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

Annex 1: Summary of individual responses received

Overview

1)The House of Commons Defence Select Committee put out an open call for evidence in relation to its inquiry into Mental Health and the Armed Forces, Part Two: The Provision of Care. It was particularly keen to hear from both current and former Servicemen and women and their families on their experiences of seeking and receiving mental health care.

2)The Committee, however, recognised that such submissions were likely to include sensitive personal information and set out as part of its call for evidence that it would not be publishing submissions relating to individual experiences. Instead, the Committee would publish this detailed review of all such submissions received to draw out the key themes.

In total submissions from 84 individuals were received, including:

3)Please note that the Committee did not actively solicit evidence from individuals and the submissions received are likely to demonstrate ‘self-selection’ or ‘volunteer’ bias, whereby they over-represent individuals who have strong opinions or interests. This review is intended to summarise and reflect the key perspectives of the individuals as outlined in the submissions received. It should not be interpreted as representative of the experiences of all current and former Servicemen and women and their families who have received mental health care. Where extracts have been used, these have been anonymised to protect the privacy of the individuals and their families. Please note that readers may find some of the extracts distressing.

During Service

4)Over half of the submissions received discussed the provision of mental health care by the Armed Forces. A small number praised the mental health care they received from the Armed Forces.

I felt compelled to let you know about my experiences over the last year as all I have seen at DCMH is utter professionalism and life changing treatment, not only for myself but for fellow Royal Marines of all ranks … . I had an appointment made for an assessment within two weeks of seeing the PMO [Medical Officer] and then started treatment three weeks later which I felt was very quick and was needed for me at this time as I regrettably had considered taking my own life due to the pain that I couldn’t stop leaking out of my mind and body. (POC0002)

DCMH Donnington provided lasting, effective care for me. (POC0034)

I had a mild mental illness last year which was dealt with extremely well by my military GP and local DCMH–timely and efficient and effective. (POC0056)

I found the provision of treatment in the military very good. I was diagnosed with long-term PTSD in Dec 2015 and had been downgraded, with no further access to weapons and ammunition. I hoped there might be improvement, but I was disappointed–though not for lack of effort from the staff. (POC0084)

5)In many other submissions however, the experiences reported were negative and set out a number of key issues around effectiveness, access to treatment and how long that took, lack of early intervention and how actions by the Ministry of Defence affected their mental health.

Effectiveness of treatment

6)Some individuals reported that the care or treatment provided was poor or inappropriate, citing poor staff skills and inconsistent care.

In my opinion my care was appalling, it was a waste of a promising [sailor]. I suffered many years of mental health issues because the causing Factor was ignored until I put my notice in. As a downgraded serviceman at my time of leaving, I feel I should have been medically discharged and had ongoing care to prevent further risk of suicide. (POC0014)

It was very difficult for me to take that first step in seeking out aid, mainly due to stigma whilst serving in an infantry unit. But to be diagnosed by an RAF Corporal who was an unqualified psychologist and my treatment was a guidebook with no future referrals is a complete farce … A 6 page guide on how to identify when I feel stressed and how to deal with anxiety … I have continued my army career thus far with no further interaction from DCMH. (POC0037)

Our priority would be for consistent treatment from one person over a prolonged period and for that person to have the specialist MH [Mental Health] skillset whether civilian or military. We have had greater success personally funding regular sessions with a private counsellor over a 2 year period rather than the haphazard military MH care pathway. (POC0062)

I believe he needed some pastoral support and signposted him to Welfare and the medical centre to access DCMH. He was unable to be referred to DCMH (no reason was given), and the doctor stated it was not in the ‘interests of the service’ to medically downgrade him from active duty. (POC0097)

7)A few also noted the time-limit on their treatment of a certain number of weeks or sessions and the reduced level of care once the decision has been taken to discharge someone.

Many DCMH units have a 6-week treatment policy and if you require further treatment it has to be approved by the OC of the unit. (POC0074)

Once decided you are to be medically discharge then medical treatment tails off, no matter how long it takes to discharge. Service treatment does not provide clear diagnosis or prognosis or a treatment plan for transition… The medical staff are employed by the MoD and have a remit under joint service policy (and single service policy) to ensure you meet with certain employment standard of medical fitness, once you no longer meet those requirements treatment falls off. I presume this is in part due to the conflict of interest which is caused by claims under the AFCS [Armed Forces Compensation Scheme] and AFPS [Armed Forces Pension Scheme] being assessed on the service medical notes. I believe that due to their occupation restrictions that the mental health treatment in the service is limited. (POC0048)

Speed of access

8)Individuals who had accessed Armed Forces’ mental health care experienced a range of waiting times for assessment and treatment. Some were seen quickly, but a struggle for others.

