Armed Forces: Post-service Welfare

Baroness O'Loan Excerpts

Thursday 27th January 2011 Lords Chamber

[Baroness O’Loan]

My Lords, I thank the noble Lord, Lord King, for tabling today’s debate and for giving us the opportunity to discuss the serious issues involved.

First, I declare an interest. I am the aunt of a young TA soldier who was 18 years old when he was seriously injured in Iraq in 2007. I know that it was the treatment that he received in the American military hospital in Basra, in Selly Oak Hospital in Birmingham and in the rehabilitation offered at Headley Court that gave him the life that he has today, as is the case for many others. I pay tribute to those working so valiantly to help the wounded and disabled, including the British Limbless Ex-Service Men’s Association, Help for Heroes and the British Legion.

The Report of the Task Force on the Military Covenant states that there needs to be a coherent national approach to trauma research to develop new technologies, particularly in,

“acute trauma, repair, reconstruction and long-term rehabilitation”.

That is important, but equally important is the issue of mental health, on which all previous speakers have focused. I am talking about the mental health of veterans returning from conflict zones, whether or not they have been injured.

Provision for the care of veterans with mental health problems is fragmented and patchy. There have been various initiatives. In November 2006, the MoD launched the reserves mental health programme, but by 2008 84 per cent of GPs were unaware of its existence. It is of limited application and does not address all the needs. There are particular problems for the early service leavers who are discharged, for whatever reason, and who may carry the mental scars consequential on or consequent to their military experience into their civilian life. Those scars may have catastrophic consequences.

The Murrison report recommends an increase in the number of mental health professionals to one per two mental health trusts. Their role is only to identify cases and to refer them to veterans’ organisations and other professionals. There is no evidence that such identification has been carried out effectively and we do not know the extent to which veterans who are identified as suffering from mental health problems actually receive the care that they need. They are a forgotten and, possibly in some people’s minds, less important group. They do not carry the scars in the same way as those young men and women like my nephew, but the consequences can be equally life-limiting.

The maximum level of compensation for mental health disorders appears to be fixed under the review of Armed Forces compensation at £2,888. That is not a large sum for someone who may be incapable of permanent employment for the rest of their live. The report acknowledges the fact that mental health services do not always fully address the needs of veterans. Pilot schemes have been established, but there is simply neither the level nor the quality of mental health provision that is needed.

These issues have been thought about at length. There is clearly some recognition of the problems faced by veterans with mental health needs, but they come low down the list of priorities in general health service delivery. Of course, there may be a reluctance among veterans, particularly men, to identify themselves as suffering from service-related mental health problems. The DoH’s New Horizons mental health strategy states that the prevalence of mental disorders in serving personnel and veterans is broadly similar to that of the general population, yet the research done by the Mental Health Foundation found that the risk of suicide in men aged 24 years and younger who had left the Armed Forces was approximately two to three times higher than the risk for the same age group in the general and serving populations—and the risk for this age group is high. Research also shows that reservists who served in Iraq were almost twice as likely to have mental health problems as those who have not served in Iraq—26 per cent compared to 16 per cent. Reservists who served in Iraq are twice as likely to have PTSD as those who have not served in Iraq. I am sure that there will be similar figures for Afghanistan.

We know that there are high levels of alcoholism, suicide and mental health problems. This is not unique to the UK, but it is a fact of military life. Post-traumatic stress disorder is not uncommon among those who have been affected in any way by conflict. The triggers can vary and the symptoms are now well identified. The triggers can be very simple. I think of the young man I know who was part of a patrol sent to search a village. Passing children playing on the road, they threw a bottle of water to a little girl of five who was waving to them. They accomplished their task and were driving home when they saw her little body hanging from a tree, her throat cut, a warning to others not to collaborate with the troops. I think of others who have seen their colleagues blown to bits or who have tried to carry out immediate first aid on colleagues who are suffering from major traumatic injuries and who have died. I think of those who should have been in the patrol that never came back but for some reason were not and who suffer survivors’ guilt. I think of those who survived explosions, only to face the flashbacks, night terrors, sleeplessness and fear of crowds et cetera that are so symptomatic of trauma. Research also shows that subsequent traumatic experiences can cause flashbacks to the original experience, thus compounding the suffering.

PTSD and the various mental illnesses consequential on involvement in armed conflict are well identified. However, the reality on the ground is that people are naturally reluctant to present with mental health problems and may well delay until the condition becomes too serious. When they do present, the services are not as accessible or as available as they should be. It is not enough in many cases to take people in for a week’s group and individual therapy and send them home. There is a well identified and serious risk that exposure to brief therapy can retraumatise the traumatised, leaving them to face their terrors alone.

What happens in reality is that people go into a lottery of available mental health care. People can often end up in psychiatric hospitals, heavily medicated to keep them compliant and hence unable to make any journey towards recovery from their trauma. There are limited services offering cognitive behavioural therapy or therapy for PTSD and they are often located at too great a distance for those incapable of individual travel. I think of one young man I know who cannot travel alone but faces a four-hour journey for one hour’s therapy and a four-hour journey back.

My questions for the Government are: can we find out the extent and geographical incidence of mental ill health consequential on armed service? Can some more attention be paid to the difficulties faced by those with serious mental health problems in accessing treatment and to the fact that such treatment is so scarce?

One of the things about trauma is that it can lie dormant for 25 or 30 years and then manifest itself suddenly. As the noble Lord, Lord King, said, we are talking not just about Iraq and Afghanistan, but about Korea, Northern Ireland and all the other conflicts. The reality is that many of these people end up in prison. Veterans are disproportionately represented in the prison population. We do not need more research to tell us that there is a problem; we need more planning for a future in which those who are currently struggling can keep going. Many of those who will be afflicted by PTSD in the future will need care. Those who have served in locations as diverse as Northern Ireland, Iraq, Afghanistan and Korea and who subsequently suffer the trauma of mental ill health in its various manifestations deserve our care.