Mental Health (Veterans)

James Gray Excerpts

Tuesday 6th December 2011 Westminster Hall

[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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[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

I congratulate the right hon. Member for Salford and Eccles (Hazel Blears) on securing the debate. It is on an issue that I have spoken about on one or two occasions. I am delighted to say that in my maiden speech I gave warning and notice to my right hon. Friend the Minister that I was likely to carry on banging on about it. I am therefore grateful to have the opportunity to do so. A big problem with such debates is that the issues are covered by not only the Ministry of Defence but the Department of Health, and it would be helpful if we could, at some stage, get a Minister to come to talk about the health implications of what we want.

The right hon. Lady has given a very good briefing on Combat Stress, and I, like her, have been to talk to that organisation. It has been incredibly good at ensuring that I am kept informed and have an understanding of exactly where the problems are. Of course, we have heard a lot about the concentration and focus on veterans who have come out of Iraq or Afghanistan, but we must remember that people who were involved in conflicts in Northern Ireland will also need help. They also make up a significant number of the casualties who were created from that long and bloody conflict.

We talked at some length about how there will be an increasing number of people dealing with combat stress over the years. The Government have announced that we will withdraw from the Afghanistan conflict by 2014, but activities will continue there. During a trip that I made to Afghanistan a couple of weeks ago, I was told that although the troops will not go out on patrol, we will almost certainly need to support and help those in the Afghan army and police, who will need guidance. I am in no doubt at all that elements in the Afghan resistance will seek to ensure that our troops are subject to many attacks.

I grew up with these issues. My father went into the Royal Navy at 14, and was awarded the distinguished service cross for his activities in Narvik. He told me, when I was a child and a teenager, of how it was that he had been responsible for trying to take the head of one of the people he had served in a cabin with to throw it over the side when it was blown off in action. Fortunately, that did not have an impact on us as children. He was a very normal man and lived a full and active life until he was 89, but there was a real chance that such activity could have had a significant impact, not only on my mother, who, I have to say, had the most wonderful sense of humour, but on us, as children. We have all come out, I hope, reasonably sane and balanced.

The other day, I visited the Royal Marines in Exeter. One person told me a sad story of how when he had served abroad in action, he came back and wanted to talk to his wife about what he had faced. He wife looked at him and said, “Don’t start talking to me about any of that. I’ve had a damn awful day as well. I’ve had to deal with 300 e-mails, so that’s my priority”, so he did not talk to her about it. He tried to talk to his mates, who were not involved in the armed services, but they found it very difficult to understand, so he had to find his fellow servicemen—Royal Marine friends—who lived in Aylesbury, where he came from, and talk to them. It was only by having that opportunity to share his experiences that he saw what was going on.

I represent Plymouth, Sutton and Devonport, and it is a great pleasure to do so. We have just, literally, had 3 Commando Brigade come back from Afghanistan, and I think it also has some of the scars that come with that.

I am delighted that we have accepted the military covenant into law. I hope that the Secretary of State’s regular reports on that issue will be informed, and that we will be able to talk about mental health. I congratulate my hon. Friend the Member for South West Wiltshire (Dr Murrison) on writing the paper called, “Fighting Fit”. I think that that was the benchmark for ensuring that we were able to produce a strategy, and we are taking the issue more seriously.

I am also concerned about the reservists. We are enormously good at talking about regular service personnel, but we do not talk too much about reservists, although I know that my hon. Friend the Member for Canterbury (Mr Brazier) has been doing an extraordinarily large amount of work on this. I was talking to the British Legion the other day, and it told me how it did not seem possible to share information on reservists with charities that are delivering support and help. Could we look at that? Can we make sure that the information is much more readily available, so that people such as Combat Stress and the British Legion are aware of exactly where the issue is going to?

[Mr Gray]

There is a particular problem regarding the Territorial Army and reservists in general. Whereas a regimental family closes around someone among the regulars who is bereaved or has mental problems, and regulars tend to live in the same place as where they are serving, reservists often come from right across the land, and there is a much less strong regimental hierarchy to look after them. Reservists need particular help from the Ministry of Defence.

[Oliver Colvile]

I was just about to make that point. Those people work and live in isolation. The problems that they have with decompression are enormous. When they come back, they do not necessarily have the same amount of time as regulars do to unwind and be debriefed. We need to look at that issue. When I was talking to a senior Royal Marine the other day, he said that it would be helpful if the decompression time for reservists could be longer. I urge the Minister to consider that.

