INVESTIGATION: Call for national framework of mental health care for veterans

Report first published in the Western Morning News, November 2017 and Devon Live, January 2018:

Story first published via Plymouth Herald online:

A Conservative MP who is a leading voice on military affairs, and the chief executive of the country’s leading military charity for mental health, are calling for the establishment of a national framework of mental health care for veterans.

According to the Ministry of Defence’s (MoD) medical discharge report there has been a “significant” rise in the number of service personnel being discharged due to mental health related reasons in the last two years.

And the country’s leading veterans’ mental health charity, Combat Stress is reporting a 143 per cent rise in veterans accessing its support in 10 years.

Improvements to the system have been introduced by NHS England since April 2017 and include the mandatory recording of the total number of veterans each mental health care trust or provider is treating.

Prior to April this was not mandatory: information revealed via a series of Freedom of Information requests to all of the UK’s mental health care trusts in November 2016, revealed that more than half of those that supplied data, did not make a total record of how many veterans they were treating.

This prompted Conservative MP for Plymouth, Johnny Mercer, who is a former Army captain and endured three tours of Afghanistan before being elected in 2015, to question how the demand for support can be adequately assessed if veterans are not recorded.

A spokesperson for NHS England confirmed that mental health trusts using the Improving Access to Psychological Therapies (IAPT) programme have been required to record veteran status since 2013, but they were not required to record the total number of veterans they are treating.

The spokesperson confirmed that since the figures were obtained at the end of last year, “a duty to record veteran status was extended to all mental health services in April” meaning that it is now mandatory for trusts to record veteran status and it is now part of the data NHS Digital records.

It is voluntary for a veteran to disclose this information. But it is still not mandatory for GPs to ask or record whether a patient is a veteran, although this is “strongly recommended”.

Despite improvements, there is an absence of an agreed, statutory, unified system of care for veterans for every mental health care provider to follow, nor an agreed, statutory training or awareness programme for mental healthcare professionals to deal with the specific needs of former service personnel, resulting in a “patchwork approach” to care from one trust to another.

Research based on figures obtained in November 2016, also revealed that, despite the joint NHS and MoD covenant which states that veterans “should be able to access services with health professionals who have an understanding of Armed Forces culture”, around a third of mental health care trusts in England had no additional training provision in place for their healthcare professionals to deal with the specific needs of veterans.

Other improvements, as of April 1, include NHS England’s investment of £9m in its three-year Transition, Intervention and Liaison Veterans’ Mental Health Service (TIL) for service men and women approaching discharge and veterans, following a national engagement process.

A key difference is that for the first time, armed forces personnel approaching discharge can now consistently benefit from receiving NHS care and treatment for mental health difficulties before their discharge date and have continuity of care thereafter. Access to local care and treatment has also improved and increased across the country and patients will receive care in a more uniformed manner, with patients having a single point of contact at the service. The scope of treatment has also increased under the new service with a holistic package of care.

Under the new TIL programme 12 mental health care trusts which were responsible for veterans’ care in their regions, have been replaced by four: Avon and Wiltshire Mental Health Partnership NHS Trust is the designated trust for central and South West England.

The MoD’s Mental Health and Wellbeing Strategy 2017-2022, launched in partnership with the Royal Foundation of the Duke and Duchess of Cambridge and Prince Harry this October, outlines how it intends to improve mental health through the improvement of training and education among Armed Forces personnel and their families.

Mr Mercer has welcomed the improvements, but added: “Despite commendable and serious effort by some, currently, mainstream mental health care for veterans remains simply not fit for purpose. Many feel their specific needs cannot be met in a system where health professionals do not receive training, or adequate training, about the issues that are common to veterans, who may be suffering mentally because of trauma on the battlefield.

“Despite the NHS-MoD covenant, and despite a big increase in the number of veterans seeking help for mental health issues, it does not make sense that the majority of mental health care trusts across the UK are not making a record of the total number of veterans coming through their doors; how can the demand for support, or the specifics of that support be adequately assessed if the simple act of recording veterans’ numbers, is not done?

“But what is perhaps most concerning, is that there is no agreed, statutory, unified system of care for veterans, nor an agreed, statutory training or awareness programme for mental healthcare professionals to deal with the specific needs of former service personnel.

“Basic principals must be adhered to. There needs to be a common needs assessment or access point for Veterans; data collected to drive performance, clear treatment pathways, and a commitment by this Prime Minister that we take the Mental Health of our Armed Forces community as seriously as any other part of their health.

“This patchwork approach – good in some areas, non-existent in others, would not be accepted for physical injuries, although there is still work to be done on that front. If we really are to make a reality of that oft-used phrase ‘parity of esteem’ for Mental Health, this would be a very good place to start.”

Chief Executive of Combat Stress, Sue Freeth has welcomed the efforts made to improve the service veterans receive, however believes improvements are needed to ensure healthcare providers can cope with the increasing demand.

“At the moment it feels like meeting the social and cultural needs of veterans is voluntary,” she said. “If the Government is serious about the Covenant then a national framework needs to be in place to drive consistent improvement.

“We need to take the delivery of mental health care of veterans seriously if we’re going to meet the growing demand for support – if we don’t, there will be serious consequences.

