In late February 2019, the UK Defence Committee published Part Two of an on-going inquiry into Mental Health and the Armed Forces. It is clear from the report that the UK Defence Committee recognises that whilst the Ministry of Defence (MOD) is making improvements to their provisions and services, there is still a significant gap that leave many personnel members and veterans suffering with mental health conditions feeling let down by the Service.
There has been a significant increase in the volume of Mental and Behavioural Disorders within the Armed Forces and the Veteran’s Community over the last decade. [1]However, it remains unclear exactly why this is the case. The MOD report that in 2017-18, 3.2% of serving personnel were diagnosed with a mental health disorder. This increase may be due to the increasing awareness of such issues through anti-stigma campaigns, resulting in higher detection rates. Alternatively, it may be a result of the nature of modern warfare in recent conflicts, such as those in Iraq and Afghanistan. What is clear, however, is that it remains a problem for sufferers and their families.
Mental health and the Armed Forces
Part one: The scale of mental health issues – An overview [2]
In January 2018, the Defence Committee began Part One of an inquiry into Mental Health and the Armed Forces, with the aim of examining the extent of mental health issues within the Armed Forces Community. It was concluded that the vast majority of service personnel leave the military with no-ill effects, having had a positive experience. However, there are many individuals that are not as lucky and leave service suffering from a mental and/or a physical health condition. Such individuals require timely and appropriate care, but the question here is whether the Armed Forces are providing this to an acceptable standard, specifically with regard to those with mental health conditions.
Mental health and the Armed Forces
Part Two: The Provision of Care – An Overview [3]
Part Two of the Defence Committee’s investigation into Mental Health and the Armed Forces focused on the provision of care, and assessed whether the current provision and services available are in fact satisfactory.
The report is broken down into the following five sections:
- Provisions available during service
- Provisions available when transitioning back into civilian life
- The statutory provisions in place for veterans
- Armed Forces Charities
- The help available for families of those suffering from mental/behavioural conditions
Whilst it is accepted that there are provisions and support in place for serving and ex-service personnel, the report highlights major flaws with the current system.
Shortfalls during service?
The main problems highlighted within the report are:
- There is a stigma attached to the topic of mental health;
- Individuals fear damaging their career by reaching out for help;
- There are inconsistencies within the speed, access and quality of care available;
- Low numbers of uniformed psychiatrist and mental health nurse postings.
Despite the attempts of the MOD to raise awareness and promote de-stigmatisation of mental health within service, several of our clients say they are still unaware of the help and treatment available to them. They also say they are often discouraged by more senior members within their Chain Of Command to speak up about their mental health concerns and are reminded of the potential career implications of doing so.
The Committee calls on the Government to continue to champion a change in attitude towards mental health within the Armed Forces by demonstrating that mental conditions are taken seriously and will not impinge on careers. The Committee suggests a complete review on the management of military mental health services to establish why there are such variations and inconsistencies in the care that is available, as well as reviewing the recruitment process for military mental health roles.
What problems are identified when transitioning into civilian life?
The main problems highlighted within the report are:
- Insufficient duration of follow up period following date of discharge.
- Difficult threshold to be achieved for a successful Armed Forces Compensation Scheme (AFCS) award which leads some to feel their condition is not recognised.
We have heard first hand that a large number of our clients have made unsuccessful AFCS claims due to not achieving the high requirements set by the scheme. This can be extremely frustrating when an individual entered service with excellent health and left service, having been advised by medical professionals that they are suffering from a mental health condition which is believed to be caused by service.
The Committee suggests that the Defence Department focus on ensuring continuity in support for veterans leaving the service through revising its follow-up policy, and improving the current AFCS system in place.
The shortfall in veteran-specific healthcare services
- Less than 0.007% of the UK-wide NHS budget is dedicated to veteran-specific mental health services.
- Certain areas are experiencing waiting lists of up to a year before treatment is provided following initial diagnosis.
We are frequently told by clients that they have been diagnosed with mental health conditions such as PTSD but are struggling to secure treatment or medical appointments. In particular, appointments with medical professionals with experience in dealing with military personnel and ex-service personnel.
The Committee urged the Government to address the evidential gaps within veteran-specific provisions across the UK. It recommended achieving this by ensuring that the correct resources are available, that priority treatment for veterans is given in practiced and that plans are put in place to combat the deficiency in funding. The Committee was also keen to establish a world-class centre for the treatment of mental injuries relating to service, similar to the new-state run Defence and National Rehabilitation Centre (DNRC) at Stanford Hall that treats physical injuries developed through service.
The strain on Armed Forces charities
In 2017 there were 76 Armed Forces charities providing mental health support to veterans. Whilst the work they are doing is invaluable, many argue that it should not be their responsibility to pick up the pieces due to the shortfall of the Government and the NHS.
The main problems highlighted in the report are:
- There is a risk that these charities will become overburdened as the demand continues to outstrip the supply of care available.
- The lack of coordination between the Government, the NHS and Armed Forces charities portrays a disjointed system that veterans feel fails them when they need it most.
The Committee highlighted the need for a more cooperative relationship between charities, NHS and the Government to ensure the most beneficial outcome for those suffering with their mental health due to service.
Is there any help available for families of suffered?
With regards to the Armed Forces Covenant the report suggested the Government are not living up to their promise made to the families of service personnel. There are no specific mental health care provisions in place to support family members that can also be affected by traumatic events suffered by serving personnel.
The Committee called for the Government to place a greater focus on the services available to military families, and review exactly what assistance can be provided.
The future
Through our direct experience of dealing with clients who suffer from mental health conditions such as PTSD, we have been told first hand of some of the challenges they face and the difficulty they often experience finding and accessing help. It is a frequently voiced concern of our clients that they often feel abandoned and unsupported when suffering with a mental health condition, caused during their service to our country.
We welcome the changes the MOD is are making, but for some they have not come soon enough. We hope that following the release of this report, serious steps will be taken to improve the current state of the system and provide serving personnel, veterans and their family members with the care they need and deserve.
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[1] Ministry of Defence, Annual Medical Discharges in the UK Regular Armed Forces (July 2018)
[2] House of Commons Defence Committee, Mental Health and the Armed Forces, Part One: The Scale of Mental Health Issues (July 2018)
[3] House of Commons Defence Committee, Mental Health and the Armed Forces, Part Two: The Provision of Care (February 2019)
