Mental Health

Madeleine Moon Excerpts

Thursday 16th May 2013 Commons Chamber

[Mrs Madeleine Moon (Bridgend) (Lab)]

It is a privilege to follow the right hon. Member for Sutton and Cheam (Paul Burstow). The House will recognise the work that he has done in bringing this issue not just to our attention, but to that of the wider public. I also pay tribute to the hon. Member for Broxbourne (Mr Walker), who has done fantastic work in this area, and to my hon. Friend the Member for North Durham (Mr Jones). [Interruption.] My hon. Friend moves away from me just as I am commending him.

I want to consider mental health issues in the armed forces, because there is an urgent need to address some myths and problems. The armed forces also have wonderful examples of best practice that are not generally appreciated and have not been dispersed throughout wider mental health services.

Looking back in time, there were 80,000 cases of shell shock or battle fatigue during the first world war. The British Government, realising that they had to do something because of problems in getting troops to the front line, started looking at mental health. Changes in mental health treatment started because the military needed to deal with mental health problems.

[Jeremy Corbyn]

My hon. Friend is making an important point about the experience of the first world war. Does she recognise that there was a great deal of discrimination against and abuse of ordinary soldiers who suffered mental health trauma as a result of the first world war, whereas some of the officers who suffered it got therapeutic treatment in special homes around the country? There was an enormous difference between the approach taken to soldiers and to officers.

[Mrs Moon]

My hon. Friend is correct. Craiglockhart hospital and the work of Dr Rivers are a prime example of the excellent treatment that was given to some officers. Many people continued to cope with post-traumatic stress disorder, which we now recognise. It was not identified as a condition at the time, although it is detailed in some post-war journals. We have, however, moved forward.

To return to my original point, the military is often at the cutting edge—it needs to be—of looking at mental health problems. Post-traumatic stress disorder has risen up the mental health agenda in the armed forces, mainly because of statistics from the United States. The US Department of Veterans Affairs estimates that post-traumatic stress disorder affects 11% of veterans of the war in Afghanistan and 20% of Iraq war veterans. By contrast, the figure for the UK—these statistics are taken from a 2010 edition of The Lancet—is 4%, while 19.7% reported more common mental health disorders and 13% reported alcohol abuse.

I want to consider the issue of alcohol abuse in the armed forces and its impact on mental health problems. The Ministry of Defence has spent a lot of time providing services, raising awareness and developing programmes such as TRiM—trauma risk management—which I will look at later, and there is far greater understanding of mental health problems among the military. Much of that is thanks to the excellent work of and collaboration between the MOD and King’s college London. I draw Members’ attention to “King’s Centre for Military Health Research: A fifteen year report”, which was published in 2010 and sets out the stunning work that has been carried out. It talks about the roll-out of TRiM. The unit has helped to raise the awareness of most common mental health problems among military personnel, including depression, alcohol misuse and post-traumatic stress disorder, although that is not the most prevalent. The unit found that pre-deployment screening was not effective in picking up problems and that mental health problems did not necessarily apply only to those whose problems had been indentified before they were deployed. Who will be affected by deployment cannot be predicted.

[John Glen (Salisbury) (Con)]

In the hon. Lady’s investigations into this critical area, has she discerned any difference between the ways in which reservists and regulars are treated with respect to screening and treatment? If she has, does she think that that needs to be addressed?

[Mrs Moon]

I thank the hon. Gentleman for his intervention. When he was on the Defence Committee, he took a particular interest in this area. As I will explain later, reservists are particularly vulnerable. That is more of a problem in the US because they are deployed for longer and have less support once they are home. However, it is a major issue that we must address in the UK as we increase the percentage of reservists in our armed forces.

The work at King’s college London highlights the importance of adhering to the Harmony guidelines and the negative impact of changing tour lengths during tours. The Secretary of State for Defence announced in a statement yesterday that we are extending the tour length for two brigades that will be deployed over the next two years. That has implications and we must ensure that King’s college London is involved in tracking the changes that it brings.

