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Veterans’ Mental Health

Volume 673: debated on Thursday 12 March 2020

It is with deep regret that I can confirm that an incident occurred at Camp Taji in Iraq last night in which a service person from the Royal Army Medical Corps has died. The service person’s family have been informed, and requested a period of privacy before further details are released. It is a timely reminder of the ongoing and extraordinary commitment of the men and women of our armed forces. It was a cowardly and retrograde attack, and there will be no hiding place as we hunt down those responsible and bring them to justice. The thoughts and sympathies of the Prime Minister, the Government and the whole House are with the family and friends of the service person at this sad time.

Mr Speaker, following an internal review commissioned by my right hon. Friend the Secretary of State for Defence, I wish to make a statement about serving and former members of the armed forces ending their own lives. Speaking publicly about suicide requires a balance between risking similar episodes and ensuring that I follow through on the Prime Minister’s intent to ensure that every serving or former member of the armed forces knows exactly where to turn in times of acute need. I am very aware of how it feels to be a member of a service family, particularly a spouse or relative of someone who feels that they have nowhere to turn or that Ministers are indifferent to the situation. It is this that has led me to make this statement to the House.

Suicide is almost never due to a single factor, and some reasons are impossible to identify. However, the facts on suicide in the armed forces remain broadly consistent. Current data shows that someone is significantly less likely to take their own life if they are in the armed forces—the rate is around eight in 100,000, compared with around 17 in 100,000 in the equivalent male population in the United Kingdom—but we are not complacent, and I accept that Governments have not acted fast enough to update our data and understanding of military suicide.

I am aware that we are currently experiencing a higher incidence of suicide in a cohort who served at a specific time in Afghanistan. Some people want to make suicide about numbers, but suicide is not a number. One is too many, and in my view any suicide is an individual tragedy—yes, for that person and of course for their family, but also for the military as an institution. I must, however, challenge a false narrative that veteran suicide is an epidemic, or that professional clinical services are not there. They are there. Such comments risk harming others by wrongly fuelling a perception that help is not there when it is. I therefore wish to outline to the House what I am doing about it.

I am committed to providing better support for individuals in mental distress and to learning why suicide happens and what more can be done to stop an individual reaching the decision to end their life. I meet with families, widows and experts to understand when, or if, we could or should have intervened in those crucial weeks and months before an individual took their own life—even if sometimes the answer is tragically nothing. Alongside that work, we are aiming to reduce suicide risk through tackling stigma, through education, and by providing access to mental and physical health support. Armed forces personnel now undergo “through life” psychological resilience training, enabling them to recognise and manage mental ill health in themselves and their colleagues. This actively encourages help-seeking at an early stage.

Data is key to understanding what more needs to happen. The Ministry of Defence tracks all suicides for serving personnel and annually publishes data on coroner-confirmed suicides. It tells us that we are seeing more deaths in recent years, but the number is still well below that observed in the 1990s. Unlike in the 1990s, this is not predominantly an untrained young Army male issue, but predominantly a male issue, and in older age groups, which reflects the trends in wider UK society.

A 2018 review saw the implementation of new suicide prevention measures across defence, and a defence suicide registry will capture information related to in-service suicide across the services.

The Office for Veterans’ Affairs is funding the next stage of a long-term study of nearly 30,000 veterans who deployed to Iraq and Afghanistan. Started in 2003 and led by the world’s leading experts at King’s College, this provides data that ensures better Government policy decisions about veterans. The Ministry of Defence and the Department of Health and Social Care together will fund Manchester University to examine, over the past five years, the 12 months leading up to veterans’ taking their own lives.

A new veteran mortality study will show the incidence of suicide, alongside other causes of death, among veterans who served since 2001. I am expanding this study so that it provides, for the first time, a near real-time surveillance capability, ensuring that we can respond quickly to any new cluster of events. The first report will be published later this year.

More importantly, a shift is under way in the provision of veterans’ mental health support—help is out there. For many years, I and others have called for this nation to realise her responsibilities towards those who have served. That strategic change is happening.

It is the NHS in England and the devolved Administrations who deliver veterans’ healthcare. Over the years, our service charities have shouldered much of this, underpinned by the generosity of the public. This is changing and I commend the NHS on its efforts to provide services, including those bespoke for veterans, some of which the NHS commissions the charity sector to provide. It has transformed its provision for the armed forces. A clear clinical pathway exists for veterans’ mental health services in England, with the transition, intervention and liaison service and the complex treatment service. I have worked recently with the NHS and ministerial colleagues to accelerate the introduction of a new high-intensity service for those in most acute need, following the challenges faced by Combat Stress.

