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Iraq and Afghanistan: Post-Traumatic Stress Disorder

Volume 684: debated on Wednesday 5 July 2006

asked Her Majesty's Government:

What steps they are taking to provide assistance to Armed Forces personnel suffering from post-traumatic stress disorder and other mental conditions as a result of service in Iraq and Afghanistan.[HL6421]

The MoD recognises post-traumatic stress disorder (PTSD) as a serious and disabling condition, but one which can be treated. We attach a high priority to increasing awareness of stress-related disorders, and to their diagnosis and treatment.

Teaching and training service personnel about operational stress and its management starts at the time of entry into the services and continues through their career.

We have put in place measures to increase awareness at all levels and to militate against the development of PTSD and other stress-related disorders occurring among service personnel. These include pre- and post-deployment briefing and the availability of support, assessment and, if required, treatment, both during and after deployments. This is available to all personnel, whether regular or mobilised reservist.

During their pre-deployment medical, while deployed or during the post-deployment normalisation period, all personnel including reservists can identify themselves to any medical officer or their chain of command if they believe they are suffering from any mental health condition. It is our policy that no stigma should be attached to this. Diagnosis and treatment of mental illness, including PTSD, is then performed by fully trained and accredited mental health staff.

Mental health professionals (psychiatrists and/or mental health nurses) are part of the deployed medical team on all significant operational deployments. This team will continue the educational process during the operational tour and will also brief the chain of command about operational mental health issues that are detected. Individuals might be referred to the team for assessment and management—the therapeutic options will include psychological treatments, the use of medication, or aeromedical evacuation of the individual out of theatre back to further care at their home base.

After deployment, it is policy to offer individuals a further briefing prior to returning to their home base, using a variety of media materials. Efforts are also made to arrange a “decompression period” during which servicemen can begin mentally and physically to unwind after their operational tour while having time to talk to colleagues and superiors about their experiences. Such a decompression phase appears to help the return to the non-operational environment. Returning personnel are also offered a presentation and issued with leaflets to alert them to the possible after-effects of the operational deployment.

Once back at their home base, community-based mental healthcare is available to every military unit via our 15 departments of community mental health (DCMH) across the UK plus satellite centres overseas. DCMH teams comprise psychiatrists and mental health nurses, with access to clinical psychologists and mental health social workers. The aim is to see referred individuals at their unit medical centre and, with the patient's permission, to engage with GPs and the patient's chain of command to help manage any mental health problems identified. The full range of psychiatric and psychological treatments are available, including medication, psychological therapies and environmental adjustment, where appropriate.

Inpatient care, when necessary, is provided in psychiatric units belonging to the Priory Group. Close liaison is maintained between DCMHs and the Priory units to ensure that all service elements relating to an inpatient’s care and management are addressed.

Should it be decided, after a patient has been assessed and managed as effectively as possible, that he/she will not be able to continue serving in the Armed Forces and will therefore need to be medically discharged, every effort is made to ensure a seamless transfer back to civilian life. The MoD liaises with the individual's future civilian GP and any NHS consultant that he or she might need to see. Individuals are referred to the defence mental health social workers, who offer the individual significant help in rehabilitating them back to civilian life, with advice on resettlement, medical issues, pensions, housing, employment etc. Service personnel are also made aware of the services offered by ex-service men’s organisations such as the Royal British Legion and the specialist mental health charity Combat Stress.

Upon leaving the Armed Forces, or on demobilisation for reservists, it is the long-established practice that responsibility for medical care passes to the NHS, and for the majority of veterans their health needs will be met by current NHS provisions. However, the MoD has work in hand to ensure that there is a coherent response to veterans’ mental health issues, co-ordinating inputs from the NHS, health departments throughout the UK, the services and ex-service men’s organisations, including the charity Combat Stress. Indeed, for treatments not available under the NHS, the Government fund courses of care at Combat Stress facilities, which last year cost £2.8 million, for those whose condition is due to service and for whom this is an appropriate course.

In support of these developments, the MoD is also working on further initiatives relating, for example, to the prevention and management of problems arising out of operational stress and to the need to address issues of stigma and discrimination. With respect to the department's responsibility for veterans in particular, we have work in hand to ensure that service leavers can recognise the signs of stress and know where to go for help, using suitable magazine-style material.

The MoD recently announced a new mental healthcare initiative for recently demobilised reservists, which will include a dedicated mental health assessment by appropriately qualified members of the Defence Medical Services (DMS). If individuals are then assessed as having a mental health problem that is categorised primarily as PTSD or a related traumatic adjustment disorder that is linked to their mobilised service, they will be offered outpatient treatment by the DMS. In instances where the assessment identifies cases that fall outside these parameters, such as complex multi-disorder diagnoses or acute cases requiring inpatient care, the DMS will refer them to the appropriate NHS provider, as well as encouraging contact with the relevant welfare organisations to ensure follow-up. Details of the programme will be confirmed later this year, including the location(s) at which the assessments will be provided, and the date on which the service will commence.