148.We concluded in our Part One report that the stresses of Service life can also affect Armed Forces families. Spouses and other family members can be affected by a traumatic event suffered by serving personnel or by constant redeployment. We recommended that the Government placed a greater focus on Service and veterans’ families as part of its mental health care provision, including greater research.
149.In its response to our report, the Ministry of Defence acknowledged the pressure that can be placed on Armed Forces families and suggested that most families can seek mental health support help through the mainstream civilian health systems for their nation. If necessary, the new veteran-specific services in England could also offer some support to families. It also told us that a charity, the Centre for Mental Health, has a Mental Health Research Programme focused on veterans, with the impact on families being one of its priorities. In January 2019 the Ministry of Defence also announced that it had commissioned a study to assess the support available to Armed Forces families. It is expected to report in Summer 2019.
150.Armed Forces charities, such as the Royal British Legion and the Naval and Army Families Federations, believed that Armed Forces families did have specific mental health needs different from those of the general population. As the Contact Group told us, this is “due to unique stressors, including deployment and needing to support a spouse or partner with their own mental health problems”. The British Psychological Society and the family federations also identified Armed Forces’ children aged under 16 as a specific group at risk, not least given the lack of children’s mental health services in general. As Tim Boughton, a veteran, told us:
I was becoming angrier and more aggressive, and it was my wife at the time recognised it. She would sit on the step at home and dread the day of my walking through the door, because she didn’t know whether I was going to be angry and storm upstairs or whether I was going to be fairly nice. That also impacted on my daughter at the time.
151.Like veterans, families looked for understanding by civilian medical practitioners of their particular circumstances as military families. A survey by the Naval Families Federation found that, nearly 60% of those who accessed NHS care, believed that the GP or other NHS medical professional was “not sufficiently understanding of their circumstances as part of an AF [Armed Forces] family”. It was also reported that NHS staff did not understand that this had any relevance. One spouse told us that she simply did not feel comfortable talking to her GP about her issues, while another told us that:
We are dealing with specific mental health issues which sometimes cannot be addressed or understood by civilians. I have attended IAPT [Improving Access to Psychological Therapy] assessment appointments only to be told to find a private counsellor or do some CBT [Cognitive Behavioural Therapy]—unfortunately the private counsellors just do not understand the circumstances in which we live in.
152.There is very little current statutory provision of Armed Forces’ family-specific specialist mental health services. Veterans’ NHS Wales said that they were only funded to treat veterans while the Big White Wall, funded by NHS England, provides online mental health support to the Armed Forces, including families, but no treatment. The Contact Group reported that some NHS Transition, Intervention and Liaison Services (TILS) provided support to families. However Dr Deirdre MacManus, Royal College of Psychiatrists and lead psychiatrist for the London TILS, told us that they had identified this area as a gap in the service and were bidding for further funding to allow them to provide services.
153.There is also limited provision by the Armed Forces charity sector, as the Royal College of Psychiatrists and The Contact Group reported to us. Combat Stress reported that Walking with the Wounded and The Big White Wall have been seeking to introduce family services, but there remain challenges over clinical governance. However, Mark Birkill, therapist at Veterans’ NHS Wales, and Dr Jonathan Bashford, Director at Community Innovations Enterprise, told us that there are local charities that provide at least some support to families. NHS England reported that it is working with the charity sector to improve the mental health care provision for Armed Forces families.
154.Witnesses also reported that family members might not seek help. Research by Help for Heroes found “16 per cent [of those surveyed] saying they would try to cope with any issues alone, with only 5 per cent saying they would seek help from a mental health professional”. It also found that stigma was the main reason for not seeking help, with over 40 per cent believing that they “need to be the strong one”. One mother told us:
I also joined The Ripple Pond it took me several goes of telephoning and putting the phone down. Not having the courage to do it, not wanting to feel guilty. Eventually after one argument too much with my son I did it. They were amazing. I was breaking my heart. They listened and gave me advice.
155.Kate Davies, Director of Health & Justice, Armed Forces and Sexual Assault Services Commissioning at NHS England, recognised the importance of family members in supporting those with mental health needs and, in its written submission, NHS England reported that carers of veterans were involved with NHS England care provision to veterans. However, veterans and Armed Forces families said there was inadequate support for their efforts to help their Armed Forces’ family members to manage mental health issues (Case examples 18).
Case examples 18: Veterans’ and family members’ views on support as carers
“The impact of MH on families seems to be wholly underestimated and unrecognised. We provide support 24/7 and have first-hand experience of how our partners are coping. We receive no training in how to support our loved ones or how to cope with someone with MH issues. This leads to a detrimental impact on our own mental health (as I can personally testify).”
“There should be information sent out to wives of ex military personnel of symptoms to look for, they are the front line and take the brunt of a husband/partner with PTS.”
Partners and soldiers/veterans’ families (not only wives) should be provided with adequate support and be invited to discuss the issues they are facing and receive guidance and support to enable them to best assist the soldier/veteran.
Source: Annex 1: Summary of individual responses received
156.We are very concerned by the lack of Armed Forces’ family-specific specialist mental health care in the UK, including the very limited provision within the Armed Forces charity sector. As we reported in Part One, the mental health of families can be just as exposed to the stresses of Service life, especially if they are living with serving personnel or veterans who have complex mental health issues. Yet many may be reluctant to seek help, perhaps because of the perceived stigma or because civilian medical practitioners would not understand their situation as an Armed Forces’ family member.
157.We repeat our recommendation from Part One that the Ministry of Defence, in conjunction with the health departments of the four nations, should place a greater focus on service and veterans’ families as part of their mental health care provision. This should include providing additional funding to statutory services, such as the Transition, Intervention and Liaison Service in England, to assist families. We also recommend that the Ministry of Defence, alongside the four health departments, review what assistance can be provided to family members of serving personnel and veterans with mental health issues.
213 Defence Committee, Eleventh Report of Session 2017–19, , HC813, para 111 and 112
214 Defence Committee, Twelfth Special Report of Session 2017–19, , HC1635, para 26 and 27
215 Ministry of Defence, , 19 January 2019
216 The Royal British Legion (); Contact Group (); The Naval Families Federation () and Army Families Federation ()
217 The Naval Families Federation (); Army Families Federation () and The British Psychological Society ()
218 Q216 [Tim Boughton]
219 The Naval Families Federation ()
220 Annex 1: Summary of individual responses received
221 Veterans’ NHS Wales () and the Big White Wall ()
222 The Contact Group ()
224 Royal College of Psychiatrists () and the Contact Group ()
225 Combat Stress ()
226 Q50 and Q131
227 NHS England () and Ministry of Defence ()
228 For example, Combat Stress (); The British Psychological Society () and Help for Heroes ()
229 Annex 1: Summary of individual responses received
230 Q379 and NHS England ()
Published: 25 February 2019