Another issue that we need to look at is how the national health service is dealing with the matter. As I said, the question is not just about how the MOD deals with the issue, although the Minister has been doing excellent work on veterans. I support the way in which we will change the structures of the NHS. I voted for the legislation, and I think it is the right way of going about it, but will our general practitioners and commissioning boards be able to manage the matter? If GPs commission such services, how far up the agenda is the mental health issue going to be? How will policies be implemented? Will we have lead GPs taking an interest? I will most certainly be asking my GP commissioning board down in Plymouth how it is proposing to manage the issue. We must think the matter through. We in this place can pass legislation easily, but we must ensure that it is implemented and that we monitor the results.

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[Ian Paisley (North Antrim) (DUP)]

I, too, add my congratulations to the right hon. Member for Salford and Eccles (Hazel Blears) on securing this important debate today. Raising the profile of the matter will in itself do much to enhance public recognition of the issue, and she spoke passionately and poignantly about the need to achieve that.

The hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) made an excellent point in his comments, which is that we must cast the net a lot wider than the immediate conflicts that we are aware of in Iraq and Afghanistan. It will not be unusual for Members to hear me speak about what has happened in Northern Ireland. We have a walking community of forgotten heroes who have served the nation well and with gallantry, from the Ulster Defence Regiment, the Royal Irish Regiment, the British regular Army and the Royal Ulster Constabulary. Only today, as the situation has normalised, has there been a true opening and unfolding of the trauma and devastation in the lives of individuals who gave service to this nation, and the effect that the conflict had on their families. Families lived with service personnel who not only served our country but lived within the community that they were serving—it was a double impact. It is only now, in this new Northern Ireland, in a more peaceful society, that that is starting to unravel and unfold. We must ensure, as we have started to peel back the issue and look at what could be an appalling vista, that we as a country recognise that we have a responsibility to address the concerns that we are starting to discover.

Several former soldiers, from the Ulster Defence Regiment in particular, visited me in my constituency office. They had stopped serving in the late ’80s and early ’90s, and yet they were still talking about things that they saw that are impacting their lives now. They look back and recognise that the awful pictures that flash in their memory have had an impact on how they have lived their lives in the past 20 years, and on members of their community and family.

[Mr Gray]

What the hon. Gentleman is saying with great passion brings to mind an episode yesterday. My hon. Friend the Member for Beckenham (Bob Stewart) was entertaining on the Terrace of the House of Commons one of the widows from the outrage of Ballykelly all those years ago, when 20-odd souls were killed in a pub. My hon. Friend was reminiscing about how he cradled his lance corporal in his arms. His lance corporal had lost all four limbs before he died. What sort of effect does that have, not on my hon. Friend—I am glad to say—who is remarkably well-balanced, but on any less well-balanced soldier? What possible effect will that have on the rest of their lives?

[Ian Paisley]

The hon. Gentleman makes a very important point. I also had a constituent who visited me about this problem. He was a big, strong, tough frame of a man, but he was like a quivering autumn leaf when he started to tell me about what he had seen and what he remembered. Indeed, his constant memory was the sound of the scrape, scrape, scrape of the shovel that he had used to put his comrades and colleagues into a waste disposal bag after an outrage by the Provisional IRA. It is a burning memory that he will never forget and that woke him in the dead of night, leaving him soaked in sweat and crying out in fear, and yet it is a memory that he has had to bottle up and carry with him.

As a nation, we must take responsibility and recognise that there are things that can be done for these people we are talking about. They are not hopeless people; they are people whom we can actually give hope to, if, as the right hon. Member for Salford and Eccles said, we first help to remove the stigma, and help people to recognise that there is help available and that they will not be stigmatised by going for that help. In fact, that help will only be of benefit to this community, this nation and indeed the NHS, which will have fewer problems to deal with as the years go on.

I hope that the passionate words that the right hon. Member for Salford and Eccles put to this House this morning will be recognised and that we also recognise that post-traumatic stress disorder is not only about the immediate battles that we are aware of today but about the long-term problems that our country faces. More than 100,000 gallant soldiers from our nation passed through Northern Ireland in service and we are just starting to scrape the surface of this issue when we recognise that, 20 or 30 years after the conflict ends, there could be people who will come forward to say, “I have a problem because of what I saw, because of what I witnessed and because of what I went through as a serving personnel officer in Northern Ireland.” We must ensure that that issue is properly recognised.