“Some good work has been done, and in some parts of the country there are examples of integrated health and social care for veterans which appear to be working well, but it is not yet wide spread; we need a two pronged strategy which makes it easier for veterans to access via their General Practice and then make a choice about the treatment path to recovery. The majority of veterans seen by Combat Stress are self-referred, which suggests that GPs aren’t aware of our specialist treatment service.”

Combat Stress had been providing NHS England’s Veterans Mental Health Intensive Service, a six week residential intensive treatment programme for five years before the contract was put out to tender in June. The new contract is for a community based service. Combat Stress will continue to provide both community and residential treatment.

“Veterans are concerned about how the new service is going to work as are we“.

She continued: “NHS England is working hard to try to generate a more integrated pathway for veterans. Each Health and Wellbeing Board in England or Health & Social Care Board in Scotland and Ireland should have a Joint Strategic Needs Assessment for its veteran population. They can’t assess the demand and plan for care without it.

“The new TIL programme will play a part in this. We met the TIL providers in September and they’re already seeing a huge demand.

“GPs surgeries and mental health trusts should be recording the numbers of veterans in their practice in order to plan for their health needs.

“My concern is that meeting the growing demand without more resources is going to be impossible.

“One of the things NHS England could be doing is putting more pressure on local Health and Wellbeing Boards to produce local veteran mental health plans. Even if there’s no new money, they could be using the data collected to show what they are spending and on which local services. How can local elected officials assess how well local services are performing if they don’t? Each Health & Wellbeing Board should be held accountable for publishing their veteran mental health performance results.”

A spokesperson for NHS England, added: “The NHS is committed to providing every veteran who needs mental health support with the right care. As well as the general mental health services provided by the NHS, earlier this year a new mental health service for veterans was launched which is providing increased, improved access to local care across the country.”


FACT FILE: How the South West’s Trusts operate:

Plymouth: Livewell Southwest

A spokesperson confirmed that it is not mandatory for a veteran to disclose this information, or for them to make a record of veterans being treated. However the body has been recording patients who are veterans, but was not able to confirm if they had been making a total record.


Specific staff training is not given but the body’s deputy director of operations is the nominated veterans’ lead and “work to support veterans is going on at a many levels”.


Devon: The Devon Partnership NHS Trust


In a response to the original FOI, the Trust stated that it has had a Veterans’ Service since 2011, with data collated since 2014.


A spokesperson said the Trust has “continued to develop” its service for veterans and “comprehensive” assessments are followed by signposting to “other support services”.


The Trust has a Veterans Service that provides advice to anyone supporting a veteran, and is currently embarking on a training and education programme for its frontline teams in order to promote a better understanding of veterans’ particular needs and to improve staff effectiveness.


A working group has further developed the Trust’s Wellness Recovery Action Plan (a wellness process) to better meet the specific needs of veterans.


Dorset: Dorset Healthcare Trust


In response to the original FOI, only veterans’ data was supplied for IAPT service as the Trust’s general services did not hold veterans’ specific data.


The Trust has been collecting data on veterans for about 12 months, including the total number.


Army veteran AJ Gritt, was appointed as a part time service lead for the newly formed Armed Forces Community Health and Wellbeing Team in April 2016, when a fully coordinated care pathway for veterans was instigated and an action plan put in place.


He has a full time support worker. Therapists and other mental health care professionals have to complete mandatory online training and receive awareness training from AJ.


Prior to April, he said the approach was “patchy”, a description he used to describe the nationwide approach to veterans’ mental health care.


Somerset: Somerset Partnership NHS Foundation Trust


The Trust was unable to provide the number of veterans it was treating in the original FOI because it did not hold a specific record.


A spokesperson confirmed that for at least 12 months, the Trust has been recording whether patients are veterans but was unable to confirm if it made a record of the total number of veterans it is treating.


The Trust appointed a veterans’ lead in 2007 who received eight days training and currently involves one day a fortnight. The original FOI stated that half a day a week was committed to the role.


Cornwall: Cornwall Partnership Trust


The Trust did not respond to the original FOI citing “commercially sensitivities” as the reason as it was involved in a procurement process for its IAPT service. Since the retendering process, Outlook South West provides this service.

A spokesperson confirmed that the Trust doesn’t routinely record veteran status because feedback from veterans has been that they do not feel it would be useful.

The Trust does not provide specific training for all staff, however it provides a Community Veterans’ Service provided by a specialist worker who provides treatment to veterans with more complex mental health problems.


The spokesperson said: “This nurse provides expert advice to other clinicians in the Trust to ensure the needs of veterans are met. She also works closely with organisations which support veterans.


“The Trust also employs a senior clinician who has worked extensively within military mental health services and the veterans’ community who acts as an advisor on these matters.”




Information received via a series of FOIs in November 2016 also revealed what the approach was in the rest of the UK:




A  Veterans NHS Wales Service was established in 2010 and receives annual Welsh Government funding of £585,000. When surveyed, virtually all health boards made a record of the total number of veterans being treated and reported a rise. The service funds veteran specific therapists in each board area.




When surveyed, the majority of health boards did not record veteran numbers however most were linked to the NHS Scotland funded Veterans First Point service which has eight centres across the country and is staffed by an alliance of clinicians and veterans.


Northern Ireland:


Freedom of Information requests to each of the five health boards revealed that none made a record of the total number of veterans they were treating and confirmed that they did not have any specialist training for its staff.


A Department of Health spokesperson confirmed that Armed Forces families and veterans have access to mental health services within the health and social care system on a similar basis as other members of the local population.


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