Retired Colonel, Dr Jonathan Leach is a general practitioner in Bromsgrove, Worcestershire and chair of the NHS England Armed Forces and their Families Clinical Reference Group. Dr Leach served for 25 years in the Army including 17 years overseas. His perspective on the mental and physical health needs of military veterans is therefore invaluable - a perspective he kindly shares with us now in this blog.
![Dr Leach: 'Many myths have been perpetuated... including assertions that a greater proportion have mental health problems [than others in society], are in prison, or sleeping rough... none of these myths are true.'](https://socialcare.blog.gov.uk/wp-content/uploads/sites/8/2016/02/JL2.png)
In England there are estimated to be approximately 2.8 million veterans, many of whom are senior members of society who served in the military during the 1940s and 50s.
Evidence from younger veterans is that the majority transition into civilian life without significant difficulties. However, many myths have been perpetuated by the media and others, including assertions that military veterans are more likely to take their own lives compared with others in society, a greater proportion have mental health problems, are in prison, or are sleeping rough on a regular basis. None of these myths are true.
Having said this, there is a cohort of ex service personnel who have both mental and physical problems as a consequence of their military service. The Government has addressed this by means of the Armed Forces Covenant which describes how public services broadly should support current serving personnel, military veterans and their families.
Within health there is specific funding available to provide increased access to the range of services available for those who have suffered the most serious trauma – for example limb amputation whilst on duty. There is also specific funding for the treatment of mental health problems attributable to service life. These include funding for 12 community mental health trusts in England as well as the provision of detailed and concentrated care under contract with Combat Stress, a national charity that specifically provides mental health services for ex service personnel.
NHS England (NHSE) is also seeking the views of patients, carers and provider organisations on the current provision of mental health services for veterans; the questionnaire can be accessed here.
To supplement, NHSE - in conjunction with Health Education England - are developing a range of educational packages aimed at health and social care professionals that will hopefully provide greater insight into the needs of the military community including veterans and improve the care of those who require support and treatment. These packages will be available shortly."
Overall, whilst the majority of veterans do not require care that is different from other members of society, there is a small cohort requiring an enhanced range of services. As the Government stated in its most recent policy statement (May 2015) The Armed Forces Covenant “…recognises that the whole nation has a moral obligation to members of the armed forces and their families, and it establishes how they should expect to be treated.”
5 comments
Comment by Dr S Davies posted on
I'd be interested in the evidence that "none of these myths are true". Is this published anywhere?
Comment by Tony Gauvain posted on
It is our experience that some Veterans, Reservists, and family members cannot or do not want to access mainstream services; nor do some of them wish to be put on waiting lists or travel far away for an appointment; and some are in prison and find it difficult to access treatment. Many have been through several programmes of unsuccessful treatment. For this reason PTSD Resolution (www.ptsdresolution.org) was started seven years ago, to give another route to treatment for those who want to try something else. We have now had 1204 referrals, and receive an average of seven new ones a week. We offer free, prompt, local, brief, effective therapy across the UK, accessible through the single number 0300 302 0551. It would be helpful if this choice could be made widely available.
Comment by Hannah Walker posted on
I am very suspicious of both Colonel Leach's statement that: "none of these myths are true", and the rather pro-Government bias which pervades this blog article. I, too, would be interested to see the evidence on which he bases his argument. Although the media in general (who are these "others", by the way?) can have a tendency to exaggerate, the coverage of these "myths" is so widespread, and from so many different sources, that these so called myths are likely to have at least some basis in fact. The Telegraph - not known for its anti-Conservative stance - published this article, following on from a BBC Panorama investigation, as recently as 14 July 2013:
http://www.telegraph.co.uk/news/uknews/defence/10178403/More-British-soldiers-commit-suicide-than-die-in-battle-figures-suggest.html
If more soldiers were committing suicide 3 years ago than being killed in battle, then the ratio is almost certainly a lot worse now. If is still the case that the Government does not record suicides among former soldiers, then that is a scandal. It flies in the face of Colonel Leach's assertion that the Government has "addressed both the mental and physical problems (of service veterans) as a consequence of (their) military service by means of the Armed Forces Covenant". The MOD does not track the mental and physical health of veterans; even those who have been invalided out as a result of service attributable injuries or mental health problems are not automatically followed up. They are nearly all left by the MOD to fend for themselves (apart from any pension they may receive), or approach a charity to obtain the vital help that should be provided and funded by the Government. The Telegraph also reports (2015) a troubling decline in the state of veterans' mental health - particularly the number of veterans suffering from PTSD. Afghanistan veterans wait an average of 2.2 years after leaving the military before coming forward for treatment, Iraq veterans take nearly four years, but for veterans as a whole including those from earlier conflicts, the average wait is 13 years. The "macho culture in units, where people are bullied for admitting they think they have PTSD" merely serves to reinforce the reluctance of veterans to tell anyone that they are suffering. Anxiety, depression, panic attacks and sleeplessness are the most commonly cited symptoms suffered by veterans. I do not intend to go into the number of veterans in prison, or the numbers sleeping rough, as that would simply extend what is already an extremely long comment. All I will add is that if Colonel Leach genuinely believes that the very real and life threatening problems that face ex-service personnel on a daily basis are "myths", then I have very little hope that NHS England's attempt to improve mental health services for veterans will succeed. (I do not expect any answers to this comment from either Colonel Leach or the Department of Health, as they have not responded publicly to either Dr Davies or Tony Gauvain)
Comment by Michael Carder posted on
The Col has as any management does answered the question with facts figures and filla. However there isn't actually an answer. How does the poor vet who requires support actually find the relevant body or individual who could then sign post them on. All I want is some help, I'm not playing any blame game I just want a fair cracking of the whip.
Comment by Jonathan Leach posted on
I am grateful to all that have responded to this blog. I apologise that I have not been able to respond until now; this has been because I have been away from work due to an illness in my family.
The first point is that there is an absolute determination to improve the services for the Armed Forces Community, where this is appropriate. A lot of the feedback we get is positive but we are conscious that some services could be improved. It is for this reason we are seeking views from a wide section of the community on what is provided and we will use this to help inform the specifications of services as we re-tender them. I believe that we have received nearly 900 responses to our survey so far, which I think is really good, so if you have not responded, please do so. Secondly a major piece of work is to see if we can improve the knowledge and understanding of health and social care staff (and especially clinical staff) on the needs of the Armed Forces Community and veterans in particular. This is really important as individuals are sometimes entitled to a different range of treatment options. However, I and colleagues (as are many veteran organisations) are also very clear that many have health needs which are no different from other members of society (just as an example is the veteran I saw in my surgery on Friday afternoon, with a medical condition not attributable to his time in uniform) and transition into civilian life well and bring real positive attributes of professionalism, self reliance etc to society, employers and their families. Having said this, there are some that have specific or different needs as a consequence of their time in the military and this is our focus; both the NHS and the Country (via the Armed Forces Covenant) have a duty to do all that we reasonably can to assist and help and this is what we are trying to do. Our priority is therefore to use all the mechanisms at our disposal, which is the underlying purpose of the feedback exercise currently taking place.
With regard to evidence, we look very widely at a wide range of sources which includes both published evidence (such as from Kings College https://www.kcl.ac.uk/kcmhr/index.aspx) as well as internally within the NHS and charitable sectors. We also link very firmly with colleagues from the Health and Justice sector as this is a significant priority for us.
Can I thank you for your feedback; it is all helpful. We are all trying to improving the care and responsiveness of the NHS for an important group.
Jonathan