The right hon. Member for Salford and Eccles spoke about the capacity to take on board the cases that will come forward. I want to see that capacity extended, to ensure that the needs of Northern Ireland and of the soldiers there are also taken on board. The Big Lottery Fund money—the £35 million—that has been brought to our attention today will be a welcome spend and of course it must include spending on people who served in Northern Ireland under Operation Banner, to ensure that their issues are properly addressed.

I want to make a final point about the issue of stigma. We need a public champion who can be identified with this issue and whose association with it will give a boost and encouragement to those soldiers who are sitting at home, and perhaps staring into an empty glass, contemplating self-harm or having a fight with their children or other family members. That public champion will give those soldiers the ability to say, “There is someone who can help me; there is an organisation addressing what has affected me, and I can now see that I have someone to shoulder this burden and someone who can be a help or a crutch”, at the most important time—when they are at their most vulnerable. I hope that that public champion can be identified.

In addition, I love the idea of a GI Bill or something similar for the UK. There would be so much opportunity with such a Bill that we could build on, and I think that we could do things even better than they have been done in the US because this is a nation of people who come up with even better ideas than people in other nations do. We could learn from what has been done in the United States and come up with something really tremendous. I hope that this debate itself acts as a springboard and is a very hopeful and positive start to something that we can take great pride in.

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[Stephen Gilbert]

I am very grateful to the hon. Lady for that intervention, and she could not be more right about that issue. I chair the all-party group on housing and I have made it a particular business of mine to look at homelessness; in fact, I have applied to speak in an Adjournment debate on that very issue, Mr Dobbin. When I talk to organisations such as Centrepoint or St Mungo’s, it is absolutely clear that there is a particular problem with people who leave our armed forces and who are unable to adapt to civilian life and stabilise their housing needs. The hon. Lady makes a point that I hope the Minister will find time to address when he winds up the debate.

[Mr Gray]

I just wanted to intervene on that particular point, before the hon. Gentleman moves on. It is often anecdotally said that there are more people living on the streets who are from a service background than there are civilians and it is also anecdotally reported that there is a higher proportion of people in prison from the armed forces than there should be. However, I suspect that there has not been a proper statistical analysis of either of those issues and perhaps one of the things that the Government could usefully do is to come up with some hard facts to establish whether or not the anecdotal reports about those issues are actually correct.

[Stephen Gilbert]

My hon. Friend steals one of the key points that I was going to ask the Minister to respond to, but hopefully the fact that we are both making the same point will be better than just one of us making it, and so I am very grateful to my hon. Friend for that intervention.

The risk of suicide in army males under the age of 24 is two or three times greater than that of young males in the same age group in the general population. A recent study of 9,000 veterans showed that 20% of them had symptoms of common mental health problems and that 13% had symptoms of alcohol misuse. The right hon. Member for Salford and Eccles is absolutely right that we should be entirely clear that mental health issues can affect anybody in any part of the population, and that we should try to move away from the stigma that is all too frequently associated with those issues. Indeed, it is my understanding that 25%, or a quarter, of British adults experience at least one diagnosable mental health problem in any one year, and that one in six experiences such a problem at any given time. Mental health problems are very pervasive in our society and we must tackle the taboo about discussing them.

I have spoken before in the House about the harm that alcohol abuse can cause, and that same study of veterans showed that 40% of the veterans who responded met the criteria for heavy drinkers; 27% of them met the criteria for very heavy drinkers; and 15% of them were classed as problem drinkers. Again, young men in the armed forces are more at risk than young men in the general population, with 36% of 16 to 19-year-olds in the armed forces drinking harmful amounts compared to just 8% of 16 to 19-year-olds in the general population.

It is right and proper that we do all we can to help those who have served our country, and not only while they are serving but after they leave the armed forces. That is why I welcome the recent pilots by the Department of Health and the Ministry of Defence to ensure that NHS health professionals have the appropriate support and available expertise to treat veterans with mental health problems. The four national health Departments, the UK Ministry of Defence and the charity Combat Stress have been working together closely to develop and pilot a new model of community-based mental health care, and I particularly welcome the fact that one of the pilots is in Liskeard in Cornwall, which is close to my constituency.

Nevertheless, we need to see what else we can do. At the moment, the support offered for the reintegration of former service personnel into civilian life is proportionate to the time they have served but, as we have seen, those with mental issues and other illnesses often need the most help, and we need to consider whether we have right the balance between the time we are putting into their transition and their needs. We also must ensure that when people leave armed forces medical care, their transfer into the NHS is seamless. My hon. Friend the Member for Plymouth, Sutton and Devonport made it absolutely clear that we need to look again at what happens to our reserve and territorial forces when they are demobilised, as they are increasingly part of our war-fighting mix. I welcome the previous Government’s reserves mental health programme, which aimed to tackle some of these issues.

