Veterans (Mental Health)

John Pugh Excerpts

Wednesday 7th March 2012 Westminster Hall

[John Pugh (Southport) (LD)]

I congratulate the hon. Member for York Outer (Julian Sturdy) on opening this important debate.

I must admit that I am not a natural when it comes to defence-orientated debates. I do not come from a garrison town and I have no experience of the forces—I suspect I am naturally too insubordinate to fit into them. However, I have a genuine interest in this issue. It is spurred not so much by constituency cases, although a soldier came to see me who was severely traumatised by the conflict he had endured, and the atrocities he had seen, in Aden. It was an awfully long time ago, but it had scarred his whole life, traumatising him, driving him to alcoholism and creating huge mental health issues. I also dealt with a case in which a gentleman who had been advised by the Ministry of Defence to assist it with research at Porton Down on the common cold subsequently had a lot of worries that were quite unrelated to his exposure to the common cold.

What really sparked my interest, however, was my experience on the Public Accounts Committee, which produced a series of interesting reports on and around this area that showed up some quite distinctive and worrying issues. The report I want to dwell on was called “Ministry of Defence: Treating injury and illness arising on military operations”. It showed quite categorically that the forces were excellent at dealing with people’s physical ailments in the theatre of war and subsequently—the profile and the results were good, and the medical treatment was exemplary. When it came to mental health, however, there were some very odd results. For example, it appeared that American and British soldiers exiting the same theatres of war had widely disparate experiences in terms of their mental health, with more Americans reporting themselves, or being reported, as having mental health problems by a considerable margin.

Even more strangely, the figures coming out of the British forces for mental health problems showed soldiers were experiencing no real anxiety at all; in fact, they showed that troops were in just as good mental health as the ordinary population, which was odd. During the PAC inquiry, I told Sir Bill Jeffrey, who was permanent under-secretary at the time:

“I think we would all accept that war is extremely stressful and people see some horrid, fearsome things that would disrupt the psychology of almost anybody. What surprises me”—

then and now—

“is that the referral of the Forces appears to be lower than the referral rate of the population as a whole.”

I put it to him that that was intrinsically implausible:

“You would have thought there would be more mental health issues amongst a population of people who see quite traumatic scenes than amongst those who do not.”

More brutally, I said the rate of referrals

“is actually lower than the population at large. In other words, it would appear…that in the confines of Committee Room 15”,

where the PAC was meeting,

“we are far more vulnerable to mental health stress than people in the operational theatre of war.”

It can be pretty torrid in the PAC at times, but I suggest that result shows that something is going awry in the forces’ reading of troops’ mental health post-war.

Equally puzzling was the disparity between people coming out of the Iraq and Afghanistan theatres of war. Lieutenant-General Baxter, who was then the deputy Chief of the Defence Staff, explained:

“I think you have to look at the nature of combat…When you are being shot at and you can shoot back, it is a lot less stressful than when you are being bombed or suffering indirect fire.”

I do not know whether that is true, but it invites serious questions about the level and quality of screening when people are discharged.

Other reports that the PAC produced at the time were equally troubling. They showed, for example, that squaddies were far less well prepared for the outside world than they could have been when they were discharged. There were also troubling statistics, with which we are all familiar, about high rates of alcohol problems, imprisonment and homelessness among people leaving the forces.

That is all very troubling, and the causes are fairly complex, but one thing is absolutely clear: the screening of soldiers exiting the theatre of war was very poor in the British forces. Often, it was done simply through self-completed questionnaires, but people do not ordinarily volunteer any deep psychological problems they may think they have in such a questionnaire.

There was also evidence in the PAC report that I quoted that support for people in the theatre of war was relatively poor. The most that they seemed to get out there most of the time was three community nurses, along with one consultant psychiatrist every three months. If people showed up with problems in the theatre of war, those problems were unlikely to be fielded especially well. There are particular issues here, and we must be prepared to face up to them. One, although I have only anecdote to go on, is that some people enter the forces because the structure that they provide is exactly what their personality needs. When they leave the forces, however, that structure simply disappears. Often, their homes will have gone, and their families will sometimes have gone, too, so they find themselves in difficult territory.