Access to metal health services for me was swift (once the need for them was recognised) and well organised. (POC0034)

Delay in treatment and waiting lists in the services has increased the risk of long-term detrimental effect, especially when individuals are signed off sick for long periods without unit support. (POC0048)

A serious incident… led to my returning to severe depression, and I reported my concerns to the TRIM administrator following the incident. It all poured out and I was quickly referred to the padre, and the MO of the camp I was at. He referred me immediately to a DCMH, and I began weekly treatment. (POC0084)

I was invited to a DCMH appointment 6 months after referral and 15 months after originally seeking support and I was almost immediately discharged… (POC0097)

Access to treatment

9)A few individuals raised the physical difficulties of accessing DCMHs, which may discourage serving personnel from seeking help early.

The infrastructure of these resources is also very poor, e.g. Mental Health Unit RAF Cranwell, is shoved into a rotting porta cabin, the door of which for several years was so swollen and rotten with damage the physical security of the buildings records could easily be compromised … Often, such a St Georges Barracks, North Luffenham near Graffam Water, the mental health provision is within an un-used part of a medical centre, with little privacy, and a significant distance from the domicile of the patient. (POC0006)

DCMH is known to be very hard to access, because there are only certain ‘hubs’ across the UK, necessitating travel, time away from work and difficulty in getting appointments in a timely fashion. All of this, to a depressed person, makes life much harder, and (together with lack of chaplain availability) means that they are less likely to seek help at an early stage where their problems are less critical. (POC0052)

10)A small number of others also reported that it was particularly difficult to access mental health care when stationed outside of the UK, particularly if they were not stationed overseas as part of a unit.

There is no MH med [Mental Health medical] plan provision for France to my knowledge. The nearest MH facility to France is in BFG [British Forces Germany]. Therefore the choice was stark, cut the tour short, move home early or get no treatment. (POC0007)

I went to the medical centre to ask for help. It took some time but was well organised. I did not want to go to the medical centre as I was afraid it would impact my career, however I had little choice living in Germany. (POC0108)

11)One individual also raised the concern that some civil servants who deployed alongside the military during Afghanistan and Iraq also developed mental health issues as a result, but received “very little of the support given to returning military personnel” (POC0005)

Early intervention

12)A number of submissions emphasised the importance of early intervention in helping to manage and treat mental health issues as they developed. They believed that if intervention or treatment had taken place earlier in their cases than it might have forestalled the development of more serious mental health conditions.

No one picked up that my son was suffering in silence and he was finally diagnosed with severe PTSD in 2018 it had got that bad. (POC0086)

13)Submissions suggested reasons as to why early intervention had not occurred, including stigma, the lack of recognition of mental health symptoms and the fact that the mental health issues had stemmed from or were exacerbated by the Ministry of Defence itself.

Stigma

14)Serving personnel may not come forward in the early stages of their own mental illness because the stigma associated with mental illness makes them fear for the consequences of ending their careers.

Serving personnel seeking help with mental health come forward with great courage, in fear of reprisal, repercussion and potential career loss … This is a fundamental reason that service personnel hide & suppress their suffering from their chain of command, and an underlying cause of self-medicating through various coping mechanisms, such as becoming a workaholic, substance misuse, alcohol, violence, disciplinary issues and suicide (POC0045).

Unfortunately, it remains better financially and for career progression for front line military personnel to keep mental health issues a secret than to seek help. (POC0099)

Recognising the symptoms of mental health

15)Some submissions also suggested that early intervention did not occur as the signs of mental health were missed, not just by the Serviceman or woman but also by those around them, including medical personnel, family, and colleagues. This was particularly the case for older veterans

No one had ever heard of PTSD as we looked after ourselves, normally by drinking ourselves to oblivion. (POC0032) [Veteran who had been deployed to Northern Ireland]

Despite showing signs of deteriorating mental health as early as the late 1990s, I was not diagnosed with PTSD until 2018. During the intervening 20 years my condition worsened and became more deeply embedded but was not recognised by myself, military Medical Officers, my GPs, or any other clinician until the day that I was gently talked off Beachy Head. (POC0060)

16)A few individuals believed that there still remains a general lack of knowledge of mental health issues which makes it difficult to correctly identify changing behaviour as a potential indication of mental health issues and then to know what actions to take.

Senior staff throughout the Army were clearly inadequately trained in the signs and symptoms of PTSD, and in the seven years since his first deployment and major change in behaviour and increased aggression there was never a suggestion made by anyone that his change in demeanour might be related to mental health. (POC0082)

Exacerbation of mental health issues by the Ministry of Defence

17)A small number of submissions reported that their mental health issues stemmed from or were exacerbated by mismanagement of their cases by the Ministry of Defence or poor administration. This ranged from bullying issues that were not investigated and complaints about their chain of command that were not resolved to the administration requirements of applying for Armed Forces compensation.