We must redouble our efforts to raise awareness in the NHS, to help veterans who are concerned about their mental health. And it is not just within the NHS; there is an issue closer to the Minister’s own Department. The MOD’s website has only one link buried within it to a charitable organisation that can help with these kinds of issues, and I ask the Minister to undertake to see whether the website could be looked at, and the links made more prominent, so that people who are clicking through will be better signposted towards help.

In all the defence establishments that I have visited during the 18 months I have been an MP, and before that as a parliamentary candidate, I have seen awfully large numbers of posters, notice boards and other ways of conveying information to our forces, and I wonder whether they are being adequately exploited to signpost our armed service personnel to the help that they need. As my hon. Friend the Member for North Wiltshire (Mr Gray) pointed out, we need more analysis and research into the wider consequences, and into whether we are providing the seamless support that we should, and to families as well.

Our service personnel never let us down. We ask them to do a difficult job under very difficult circumstances and they are prepared to make the ultimate sacrifice, so it is vital that this Government maintain the military contract post their departure from uniformed service. We must not let them down either.

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

I did not intend to speak, and I see the little time available to us, so if I may I will hold the House for just a few minutes before the shadow Minister does her bit and the Minister, from whom I very much look forward to hearing, speaks.

First, I pay a warm tribute to everyone who has spoken so far in the debate, in particular to the right hon. Member for Salford and Eccles (Hazel Blears). She and I might not agree on many subjects, but on this one I think we are entirely ad idem. Everything she said was absolutely right. This issue is terribly important and she has raised it in a timely way. I also pay particular tribute to my next-door neighbour, in constituency terms, my hon. Friend the Member for South West Wiltshire (Dr Murrison), whose seminal work on this subject fulfilled a coalition agreement commitment to do something about the mental health conditions of the armed services. His report was extremely good, and it has given the Government a series of pointers as to what they can now do about this terrible problem.

I think that we are unanimous about the fact that there is this problem. I was struck by a conversation I had yesterday with my hon. Friend the Member for Beckenham (Bob Stewart), who sends his apologies for not being here. He was having a drink on the terrace with a young lady who was the widow of one of his soldiers. He recounted how when he was digging into the pub in Ballykelly, she insisted on calling him “sir” throughout the time she was struggling to escape from the mud and dirt, and how he said, “You don’t need to call me ‘sir’ under these conditions. Your husband is dead beside you; we can forget the ‘sir’.” What kind of effect can that kind of episode, in which someone cradles a dying soldier who has lost all four limbs, have on those who are left behind? My hon. Friend is one of the most well-balanced individuals I know, and I am not for a second suggesting that he has any such problems, but how many people will have had similar experiences in Afghanistan and Iraq, and how many soldiers who have had such an experience know what effect it will have on them in later life?

I remember speaking to a 19-year-old sniper when I was visiting Afghanistan last year. I asked him, “How many confirmed kills have you got as a sniper?” and he replied, “I’ve got 34 confirmed, and a further 26 probables”, so something like 50 or 60. I asked, “Doesn’t that worry you?” and he said, “No, sir, it’s no trouble at all. It’s a blur at the end of the sight, and I pull the trigger and do my job and that’s that. It has absolutely no effect whatsoever.” Who are we to say whether when that young lad is 50 or 60 he will have some form of effect from that experience? It is therefore incredibly important that we address this grave issue. I pay tribute to Help for Heroes and to my constituents in Wootton Bassett and across the area, who have done great stuff with bereaved families and soldiers coming back from theatre of war with injuries, but this is a much more invisible problem. We should be just as aware of it, even though the average time before a patient realises his problem is 14 years after the incident, and it may well be 20 or 30 years. It is important that as a society we do something about the problem.

Having agreed that—I am sure that everyone here today will strongly be in agreement—it is much more difficult to say precisely what to do. It is very easy to say, “Isn’t this an awful problem? Mustn’t we do something about it?” Well, yes, but what do we actually do? Two or three interesting proposals have come up in the debate. The first, and as I come from the Territorial Army myself I think this is very important, is that we should ask the reserve forces carefully to consider precisely what they can do. Very often, TA people coming back from the theatre of war leave the reserve forces within a year or two. They do not particularly want to carry on much beyond that, and they then disappear into civilian life and are gone for ever. We do not know where they are or who they are, and they may well be suffering from these same problems. We must find a way of pinning down where our reserve forces go when they retire, and do something about it.