[Rehman Chishti (Gillingham and Rainham) (Con)]

Will the hon. Lady give way?

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[Mrs Moon]

I will, but this is the last intervention that I will take.

[Rehman Chishti]

The hon. Lady is talking about the research undertaken by King’s college London. Experts at Imperial college London have said to me:

“Mental Health Services and research are a UK success story. We have produced world leading research in many areas which has led to new treatment approaches which have improved patients’ lives”.

Will she join me in paying tribute to all the researchers and academics in our country who have done so much to improve the quality of care for patients?

[Mrs Moon]

The hon. Gentleman is right that a number of universities are doing excellent work in this area. The centre at Oxford has done wonderful research, as have Bristol and Manchester. I have referred several times to King’s college London because of its expertise in defence medicine. I am not denigrating the work that is taking place elsewhere; I am merely highlighting the importance of the work at King’s college London.

The King’s college London research has looked at the importance of decompression, whereby serving members of the armed forces have the opportunity to spend time together and take part in physical activity before they reach home. That has made a huge difference in the mental health outcomes of serving personnel.

Interestingly, the research has identified the groups that are most at risk of problems. They are not those who have served for the longest or most frequently in the armed forces. They are the early service leavers—those who leave the service shortly after their initial training. The risk is higher among those who fulfil combat roles. We forget how small a percentage of our armed forces is made up of people who go out through the gate and pursue combat roles. That work is of great benefit to the military, but it is also important that it is sustained and utilised in our wider understanding of mental health.

I want to talk briefly about TRiM, which is about trauma resilience. It was developed and utilised by the Royal Marines. It trains individuals to identify signs of distress within their own units and within themselves. It means that problems can be identified early on, and help provided quickly. Interestingly, the trauma and resilience handbook that is given to serving personnel and their families provides advice on looking after themselves, talking about their experiences, and how to deal with returning home—coping skills such as dealing with anger and alcohol, combating stress, and sleeping better. It provides tips for spouses, partners, families, friends and parents of returning serving personnel, as well as for the returning reservist. It is a prime example of how we help prepare people for what they are going to experience. We do too little in this country to prepare people for the risks of mental health problems. We do not tell people; we are not educating our young people in how they can identify within themselves, or within their families and friendship groups, some of the risks they will inevitably face in times of difficulty throughout their lives.

I am pleased that the work of TRiM has gained traction elsewhere and been adopted by many other organisations and employers. Even a cursory internet search demonstrated that a number of organisations are using TRiM to help their employers, in particular the blue-light brigades. The police force and Departments including the Foreign and Commonwealth Office frequently train their officers in TRiM.

US research into factors predicting psychological distress among rape victims has shown that initial distress was a better predictor of subsequent psychological functioning than other variables, as well as in the treatment of rape and other types of post-traumatic stress disorder. The use of TRiM and post-traumatic stress disorder management is extending into areas that we had not previously recognised would impact on the general mental health of people in the wider community.

Another area in which the military has taken time to expend its capabilities is the Big White Wall—an online 24/7 early intervention service for people suffering from mental distress. It is free for serving personnel veterans and their families, and as of December last year, 2,500 members of the armed forces community were registered. Seventy-five per cent. of members talked about an issue for the first time on the Big White Wall, 80% managed their psychological distress, and 95% reported an improvement in their well-being as a result of using that service.

There is consensus that reservists are more likely than other serving personnel to experience mental health problems as a result of their service, which is thought to be because when they return from tour they return to civilian life, away from the support network that a regiment offers. Academics at the King’s Centre for Military Health Research, in conjunction with others, conducted a five-year study of 500 reservists who worked in Iraq, which showed that they were twice as likely as regular soldiers to suffer from post-traumatic stress disorder.