The military should actively identify and remove toxic managers. Such personnel should be prevented from reaching Senior Management positions where they can negatively influence more junior members of staff. (POC0034)

The methods and time line that AFCS [Armed Forces Compensation Scheme] use to assess claims is inadequate and adds a great deal of pressure and anxiety to personnel; as compensation or not makes a difference to the employment choices they have to make. I want to appeal, but producing all the documentation necessary is causing me such anxiety that I feel paralysis each time I attempt to start the appeals process. (POC0074)

A number of wrongs however were ‘done to me’… by the Chain of Command and in my efforts to recover injustice I was treated with contempt, alienated, discriminated against and victimised to the point that my health deteriorated as a result of the betrayal I endured by the Chain of Command. (POC0100)

Preventative mental health provision

18)To help with early intervention, a few submissions referenced or recommended the need for better preventative mental health work to assist with early intervention. This included looking out for early signs of mental illness and identifying ‘at risk’ individuals to provide early emotional support.

Another recommendation that I would suggest is that there needs to be a better screening/evaluation process for those who may be classed as ‘high risk’ to mental health issues. With the increase in mental health issues … it’s my understanding that there should be some form of record for those who have experienced traumatic incidents, whilst on tour and that this should be logged and those individuals involved either directly or indirectly (secondary trauma conditions) can be evaluated and the appropriate support, either sign posting or referral to a specialist to be available. (POC0033)

Mental health care and transition

19)Over a third of submissions expressed views about the transition from service life to civilian life, with many believing that they were unsupported and left to deal with mental health issues alone.

Upon leaving the Navy I had no aftercare whatsoever. I have dealt with my issues myself. (POC0014)

I support our Armed Forces totally, but feel that when an individual leaves their Service, too little is done to prepare them for “civvy street!” This is a very important matter to address as it directly affects the Mental Health of all ex-forces. Too many people are unprepared for ‘going solo’, without a network of support around them. (POC0035)

This common indoctrination is meant to end when your service ends, but few are prepared for the transition. When they leave and return to a (safe and stable?) life in civvie street, many, though not all, cannot switch off and they descend into a spiral of drink and drugs, violence, low self-worth, unemployment, debt and mental ill health. (POC0123)

20)To help address this, many recommended better and longer follow-up by the Ministry of Defence after discharge. Individuals believed this would be a good source of emotional and practical support and act as preventative mental health practices.

Since I’ve left the military the only contact my former family has had with me is an email from the resettlement team with information on possible jobs/career paths I might like. After 16 years this is just not good enough, I deserve a call, hi how are you, are you well, coping with civilian life and people ok. My answer would have been no. Appreciation, Consideration, Direction… I believe would have been crucial in helping me stabilise my mental health. (POC0018)

As a veteran having served 15 years, I left the service in 1980. Since my discharge the only contact with the MoD has been for them chasing me with ‘Long Term Reserve’ paperwork and telling me I must advise them of my whereabouts until I was 45. NOT ONCE has anyone enquired about my health, welfare or wellbeing or even if I had found employment. (POC0029)

One thing you get when you leave the forces is help from the Career Transition Partnership for two years. It is believed that it takes 3–4 jobs before you find your niche. As a medical discharge I believe this support should be extended to at least four years as your time to resettle out of the military is normally less than a year and this would help compensate. (POC0125)

21)Some also suggested a ‘buddy’ or mentor system be put in place.

Transition period in the last year of service to have monthly interviews with health professionals to spot mental health issues before discharge date. Reward those that attend … Anyone leaving the forces should have a two year mentor assigned, just to check in occasionally, and to make sure they are hitting the correct milestones in treatment. Veterans TILs NHS are starting to do this, and the fact that the team are ex Mil makes life easy. (POC0008)

I would love to see all personnel that are medically discharged be offered a kind of ‘buddy’ for a period of at least 18 months. This ‘buddy’ I would like to see then ‘check in’ with the service person on a weekly basis to begin with, perhaps for a period of 6 months before dropping down to perhaps monthly calls. I would like these calls to be placed to both the Veteran AND the spouse (as often the spouse will be more forthcoming about difficulties the service person may be facing in civvy street). (POC0092)

Transition between the Ministry of Defence and civilian health care

22)Some individuals raised concerns about how veterans who were already being treated by the Armed Forces were then transferred to civilian health care.

