Mental Health (Veterans)

Hazel Blears Excerpts

Tuesday 6th December 2011 Westminster Hall

[Hazel Blears (Salford and Eccles) (Lab)]

I am very grateful to have secured the debate. It has attracted interest from hon. Members on both sides of the House, who have offered me their support. Many hon. Members, in all parties, have pursued the issues relating to veterans for a considerable time and have been very effective in securing improvements in the way in which the country looks after and supports veterans.

I am here today because of a very special young man, Mr Neil Blower, who is one of my constituents. He is here to observe the debate. Incidentally, that is because of much appreciated help from Virgin West Coast Trains. We are glad that he has been able to make it here today. Neil is 28. He served in the Royal Tank Regiment for six years. He served a tour of duty as a peacekeeper in Kosovo and he was involved in the invasion of Iraq. He was in his tank when it was attacked at a vehicle checkpoint in Basra and he had the terrible experience of watching his sergeant be attacked and killed. He saw for himself the real and terrible horrors of war.

In 2005, Neil was discharged from the Army, suffering from post-traumatic stress disorder as a result of the horrific experiences that he had undergone. When Neil turned up at my surgery, I did not know what to expect. I thought that there would be issues about the practical help for veterans with mental health problems—issues about housing, employment and all the things that we associate with people adjusting to civilian life. What I did not appreciate was that I would meet someone who is incredibly articulate, passionate, committed and determined. Neil Blower is a very special individual indeed. I wanted to help him as much as I could in any event, but our discussion was quite enlightening to me. He told me not only of the problems that he had encountered when he left the Army—finding a home, looking for a job and trying to pick up the pieces of a normal life—but that he had discovered a new talent, a passion for writing, which had helped him to come to terms with the horrors that he witnessed during his Army service. He gave me his book to read. It is called “Shell Shock: the diary of Tommy Atkins”. There is a warning on the front cover that it contains strong language, and it certainly does, but it also contains a deep insight and a profound humanity. I have read the book. It has the power to move people and to make them laugh. It certainly made me laugh, but it also moved me to tears.

As I said, the book is called “Shell Shock: the diary of Tommy Atkins.” We all know the words of Rudyard Kipling in the poem “Tommy”:

“For it’s Tommy this, an’ Tommy that, an’ ‘Chuck him out, the brute!’

But it’s ‘Saviour of ’is country’ when the guns begin to shoot”.

Neil’s book is the diary of an ordinary soldier who has served in Iraq and Afghanistan, who has watched his friends die, who feels guilty that he has survived and who is struggling to come to terms with civilian life. If that sounds familiar, it’s because it is. That is why this debate is so welcome.

Luckily, combat stress and post-traumatic stress are now widely recognised by our armed forces, but that was not always the case. During the first world war, 266 British soldiers were executed for desertion, 18 for cowardice, seven for leaving their posts, five for disobeying a lawful command and two for casting their weapons aside. Some of those men were no doubt victims of shell shock. Their families had to live not just with the loss of their brothers, husbands and sons, but with the shame, anger and humiliation of their deaths at the hands of the state. In 2006, a conditional posthumous pardon was granted in respect of those individuals. That was a big turning point in how the country approaches these matters. We have come a long way in recent years in recognising the problems experienced by those who have been in battle, and Governments of both parties have taken action to provide improved health services for both physical injuries and mental health problems, but there is still more for us to do.

I pay tribute to Combat Stress, which does a tremendous job in helping veterans and is the UK’s leading military charity specialising in the care of veterans’ mental health. It looks after people who have post-traumatic stress disorder, anxiety, depression, sometimes phobias and certainly nightmares and flashbacks—all the things associated with having been in the heat of battle and having a mental wound as a result.

Last year, Combat Stress received more than 1,400 new referrals—that is the scale of the problem. It has a current case load of more than 4,600 individuals, including 211 who have served in Afghanistan and 583 Iraq veterans. In March 2010, its patron, His Royal Highness the Prince of Wales, launched the Enemy Within appeal on behalf of Combat Stress. That is a three-year fundraising campaign to try to ensure that Combat Stress has the capacity to continue to treat the increasing numbers of people who are now, happily, coming forward with the problems that they have developed. I understand that on average it takes someone who has developed anxiety and depression after having experienced the horrors of battle an unbelievable 13 years to come forward. For some, it will be longer, and for others it will be a shorter period, but that length of time indicates the embarrassment and shame that people still feel and the stigma that there still is around mental health problems. Of course, that is not limited to military life; there is still a huge stigma about mental health problems across society as a whole. But I think that, when people have been in combat situations, it is even worse.

