Mental Health (Veterans)

Paul Beresford 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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.

[Sir Paul Beresford]

That issue was raised with the previous Government. Some time between then and now, national commissioning of Combat Stress long courses was introduced. My hon. Friend is absolutely right about the recommendations of potential patients and about the other niche groups and niche courses. The Department of Health will need to look at the issue.

[Oliver Colvile]

I think that that is right. Local authorities also have to be involved. They will now take increasing responsibility for the matter. I was talking to the leader of my council last week, and she explained that until recently, the primary care trust had not been that interested in engaging on some of those big issues. I will be interested to know how that will happen. The whole story of mental health, as the right hon. Member for Salford and Eccles said, is an important issue.

We closely support our armed forces and veterans. Some of us—I happen to agree—are not convinced that we have handled the politics of what is going on in Afghanistan particularly brilliantly. However, if we are going to support our armed services, we must ensure that we look after them properly and that they come out with good results. How we deal with the issue of mental health will be paramount. As others have said, there are issues regarding licensing. In Plymouth, we have significantly more licensed premises than in Liverpool. That is a big issue. When people get depressed, they end up turning to alcohol and other substances. We must ensure that there is a joined-up and co-ordinated approach.

If we do not deal with the issue, we will have problems with our infrastructure, not only of the health service but of education. I heard a story that it is not mainly what comes out in the health stories but what happens in the home that is absolutely, utterly and desperately important. That is where all the problems kick off, and they do not become apparent until significantly later.

Mr Dobbin, thank you for allowing me to talk about the matter. I feel absolutely serious about the issue. It has been a great pleasure and honour to follow the right hon. Member for Salford and Eccles.

--- Later in debate ---

[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.

[Sir Paul Beresford]

The point made by the right hon. Member for Salford and Eccles was that many of these people will not present themselves and do not understand the problems, and that asking them will not get the result that the hon. Member for West Dunbartonshire (Gemma Doyle) seeks. That is why I have insisted— I think this point was raised earlier—that the decommissioning that is done in the States, and to some degree here, might be the answer, without the paper.

[Gemma Doyle]

No one measure will sort out this problem—there needs to be a range of measures. I think that, taken together, the hon. Gentleman’s suggestion and mine would help to address the problem. I do not think that we will be able to quantify the issues unless the data and the systems are in place.

The hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) has already mentioned that it is important that we do not overlook the particular impact of deployment on the mental health of our reservists. Professor Simon Wessely of the King’s Centre for Military Health Research states that reservists who have served in Iraq or Afghanistan are three times as likely to suffer mental health problems as members of the regular forces. The Government’s Future Force 2020 plan suggests that the role of reservists is to increase substantially as a result of the reductions in the number of regular service personnel, so the Government must have the support in place to ensure that reservists are prepared to take on those extra responsibilities and that extra role, as well as guarantee that they have access to the correct mental health care and support when they return from deployments or are no longer mobilised.

As in the rest of the forces, there has been progress in recent years. The reservist mental health programme extended mental health support for reservists, but, with their role set to increase, the provision of support will have to be pointed in the right direction to cope with the increased number of reservists who are to be deployed. I would therefore appreciate an assurance from the Minister that the mental health care of reservists will be given due attention.

In conclusion, I again congratulate my right hon. Friend the Member for Salford and Eccles on securing this debate. We have heard of experiences from around the country, and they have illustrated the need for attention not to be diverted from the issue. The hon. Member for North Wiltshire (Mr Gray) asked what measures we can and should take to improve the situation. Combat Stress is asking for five things. I do not think that I can improve on them and would welcome the Minister’s comments on them. This debate has given us the opportunity to recognise the role that the NHS, the Ministry of Defence and Combat Stress play in supporting the mental health and welfare of our veterans. I pay particular tribute to Combat Stress, which, along with many other service organisations and charities, plays an outstanding role in support of the whole armed forces family, for which we should thank it.