These services mean that the state is now leading the way in supporting our veterans, though a range of partnerships, including with the third sector and others. The help is there, and we all need to be better at encouraging our family, friends and colleagues to seek it.

Veterans will have experiences, training, friendships, highs and lows like no other profession. Some may feel far from those times, challenged by the reality of resuming civilian life after intensive and unique experiences. I am ensuring that the help is there to make that transition successfully.

I care and this Government care, with record investment reinforced by yesterday’s Budget’s additional funding for veterans’ mental health. A strategic shift is taking place, from reliance on the third sector to the state finally realising her responsibilities, ensuring that this country is the best place to be a veteran and everyone knows where to get help. This Prime Minister will accept nothing less. Having shared those battlefields with you, I have staked my professional reputation on it. But it requires everyone to play a role—to speak out, to reach out, to look after yourselves and each other. And never, ever give up. I commend this statement to the House.

I thank the Minister for the advance copy of his statement.

First, I would like to take a moment to also express our sincere condolences to the loved ones of the service person from the Royal Army Medical Corps who so tragically died at Camp Taji in Iraq last night, and with the loved ones of Private Joseph Berry, who died last week due to a non-battle injury in Afghanistan. Our thoughts and sympathies are with them today.

We know that most service personnel transition successfully back to civilian life. However, there are some who struggle and need our continued support. I welcome the Minister’s statement, but nevertheless there is still much more that needs to be done.

We know that some veterans who struggle ultimately, and tragically, end up taking their own lives. Indeed, there are reports that 14 former and current serving personnel have committed suicide in the past two months alone, many of them having served in Afghanistan.

The Minister has raised the point about data collection for serving personnel. However, we do not know the full scale of this crisis for veterans, because unlike our major allies, such as Canada, New Zealand and the US, coroners in the UK do not record veterans’ suicides. This lack of data makes it extremely difficult to know the full scale of the problem, but it also makes it difficult to provide better, more targeted interventions. I and others, including the former head of the armed forces and several military charities, have raised that issue before. Will the Minister update the House on what action is being taken by the MOD and the Ministry of Justice to improve the situation of recording veterans’ suicides?

The Minister’s statement also raised the huge issue of stigma around mental health. I appreciate that he is working to improve the situation, but some reports suggest that approximately 60% of military personnel who experience mental health problems do not seek help. The Minister mentions “through life” psychological resilience training, but it is important to ensure that the MOD continues to work with our civilian services to support our personnel once they have left the forces. Indeed, armed forces charities have found that it can take four years on average before Iraq and Afghanistan veterans seek help for mental health issues. Despite this, the MOD follow-up period for writing to veterans is only one year after discharge. Will the Minister update us on the steps being taken to expand and improve transition support for veterans post-service?

Finally, I closely followed the Chancellor’s Budget speech yesterday and was disappointed to find out that only £10 million extra was going to veterans’ mental health services, through the Armed Forces Covenant Fund Trust. That is 0.007% of the NHS budget—a minuscule amount. What extra funding will the Minister be seeking for veterans’ mental health in this autumn’s comprehensive spending review, to ensure that veterans’ mental health is treated on an equal platform to physical health?

Our armed forces work hard to keep us safe so that we can live our lives to the full without fear. Day in, day out, they do things that cross the line into the remarkable. It is only just, fair and right that we have veterans’ mental health care provision worthy of these men and women.

I thank the hon. Gentleman for raising clear and pertinent points in this fight to understand this issue. I will cover them in turn.

We are in conversation with the coroner service about coroner data. The hon. Gentleman will understand that suicide is a very complex and difficult issue. When it comes to data, Governments of all colours over the years have started from a very low point. That is why some of the earliest funds of the Office for Veterans’ Affairs have gone into gathering the data—so that we can lead the way with evidence-based, research-based, genuine solutions to provide outcomes to our servicemen and women. A number of studies are under way. I mentioned the cohort study and our “through life” study of three quarters of a million veterans. Conversations are ongoing with the coroner service and I am happy to write to the hon. Gentleman with an update.

I believe that this place has made serious progress on stigma. When I first came here in 2015 and talked about the issue, we were in a very different place with mental health. Sterling work has been done by other people and I believe we are beginning to win the battle on stigma. The critical ground now is not stigma but the need to ensure that when people have the courage to come forward, the services and provision are there to meet their needs. I am fully focused on that.

On resilience training, the military now is a fundamentally different experience from five or 10 years ago. Op Smart and other service applications are doing brilliant work. We take the issue very seriously. Mental fitness and mental wellbeing are embedded in training, in phase 1 and throughout a person’s career. Indeed, we are looking to launch an enhanced programme later this year, with the Royal Foundation.