[Sir Paul Beresford (Mole Valley) (Con)]

I am delighted to hear the praise for Combat Stress, which is located in my constituency. The right hon. Lady mentioned the figures. Is she aware that the rise in applications is running annually at about 12%, whereas the percentage of Government funding is dropping quite dramatically? I hope that she will touch on that.

[Hazel Blears]

Yes. The hon. Gentleman makes a very important point. The capacity of the people at Combat Stress to cope with the increasing number of referrals is of concern to all of us in the House, because they are specialists—they know what they are doing and are very effective. The best way to use Government funds is to put them into the services that we know achieve positive results, and Combat Stress has an excellent record. I will come to the issue of funding shortly.

Combat Stress provides very practical help. It is establishing 14 community outreach teams across the country. It has three short-stay treatment centres and it wants to enhance the clinical care that it provides at those centres; it wants to provide better clinical care. That is one of the uses to which any additional funds should be put. These are very specialised areas of intervention, and giving people the highest-quality clinical support is very important indeed. Since 2005, Combat Stress has seen a 72% increase in demand for its specialist services catering for veterans’ mental health problems. The services are free of charge to veterans, so they have to be financed through fundraising and from public sources as well.

A number of veterans leave the armed forces with very severe psychological wounds. Post-traumatic stress disorder can go on for a long time—for years, in fact. These conditions are not susceptible to easy treatment. Therefore, there needs to be a sustained commitment to funding and support for organisations such as Combat Stress.

Combat Stress also offers a 24-hour helpline. That provides confidential help not just to people who have been in the military, but, crucially, to their families. We sometimes forget the huge impact on the families of veterans suffering from mental health problems. If people commonly have nightmares and panic attacks, lose their temper and occasionally become violent, the impact on families can be enormous. The 24-hour helpline is therefore a practical way for people to get emergency help when a situation gets out of control.

Combat Stress has an expanding outreach service. It has a team of mental health practitioners, community psychiatric nurses and regional welfare officers. It has three centres, in Shropshire, Surrey and Ayrshire. In September, it introduced a six-week veterans programme, which provides enhanced treatment for people with complicated presentations—it is intended really to dig deep and to delve into all the symptoms people exhibit.

Combat Stress also has a well-being and rehabilitation programme, which is available to all the veterans in the short-stay treatment centres. The programme uses a really structured occupational therapy model, which draws on best practice in civilian mental health. It includes employment mentoring and life skills workshops, and it deals with the practical issues of rehabilitation so that people can take up social activities in the community, which they may have lost touch with while they had post-traumatic stress disorder.

Combat Stress is absolutely the leading organisation in this field in terms of expertise. It now has a partnership agreement with the Ministry of Defence and the Department of Health, and £350,000 of investment was recently agreed, which is, of course, very welcome. Despite that, however, Combat Stress is still feeling the pressure, as the hon. Member for Mole Valley (Sir Paul Beresford) said, and that pressure is likely to increase. I therefore asked it what it was looking for from Ministers, and I want to put to the Minister the points it raised so that he can address them.

First, Combat Stress is looking for increased recognition of the number of people who are beginning to disclose that they have post-traumatic stress disorder, especially given that an increasing number of servicemen are being withdrawn from the combat zones we have had in Iraq and Afghanistan. As these people come home, the pressures will build, and more and more of them will need services.

Combat Stress estimates that 960 of the service personnel leaving the armed forces in 2012 are likely to suffer from post-traumatic stress disorder, while about 4,700—a huge number to cope with—are likely to suffer from a more common mental illness, such as depression or anxiety. That is the nature of the problem. Combat Stress’s services are running at capacity and demand is going up, so my first question to the Minister is whether the MOD and the Department of Health, which is responsible for treatment, recognise that this problem, which will increase, should be firmly on the agenda.