[Mrs Linda Riordan in the Chair]

The second problem that people talked about very convincingly earlier was that of stigma and of people feeling that they do not want to come forward, and I think that that particularly applies to the testosterone-filled young men we send off to war—and women to a degree, but not the testosterone. They come back and do not want to say, “I’m a bit daft. I’ve gone a bit loopy. There’s something wrong with me.” The ethos is not to say that, and we have to find a way of encouraging them to believe that it is a normal thing to do, that they can perfectly sensibly bring themselves forward and say, “I’ve got a problem here, and I need some help.”

One thing we might want to think about doing is this. Some 10 or 15 years ago, our servicemen coming back injured from the theatre of war felt very uncomfortable being in civilian wards in Birmingham. No one is saying that they were not well looked after, but only a year or two after the conflicts began the previous Government introduced military-style care in Birmingham. Armed servicemen feel at home and relaxed in such an arena, and I think that something similar has to apply to mental health. Too many civilian mental health workers do not understand the problems, which may well present many years after the incidents that cause them. Particularly in areas such as mine and that of my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile), where there are very large numbers of armed servicemen, we have to find a way of saying to our primary care trusts, “This sort of problem is coming your way over the years. You have to find a quasi-military way of dealing with it. You have to realise that military life is different from civilian life and that these are different problems from civilian mental health problems, so let’s find a specifically military way of dealing with them. Let’s keep in touch with the armed services and find out precisely what they know about post-traumatic stress disorder and the rest of it, and let’s find a military solution to what is a military problem, albeit within a civilian environment.”

This has been a useful debate. We have raised the issue very satisfactorily and the armed services, which are aware of the problems, will, I think, be grateful to us for having done so. But it is very easy to do two things. First, it is easy to exaggerate the problem, and it would be useful if the Minister could initiate a statistical analysis of how many people it affects in a real sense. Earlier, we discussed prisons, alcohol and homelessness. How much of that is caused specifically by combat, and how much is in the normal run of human beings? There are 200,000 people in the armed services. A number of them will be drunken or homeless. That is the nature of the beast. How much of that is caused by military service, and how much is incidental to it?

So first, we must not exaggerate the issue. Secondly, we must not just take political capital from expressing our sympathy and concern; in debates such as this, we must make specific proposals about what we can actually do to lessen this problem in our society. I look forward to hearing from the shadow Minister and, perhaps more importantly, from the Minister, on what we can do about this dreadful problem.

[Gemma Doyle (West Dunbartonshire) (Lab/Co-op)]

I, too, congratulate my right hon. Friend the Member for Salford and Eccles (Hazel Blears) on securing this debate on an important and topical issue. More importantly, I thank Neil for coming along today and allowing us to hear his story, which has both provided a context for our discussion and put a face on the issue that we are debating.

I welcome the opportunity to discuss these issues with the Under-Secretary of State for Defence, the right hon. Member for South Leicestershire (Mr Robathan). We have spent much time during the past year discussing the Armed Forces Bill and the armed forces covenant. The Bill has now received Royal Assent, so it is perhaps fitting that as we come to the end of the year, we are again discussing the welfare of our brave serving personnel and veterans and the impact on their families.

My right hon. Friend painted an honest and vivid picture of the problem of veterans’ mental health. It is easy to be preoccupied with the scenes from Afghanistan that we still see and not to pay as much attention to the issues facing service personnel and their families when they leave the forces or return from theatre. We know that they are skilled, highly trained and resilient people, but more than 180,000 personnel have served in Iraq, Afghanistan and elsewhere, as we have heard, and a significant number will have returned with mental ill health or will, sadly, go on to develop problems later in life. We should be prepared to deal with that and ensure that the right facilities and support are in place to diagnose and treat such conditions.

Significant progress has been made in recent years, particularly through mental health pilot schemes and work done since then, to improve support and treatment for personnel suffering from mental health problems, but no party has a monopoly on wisdom when it comes to improving services for our forces. We have all met constituents who have told us about their experiences. We have heard about some of those and about Members’ personal experiences of the issues.

I emphasise the importance of the current campaign by Combat Stress about the stigma attached to mental health, which my right hon. Friend mentioned. Combat Stress provides an invaluable service to veterans around the country. Its centres and outreach work allow veterans to get the help and support that they need in a specialised environment, along with other veterans going through similar experiences. Combat Stress’s “The Enemy Within” campaign seeks to tackle the stigma that, unfortunately, can be a barrier to people getting the support and help that they need.