The MoD can discharge you if there is suitable treatment available on the NHS. In my own case they didn’t actually hand any notes to my now civilian GP nor did they follow up on how any treatment may or may not have been going. (POC0021)

I accepted the treatment from DCMH Catterick (RAF Leeming)… it helped a great deal and I was very appreciative of the help. However, I was no wiser of my condition, apart from a few hand outs and a few coping mechanisms. So only a few weeks after my treatment, stopping my medication due to thinking I was cured, and life was back to normal. I spiralled back into my depression and was suicidal again within days. My family tried to contact DCMH for help, but those horrible words, of our Duty of Care has been done, you will have to go through the NHS. (POC0047)

My son was discharged… with PTSD. He had been receiving treatment [from the Armed Forces]. He did receive some good care, as a former registered mental health nurse I know what good care looks like. When he was discharged into the care of the local NHS Trust, Norfolk and Suffolk NHS Foundation Trust, the care received could not be recognised as good care. (POC0061)

Before leaving the service I was in the care of DCMH, they took over 5 years to diagnose me with PTSD and once I left they just left me to find help by myself. It took a lot to admit I had a problem and then to be left to find help once out of the service was hard. It seemed that once my termination date was reached I wasn’t DCMH’s problem anymore. Don’t get me wrong I am grateful for them diagnosing me but why did it take so long and why did they just discard me once my tx date was reached. (POC0065)

23)Individuals particularly recommended better coordination and transfer of medical files between the Ministry of Defence and the civilian health services.

There is no visible transition period of medical care when leaving the services; you leave and you’re on your own! However, this could be easily achieved and administrated, prior to discharge by Unit medical centres, ensuring registration and initial medical screening appointments (including drug history) are completed, with subsequent health check appointments booked in as standard. Military medical documents need to be seamlessly transferred to the NHS/GP system, including historical access to FMed4 archives. The MoD must also be up front and honest when service medical documents (pre-DMICP) “have been lost” and the surgeon general must not accept this as the norm. (POC0045)

From experience of the NHS and settling into a different medical system. I would suggest that increasing the availability of mental health care for those that leave with mental health issues is increased by six months to a full year. Initially setting up my NHS medical care was difficult, and the paperwork I was given to hand to my NHS medical centre was dated … and looked at with amusement and somewhat scepticism by the staff at the centre. This needs to be urgently updated and maybe re-issuing with updated details, maybe referring to the Armed Forces Covenant and TILS. (POC0075)

Statutory provision for veterans

24)Most submissions discussed their experiences of mental health care in the civilian health system and a number of common issues were raised including a lack of understanding of the military culture by civilian medical practitioners, variation in care, speed of access and a lack of provision for complex and long-term cases.

Understanding of military culture by civilian medical practitioners

25)Many believed that veterans needed to be treated by medical practitioners who understood their military background, the mental health issues they were suffering from or the services available to a veteran and a number provided examples of how this led to ineffective treatment.

When my wife spoke to our son’s local GP in [Norfolk], he had no knowledge of PTSD and she had to refer him to a book and website explaining it! There was some knowledge of veterans having priority to some services but it was a bit patchy. The recently announced introduction of having one GP in every practice trained in this area is very welcome. (POC0067)

I was referred to a civilian doctor via Service Veterans, and I viewed that assessment as fairly useless. I found it hard to explain to a civilian how I felt or how things had come to pass, and this attitude was reflected by my civilian GP, who I found obtuse and negative. Hence, although things have remained as bad as they were before, I have sought no further medical help. (POC0084)

Veterans complain that they simply shut down to the healthcare specialists very quickly as it is obvious very quickly that they simply have nothing in common. (POC0087)

My partner’s GP did not understand what he needed or was entitled to. One example of how this has impacted us is that he has been on the wrong medication for over four years. He was recently referred to the Complex Mental Health Service for veterans, they have identified that he should have been referred to a psychiatrist at six month intervals by his GP but this never happened, and he continued to collect his prescription for inappropriate medication for his condition. (POC0088)

Military personnel do not respond well to the ‘professionals’ that are in this field. They do not feel a ‘civvy’ will understand them and will certainly not relate to anyone they feel is patronising and does not understand their mindset. Straight away there is a barrier in place and they are unlikely to engage. (POC0098)

Mental health care must be provided by those who understand military service, the psychological impact of training, deployment, and transition, and the effects on family life. In my observations, forces personnel tend to ‘play down’ their symptoms and there is a culture of stoicism, that is at odds with the prevailing healthcare culture of speaking openly about symptoms. (POC0124)

Variation in care across the UK

26)Over a dozen submissions also highlighted the differences, both in quality and availability, in civilian mental healthcare, which depended on where a veteran lived in the country.