There is a challenge in tracing people who have left the forces, as we do not have a veterans’ administration like our colleagues in the United States, and nor would I seek to create one. But there is work that we can do. Three months ago, I tasked the Department to come up with options for tracing individuals as they go back into civilian life. There are mechanisms through which to do this already, such as writing to people to remind them of their reserve service. I am looking to couple that with a requirement for a GP appointment or similar—even if people feel well and do not want to go—so that we can get a better handle on outcomes.

I warmly welcome the commitment in yesterday’s Budget to funding for mental health. That funding is going to a specific area, but in no way is that the total amount going into veterans’ health. I have asked the Department to do a study outlining what we are actually doing. We are investing more than £200 million in veterans’ mental health over the next 10 years, but I accept that it can be hard to see where some of this stuff goes and what we are doing with it, which is why I have tasked the Department with making clear what we are spending where. It is not fair on the professionals who are working so hard in this arena day to day for politicians to try to score points on money when there is a whole load of money going into this project, but I accept that we need to do better to get that message out there. The shadow Minister makes a fair point. This is a challenge for the Department, but we will meet it. I look forward to meetings with him in due course. This is not a party political issue. We have to meet this challenge and, under this Prime Minister, we will.

With the Minister’s own strong record on the subject, I am sure that he will agree that the misapplication of human rights law to the battlefield, rather than the law of armed conflict, is a cause of immense stress and mental distress to the veteran population who have taken part in campaigns and fear being dragged through the courts. When will the Government be bringing forward the promised legislation—I have in mind the promise made on Armistice Day last year, during the election campaign —to stop the repeated reinvestigation of veterans in the absence of any compelling new evidence?

I thank my right hon. Friend for his continued doggedness on this issue. I can confirm that I will be introducing a Bill on Wednesday next week that meets our manifesto commitment on this issue. The Prime Minister has made it absolutely clear that the days of lawyers running amok in our services and our veterans community, trying to rewrite history in order to make money, are over. Through a series of measures starting next Wednesday when I will introduce the Bill, this Government are going to go to war on lawfare, and we will ensure that those who serve are protected when they come home by those who should be protecting them.

I thank the Minister for the advance copy and the tenor of his statement. This is a vital but distressing topic that is altogether rather shameful on us all.

Like the Minister, I have met individuals who have suffered. My old Scottish parliamentary seat contained an Army personnel treatment centre that dealt with not physical injuries, but psychological ones. The people treated there were overwhelmingly young men who were being prepared for discharge because of the experiences they had endured in the conflicts to which the Minister has referred. I can appreciate that the Army has difficulty in dealing with these issues because they often manifest years down the line. It could take three months, three years or 30 years for people to experience effects, but sadly we know that they do. Indeed, the Minister is making this very statement because these issues sadly result in the tragedies that we have seen.

There is a responsibility—if not for the Army, most certainly for the state—to address this issue. It cannot simply be left to the third sector and worthy charities, no matter how valiant their efforts are; we are required to do this collectively. In that regard, may I ask the Minister specifically about the war disablement pension? The Department for Work and Pensions currently counts the pension as income in employment and support allowance applications. It is hardly a king’s ransom for people taking the king’s shilling and, indeed, suffering for their country. Will the Minister and his colleagues ensure that this modest compensation—made for suffering sustained in the line of duty—does not count against people? It seems to me the very least that we can do.

The hon. Gentleman is right. The war disablement pension is listed, in line with all other pensions, as a source of income against universal credit, but it is different in different cases—for example, payments made to widows and so on. There are aspects that do not count against benefit claimants. We are trying to achieve the right balance of fairness across the country, but this is something that I look at on an ongoing basis and I would be more than happy to have a conversation about it with the hon. Gentleman offline.

I commend my hon. Friend and, indeed, all Governments for all they have done in this area. When I came back from a very heavy tour in Bosnia in 1993, I had an interview with a psychiatrist. He said to me, “How do you feel?” I said, “Fine.” He said, “Thanks,” and left. Things have changed. There is £10 million of extra funding going into the covenant specifically for mental health. May I pitch again to my very good friend the Minister on behalf of PTSD Resolution, which has never, ever taken a penny from the Government, but which does such sterling work?

My hon. and gallant Friend is a long-term and passionate advocate of PTSD Resolution, which does good work. In the framework of veterans’ mental health, I will be bringing forward a programme in April that I will launch with Simon Stevens, the director of NHS England. My hon. Friend will see that that programme includes a clear role for charities of whatever size to bid to run some of the specialist services that PTSD Resolution and others do so well. The offering to our people is changing and I encourage my hon. Friend, PTSD Resolution and others to work together. We can meet this challenge if we work together and focus on outcomes, as I know both he and PTSD Resolution want to do.

