Mental Health (Veterans)

Lord Robathan Excerpts

Tuesday 6th December 2011 Westminster Hall

[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.