14th REPORT OF 2017–19: 'MENTAL HEALTH AND THE ARMED FORCES, PART TWO: THE PROVISION OF CARE' (HC 1481)
World-Class Mental Health Centre Essential for Service Personnel and Veterans
Defence Committee Press Notice – 25 February 2019
A “world-class centre for the treatment of mental injuries” suffered by Service personnel should be established in the next 12-18 months, says a new Report by the House of Commons Defence Committee, if veterans and their families are to receive the provision and support promised in the Armed Forces Covenant.
Whilst the Committee previously found that the vast majority of veterans leave the Services with no ill-effects, the minority who do suffer from mental health conditions need timely and appropriate care. The Ministry of Defence and the four UK health departments have made improvements, over the past decade, including the introduction of some veteran-specific services. Yet, for some serving personnel and many veterans, the current system still falls far short of what they need and deserve.
For those in uniform, stigma around mental health and the fear of career damage remain key disincentives to seeking help. And, when help is sought, there is an entirely unacceptable variation in the quality of care offered to serving personnel based in different locations in the UK.
Specifically, the Care Quality Commission rated two of the four MOD mental health care centres it inspected either as requiring improvement or as inadequate. Shortfalls of 50% in some military mental health staff posts have exacerbated the problems. The Committee therefore urges the MOD to demonstrate that seeking help for mental health problems is not career-limiting, and to improve the consistency of care received when Service personnel decide to come forward.
The Committee also found that less than £10 million a year—a shamefully small fraction (0.007%) of the £150 billion UK health budget—is being spent on government-funded veteran-specific mental health services across the UK. As a result, veterans face wide variations in the quality of treatment available, according to where they live and whether they are fortunate enough to have a GP with awareness of veterans’ mental health needs and services. Veterans in Northern Ireland, especially, lack specific mental health services.
Demand for veteran-specific services is swamping available capacity, leading to missed waiting-time targets. Some veterans are having to wait up to a year for treatment, after initial diagnosis.
The Committee is convinced of the need for a highly specialised place of safety to which veterans can be sent as soon as they are diagnosed, in order to be stabilised and to begin receiving assistance. Such a centre should preferably be co-located with the new state-run Defence and National Rehabilitation Centre (DNRC) for physically injured serving personnel at Stanford Hall. The NHS should urgently consult with the Ministry of Defence and the DNRC in order to establish this facility, with an initial operating capability, within the next 12-18 months.
Armed Forces families
The Committee is greatly concerned by the UK’s lack of Armed Forces' family-specific specialist mental health care—even when the very limited contribution of the Armed Forces charity sector is included. The mental health of families can also be damaged by exposure to the stresses of Service life; yet, many family members may hesitate to seek help. MPs urge the MOD, in cooperation with the four UK health departments, to review what help can be given to the families of serving personnel and of veterans with mental health issues.
Defence Committee member and Chair of the APPG for the Armed Forces Covenant, Ruth Smeeth MP, says:
"We acknowledge the work that the MOD and the UK health departments are doing to improve the mental health care provided to both serving personnel and veterans; but it is simply nowhere near enough. Fundamental issues still clearly exist, with scandalously little funding allocated to veteran-specific services, and it is unacceptable that veterans and their families should feel abandoned by the state as a result. It is vital that veterans get the quality of care they need when they need it, no matter where they live, supported by a world-class national centre. Only then will the Armed Forces communities believe that the promises made in the Covenant are not just hollow words."
[To read the full Report, click here.]
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We concluded in Part One of our inquiry into Mental Health and the Armed Forces that the vast majority of veterans leave the Services with no ill-effects. However, the minority of serving personnel and veterans who do suffer from mental health conditions clearly need timely and appropriate care.
The Ministry of Defence and the four health departments in the UK have together sought to improve the care available over the last decade and reduce the sense of stigma surrounding mental health. We welcome this and recognise that there have been tangible improvements, including the introduction of veteran-specific specialist mental health services across much of the UK.
Despite such improvements, there is no doubt that some serving personnel, veterans and their families who need mental health care are still being completely failed by the system.