Postcode lottery, guys in remote areas struggle, and there is too much big city centric outreach centres, London, Birmingham, Salisbury, there is a North South divide and its makes life hard for veterans to travel for a whole day for a fifteen minute appointment. (POC0008)

I saw two different people from Veterans First Point. Both were not professional in their approach and did not explain their roles. The second was a therapist who said they could not offer assessment because I was in Fife and a psychiatrist’s time had not been provisioned for in Fife but if I lived in Lothian I would have got this service. I felt poorly supported so chose to speak with my GP to be referred back to the NHS Fife Adult Psychology Service. (POC0039)

Now having moved up to live with family who are both ex-military, he has been seen by a NHS Team at Reading, Berkshire. This is far superior service than South Devon Health Care provided… NHS Reading Berkshire told us they are one of the most efficient in the country for military mental health. I do not think this is right. All military personnel should be treated in the same amount as time all over the country. (POC0086)

Speed of access

27)Many submissions also criticised how long it took to access specialist mental health treatment, even if care was critically needed, arguing that this was due to insufficient capacity within the system to meet demand.

I had to wait 6 months after discharge before NHS sent me to a sub-contractor civilian psychologist, for a set number of sessions (which ended up doubling) but had no useful effect on my condition. (POC0006)

After a particularly bad attack by me, my wife woke with me strangling her while I was asleep which led to me also attacking my daughter and grabbing her by the throat and lifting her off the floor choking her, my family had had enough. There was nowhere to go, the GPs were stuck with waiting lists, I was seriously ill and my wife on the edge of suicide herself. The Crisis Team was also cutback in that time so they were no help. (POC0032)

For my issues, seeing the GP was very quick (same day as crisis). However, appointments with appropriately trained mental health professionals was very slow (many months). I believe far more resources are required for mental health provision, particularly for veterans. (POC0040)

I have been waiting over 3 months after being assessed for severe PTSD from NHS Mental Health Team. The Government has fell well short of the Covenant. (POC0059)

In our case, once my husband ‘broke down’ and was made to go to the GP, he had to wait 2 months for an initial consultation and then subsequently told he would have to wait 6 months for a first consultant appointment. He was covering up that he was suicidal and what were we to do in the meantime? … There is an insufficient number of psychiatrists and psychologists to support the number of mental health casualties. (POC0090)

Priority treatment and the Armed Forces Covenant

28)Of those submissions that referred to the Armed Forces Covenant and its principle of priority treatment for veterans, nearly all believed that there was a lack of awareness within the civilian health sector of either, with only one or two examples where a veteran did receive priority treatment. As a result, veterans and their families felt that the Armed Forces Covenant is ineffective and does not deliver what it promised.

I can personally testify (as can many others), that quoting the requirements of priority treatment in accordance with the Armed Forces Covenant, and even with an endorsement by local NHS management, access to treatment was not reduced and actually exceeded the 6 months maximum. This is another example of veteran’s expectations being crushed by the MoD and the supporting NHS system. (POC0045)

I have seen no evidence of the Armed Force’s Covenant’s principle of priority care. The suicidal soldier I met yesterday was not offered a bed as he was not viewed as a risk, even though he had just tried to take his own life a few hours before. He was sent home… this one specific case and many anecdotal cases show there is zero priority given to veterans… It is only after veterans have left for several years that I am seeing the real problems. By this stage their former service is all but forgotten and they receive absolutely no prioritisation, despite what they have sacrificed for their country. (POC0087)

I was seen very quickly after this referral, apparently being advanced in the queue due to my veteran status. (POC0099)

In my experience of supporting both my husband, his former colleagues and members of his regiment … many NHS providers have not heard of the armed forces covenant. When GPs are aware of it, they are unable to prioritise referrals, because they are not accepted as priority by mental health services. (POC0124)

29)A few submissions also raised examples of difficulties with other Government Departments:

However, every year I am subjected to a Work Case Assessment, and at my last one was deemed fit enough to work full time. My ESA was suspended, which in turn led me back onto anti-depressants and another relapse with mental illness. In the past 8 months I have had my ESA suspended 3 times and each time it has been reinstated. Whilst I would like to return to make a full contribution to society, the Benefits system, I feel does not allow for people, including myself. (POC0027)

They are stove-pipe organisations, there is a faux emphasis on cross department talking but in reality it does not work. If a veteran is on War Pension, he has to go through assessments for PIP, and assessments for other benefits. Why not just one assessment, and then all departments can respond to that. Veterans are put through more stress that way, and in the case of multiple appeals, it puts a strain on your recovery… It should be that a veteran is diagnosed, assessed, then automatically put on all the benefits, and allowances across DWP, Veterans UK, NHS, Local Authorities. Without having to be assessed multiple times. It nearly killed me. (POC0028)

Complex and long-term mental health issues

30)A small number of submissions also specifically raised concerns over the insufficient care available to those with complex mental health needs, including the limitations on repeat treatment.

