist services such as ours, that understand and can successfully treat those veterans with complex PTSD. There is a significant funding gap for veterans with complex mental health needs who need intensive clinical rehabilitation and struggle to access this support elsewhere.”

I congratulate the hon. Gentleman on securing this important debate. As the Member who represents part of Salisbury plain, I have a lot of interest in this, and I know the charities that he refers to well. I fully endorse everything he has said about those brilliant charities, and we need to support them directly, as well as providing more support through professional mental health services. Does he agree that beyond money and civil society, we have to consider the role of the statutory system and the literacy of some public servants, who are well-meaning but often let our veterans down? Veterans are sent from pillar to post, and they often have to repeat their terrible stories to frontline public servants in the Department for Work and Pensions or the Department of Health and Social Care, who do not really understand this matter. If we improved the literacy of those who work in our frontline public services, it would make a great difference.

The hon. Gentleman makes his point extremely well. The mention of Salisbury brings to my mind mixed memories as a private soldier in the Territorial Army, but we will gloss over that.

I believe that the Government must try to step up for veterans and bridge the funding gap, if they can. I do not have all the answers, but as a start we should ring-fence NHS funding for mental health support. As a Scottish MP, health is outside my remit, but, as my presentation Bill set out a few days ago, it is entirely possible for the Government to ring-fence NHS spending for veterans’ mental health support. As much as I think that ring-fencing NHS expenditure would be a good start, it is not, in all honesty, a catch-all answer. As many hon. Members know, mental health treatment can be complicated, and the circumstances surrounding veteran welfare can be challenging. We all need to bash heads together and see how we can collaborate more effectively to deliver a more holistic mental health strategy.

Does the hon. Gentleman agree with me, and with the Defence Committee, that there is a strong case for establishing a national mental health residential rehabilitation centre, with the emphasis on the public sector?

The hon. Gentleman makes an excellent and important point, which he and I discussed when we were on the armed forces parliamentary scheme last year.

As we know from recent publicity, last week Commonwealth veterans took legal action against the Home Office and the Ministry of Defence over a systematic failure to assist them properly with complex immigration rules. Many of those veterans, sadly, now fear deportation. The claimants allege that the Government failed to follow their own duties at discharge, meaning that little guidance was given about their immigration status. Under current Home Office rules, a Commonwealth veteran with a partner and two children would have to pay—can you believe this?—nearly £10,000 to continue living in the UK.

Why do I raise that point in a debate on mental health support? Imagine someone risking their life for a country only to find out that they will have to pay just to live there when they retire. I cannot begin to think how stressful it would be for someone on a military pension to try to pay the Home Office’s extortionate visa fees. When the Home Office makes such decisions, they tap into the general problem, which has already been alluded to. Mental health support for veterans is not just a matter for the Ministry of Defence or the Department of Health and Social Care: it is also a matter for the Home Office, the Ministry of Housing, Communities and Local Government, the Department for Work and Pensions and many others.

Just last week, Craig Bulman, who served in 2 Para, the Red Devils freefall team and the Household Cavalry, contacted my office and told me about his experience with the Child Support Agency. Again, it is not an issue that would immediately strike us as relating to mental health. However, Craig told me:

“I am currently helping with 13 cases, mostly veterans. Of those, I have four veterans who are suicidal due to their experiences with the CSA. In a couple of these cases, it triggered their PTSD.”

I do not know a huge amount about those cases—in fact, I know little, and there is a lot more to the story—but I would be grateful if the Minister would agree to meet me to discuss Craig’s experience in more depth. I think it would be useful for the Ministry of Defence, as it would for the people Craig is helping. I bring it up again today to reiterate the simple point that we require a more collaborative and holistic approach to improving mental health support for veterans.

I have listened with great interest to the hon. Gentleman. As a veteran, I defer to no one in my admiration of our veterans, or my desire to ensure that their mental health is promoted. However, for credibility, it is only fair to point out that many other public servants are at least as badly affected by some of the traumas to which the hon. Gentleman referred. If he is trying to create a system in which we prioritise the management of particular groups, he needs also to consider the police service, for example, which today loses more frontline people than the armed forces. Otherwise, his case kind of falls apart. I wonder whether he agrees.

I absolutely accept the point and can think, off the top of my head, of a number of policemen in my part of the far north of Scotland, who, most unfortunately, are leaving the service. That is something we do not want to happen.

I spoke earlier about the highlands’ very own Mark Lister, and it is true that constituencies such as mine face an additional challenge with regard to access to public services. Transport is not good, health services are patchy and we have a housing shortage, as I am sure nearly all constituencies do. I stress again that improving mental health support for veterans requires Government Departments to work together, possibly with other services such as the police, and it requires the Treasury to find the money and put it where it is needed.

The big ask that I want to conclude with is my hope that the Minister and the Government will look closely at my Bill, the National Health Service Expenditure Bill, which has received support from across the House. I am grateful to Members of all parties for what I take as a great expression of support. Second Reading is scheduled for Friday 26 June, the day before Armed Forces Day. I hope that Members recognise that I do not intend to let the matter drop.

