Mental Health and the Armed Forces, Part Two: The Provision of Care Contents


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.

Published: 25 February 2019