For those in service, fear for their careers remains a key barrier to seeking help: even if they do, it is unacceptable that the quality of care received is not always up to standard, with shortfalls in staff exacerbating the problem.
Furthermore, it is a scandal that in an NHS budget of over £150 billion UK-wide, less than £10 million per annum (0.007%) has been allocated to veteran-specific mental health services. We found that the availability of government-provided care varies significantly depending on where they live and whether they are fortunate enough to have a GP who is aware of veterans’ mental health needs and services. Indeed, the continued lack of knowledge of the Armed Forces Covenant in the civilian health care system is a cause of deep concern and there is still an urgent need for clarity over how the Covenant’s principle of priority care is implemented in practice across the UK.
Even when specialist care is available, such services are clearly swamped by the scale of demand, leading to some veterans having to wait up to a year for treatment. Many of these veterans see their conditions deteriorate further whilst waiting for access to treatment and, in the most extreme cases, they take their own lives whilst awaiting help. To prevent this, patients must be continually monitored and reassessed during the gap between initial diagnosis and the commencement of treatment.
There needs to be a highly professional place of safety to which these veterans can be sent as soon as they are diagnosed, in order to be stabilised and to begin to receive assistance for their recovery. The Committee strongly believes that it makes sense for such a centre to be co-located with the new state-run Defence and National Rehabilitation Centre (DNRC) for physically injured serving personnel at Stanford Hall. The DNRC evolved from Headley Court, which rightly established a world-class reputation for the treatment of the physically wounded from conflicts such as Iraq and Afghanistan and it should be a national aspiration to establish a similar world-class centre for the treatment of mental injuries relating to service as well. The NHS should urgently consult with the Ministry of Defence and the DNRC in order to establish this facility with an initial operating capability within the next 12–18 months.
Specialist care is often too time-limited, which means those veterans with the most complex and long-term mental health needs find themselves alone or dependent on Armed Forces charities.
Thus, many veterans have to rely on the valuable services provided by these charities; but the sector remains stove-piped and does not work together to the full benefit of the veterans. The Government must “knock heads together” to provide a far more joined-up service.
With specific mental health care provision for Armed Forces families also non-existent, it is no surprise that many veterans and their families believe that they have been abandoned and that the promises made to them in the Armed Forces Covenant have not been kept.
It is vital that the improvements which the Ministry of Defence, the four UK health departments and the rest of Government are making in this field fully address these gaps and prove to the Armed Forces communities that, if they have mental health problems, they will be supported. Those who have worn the uniform of their country deserve no less.
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Armed Forces Provision
- The Care Quality Commission rated two out of four MoD mental health centres as inadequate or needing improvement between April 2017 and January 2019. (paragraph 10)
- There were at least 50% shortfalls in both uniformed and civilian psychiatrist posts in 2017–18. (paragraphs 19 and 20)
- Armed Forces charities have found that it can take four years on average before Iraq and Afghanistan veterans seek help for mental health issues. (paragraph 45)
- Despite this, the Ministry of Defence follow-up period for writing to veterans is only one year after discharge. (paragraph 43)
- Veterans in England wait 18 days, on average, for an assessment from the Transition, Intervention and Liaison Service after referral against a target of 14 days, according to NHS England. (paragraph 80)
- Veterans can wait up to a year for mental health treatment after assessment, particularly in Northern Ireland. (paragraphs 80 and 83)
- We estimate that total government spending on veteran-specific mental health services in England, Scotland and Wales is less than £10 million a year. However, there are no such services open to all veterans in Northern Ireland. (paragraphs 55 and 59)
- It is difficult to obtain authoritative statistics on veteran suicides. However, a study conducted for ITV last year, produced a figure that at least 71 serving personnel/veterans unfortunately took their own lives in 2018. Even as a rough estimate this gives a good idea of the scale of the problem. (paragraph 110)
- There were 76 UK Armed Forces charities providing mental health support in 2017, according to the Directory of Social Change and the Forces in Mind Trust. Of these, one-third exclusively focused on mental health. (paragraph 115)