It is a pleasure to speak under your leadership this morning, Mr Stringer.

I pay tribute to the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) for his interest and for the way he continually drives the debate. Clearly, I have a script that talks about all the stuff we are doing, but I want to answer some of the specific points that he has raised this morning. I am delighted that he shows such an interest in the subject. He will know that support for veterans was a driving force for me in coming to Parliament; I wanted to drive through change. I can honestly say to him that a shift in strategy is under way in how we support armed forces veterans. For too long, colleagues in charities and in this House have asked the Government to step up and do more, and we are now starting to do that. I do not pretend for an instant that we have always got it right. That has led to some of the challenges that we face today, and I came into Government specifically to try to lead the change.

I want to challenge a couple of things that were said, and the first relates to the portrayal of veterans. There is no doubt that some of our people are extremely poorly because of what we have asked them to do over a number of years. I am acutely aware of that. The Prime Minister and I are acutely aware that the nation has a debt of gratitude to them that must be realised by more than words and ceremonies in Whitehall; it must be repaid by provision to look after them throughout life. It is important to me to challenge the portrayal of the problem as greater than it is. There is in the country undoubtedly a way of portraying veterans—exacerbated by the media and TV programmes—that suggests that military service or combat experience equals mental health problems. In reality, we all know that that is not so, and we cannot say that too much, because the problems that that view causes are significant. This week we are bringing in changes with respect to national insurance contributions, and that is important because although there are pretty good veterans programmes at big firms in cities, for people who can get access to those workplaces, sometimes when I have been to towns and cities someone from the CBI has stood up and said, “I can’t take the risk on a veteran.” They are worried about whether they will be off sick, and all the concomitant issues with service. We must be careful about the narrative that veterans are all broken. I would not advance this view if it were not true: the vast majority leave their service greatly enhanced by their time in the military. The reason I raise that is that is that if we do not get it right we will simply be unable to meet the challenge of those who are genuinely poorly and unwell because of what the nation asked them to do. I am committed to getting those people the help they deserve.

I support exactly what my good Friend the Minister is saying. I am backed up by other Members here, such as my hon. Friend the Member for Bracknell (James Sunderland). The vast majority of members of the armed forces go through their service and do not have a problem at the end of it—that is absolutely true; but please, Minister, give more resources to PTSD Resolution, because it deserves them.

I thank my hon. Friend, who knows the impression he left on me in my formative journey into this place. I think that I am speaking for him at a dinner tonight, where we can take the matter further. I shall come on to the question of funds for specific charities in a minute.

The Minister is of course right that service in the armed forces is positive, generally speaking, in terms of mental health, and veterans probably have better mental health than a non-serving cohort would. However, does he agree that that slightly misses the point, because if PTSD is service-attributable, then in accordance with the military covenant and “no disadvantage” we have an obligation to do what we can to resolve any problems that may have been caused as a result of service? I pointed that out in my report, “Fighting Fit”, about 10 years ago.

My right hon. Friend is absolutely right to point out that it is no good sitting down with the widow of somebody who has taken their own life, or with their family, and saying, “Actually, statistically, we are in a pretty good place in this country when it comes to suicide.” The reality when it comes to figures and so on is that we are—the rate of suicide in the service community is eight in 100,000; in the civilian equivalent cohort it is 32 in 100,000. People who have served in the military are less likely to take their own life. However, he is absolutely right that each one of these suicides is a tragedy not only for the individual and their family, but for us as an institution, because we owe this unique debt of gratitude towards those who serve.[Official Report, 16 March 2020, Vol. 673, c. 6MC.]

We are beginning to really shift the debate. We have invested a lot of early money in data. We started from a very low point when it came to veterans’ data and data on suicide. We have put money into a cohort study, looking at 16,000 people from the beginning of the Iraq process through to where they are now. Clearly, most of them are civilians, but we are watching what happens in their lives, the cause of death if they die and so on. We are marrying that with an exercise in the MOD, going over the records of every individual who served who has died since 1991—almost three quarters of a million people —to have a look at the cause of death and the incidence rates. We have just signed the contract to give some money to the University of Manchester to look at cases in which veterans take their lives, to undertake a comprehensive study of the events in their life in the 12 months leading up to that, to answer the question whether we could or should have done anything more to intervene. I totally accept that the Government have not started from a strong start point when it comes to data around suicide and what we have done on it, but I want to make clear this morning that that is changing.

When it comes to this strategic shift in healthcare provision for our service people, I start by paying tribute to the service charities. They have done an amazing job—there are no two ways about that. When Combat Stress started, and throughout the period where mental health really was a Cinderella service—we talk now about winning that battle on the stigma of mental health, but 30 years ago that was not the case—Combat Stress held a candle for this stuff and was the only port in a storm. It has done an incredible job over the years.

