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Veterans: Mental Health

Volume 785: debated on Tuesday 7 November 2017


Asked by

To ask Her Majesty’s Government whether the symptoms of neurotoxicity caused by prescribed prophylactic drugs are being addressed within veterans’ mental health diagnoses.

My Lords, the majority of those serving in the Armed Forces have a positive experience, but it is our duty to make sure that veterans with physical or mental injuries continue to receive the best possible care. The Good Psychiatric Practice report from the Royal College of Psychiatrists states that clinicians must,

“be competent in obtaining a full and relevant history that incorporates developmental, psychological, social, cultural and physical factors”.

Veterans, like all other patients, should be diagnosed in that way.

My Lords, I am grateful to the Minister for that reply, but there is a very serious problem. I think particularly of the antimalarial Lariam, which is issued to members of the military without the normal warnings you get when given a drug. In some cases there are recognised psychotic results. Unfortunately, when these men become veterans they are referred to their GPs, who often have very little knowledge about the drug or its effects and who may well treat the patient for PTSD. Does the Minister recognise that there is a severe danger of these men being given drugs that will increase their psychosis and cause them to end up in prison?

I reiterate the point I made in my Answer: NICE guidance on the treatment of post-traumatic stress disorder is clear that clinicians should take into account a range of factors when seeking to make a diagnosis. That should include the patient’s detailed case history, including medicines taken and under what circumstances. Regardless of whether the person is treated while serving or afterwards, that should be on their patient record, be accessible for anyone giving them direct care, and influence any prescriptions of treatments given. I also point out to the noble Countess that veterans’ issues are now in the training curriculum for all GPs. That came out of the Armed Forces covenant.

My Lords, the treatment of veterans is clearly important, but so is prevention. Will the noble Lord confirm that for the drug the noble Countess referred to, whatever geographical area you are in in the world, there is always an alternative? Will he also confirm that the Surgeon-General told the Defence Select Committee last year that he could not guarantee that every member of the Armed Forces had a face-to-face risk assessment before the drug was given to them? Have the Government now ensured that face-to-face risk assessments take place?

For the drug in question, Lariam is the brand name and mefloquine is the generic name. There are indeed alternatives available, and only 1% of antimalarial drugs prescribed to the Armed Forces are of mefloquine. There are instances when alternatives are not available, which may be because of a particular response to individual drugs or because the prescribing details are different—mefloquine is given on a weekly basis, for example—but the proportion is only 1%. The Defence Committee set out several recommendations, one of which was that there should be face-to-face risk assessments before prescribing. That figure is now up to 89% of the total; for the remaining 11%, the problem may be about recording rather than their not happening. The rate is much higher than it has been historically.

My Lords, I was prescribed Lariam in 1985. When I came back from Kenya in 1986, I was specifically told that it was linked to suicide. When I became a Minister, I asked for this to be investigated, but unfortunately I was pushed off elsewhere before the results came in—it happens the whole time. Can my noble friend look again at this, because the threats from taking Lariam are often worse than the threat of getting malaria?

I am glad to see that my noble friend is still in very good shape. It is important for me to point out that a link between mefloquine and severe and persistent psychiatric symptoms has not been established. What I can talk about is what the NHS is doing to make sure that there is proper treatment of and care for veterans and those serving in the Armed Forces. The MoD is now giving on a six-monthly basis a report to the House of Commons Defence Committee on its actions. As I said, that includes increased risk assessments and so on. This is constantly under review, not just in the government department but in the MHRA, which is the licensing authority with responsibility for drug safety.

My Lords, the Lariam case is a severe one, and I understand that the manufacturers acknowledge the link on the packaging of the drug. More broadly, the Armed Forces covenant is an acknowledgment of the debt and duty that society owes to its veterans, but one challenge for those providing public services such as within the medical profession is to identify those who fall within the ambit of the covenant. Those who most need some of those resources and some of that help from public services are the least able to identify themselves. What are the Government doing to ensure that those who provide such services are fully aware of the status of those veterans?

On the first point, there have been reviews at European level to improve the packaging and the patient information leaflets about any risk that might attend taking this drug or indeed any others. Status as a veteran is now recorded in the NHS and goes into the patient record.

My Lords, the mefloquine help page for veterans and current serving officers is very good at explaining the signposting, but there is no mention in Meeting the Healthcare Needs of Veterans, which has not been updated since 2011. Only 2,000 GPs out of more than 50,000 have attended the day training course on working with veterans. Can the Minister ensure that at least one GP from every surgery has training, so that he or she can advise other GPs when they are helping to serve our veterans once they are back in the civilian workforce?

The noble Baroness makes a good point. As I mentioned, that training is now in the curriculum, but of course that deals with the flow of new GPs as opposed to the stock of existing GPs. I shall certainly look at that and see what more can be done to make sure that GPs have up-to-date training.