I had no effective treatment for nearly 28 months before placement on their [Combat Stress’] ITP [Intensive Treatment Programme]–however, because NHS Scotland and the Scottish Government are involved with funding, there is a caveat that individuals attending the ITP do it once, anything after is community outreach, if available. (POC0012)

Anyway I found out about the new complex mental health service coming out on April the 1st 2018 and I rang them, yet to be told my husband was too complex/severe. Yet again hopes raised and then come tumbling down with a crash. [NHS England later told her that the Complex mental health team could take him on no matter what] (POC0020)

[His GP] referred him and he was offered another course of CBT [Cognitive behavioural therapy]. On the initial assessment appointment he was told that he had too many issues and was too complex a case and was sent away feeling very let down and on his own. (POC0077)

Veteran suicides

31)A number of submissions raised cases where a veteran had taken or tried to take their own life as a result of mental health issues. A few also criticised the lack of recording of the deceased being a veteran by coroners.

Should a veteran feel that their last or only option that remains to them is suicide, please let it be recorded that they were a veteran. Coroner’s currently do not acknowledge veterans, nor the correct number of veterans who have commuted suicide. Please at least help to change this. This is only my opinion, but one that is shared. (POC0003)

I myself am suffering with PTSD, it has destroyed my life … I attempted to kill myself a few years back but failed! luckily for me my ex-partner contacted Combat Stress, I then spent in total 8 weeks with them that helped me tremendously, I managed then to sort my life out to a point … I have signed this petition [on recording suicides by veterans] because of the above and because a friend who I served with took his own life a couple of weeks back because of PTSD, also in the last couple of months I know of at least 8 veterans that have committed suicide for the same reasons. Something must be done to stop this epidemic! (POC0030)

Sadly we are losing too many ex service personnel to suicide, many of them not recorded as ‘service related’ It is difficult for family members to know what is best to do to help or, more importantly, what not to do and make things worse. My greatest concern is for those who are alone with no family support. (POC0077)

Armed Forces charities mental health care provision

32)Around half of the submissions received made reference to the provision of mental health care provided by Armed Forces charities.

33)Several submissions, however, criticised the Ministry of Defence and the health services for veterans having to rely on charity provision in order to receive the care they need.

Now before I had seen anyone face-to-face, I was well advised to self-refer myself to combat stress–As great a name that they are, They are a CHARITY, not a an NHS service. No member of our serving and ex-serving community should be referred to a charity by our own care system. (POC0003)

There are many organisations that have been set up to help Veterans, especially with mental health issues, and the very difficult transition from military life to being a civilian. The fact that these organisations are charities is a complete disgrace, a dark and bloody stain on our society; it makes a mockery of the supposed covenant we were promised. The Gateway scheme is a step in the right direction, but these charities must be funded by government and not left to the goodwill of citizens. (POC0004)

Again I must emphasise that funding for the agencies involved must come from government and not rely on the charity of the population at large; most of whom are disgusted by the way Veterans are treated once the services cease to have responsibility for their welfare. (POC0036)

The hotch potch of charities who provide support do an admirable job at present but they are not equipped or resourced well enough to cope with this massive issue. The UK government must step up to the plate on this. (POC0094)

Experiences of care received

34)Some submissions praised the mental health care provided by charities

My wife did a search online and found a small advert for Combat Stress and as a final attempt phoned and asked for help. Within 2 weeks we were visited by a welfare officer who did a quick assessment, before leaving I was in tears as for once someone listened to what I was saying, not what they thought I should be saying. Within another month I was invited for a 1 week assessment where I was given a written diagnosis of severe PTSD. My life was about to change. (POC0032)

I found Combat Stress extremely helpful, being amongst similarly affected Veterans removed some of the stigma I felt. Alongside other agencies; RBL, H4H and HighGround as well as various forms of medication I have learnt many coping mechanisms and have been able to begin to realise a more fulfilling life. (POC0036)

Our experience is that nothing has been provided by central government and that the limited help that has been provided for our son has been via charities such as Combat Stress, the British Legion and Walking with the Wounded… They are the very overstretched provision. Without them, there would be nothing that we have found accessible. (POC0067)

35)However, others reported issues with the care received, due to for example a lack of capacity or limitations on the care they could provide.

I forced him to contact [a charity] and they arranged to have someone come to see him, but it was a long wait at the time. So, before that happened, he then took a huge overdose of his medication. It was enough to be fatal, but I found him in time. (POC0013)

I did get him down to [a charity] and saw a gentleman doctor there that was ex services and so he went for a two-week inpatient course which was totally the wrong thing to do for him… (think they opened up the wound even more and then said good bye). We were then told he was too severe for [them] to treat and with no sign posting to any other service (and the fact also that they were controlling his medication and then they stopped his care caused huge problems for us and his GP as they said they had no experience in this area). (POC0020)

My mental health deteriorated I begged charity’s for help I was passed around charity to charity, this went on for years. Nothing. (POC0026)

[This charity] was contacted but we had a nightmare with them. To the point where we were told that my son didn’t qualify to be treated by them. (POC0086)

36)A few also raised the lack of consistent coverage across the country.

