Very pleased to be here.
Our operations in Iraq and Afghanistan are dangerous and demanding and our forces are engaged in some of the toughest combat than at any time since the Korean War. Operational tempo is high and they – and you - are busier than ever before.
So it is no surprise there is an increasing public and media focus – quite rightly – on the way we look after and support our servicemen and women. On pay, on accommodation and of course on medical provision for the men and women who serve our country with such commitment and enduring courage.
And mental health support is increasingly in the spotlight. In the media and across Government where there are an increasing number of Parliamentary Questions on this issue. It’s certainly a very important part of my own Ministerial Portfolio.
In order to try and better understand the issues that face our people in terms of mental health I read Ben Shephard’s book ‘A War of Nerves’. For me this provided a fascinating insight into the world of soldiers and psychiatry and how views on the best approach differed and changed in both the First and Second World War.
Whilst there were many interesting points in the book two issues particularly stuck with me.
The first is the issue of treating the victim. Charles Myers observed that men were being returned to the UK for treatment but were often left alone. Shephard wrote about Myer’s thoughts on this;
“Myers began in May 1916 to press the case for treating shell-shock even earlier, not at the Base but at specialist hospitals only a few miles from the front. He was convinvced, from his own experience and that of the French, that such an innovation would dramatically reduce the levels of ‘wastage’. He was in fact putting forward the principle of ‘proximity’ on which all modern military psychiatry is based. But he met with strong opposition, particularly from the Adjutant-Generals department. The traditional view that ‘we can’t be lumbered with lunatics in Army areas’ proved hard to shake.’ Myers also came to realise that there were other elements in the equation that were out of his control.”
In further reading of the book there is one section that stands alone. In it he talks about these other elements particularly in view of the principle of selection – a debate that still takes place today in some quarters. It reads;
By the middle of 1943, it was becoming clear that by concentrating on selection, the United States Army and the psychiatrists had ignored the lessons of the past. Selection, however thorough and expert, could only address one of the several variables which went into a man’s experience of battle.
‘The psychiatrist in the induction centre’, a post-war account pointed out, ‘had no possible way of evaluating the four most important factors of influence upon the adjustment of the soldier: the nature of leadership that would be provided for him; the degree of motivation that he had to do his job or that could be instilled in him; the type of job which he might be assigned; and the degree of stress which might confront him.’
From reading this book it further heightened my interest in the subject of combat and mental health. This is why I’m particularly pleased to be here.
This is a forum which gives each of you as Defence mental health professionals – whether Regular; Reservist or Civilian; doctor; nurse; psychologist; social worker or occupational therapist the opportunity to get together, share ideas and brainstorm.
Some of you are working in one of the 15 military departments of community health across the UK; supporting the physically injured casualties at Selly Oak or Headley Court; or serving with the British Forces in Germany; Cyprus and Gibraltar. And of course I’m aware that some of you have deployed in recent years to Iraq and Afghanistan.
Many of you here today are at the forefront of supporting the men and women of our Armed Forces. I’m quite clear that mental health is a central pillar of our Duty of Care. Just as I am sure it is for our major allies – and I welcome their experts who will be sharing their experiences at this conference.
As Minister for Veterans, I am also pleased to see that Combat Stress will also be giving a presentation.
For the UK Service population the experience of recent years has shown us that a community based system of mental healthcare and the continued focus on occupational provision has definitely been the right way to go, indeed a recent report by the House of Commons Defence Committee has endorsed that.
And of course that has also – following the closure of the single military psychiatric hospital in Catterick – meant creating the ability to deliver professional in-patient mental health care on a regional basis. At the moment this is being delivered by The Priory group.
Their contract expires later this year and in line with commercial practice this now has to be tendered once again. What is very interesting is that this time around we have had a large number of expressions of interest, including several from National Health Service Trusts with foundation status who now wish to tender.
Society has come a long way in recent years in accepting mental illness as a condition that can take many forms but one that can be treated. And that’s reflected in today’s Armed Forces where a lot of work has been done in recent years to promote awareness across the Chain of Command and to be proactive when it comes to early detection of mental health problems.
But I recognise there is still a lot of work to be done when it comes to de-stigmatising the whole issue of mental health in a culture which champions physical and mental endurance, and where individuals are often reluctant to come forward for help. This is where leadership from the very top plays its part.
I see you’ll be hearing about the TRIM model of peer group support mentoring which was originally piloted by the Royal Marines.
I will leave the analysis to the experts, but if de-stigmatising mental health is the biggest challenge we face, so that Service men and women can feel they can ask for help from the professionals when they really need it, then I am readily persuaded that a unit led initiative like this one can only help in reducing some of the traditional stigma associated with mental health in the forces.
Thanks to you, our servicemen and women who do seek help are getting excellent diagnosis and treatment. Mental health is, of course, complex – depression; adjustment disorders; acute conditions; issues that are directly linked to the stress and trauma of battle. Our people look to you – the professionals – for a wide range of care and support.