Combat Stress’s second request is for increased capacity. The organisation is now extremely well known, so anybody who is in the circumstances I have described turns to it for help. The last thing Combat Stress wants to do is to turn people away because it does not have the facilities to cope. Can the Minister therefore tell us whether any planning is being done to deal with this issue? What proposals are there to meet the increased demand over the next few years? Where will the investment go? There will be investment in NHS facilities, but the facilities I am talking about, which are close to people and their families, can make a huge contribution in addition to that made by the NHS. I would therefore like to hear what specific proposals the Minister has to provide more funding, more resource and more capacity, particularly for Combat Stress’s outreach work and its 14 outreach teams, which will be extremely helpful for people suffering from the problems I have mentioned.

The third issue I want to raise with the Minister is the stigma around these conditions. There is much more to be done on this. Some 81% of veterans with a mental illness feel ashamed or embarrassed, which sometimes prevents them from seeking the help they absolutely need if they are to get well. One in three veterans—this is a very sad figure—are too ashamed even to tell their families about their mental health problems. I can only imagine what it must be like to live in a family with someone who becomes withdrawn, who is no longer part of the family, who suffers from all the symptoms I have described and who is often in a desperate state and too embarrassed to tell the other members of the family how they feel.

The Government—indeed, all of us—have a job of work to do to raise the profile of these issues and to remove the stigma around them. These things happen in conditions of war, and we should not be embarrassed or ashamed about them. We should do our utmost to help people in such circumstances. I welcome the MOD campaign on this, which is called “Don’t bottle it up”. It is a good way of starting to get rid of the stigma, but more could be done.

[Mr James Gray (North Wiltshire) (Con)]

The right hon. Lady is talking a great deal of sense. Allied to the question of stigma is people’s failure to recognise symptoms in themselves. People often suffer some of these things many years after the incident that caused them. Does she agree that another role the NHS could usefully play would be to advertise some of the symptoms and causes of these unfortunate mental disorders so that people actually recognise what is happening to them?

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[Hazel Blears]

The hon. Gentleman makes an extremely good and practical point. The NHS runs public health campaigns about a range of issues that affect people, such as smoking and obesity. If we could normalise mental health in that way to some extent, people would feel much more comfortable about coming forward and saying they have a problem. One symptom of post-traumatic stress disorder is that people often resort to drugs or alcohol and end up with alcohol problems, not recognising that there are severe mental health problems underneath them. The prisons have recognised that about 50% of ex-service people in prison could well be suffering from post-traumatic stress disorder, and that is estimated to cost the nation about £300 million a year. This is a good example of a public health issue, and taking the approach I have described could not only result in significant savings, but contribute to the well-being of all those who are suffering. The hon. Gentleman makes a good point.

[Sir Paul Beresford]

On the same sort of theme, when veterans leave the forces, it is frequently 12 to 14 years before they present, as Combat Stress says. In the meantime, as the right hon. Lady has said, families, communities and so on can face havoc. The United States and the United Kingdom have a decommissioning period in which they help people leaving the armed forces, but ours is very short. The United States actually targets individuals so that they can be picked up and referred before they get into the community. The funding that she talks about will come predominantly from the NHS, and the Minister cannot really speak for the Department of Health. However, he can speak about what the Ministry of Defence can do to catch people early, before they do any damage to themselves or others.

[Hazel Blears]

The hon. Gentleman touches on a good point, which relates not quite to prevention, but certainly to early intervention before problems get worse. I am coming to the funding that will be supplied by the Big Lottery Fund, which will specifically target this issue, and it, too, is a good step forward. One issue is how we co-ordinate all the funding going through the NHS, Combat Stress and the Big Lottery Fund to make sure that we provide a really good wraparound service.

I want to say a word about the Big Lottery Fund investment. Over the next few years, the Big Lottery Fund will put £35 million into this issue. It is setting up a trust called Forces in Mind, which will provide long-term support and advocacy across the United Kingdom—it is important that ex-forces personnel have someone to speak on their behalf. The trust is about people making a successful transition back into civilian life. It will work with the people who have served in Iraq and Afghanistan. It will look at mental health, family breakdown and alcohol-related problems, which are absolutely pressing.