From there I underwent their 6-week Intensive Therapy Program (ITP) in May/June of this year. Apart from a 1 hour, 6-week review over the phone, that is all I can get from [them]–they don’t have a community outreach program further than the Central Belt–fantastic if you live in Glasgow, not great if you live elsewhere (POC0012)

However, one of the problems unique to my regiment is the distance to reach face-to-face support. Many veterans live in isolated locations away from their former peers and away from where charitable organisations are based. To compound matters, many have lost their driving licences due to alcohol abuse so simply can’t travel to make meetings. (POC0087)

Navigating the range of services

37)At least a quarter of the submissions reported on the challenges of identifying where to seek help, given the range of Government and charity mental health providers. Some also believed that the difficulties might result in veterans choosing not to seek help.

Why are there so many charities trying to offer similar things? Is there a central hub/service centre that can support the veterans to access what they need and direct to most useful service? Help for Heroes/RBL [Royal British Legion/SAFFA/Combat Stress/Veterans Gateway etc etc… I’m confused who does what, but for the service person who likes avoidance and minimisation its likely a factor that may put them off rather than encourage engagement. (POC0064)

Whilst there is a vast support network available through charities that information is not readily accessible through a single POC. It requires major investigation which makes it difficult for someone who is struggling with MH issues, adding to stress and anxiety. (POC0062)

The environment can be mindboggling to a veteran in need of support and quite simply put them off seeking support. This in turn can lead to those that need it most, not seeking help. There are members of my veteran group, that were not aware of what charities do what, or even aware they can apply for a veteran’s badge. This is the sort of information that can be pushed through veteran’s workplace groups. (POC0125)

Since my dealing with the mental health services in 2013, I found it a very individual and splintered service at best. I believe that now it is catching up with the likes of, the Gateway, and charities raising awareness of the problems with PTSD. (POC0047)

38)Of the small number of submissions that referenced the Veterans Gateway as an initiative to help signpost veterans to the right organisation, some veterans had not heard of it until responding to our inquiry’s terms of reference, others chose not to use it or believed that it needed improvements.

A simple example is–as an ex officer who had been through MH treatment in service and then via the NHS for life threatening conditions, as someone who is press, social media and defence aware, I hadn’t heard of the Veterans Gateway until… a few weeks ago. I rest my case… The veterans gateway is reconfigured to include a triage capability able to signpost people quickly to the Samaritans, NHS Crisis team, or lastly service charity. Reliance on Charities first MUST STOP. The MoD must take responsibility for each and every person notified to it and coordinate their care until discharged. (POC0063)

I had never heard of the Veterans’ Gateway until reading this… The Scots Div Veterans’ Support Group on Facebook has 3,500+ members and I have yet to see a single reference to the VG. (POC0087)

Coordination between mental health care providers

39)Around a quarter of the submissions also received criticised the lack of coordination between national and local government and charities, with some believing that there needed to be a single ‘umbrella’ organisation to oversee mental health provision to veterans.

The committee needs to understand the dynamics of mental health within the current serving and veterans community there should be an overarching charity like the VA in the United States and in each County where the is a central mental health of excellence and drop in centre running therapy, advice in all disciplines of life and activities. (POC0022)

There is little to no evidence of govt departments, local authorities and charities across the UK working together in any meaningful way. As someone who is politically savvy, I haven’t heard of any initiatives, nor have any of the colleagues or veterans who I have spoken. (POC0063)

There is no cohesive strategy to co-ordinate the response from all the different organisations offering support. Because of the debilitating symptoms of PTSD, veterans are not able to plan their own course through the minefield that is out there. What is needed is a body overseeing all of this that allocates individuals to support and advise them - advocates who can oversee their progress through their problems. (POC0067)

From my experience, many charities are trying to cover gaps in the system but they are disjointed, stove-piped in their approach and fiercely protective of their budget. I believe that a Mental Health ‘Tsar’ appointed by Government would have a large effect in bringing them all together. At the moment too many people have an opinion for the system to deliver in an efficient and effective manner. (POC0120)

40)Some highlighted the consequences of this lack of coordination, including poor transfer of information and duplication. Others also raised the frustration of having to repeat their experiences again and again as they pass through the system.