A second suggestion is that there is necessarily a culture of mental toughness in the forces, so people are slow to own up to whatever problems they may have. Those problems might therefore go unrecognised and be submerged for quite some time, and that is at the root of some of the problems that were so well analysed by the hon. Member for York Outer.

We in this place have clocked these problems, and quite a lot has been done about them. Since 2010, when the PAC report I quoted was produced, there has been a surprising amount of really good progress. On 6 April 2010, the previous Government committed themselves to providing £2 million of new funding. They can be credited with increasing the number of helplines and endeavouring to increase the education and training of GPs. We also pay tribute to the Murrison report, which represented excellent progress. Before that, the Ministry of Defence even did some research, which helped everything along. There is strong cross-party commitment to recognising these problems and doing something about them. In a sense, therefore, Parliament can justifiably credit itself with having done something about a very real and clearly identified problem.

I would like to conclude by thinking about where we go from here. My concern is that most of the solutions that were proposed following the previous Government’s deliberations and the Murrison report involved something along the lines of specialist health service commissioning. I do not want to talk about the difficulties of the legislation currently going through Parliament, but such specialist commissioning is an issue. The hon. Member for Hexham (Guy Opperman) has advocated as a solution getting round specialist commissioning to some extent by means of an agency that is a one-stop, catch-all arrangement. Creditable though that suggestion is, it will not get us out of the business of specialist commissioning, because the problems will show up locally in many diverse settings. I wonder whether the Minister will say something about that.

[Derek Twigg (Halton) (Lab)]

When I was the Defence Minister with responsibility for such matters, we set up pilot schemes with the NHS, with which Combat Stress was involved. Delivery issues are important, because in most respects the treatment is exactly the same whether the patient is a civilian or not, but some members or former members of the armed forces would prefer to talk to someone with experience in the armed forces. That is why we involved such people in the pilots.

On the other hand, other people from the armed forces did not want to see someone who had also been in the armed forces, because as far as they were concerned that life had finished, or they wanted to move on, or they had had a bad experience. It is a difficult issue to come to terms with, and that is why there is a need to mix and match support and clinical help. It is important for people to have that choice.

--- Later in debate ---

[John Pugh]

I defer to the hon. Gentleman’s experience, and he is probably right in advocating that solution. The question is who will secure that proper mix.

[The Minister of State, Department of Health (Mr Simon Burns)]

Will the hon. Gentleman give way?

[John Pugh]

The Minister is going to tell us.

[Mr Burns]

I am grateful to the hon. Gentleman. Given that I will not have very much time to speak, can I deal with the question of who will commission veterans’ mental health services? It will be the responsibility of the NHS Commissioning Board.

[John Pugh]

I am relieved that it is placed within an appropriate body, although the board has an awful lot else to do.

--- Later in debate ---

[Andrew Percy]

I entirely endorse what my hon. Friend says. We have probably all seen examples in our surgeries of military service sometimes leading to breakdowns, which are then presented at our constituency surgery for assistance. I am reminded of the old saying: while the physical wounds may heal, the mental scars never quite go away. So I endorse what has been said by other Members today.

[John Pugh]

One of the themes in the debate today has been whether we do or do not have a veterans agency. Somebody said that the veterans agency is an American model, but the Americans do not have our GP system. Even with the existence of a veterans agency, is there not a problem with how that then interacts with the GP, who will often be the first port of call when problems occur?

[Andrew Percy]

That is exactly the point that the hon. Member for Hexham (Guy Opperman) accepted. In creating anything, there will always be interaction problems. We all know where we want to be; how we get there is probably a bit more difficult. Now that the shadow Minister and the Minister will have a little more time, I am sure that they will expertly plot a course forward to deal with these issues.