However, the work of Combat Stress and of many other important organisations and charities such as the Royal British Legion should not give the Ministry of Defence or the Government an excuse to opt out of their responsibilities, or indeed ours. It is important that we do not view the services offered by the voluntary and charitable sector as a replacement for acting ourselves. Such organisations should complement, not replace, the services that the Government offer. The voluntary and charitable sector is facing a tough time at the moment. Forces charities are spared some of that pain by generous ongoing public support, but we should not assume that those services will always exist and will always have enough funding to run.

Government should decide what services they have a duty to provide and should fund them properly. The Government need not always be the vehicle to deliver those services, as we have heard, but they can fund experts such as Combat Stress to do so on their behalf. This Government should also consider how mental health services for veterans or anyone else who needs them can be guaranteed when their national health service reforms are removing accountability. Again, we have discussed that already.

Those in the forces are trained to be strong, resilient and able to push through any challenge that stands in their way. That does not lend itself easily to admitting that one needs help because of a mental health problem. My right hon. Friend highlighted the high proportion of veterans suffering from a mental health condition—a staggering 81%—who are embarrassed by or ashamed of their condition and do not feel able to come forward. We have also discussed the average length of time it takes people to present in search of support, which is about 13 years. I understand that there are examples of people who have waited up to 40 years to get help. We must do all that we can to change that situation. We cannot just let it continue.

Combat Stress has also provided detailed evidence involving cases of individuals who have faced marriage break-up, unemployment, social isolation or substance abuse, all because they were unable to deal with their mental health. My hon. Friend the Member for Clwyd South (Susan Elan Jones) mentioned homelessness as well. We should be concerned about the figures, and I agree that it is right that we should seek to quantify the problem. The figures show that, even though help and support exist, too many people still find the stigma far too great to overcome. Until we tackle that stigma, no matter what support is out there, there will be no real change. Combat Stress’s campaign focusing on the issue of stigma is vital.

We have spent much of this year’s parliamentary debates on the forces discussing legislating for the covenant, so it is welcome that we are now debating the substance of the issues covered by the covenant and what it should mean in practice. It is right that nobody who serves their country in the forces should be disadvantaged as a result of their service. In some ways, however, getting the Government to enshrine that in law was the easy bit. The Government must now take action to implement the covenant so that we can see what it means in practice. I would welcome information from the Minister about the planned implementation of the covenant and how the Government intend to ensure that Departments and public bodies audit and change their policies to give our forces, our veterans and their families a fair deal.

My right hon. Friend highlighted the need to recognise how many veterans suffer from mental health issues. My hon. Friend the Member for North Durham (Mr Jones), the previous veterans’ Minister, announced plans when he was in post for a veterans’ ID card. The card would have enabled veterans to be identified easily and to get priority NHS treatment.

As we have discussed, it is difficult to quantify the level of need. Without a tracking system for veterans, we will never be able to do so. My right hon. Friend has asked in written questions how many ex-service people are being treated for mental health problems on the NHS, but there is no record, so the Minister replying was simply unable to give an answer because the data do not exist. Being unable to quantify the problem makes the Government unable to quantify the true cost of treating mental illness among former members of the armed forces. Therefore, the true impact is unknown at the moment. A veterans’ card would enable the Government to track veterans and offer the right support to those who need it.

In the Armed Forces Bill Committee, on which the Minister and I both served, the Minister reiterated his opposition to introducing an ID card, but the Government agreed earlier this year to launch a veterans’ privilege card allowing veterans to access commercial discounts. That is welcome, but I urge the Minister to look beyond discount schemes and extend those proposals, and to use the card as a way to ensure that veterans can access the support that they require when they need it.

[Mr Gray]

I am puzzled as to why the deeply bureaucratic and complicated system of issuing 5 million people with a piece of paper would help those suffering from mental stress many years after service to come forward and ask for the help that they need. I am not certain as to why that is a solution to the problem under discussion.

[Gemma Doyle]

The proposals were not overly complicated. The initial proposal was to start issuing a veterans’ card to people who are leaving the services now, not necessarily to go back and identify the 5 million people, because, as the Minister has told me, he cannot identify them. If we do not start to make some changes, we will never be able to quantify the problems. When we are able to know who the people are, the right support and services can be offered to them and contact can be maintained where it is wanted to ensure that the services are being delivered. Then, when an individual presents with a mental health problem, they can clearly be identified as a veteran and we will be able to see the problem much more clearly.