Current drives to recruit 30,000 reservists as part of the Future Reserves 2020 programme mean that we will need further research in that area. A number of Members will have an interest in this issue, because reservists come from across the country and live and work in all our constituencies. The most recent figures Combat Stress could give me showed that it had received 1,558 approaches from veterans from Iraq, 123 of whom were reservists. From Afghanistan it had received 752 approaches, including 55 from reservists. With the discharge of large numbers of serving personnel as a result of cuts, I am concerned that high levels of alcohol misuse within the services may be transferred into their civilian life. Service personnel are not a group that readily seek help, and much remains to do in relation to mental health. Our wider society and its services must be ready for the discharge of large numbers of serving personnel into our communities.

Every hon. Member who speaks today will no doubt be aware of the difficulty of working with general practitioners and of making them aware of the mental health services that are available. One problem is that GPs see few veterans. There is a heavy reliance on individuals to make their GP aware of their military service. In 2011, the Royal College of General Practitioners issued guidance to GPs on how to meet the health care needs of veterans, but the onus is on the GP to be aware of it. According to the last figures I have, only 320 GPs had accessed an e-learning package on help to identify veterans with mental health problems. We need to work to increase that number.

Our police forces need to be helped and supported in understanding how often they will come across veterans. Figures show that they are coming across veterans who are dealing with alcohol problems and having episodes of self-harm, which in military terms means looking for fights in which they will receive physical injuries. Alarmingly, a recent independent commission on mental health and policing showed that the Met police have a particularly poor record of dealing with people in mental distress. A quarter of calls to the Met police each year—600,000 calls—were linked to mental health. We need to tidy up the link between mental health and the police.

[Norman Lamb]

The hon. Lady makes important points on people in the armed forces and veterans. Is she aware of Lord Adebowale’s valuable work and report on the link between police and mental health, which was published last week? It was commissioned by the police and dealt with how to improve the way in which they operate. It is good news that the police were prepared to commission Lord Adebowale’s report and are prepared to listen to his advice.

[Mrs Moon]

I am very aware of that research; the point I was about to make comes from it. The problem is that we often use the police as our first line in dealing with people with mental health problems, but they are not trained and equipped to carry out that role and function. We must do something about that. Otherwise, the person with the mental health problems is often dealt with as a disruptive element, and treated as if they are someone violent and aggressive, rather than someone who has a mental health problem. We must deal with that problem.

Words and anecdotes can be dangerous, particularly in the military. Research was published this week by the Defence Analytical Services and Advice agency on Falkland veterans. It found that 95 veterans had taken their own lives since the end of the conflict. That figure is lower than previously assumed, although each death is a tragedy for the individual and family involved. The research showed that, of the 26,000 mobilised, 255 died in conflict and 95 took their own lives, but 455 died of cancer. We sometimes forget that our armed forces community has problems we need to address that are not necessarily mental health problems.

[Mr Kevan Jones (North Durham) (Lab)]

I agree totally with my hon. Friend that each of those 95 people taking their own lives is an individual and family tragedy. My problem is that, in opposition, the Conservatives, including the Prime Minister, took the figure used prior to the research and quoted it freely, like confetti, to try to discredit what the Labour Government were doing for veterans’ mental health.

[Mrs Moon]

I tracked that figure back and found that it initially came from a story in the Daily Mail. That is how currency becomes fact.

[Mr Jones]

It was repeated by the Conservatives.

[Mrs Moon]

The repeating of such figures is the dangerous part as it places the perception in people’s minds. More dangerously, it goes into the minds of veterans, who then think, “I have served. I will have a mental health problem and post-traumatic stress disorder,” when the opposite is true. It is incumbent on all hon. Members to ensure that our work and the facts we share come from academically proven research. A study by Lord Ashcroft suggested that 92% of the public believe that all veterans will have a mental health problem, but research suggests that the opposite is true—that 90% do well.

We have had a 15-year report from the King’s Centre for Military Health Research, but we need a 20-year report showing the impact of the draw-down from Afghanistan and the increased numbers of veterans in the community.

In this debate on mental health, words can be dangerous—they can harm and create impressions in vulnerable minds. They can make people believe they have a problem they do not have, or that they have a problem that they can survive and grow from. Military mental health is robust. The transition to civilian life, alcohol misuse and reservists are risks that we must take seriously and tackle. The MOD will need to work more closely with the Department of Health. As people leave the armed forces and become civilians, civilian society organisations need to be equipped and ready to help. As civilians, we face the same problems together.