The trust involves a partnership between the Mental Health Foundation, the Centre for Mental Health, the Confederation of British Service and Ex-Service Organisations and the Shaw Trust. It therefore includes a number of good organisations that have reach into these areas, which is positive.

The trust had its business plan approved by the Big Lottery Fund board last month, and it has three early projects, which I will say a quick word about. The first is the early service leavers trial, and the hon. Member for Mole Valley touched on the issues it deals with. It is called “Future Horizons” and it is an enhanced transition programme for those who leave the services early, but who currently get no support from the armed forces. One thousand such people recruited from across the UK will go to Catterick garrison. They will get 12 months —this is a long-term programme—of enhanced support with finding jobs and accommodation, as well as guidance with educational problems and mental health issues. Twenty-six different community organisations are involved, so, again, there is good local reach. That is the beginning of what the hon. Gentleman seeks—an enhanced transition. It is no good giving people help for six weeks when they are looking for a job, trying to find a home and trying to get back into life. A 12-month programme will therefore be very helpful.

Another project will involve SSAFA Forces Help, which was the Soldiers, Sailors, Airmen and Families Association. It will work with the Mentoring and Befriending Foundation, TimeBank, Shoulder to Shoulder, the British Association for Counselling and Psychotherapy and Help for Heroes—again, it is a big consortium. Working with Cruse Bereavement Care, it will support people who are bereaved. Cruse is renowned for working with bereaved families. It is expert in counselling and support and will be a crucial part of the partnership, which will work with the widows, widowers, partners, children and siblings of those who have been killed, covering the whole range.

The other project, which will come on stream quite early, is with mentoring organisations. It will involve early service leavers who are under 24, so very vulnerable young people will get a specific mentor to help them through the transition—a buddy to be side by side with them, if you like. Younger people are often more vulnerable and their problems can be very long term. If we can intervene early, perhaps the transition can be more effective. The money from the Big Lottery Fund is therefore very welcome, but in my view it does not absolve the Minister from looking at other Government resources that might help. I am sure that we will all be interested to hear from him.

Neil Blower, my constituent, has made me much more aware of the problems faced by people than I ever was before, and I am grateful to him for that. I asked Neil, as I asked Combat Stress, what one thing he would really want to happen. What is his wish to help veterans in such circumstances? Neil has been lucky enough to be admitted on to the degree course in creative writing at the university of Salford and he has had his first book published—something that many budding authors never achieve. He hopes to go on to have a career as a writer, and I am sure that he will be successful. He wishes that there were a Tommy Atkins scholarship fund, and I would like the Minister to consider that seriously. It would be akin to the GI Bill in America, whereby the American Government paid for servicemen and women, after the Korean war, to go to university when they left the forces. That helped them to go from combat to classroom. Supporting some of our forces to realise their talent and potential through access to higher education would be a tremendous step forward.

Neil is busy costing the project and I am sure that we will come back to the Minister at a later date with a detailed proposition. Giving people the chance to have an outlet into higher education, whether to enter teaching or another important area of life, would help them with job seeking and give them more skills and a better chance in the labour market. Neil felt that, for him, education was a great way to deal with his mental health issues. It helped him enormously. He felt that he was doing something worth while, it made him feel as if he belonged and made him feel part of society again. The power of education therefore can be of tremendous benefit.

I am not on a sales trip, but Neil’s book is available and I urge as many Members as possible to get it. I did not know what to expect from that little volume. It is short, but incredibly moving, and I want to finish with a quote from it. I do not want to give away the ending completely, but in the book, Tommy Atkins is at the end of his tether. He has come home and life is terrible. He breaks up with his girlfriend, his mum and dad break up and a series of terrible events happen to him. I am sure that such things happen to an awful lot of people in these circumstances. He gets to the point where he is absolutely desperate and it is so difficult for him to carry on that he thinks of taking his own life, but then something kicks in inside his head: “This was a coward’s way out. I was a British soldier and we don’t do that. We never surrender and we never give up. That is for other people. I realise that, despite all the pain and heartache and suffering that there is in the world, there is good as well—there is good in this world. The love of another, the bonds between family, friendship—these are the things that I fought for. These things are still worth fighting for and they are worth staying alive for. I will love my mum and dad whether they are together or not. I just want them both to be happy. I will meet another girl and fall in love again. I will always remember the friends I’ve lost—Kev, Johnno, the serg, Jamie. I will honour their memory by living, by leading a good life. I stood in the mirror and looked at my medals, then I did the bravest thing I have ever done. I picked up the phone, I rang Combat Stress and I told them about me. I told them what I was feeling and I felt a great weight lifted from my shoulders.”