In Afghanistan for example where in many cases those of you in mental health teams are integrated into forward positions as an essential part of the Battle group. I know from speaking to Commanders on my visits to Iraq and Afghanistan just how much they value your contribution in diffusing potential longer term problems. The work being done by the field teams is making a huge difference.
I spoke earlier about the scale and tempo of today’s operational environment and making sure our provision matches need means a tangible commitment to research. I’d like to take this opportunity to pay tribute to pay tribute to Simon Wesseley and his team for all the work they are doing at Kings in raising the profile of military mental health.
This team of experts are undertaking vital, ground breaking research that is widely peer reviewed internationally and respected throughout the academic world.
Policy and provision have to be based on hard data and empirical study. You’ll be hearing from DASA later on about how the changes they’ve made in the reporting of mental health statistics are now enabling us to have a much broader picture of mental health across the Armed Forces.
The ongoing study by Kings following the progress of a random sample of some 20,000 UK service personnel - divided between those who deployed on Telic1 and those who didn’t – will be a vital resource. And will help to inform a much wider range of work across the board when it comes to looking at a range of social and psychological aspects of military service in the 21st century.
It aims to continue the investigation of those deployed to Iraq whilst also including a new cohort deployed to Afghanistan. It’s a body of work that will provide a real insight into differences between regulars and reservists; follow-up those that have left the Armed Forces, and examine longer term implications of medical countermeasures.
It’s going to be hugely useful, not only in formulating thinking across DMS and across the Forces but also as an essential reference for our service charities who are our much valued partners in delivering support to our Veterans. Organisations like SSAFA; the Royal British Legion and of course Combat Stress, to which we have recently announced a 45% increase in funding, and who you’ll be hearing from later on today.
As Veterans Minister I work closely with these organisations who are working at grass roots level – I am a strong advocate of the third sector. These organisations are passionate champions for some of our most vulnerable veterans and their families. We are lucky to have them.
I can’t emphasise enough just how important this research is in informing policy. Reservists are a good example of where a need was determined and we took immediate action.
They have been doing a fantastic job in recent years, serving side by side on the front line with their regular counterparts but until recently were unable to access mental health support on the military network once they were demobilised.
A couple of years ago research from Kings revealed that – while the actual percentages were small - Reservists were twice as likely as their non-mobilised colleagues to declare indicators of some mental health problems on their return from deployment. .
As a result of these findings we set up the Reserves Mental Health Programme which is now up and running at Chilwell and offers assessment by Defence Medical professionals and treatment at one of the Departments of Community Health. A similar scheme has also been introduced for our MOD civilians who have deployed and who might need such follow-up help.
One of the issues that has been talked about a lot is the whole issue of de-compression, and I certainly know that it has been a subject of debate with regard to some of our reservists who have deployed on operations.
I had the opportunity to visit Camp Bloodhound on a recent visit to our Forces in Cyprus. The feedback from the latest group of troops that had just left was that 80% of them thought it was worthwhile.
I was certainly impressed with facilities which we can continue to improve.
As you’ll all be aware the rate of medical discharge as a result of psychological illness is low – at the moment the annual figure is around only 0.1% of the Armed forces manpower, and out of those 150 or so individuals only around 25 meet the criteria to be diagnosed with PTSD.
And when they are discharged there is a dedicated resettlement process managed by military mental health social workers and the whole transition of care is managed with the appropriate health authorities.
The majority of veterans, of course, are not discharged with a problem, nor do they go on to develop one related to their Service. But I recognise that across the whole of the UK and for the wider veterans community there are gaps when it comes to former serving personnel developing mental health symptoms at a later stage which are related to the time they spent in the forces.
And in the case of PTSD this might not manifest itself for months or indeed years. Or indeed the whole issue of stigmatisation may have prevented people form coming forward earlier.
But it is also the case that , once they have moved into civvie street it can be difficult for them and for their GPs to recognise the link to military service and access the right kind of help.
I’m confident that the mental health care pilots we launched at the end of last year with Combat Stress and the Department of Health – in Camden; Stafford; Peterborough; St Austell; York and Lothian - will help to bridge these gaps.
Every site has a trained veterans mental health therapist; it’s a facility that’s going to give GPS across the UK access to a regional network of military mental health expertise.
I’ve had the opportunity of visiting the pilots at both Camden and Stafford – they are going to be a tremendous resource. The schemes will run for three years and we’ll be monitoring them closely over that period.
We’ve also expanded our Medical Assessment Programme which Dr Ian Palmer has been running at St Thomas’s Hospital in London for a number of years. And that programme will now be open any Veteran – whether Regular or Reservist - with operational service going back to 1982 who is now experiencing health problems.
Across the board – from recruit to veteran – we are committed to doing everything we can to make sure that the mental health needs of our people are properly met.
Which is why I want to end by paying tribute to each of you. To the work you and your colleagues are doing to support and care for the men and women of our Armed Forces. Essential work that is often undertaken in difficult and dangerous circumstances. Work that, I am only too aware, will sometimes takes its toll on you and your families.
I am very grateful for your commitment, for your expertise and for your unstinting dedication. Our forces are lucky to have you.