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[Mr Walker]

The hon. Gentleman makes an excellent point. Patients need a voice and an advocate, and often—not always, but often—a family member is best placed to do that. The patient’s wishes should be respected.

[Mrs Moon]

I wanted to follow up on the same issue as the Minister. In preparing for this debate, I received many e-mails from people who had to become experts in the condition in the hope of protecting a family member from exactly the sort of abuse that the hon. Gentleman is talking about. The fear that carers feel when a loved-one comes into contact with the health services, which should be there to protect them and aid them in their passage through their illness, should not exist. That fear should not add to the trauma of their treatment. That is something we have to address.

[Mr Walker]

It is not a crime to be ill. It is not a crime to have cancer, it is not a crime to have heart disease and it should not be a crime to have a mental health illness. What we need is compassion.

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[Mr Jones]

We need to explode the myth that the problem is funding. I do not think it is; I think it is where the funding is spent—a point raised earlier. Indeed, funding that is properly spent on early interventions for people with mental health issues will save the NHS money in the long term, not cost it.

[Mrs Moon]

There is an issue with the interaction of mental health and alcohol. I repeatedly had texts from a dear friend of mine who is a minister in the Church. He had severe depression and was self-medicating with alcohol. His family and the police would repeatedly take him to mental health services, which would turn him away, because they said he had been drinking. He was drinking because he needed their services and could not access them. We have to ensure that mental health services cannot turn away people who have been drinking, but hold them until they are no longer under the influence of alcohol and then ensure that they access the services they need. The link between alcohol and mental health has to be explored and tackled.

[Madam Deputy Speaker (Dawn Primarolo)]

Before the hon. Member for North Durham (Mr Jones) continues, let me say that interventions are becoming speeches in their own right, when they are supposed to be brief and pertinent to the point that has just been made. If we could return to that, perhaps it would help the flow of the debate.

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[Jane Ellison]

I could not agree more.

My worry is about the 83% of teachers who just do not know about FGM or have not had the training. There are good guidelines, but they are not statutory. Not enough is filtering down. In my constituency, I have encountered people who say, “Don’t go there. It’s too difficult.” There is a role for Members of Parliament in pushing this matter at a constituency level. If teachers have no idea what FGM is or what the behavioural and psychological consequences might be, they will fail to understand why a young girl who has come back from being mutilated abroad is exhibiting naughty, disturbed or bad behaviour. It is therefore important to get more knowledge out there about the physical and psychological aspects of FGM so that we can understand and help children who present with signs of being disturbed.

In UK culture, women have an expectation that their sex life will be enjoyable and that they can have a normal expression of female sexuality. That is very much at odds with the mentality that leads to somebody being mutilated. Many of the women who are suffering the physical and mental complications of FGM do not speak English and live in socially isolated communities in which they are not encouraged to speak about it because it is entirely taboo. That is added to the taboo of speaking about mental health.

The lack of knowledge about FGM among teachers and medical professionals will increasingly be a problem as diaspora communities become scattered to places in the country where professionals do not see it as much. It is easier for a specialist in central London to know what they are looking for. Even if we stopped all FGM happening to young girls tomorrow—would that we could—we would still have to deal with the large number of women who are suffering the long-term consequences of it.

There is documentary evidence that some parents have second thoughts about having done this to their children. Some parents express regret. The Home Office had a good initiative last year, which we adopted from the Dutch, in which it provided girls and parents with a health passport to carry abroad with them to remind members of their extended family that the practice is illegal in the UK and that they must not do it, but must respect the rights of the child.

[Mrs Moon]

The hon. Lady is making some very interesting points, but the focus of this debate is mental health. Perhaps she could conclude by pointing out the mental health messages—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. It is for the Chair to decide what is in order and what the debate is about. I need no help from the Back Benches, although it was very kind of the hon. Lady to intervene.