That, for me, is the best summary that I can give of the experience of Tommy Atkins and all those thousands like him. From this book, we can all rededicate ourselves to ensuring that we press for better understanding and better support to improve the lives of those who have given so much for all of us. I am grateful for being granted the debate this morning.

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[The Parliamentary Under-Secretary of State for Defence (Mr Andrew Robathan)]

This is a hugely important topic, so I am delighted that the right hon. Member for Salford and Eccles (Hazel Blears) has secured this debate. I thank all Members who have taken part. The right hon. Lady is a former Minister with responsibility for public health and therefore knows a lot about the issues. I am not in any way clinically trained, so I tread very warily around issues of mental health. We should be wary of making grandiose statements on a very complex situation. I certainly try not to tell clinicians how to address it.

There is, however, a good story to be told. A great deal of progress is being made and the subject has rightly received a lot of attention in recent years. Our armed forces are currently deployed in the most demanding areas of conflict, and we have a moral duty, not only as a Government but as a nation, to support and look after them, to care for them when they are injured and to maintain that care when they leave service. Mental health problems, as we have heard, may take some time to manifest themselves, in some cases many years after service. Mental ill health can be a truly debilitating condition. As several Members have mentioned, it still has a stigma attached to it, and I believe that there is a lot of common ground across the political parties to remove the barriers for those seeking the help that they so desperately need.

I acknowledge the work of the previous Administration in launching ex-service mental health pilots throughout the country during the previous Parliament. Such was their success that they continue in the NHS, which is leading the fight to ensure that those who need our help receive it.

Although I am responding on behalf of the Ministry of Defence, it has been the policy of successive Governments that the treatment of all health-related conditions and problems for those who have been in service is the responsibility of the national health service. I mention that because I deal very closely with the Minister of State, Department of Health, my right hon. Friend the Member for Chelmsford (Mr Burns), who from time to time makes comments in the House about zombies—some Members may have noticed that recently—that may have deflected us from his excellent work in the Department of Health, especially his close work with us on various issues, particularly mental health. Indeed, he and I together visited Combat Stress in Leatherhead about a year ago. The NHS and the MOD together have also set up armed forces networks to ensure that ex-service personnel in particular can access health care. Members have said that people do not understand what ex-service personnel need, but this should go some way to helping in the future.

To ensure a coherent approach across the Government, my right hon. Friend the Prime Minister asked my hon. Friend the Member for South West Wiltshire (Dr Murrison), who served as a medical doctor in the Royal Navy, to conduct a study into the relationship between the national health service and the armed forces, including former servicemen, in terms of mental health. It was a thorough examination of our procedures and led to my hon. Friend’s well-respected “Fighting Fit” report. If hon. Members have not read it, I commend it to them.

The right hon. Member for Salford and Eccles asked about our plans for the future. Essentially, they are based on that report. The former Defence Secretary, my right hon. Friend the Member for North Somerset (Dr Fox), announced on 6 October last year that we would accept all of the “Fighting Fit” recommendations. They include a scheme, beginning next spring, routinely to contact service leavers at the 12-month point after discharge to establish whether they have any health need for which they are having difficulty in accessing treatment. That is actually very difficult, because when people leave the armed forces, they often change address, move away, go abroad or do all sorts of other things. It is not as easy as one might think. In addition, we will enable those identified as having a mental health problem during service to continue to have access for up to six months to the MOD’s departments of community and mental health. That will help smooth the transfer of care from the MOD to the NHS. We have also enhanced service medical examinations to enable earlier identification of mental health problems.

