Veterans are not ‘Mad, Bad or Sad’, says Defence Committee

Defence Committee Press Notice – 25 July 2018

The public perception that most Servicemen and women are damaged by their service is wrong, according to a Report by the House of Commons Defence Committee on the extent of mental illness among Armed Forces personnel.

The vast majority of veterans leave with no mental damage, and suggestions to the contrary may actually discourage those who need help from seeking it. The Committee also believes that too much attention may be being placed on PTSD, whereas conditions such as depression are much more common.

The MoD has reported that some 3% of serving personnel were diagnosed with mental health problems last year – a significant increase over the previous decade, but still slightly lower than the level found within the general population. However, as the Department can record only those who seek help, its data probably underestimate the true figure. Academic research suggests that about 10% of veterans who served over the past 20 years may eventually develop mental health problems requiring treatment, with some groups – such as soldiers in combat roles, as well as Reservists – being at higher risk following deployment to Afghanistan or Iraq.

Provision of care

The MPs believe that more must be done to care for the small minority of serving personnel and veterans who do suffer mental health problems. According to the Committee “it is still taking too long for veterans to access treatment when they need it, and levels of care vary across the UK”. Some Service leavers are also “still falling through the gaps”, especially during transition to civilian life.

The Committee intends to examine this further and, having completed its examination of the scale of the problem, is today launching its follow-up inquiry into the adequacy of the provision of mental health care to serving personnel and veterans.

Priority treatment

One of the principles of the Armed Forces Covenant is that, when conditions are Service-related, veterans should receive priority treatment subject to clinical need. Yet the Committee found that this principle has been inconsistently applied. There is palpable confusion over how to implement it, and this adds to the perception that the Health Service is failing veterans. The Committee urges the Ministry of Defence to clarify the position as part of its forthcoming Veterans Strategy.

A lack of regional understanding

The Committee also found that the MoD has an inadequate understanding of the extent of veterans' mental health issues across the UK. The provision of healthcare may be devolved, but the MoD is still accountable for how the principles of the Armed Forces Covenant are implemented. More needs to be done to assess to what extent numbers of veterans with mental health problems might vary across the four nations.

Chair's comments

Defence Committee chairman, Dr Julian Lewis MP, says:

"Contrary to public perception, most Servicemen and women leave with no mental ill-health and, to help veterans, we need to dispel the myth that many suffer psychological harm. But the MoD must ensure that the few who do develop mental health problems are receiving the level of care promised to them in the Armed Forces Covenant. At the moment they are not, and we shall examine the situation in more detail in our follow-up inquiry, launched today."

Ruth Smeeth MP's comments

Defence Committee member and Chair of the APPG for the Armed Forces Covenant, Ruth Smeeth MP, says:

"Effective support during transition, as you leave the military, is essential to ensure that our service personnel experience a positive move into civilian life without any unnecessary stress.  If they are already receiving support for mental health issues while serving, they must receive what they need as they move into NHS care.  Yet, clearly, some leavers are falling through the gaps and the MoD needs to do much better in working with health economies across the UK to stop this from happening."

[To read the full Report, click here.]

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REPORT SUMMARY

Focus on mental health has increased over recent years. Media coverage, particularly during the conflicts in Iraq and Afghanistan, and Armed Forces charities have made the public much more aware of mental health conditions in Servicemen and women, such as Post Traumatic Stress Disorder (PTSD).

The perception that most Service personnel leave the Armed Forces ‘mad, bad or sad’ is, however, not only a myth but harmful to veterans. The vast majority leave with no ill-effects and have a positive experience from their time in service. The support and sense of community offered by the military environment might have improved the mental health in some or at least delayed the onset of pre-existing conditions. Indeed, this distorted public perception may be amplifying the stigma surrounding veterans’ mental health, discouraging them from seeking help, and overly focussing attention on PTSD, when conditions such as depression are much more common.

The limitations of Government data mean that it is likely to underestimate significantly the total number of serving personnel and veterans with mental health conditions; but we believe that the true figure will still be small. The Ministry of Defence reported that the rates of diagnosed mental health conditions in serving Armed Forces personnel have nearly doubled over the last decade to around 3% – slightly lower than the rate in the general public. However, this is the figure only for those who seek help. Academic research suggests that the true rate of veterans with mental health conditions could be as high as 10%. Certain groups, such as those in combat roles and deployed Reservists in Iraq and Afghanistan, also show higher rates of probable PTSD than the rest of the Armed Forces.

Nevertheless, the small minority of serving personnel and veterans who do suffer from mental health conditions, especially those who are severely affected by conditions such as PTSD, clearly need timely and appropriate provision of care. The UK Government has sought to make improvements in its provision of mental health care to veterans, but problems remain. It is still taking too long for veterans to access treatment when they need it, and levels of care vary across the UK. There is also the risk that some can still fall through the gaps as they transition from the care of the Ministry of Defence into the National Health Service. We shall be examining in detail the provision of mental health care to serving personnel and veterans in Part Two of our inquiry.

We are particularly concerned that the Armed Forces Covenant principle of priority treatment when conditions are service-related is not being consistently applied across the UK. Confusion over how it should be implemented in both clinicians and veterans adds to the perception that the health service is failing veterans. The Ministry of Defence urgently needs to clarify this in its future veterans’ strategy.

Accurate information about the extent of mental health problems in serving personnel and veterans is also critical to determining the resources required to care for those in need of it. Yet there is no clear and agreed approach across Government, academia and Armed Forces charities, which have different and incomplete datasets, compounded by poor recording of the numbers of veterans treated in the NHS. Nor is it understood how numbers of veterans with mental health problems might vary across the UK, both regionally and locally.

Finally, we believe that the focus on mental health and the Armed Forces should also extend to the families of both serving personnel and veterans, with emerging evidence that their mental health also can be affected by the stresses of Service life and the traumatic events experienced by their military partners.