However, for a long time Combat Stress and others have talked about the increasing presentation and understanding of mental health versus a decline in giving from the public. That has presented a unique challenge about what we do now. I am very clear, as is the Prime Minister, that that basic underlying mental health provision is owed to those people by this country and the NHS must step forward to provide that. With the problems with Combat Stress that have come to light recently, which everybody knows about, I have brought forward a third service to try to fill the mental health provision gap for our veterans. We have the complex treatment service, which was introduced last year and has been very successful, and we have the TIL—transition, intervention and liaison—service to speed up access to talking therapies and so on, but there is a requirement for a high-intensity service to look after some of our most poorly people on the NHS. I have brought that commissioning forward. The bidding process is going through now and in April I will be launching that. We will have those three services—CTS, the high-intensity service and TILS. That will be the framework through which this Government will see through their commitment to veterans on mental health.

The NHS requires people to deliver those services, and that is where the charities are absolutely critical. They have bid into the services and they are indeed running CTS and TILS in other parts of the country. We have had a lot of bids for high-intensity service. Those charities are going to go through a change as they fit in around this framework and leadership, which they have asked us for for a long time. The challenge then is to make sure that every single veteran and every service member in this country when they leave service knows about the programme of mental health care, so that they cannot honestly look me in the eye and say to me, “I did not know where to turn.” That is the challenge I am absolutely determined to meet. I will come on to talk about funding for that at the moment.

I accept the generous intent of the Minister’s remarks, and I thank him for that. It is worth making the point in passing that, if we could get this right and if the general public could see us getting it right, that in turn would surely help recruitment to our armed forces—something that is a real problem for all three services.

The hon. Gentleman makes a good point. I come back to the point I made earlier: when this goes wrong, when we do not get this right, it is not only a tragedy for the individual and their families, but a tragedy for us as an institution if people come and give the best years of their lives, and we do not then have the follow-on care and so on that so many of them need.

I am confident that when we launch this service in April, it will provide the framework and the leadership that will bring in all the charities and all the brilliant little groups such as PTSD Resolution and others. They will fit in around this framework and deliver parts of the course. That is critical for the charities, because they will be able to focus on some things and not on others, but cognisant of the fact that that need is being met. There will be more long-term sustainability and contracts that they can enter into with the NHS that will give them financial stability. I am confident in 12 or 18 months’ time we will have a world-class offering for mental health for our veterans in this country.

When it comes to money, the Prime Minister is absolutely clear that we will provide the resources required to meet the demand. This healthcare model is the future of veterans’ care in this country. As he came into office, we saw a fundamental shift—this from someone who has irritated colleagues in this place over many years on this subject—towards this nation, particularly this place, being the ultimate guarantor of services for those who have served. It is not always the deliverer, but it is the guarantor.

Finally, we are going to get there with the programme. I am speaking at King’s College about it tomorrow and the formal launch is in April. I have a huge job of work to do to ensure that everybody in this country understands what it is, and I look forward to that challenge, but it is a team effort. This is not my mental healthcare plan. There are people who have done some amazing stuff in this field. All I am doing is bringing it together and providing that leadership, because that good stuff is there already. I genuinely think we are going to see a fundamental change in the next 12 to 18 months.

Order. I believe I am right in saying that the hon. Gentleman for Bracknell came in after the Minister started his speech. The Minister has given way, so I will call the hon. Member, but it is very bad practice to intervene, particularly in an Adjournment debate, when the hon. Member has arrived after the Minister started speaking.

Thank you, Mr Stringer, and apologies for that. I was going to apologise for being late and not being here. I was at the Procedure Committee. My humble apologies. I know we are short of time, but I want to clarify with the Minister that there are an estimated 2.3 million veterans in the country at the moment and we have a fantastic framework already across the UK, through the armed forces champions and also through the fantastic civil military partnership boards. The framework is already there, but there is a bit of fine-tuning that we need to get this put into statute and therefore give the veterans the help they need.

My hon. Friend is absolutely right that there are some areas in this country where mental health care works extremely well, and models of care that should be promulgated further and rolled out nationwide. The challenge is that we have perpetually judged ourselves by what we are putting into the machine in terms of money and organisation. We have an event in London and we say, “We are providing this for veterans’ mental health.”

The key for me is that the experience of being a veteran in this country in 2020 should be equalised across the country. Plymouth, where I come from, is a military city, so there are some wonderful relationships, and generally speaking someone’s chances of accessing good mental health care are pretty good, but that is not the same all over the country. That is why this kind of leadership in the centralised framework is so important. It is going to shift the dial on what we can present.

In closing, I come back to my initial remark: the vast majority of people leave genuinely enhanced by their service. If we do not have that conversation, my concern is that we will never meet the demand, because it is unrealistically inflated. No one wants to look after these people more than I do, or than anybody else here in this Chamber does, but we must have an honest conversation about it. I believe this structure will enable us to do that, and that we will have a very good service in the years ahead.

Question put and agreed to.

Sitting suspended.