One of the earliest “Fighting Fit” recommendations to be implemented is the new 24-hour helpline, which is run by the charity Rethink on behalf of Combat Stress and is funded by £200,000 from the Department of Health. It allows former personnel with mental health problems and their families to get specifically targeted support from people trained and experienced in dealing with serving and former armed forces personnel and their often complex mental health needs. It is a real success, and when I have met Combat Stress and its clients, I have seen for myself how important this enabling of the first step to seeking help really is. I telephoned the helpline shortly after it was set up because I am sometimes slightly sceptical about helplines, and I can assure hon. Members that it works.

Through working with Combat Stress, the NHS is also increasing the number of mental health professionals, with a focus on providing help to veterans with mental health problems. That provides the opportunity for veterans to be seen locally by NHS professionals who have a better understanding of veterans’ needs, working side by side with Combat Stress outreach teams and their extensive experience and knowledge.

To help with the process of removing the stigma, to which several hon. Members referred, the Government have introduced an online well-being network that is accessible to serving personnel, their families and veterans. It is called the Big White Wall and is staffed by professional counsellors, who can be contacted 24 hours a day, seven days a week. That social network, which is reflective of today’s society, allows individuals to engage with others who are in similar difficulty. The anonymity connected to that network allows for a free and frank exchange of experiences, with a view to generating a wider sense of support. The Big White Wall has logged 1,000 hits since going live, more than 40% of which are from serving personnel, which illustrates that it will be a success.

I must acknowledge the significance of Combat Stress’s collaborative approach with the NHS and the MOD, which was referred to by the right hon. Member for Salford and Eccles and others. I bought my Christmas cards this year and last year from Combat Stress, so I would like to think that I do my little bit personally to support it. My Department provided Combat Stress with £3 million in the financial year 2010-11 for the treatment of those in receipt of a war pension who require treatment for mental health problems caused by service.

Combat Stress was formed shortly after the first world war to help those returning from the battlefields, but it is as important today as it was then. Indeed, I first came across Combat Stress 25 years ago when I was serving. It was known then as the Ex-Services Mental Welfare Society. We have heard today about Neil Blower, a former serviceman who served his country in Iraq and Kosovo. He experienced difficulties after service, but received excellent help and support from Combat Stress. He has now become a published author. I wish him continued success, and I should say to the right hon. Lady that I found the quotation from his book very moving.

I accept that the Government cannot and should not do everything. Through the armed forces covenant, we are building partnerships between all arms of government—national and local—and with the NHS to deliver better support to the armed forces community. The hon. Member for West Dunbartonshire (Gemma Doyle), who speaks for the Opposition, mentioned all arms of government and how we need to bring them together. A report on the covenant will be published before Christmas.

We also need to work more closely with the charitable sector to get the right support to the right people at the right time. The covenant has the important principle of removing disadvantage. Any former serviceman who is ill as a result of their service can access priority treatment through the NHS—subject, of course, to the clinical needs of others. We continue to work closely with GPs to make that more widely known because there is an education issue. The Department of Health, working with the Royal College of General Practitioners, has put in place an e-learning package for GPs. That will increase awareness of the status of patients who are veterans, thus enabling more proactive monitoring of veterans’ mental health and helping to ensure that they receive the treatment that they deserve.

We acknowledge that, in some cases, it can take years for psychological problems to manifest themselves. It is therefore important that we recognise through-life responsibility to our armed forces and that we do all we can to increase awareness and reduce the potential for developing mental health problems in the future.

[Hazel Blears]

If the Minister’s plans to reduce stigma are successful—and I very much hope that they are—that will inevitably result in more people presenting for treatment and help and support. I specifically asked him what his estimate is of the increase in the number of people presenting for next year and the years after as troops withdraw from the theatres where they have been active and what plans he has to meet that increase in the number of people presenting. I would appreciate some detailed answers to those specific questions.

[Mr Robathan]

I was going to come to that, but we do not have estimates for the figures that may emerge because it is a very difficult clinical situation. Some people—mostly not qualified doctors—say that a tidal wave of mental health problems is coming. I do not know whether that is the case, but what I do know is that we must be ready for whatever comes, so that we can help ex-service personnel. That is the right way forward, but making estimates that must inevitably be guesses because they depend on individual situations would not necessarily be very helpful.

