Mental Health of Veterans

Andrew Murrison Excerpts

Wednesday 11th March 2020 Westminster Hall

[Jamie Stone]

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.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

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.

[Jamie Stone]

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.

--- Later in debate ---

[Johnny Mercer]

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.

[Dr Murrison]

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.

[Johnny Mercer]

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.