No long term continuity for patients needing long term mental health access to psychologists and psychiatrists and psychiatric nurses, or social workers. The latter two in military scenarios are mainly contractors, the former often high ranking medical officers who have specialist psychiatrist military body of knowledge. This can lead to duplication, re-living and re-telling the “story” five or 6 times. (POC0006)

Also at each stage the veteran has to repeat their story, traumas, and medical ad infinitum to complete strangers for assessment and treatment. (POC0008)

There is a lot of money wasted with duplication and information not being passed on (data protection must be the most overused reason for not doing anything I have heard during the last 9 years). I hate money being wasted and I think there is a lot of waste with the military charities not working collaboratively and dove tailing their provision with each other and the governments provision. (POC0098)

There is little evidence that they are working together effectively. There seems to be duplication of effort to assess veterans, but little coordination of treatment and limited resources for families. (POC0124)

Families

41)Around a quarter of the submissions received referenced to the mental health needs for Armed Forces families. Many expressed concerns over the lack of specific provision of care for them, particularly as they believed that, like veterans, they needed clinicians who understood their circumstances.

Why are there no services (or if there are why are they not advertised) to support the children of personnel with dealing with the PTSD … . what it means, impacts on them for the future. I remain concerned about the impact of my husband’s emotional and mental health on the wellbeing of my children. Currently and for the long term future … . it’s a condition that will not go away (POC0064)

As a partner of a veteran with mental health issues I often find life very difficult and I really still don’t know where to turn to or where to get help. I don’t feel comfortable talking to my GP about it. I have reached out to [a local charity] for support and I am on a waiting list for therapy however I have been on the waiting list for a long number of months now. (POC0088)

I have attended IAPT assessment appointments only to be told to find a private counsellor or do some CBT–unfortunately the private counsellors just do not understand the circumstances in which we live in. The mental health of the partner should have no bearing on whether the person/ people they live with get help. In fact, addressing the wife/ husband/ partner would be more beneficial to the serviceman/ woman as we would have more slack for their behaviours. (POC0101)

42)A few submissions also noted that the definition of family should be extended to beyond who the serving personnel is living with.

Having received treatment I am well aware of what is available within the system. However, the MoD could do more to signpost support for families. The support is well publicised to families living in Service Families Accommodation but more should be done to advertise to wider family members. E.g. most young soldiers have families elsewhere and the burden of mental health support often falls on them when soldiers go home for the weekend/ leave. The families then do not know how to engage the Army without worrying that they will adversely impact a serviceman’s career. (POC0108)

43)A few reported that they also found it difficult to decide to seek help

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. I now go regularly to my local group. I try so hard to help others as I am further down the line than some of them. I get great feeling that my knowledge can help others. (POC0086)

44)Another common theme was the view that family members receive no training or support in looking after someone still serving or a veteran with mental health issues.

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 PTSD. MoD became insular during the cold war period, we had military hospitals around the country that could help out veterans, and we got rid of them because the military reduced in numbers. (POC0032)

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). (POC0062)

Tolerance of poor mental health behaviours was shown on base, but no help given to families, where domestic violence erupted. (POC0073)

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 (POC0082)

Submissions reviewed

Statistics on the submissions reviewed

Male

Female

Serving Personnel

11 (2)

5

Veteran

54 (15)

8 (1)

Other

4

2 (1)

TOTAL

69 (17)

15 (2)

Note 1: Numbers in brackets denote how many submissions out of the total were provided by a family member of the individual serving personnel or veteran

Note 2: Other includes submissions relating to civil service experiences and experiences as a family member

Submissions from individuals reviewed

1

POC0001

22

POC0024

43

POC0049

64

POC0077

2

POC0002

23

POC0025

44

POC0052

65

POC0079

3

POC0003

24

POC0026

45

POC0053

66

POC0082

4

POC0004 and POC0036

25

POC0027

46

POC0055

67

POC0084

5

POC0005

26

POC0028

47

POC0056

68

POC0086

6

POC0006

27

POC0029

48

POC0058

69

POC0087

7

POC0007

28

POC0030

49

POC0059

70

POC0088

8

POC0008

29

POC0031

50

POC0060

71

POC0090

9

POC0009

30

POC0032

51

POC0061

72

POC0092

10

POC0012

31

POC0033

52

POC0062

73

POC0094

11

POC0013

32

POC0034

53

POC0063

74

POC0097

12

POC0014

33

POC0035

54

POC0064

75

POC0098

13

POC0015

34

POC0037

55

POC0065

76

POC0099

14

POC0016

35

POC0038

56

POC0066

77

POC0100

15

POC0017

36

POC0039

57

POC0067

78

POC0101

16

POC0018

37

POC0040

58

POC0068

79

POC0108

17

POC0019

38

POC0042

59

POC0070

80

POC0115

18

POC0020

39

POC0043

60

POC0071

81

POC0116

19

POC0021

40

POC0045

61

POC0073

82

POC0120

20

POC0022

41

POC0047

62

POC0074

83

POC0123

21

POC0023

42

POC0048

63

POC0075 and POC0125

84

POC0124


231 It was not possible to identify the status of 5 individuals who submitted evidence. See last section on submissions




Published: 25 February 2019