I want to answer a few more of the right hon. Lady’s questions. We have mentioned stigma. It is our policy and that of the armed forces that mental health issues should be recognised properly and handled appropriately. Every effort should be made to reduce the stigma associated with such problems. Service personnel are given briefings before, during and after any operational deployment that explain the symptoms to look for and signpost the support services available. As well as medical officers, welfare staff, mental health personnel and chaplains also deploy to places such as Afghanistan and are available to provide help and advice.

One of the most successful recent innovations has been the introduction of trauma risk management—TRiM—which I have seen. That is a process of peer-group risk assessment, and mentoring and support for use in the aftermath of traumatic events. Such a process is undertaken as soon as possible after the event. That could happen, for example, after a patrol in a forward operating base. Evidence suggests that that process has been successful in increasing awareness and reducing the stigma attached to mental health disorders, which the right hon. Lady mentioned.

Away from the operational theatre, we provide a range of specialist care, primarily through 15 military departments of community mental health across the UK and four such departments in Germany. Those departments provide out-patient mental health care and are staffed by community mental health teams comprising psychiatrists and mental health nurses, with access to clinical psychologists and mental health social workers. In-patient care, when necessary, is provided regionally in specialised psychiatric units under a contract with the NHS.

To help our understanding of the issues that affect service personnel and those who have left the services, we fund a large-scale research project at King’s College, London on the experiences of those who are serving or who have served in Iraq and Afghanistan. Only last Monday, I spent the morning at King’s with Professor Simon Wessely and other academic staff who are undertaking that research. If anyone wishes to go there, I can arrange a visit because they are extremely on the ball and know an enormous amount about the subject, as one would hope. The project includes a large-scale study involving more than 20,000 participants, which is monitoring the effects of operational service compared with a cohort group that did not deploy.

In May 2010—the project was funded by the previous Government—the latest phase of that research confirmed that there is a continuing relatively low prevalence of probable post-traumatic stress disorder for the UK armed forces. Some 4% of respondents displayed symptoms of PTSD compared with other studies that show a range of rates between 3% and 7% in the general population. Recent evidence suggests that PTSD is likely to present at a peak of about three years, but we accept that it may be longer in some cases. It is therefore important that we recognise our through-life responsibility to our armed forces.

I will try to cover the questions asked by hon. Members. My hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) made some excellent points. The hon. Member for North Antrim (Ian Paisley) spoke with passion about the legacy of conflict in Northern Ireland. Having spent the best part of a year of my life on the streets of west Belfast, I have a very real understanding of and a great deal of sympathy with some of his points. The hon. Member for St Austell and Newquay (Stephen Gilbert) spoke with great feeling, but we should be careful that we do not see ex-service personnel as victims. They are very capable people, and the overwhelming majority of people who leave the services plough a pretty good furrow and get a job. I had to become an MP to get a job; nevertheless, most people get a pretty decent job after they have left the armed forces, and they do not want to be patronised.

My hon. Friend the Member for North Wiltshire (Mr Gray) added his experience of the Territorial Army and acknowledged the real difficulties that we face. On the reservists, he is absolutely right. I say gently to the hon. Member for West Dunbartonshire that we must understand—I think that she does understand—that many ex-service personnel do not want to be pursued. When they leave the armed forces, they do not want to be followed up.

The right hon. Member for Salford and Eccles particularly mentioned education. I will write to her if I may with the details, but I think that she will find that the further education scheme funded by the Department for Business, Innovation and Skills provides free tuition for service leavers undertaking a first qualification at that level. That gives ex-service personnel the opportunity for higher studies, which they may have been denied by military service. Furthermore, they can build up learning credits during service that can be used to fund education for up to 10 years after leaving service. However, I will write to her with the details on that.

In conclusion, there is consensus here. The right hon. Lady has raised a very important issue. We can never remove the exposure to trauma in operations, but we must do all we can to minimise the effects that that might have. TRiM on the battlefield gives the opportunity to discuss the shared experience of trauma, and that concept is continued with the Big White Wall. For some, medical intervention is required, which I have discussed, but we continue to address the recommendations made in “Fighting Fit.” All that is complemented by Combat Stress and other service charities. As we have heard, they do a huge amount to rebuild lives, and we are, as a Government and a nation, eternally grateful for that.