Like the Minister, I have met several veterans who suffer from PTSD, most notably about 18 months ago when I met soldier N, who was like a coiled spring; I could sense the tension in his body and face about the trauma he had been through. Will the Minister support my call to provide homes for these heroes to give them that first step back into our civilian society and to ensure that we have in place the wraparound service—with mental health and other provisions—to enable them through this difficult time?

I am not going to comment on individual cases because some are very difficult. The aspiration is absolutely there to provide a wraparound service. I am not sure that providing a house for individuals when they leave service is necessarily the nirvana that people think it is. The single biggest factor that will improve veterans’ life chances is having a job, and we can do more in that area. I am more than happy to have a conversation with the hon. Member about this issue.

I thank my hon. Friend for his evident personal commitment to the mental health of veterans and members of the armed forces. This is a very big change and we very much appreciate it. I also thank the Chancellor of the Exchequer for the contribution he is making through the Budget and the £10 million he has allocated for this purpose.

Will the Minister expand a little on what he said about his efforts to

“accelerate the introduction of a…high-intensity service for those in most acute need, following the challenges faced by Combat Stress”?

I am a vice-president of Combat Stress. For all the efforts of Combat Stress to change its organisation to a hub-and-spoke model, which is being supported by charities such as the Royal British Legion, the anxiety is that the withdrawal of a large chunk of NHS funding—we are grateful for the new contract that has been granted, but it is a very much smaller one—will mean that there will be veterans who slip through the cracks. Some 1,500 or so veterans will now be entirely dependent on going through their GP and into the veterans services provided by the NHS, and there is a deep anxiety that people will not get the treatment they need, although we very much applaud the efforts of the NHS to improve what it offers to veterans.

I thank my hon. Friend and pay tribute to Combat Stress for the work that it does. For many years—over 100 years—mental health in this country was not taken seriously, and almost alone Combat Stress held a candle for some of our most injured service people. There is no doubt that veterans’ care is changing. Although £10 million on its own looks like a small contribution, we are actually putting over £200 million into veterans’ mental health over the next 10 years. There is a very clear, defined and important role for people such as those at Combat Stress, who have a specialist, important contribution to make in the area of complex PTSD and things like that. I am more than happy to meet my hon. Friend to talk about this further offline, but there should be no misunderstanding at this stage. Combat Stress is going through a change, but we must all change to adapt to the challenge that is in front of us. Combat Stress has a special place in this nation’s heart and a full and important role to play in future.

Does the Minister agree that there should be more initiatives like the veterans’ hub in Wigan? This is a dedicated building, supported by the MOD and Wigan Council, that has a one-stop shop providing access to employment, healthcare and a range of charities so that veterans and their families can get the help they need when they need it.

These veterans’ hubs up and down the country are exactly what we are looking to promote more widely. Someone in Wigan who has one of these services has an advantage, because people are already of that way of thinking in bringing the services together and trying to treat the challenges that veterans have, not as individual problems but as something requiring a whole solution. One of the key tasks of the Office for Veterans’ Affairs is making sure that best practice is rolled out across the country so that the experience of being a veteran is the same in Plymouth, Wigan and Manchester and so that we meet the commitment that I have made, and the Prime Minister has made, to this House that this will be the best country in the world in which to be an armed forces veteran.

I agree with my hon. Friend that the ability to speedily find a high-skilled, high-quality job after leaving the forces is essential to help veterans to transition back into civilian life, and for their mental health. What progress has he made in increasing the numbers of veterans who have transitioned successfully into civilian employment?

Two weeks ago, we had our figures out from the Career Transition Partnership, which does a lot of this work for us. Ninety-two per cent. of people who come out of the services go into education or employment. We have very good figures, rising year on year, on this, but it is not a case of self-congratulation. We have to work ever harder with that small cohort, who come out often with concomitant challenges around mental health or their domestic situation, and make sure that there is no reason why any individual who comes out of the military who is not medically discharged cannot go straight into employment. Being in the military is one of the best things that a young person in this country can do: it gives them skills and capabilities that they will not get anywhere else. I am absolutely committed to making sure that everybody who leaves without a medical discharge finds employment.

I congratulate my hon. Friend the Member for Caithness, Sutherland and Easter Ross (Jamie Stone) on holding a debate on this important issue yesterday. I attended that debate, and I thank the Minister for doing so. I also thank him for his willingness to work on this issue on a cross-party basis. With lots of talk about strategy, funding and intent, what practical steps is the Minister’s Department taking to work across Departments and with the devolved Administrations to deliver the critical support, which several Members have referenced, that veterans with mental health issues require?

This is the first Government ever to set up a body, the Office for Veterans’ Affairs, whose key mission is to do that. It will pull together a lot of the great work that goes on in the veterans space, whether in the NHS or in the Department for Work and Pensions, where we have seen good schemes roll out this week. I am acutely aware that nobody “owns” veterans. Nobody “owns” veterans’ mental health. It is a duty of this nation to get this right, cross-party and cross-departmentally, and I am absolutely committed that that is exactly what the Office for Veterans’ Affairs is going to do.

I am proud that our party has enshrined the armed forces covenant in law, highlighting the importance that we place on our armed forces. What steps is my hon. Friend taking to ensure that local authorities sign up to the covenant so that they can support people with their housing and local services needs?

The armed forces covenant is an important piece of work that has brought us on a long way, but it is clear to me that we need to strengthen it. In the Queen’s Speech, this Government committed to enshrining the armed forces covenant in law so that no individual, or their family, can be disadvantaged because of their service. We are going to bring that in during this Parliament, and it will strengthen the armed forces covenant further. I sincerely hope that there is not a single local authority in this country that has not signed up to it.

I concur with the Minister’s original statement and look forward to the roll-out of the military covenant in Northern Ireland, but I do take issue with his answer to the former Chair of the Defence Committee. In doing so, I challenge the narrative of vexatious claims being made against veterans, particularly in relation to Northern Ireland. It undermines the criminal justice system in Northern Ireland, which has the ability to weed out such claims; I do not even believe that examples have been cited. Can I urge the Minister to reflect on what may well be an unintended consequence of the road he is going down? Tens of thousands of people served with great honour and distinction in Northern Ireland, upholding the rule of law. If we end up putting in place some sort of measure to give unnecessary protection and warp the rule of law, that may end up de-legitimising and undermining the integrity of their service, which they are rightly very proud of.

I reassure the hon. Gentleman that I tread with the utmost care when it comes to dealing with the very bloody, very difficult and very emotional scenarios surrounding historical prosecutions. There is absolutely no Minister or individual in my position, from the Prime Minister downwards, who would ever accept that those who serve in uniform commit crimes and we do not hold them to account. Under my watch, that will never happen. But we are going to ensure that the balance and fairness in this process are restored so that those who have served their country and done nothing wrong can retire from their military service in peace. It is a challenge, but this Government are not going to run from that. We are going to meet that challenge. The hon. Gentleman will know of the many, many servicemen and women and veterans, and their families, who have been dragged through a totally unacceptable process for many years. This process is about fairness and about justice, not only for them but for people in Afghanistan, Iraq and Northern Ireland. I urge him to work with us in the weeks ahead as we tread carefully down this path.

I thank my hon. Friend for his statement on this challenging but vital issue. May I invite him to praise the work of the Tri Services and Veterans Support Centre in Newcastle-under-Lyme, which I am meeting tomorrow? Community centres such as that are an invaluable source of support to our veterans, both the recently retired and those who served many decades ago. I am sure it would give him a very warm welcome if and when his diary allows.

I thank my hon. Friend for his contribution. I cherish any opportunity to get away from London—I was going to say this place, but that is too much—and I would be delighted to come on a visit and see that good work. There is some wonderful practice going on across the country, and I am absolutely determined to champion it.

I very much welcome all the work that my hon. Friend is doing in this field. Given what he said about strengthening the armed forces covenant, what steps is he taking to encourage universities to sign up to the covenant, so that our veterans do not face barriers when they apply for education?

I want to be clear with my hon. Friend: there is no reason why any organisation in this country that takes public money cannot sign up to the armed forces covenant. There is no reason why somebody who has served or their family should suffer any disadvantage because of their service. Where that is happening, I urge people to get in touch with me. We are legislating to ensure that that cannot be the case, to put the power of the armed forces covenant into individuals’ hands and to make it really mean something.

I thank the Minister for his statement.

Bill Presented

Gender-based Pricing (Prohibition) Bill

Presentation and First Reading (Standing Order No. 57)

Christine Jardine, supported by Daisy Cooper, Wendy Chamberlain, Layla Moran, Sarah Olney, Wera Hobhouse, Munira Wilson, Jess Phillips, Caroline Nokes, Mrs Maria Miller and Hannah Bardell, presented a Bill to prohibit the differential pricing of products and services that are substantially similar other than being intended for, or marketed to, a particular gender; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 27 November, and to be printed (Bill 105).