Veterans: mental health

There are an estimated 5 million veterans in the UK, and a further 20,000 personnel leave the forces each year. The Ministry of Defence (MoD), UK departments of health and charities are working together to improve mental health services for veterans.

When staff leave HM Forces, their healthcare transfers from the military to the NHS. For those with a medical discharge on mental health grounds, a military social worker works with them for up to 12 months to help them access the right NHS services.

In 2010, 164 personnel had to leave the armed forces because of a psychological condition. Of these, 35 were diagnosed with post-traumatic stress disorder (PTSD). Around one person in every 1,000 regular service personnel is discharged annually for mental health reasons.

For those leaving the forces, most make the transition to civilian life without difficulty. If they have ongoing medical issues the MoD will let their GP and the NHS know what needs to be in place to ensure the best possible healthcare.

Being a veteran opens the door to a range of help and support from the MoD, other government departments and ex-service voluntary and charity groups. You can access all of these services by calling the Veterans-UK free helpline on 0800 169 2277, or, for those with mental health concerns, the helpline run by Combat Stress and Rethink on 0800 138 1619.

If veterans need help

There are some veterans who develop mental health problems.

Around 100 veterans a year who feel they have mental health problems related to their service accessed the Ministry of Defence (MoD)’s Medical Assessment Programme (MAP), a national service for veterans. This service has now moved to Chilwell and has been renamed the Veterans and Reserves Mental Health Programme (VRMHP). It remains a national service for veterans on referral from a GP, but self-referrals are accepted.

It can take years for a veteran to seek help after becoming unwell, either because of stigma or because they believe that nothing can be done.

Mental health symptoms

After a traumatic event it's normal to experience anxiety or nightmares, and these usually go away within a few weeks. However, some individuals experience lasting psychological problems, resulting in depression and anxiety. Find out about the symptoms of depression.

A relatively small percentage will develop PTSD. Symptoms can include:

being constantly anxious
being unable to relax
vividly re-experiencing a traumatic event
avoiding anything that might trigger distressing memories or feelings

Post-traumatic mental conditions can lead to problems in relationships and at work, which may be related to irritability, anger and substance misuse, particularly alcohol.

While some symptoms, such as nightmares, are normal in the weeks following a traumatic event, symptoms that last for longer can indicate a problem.

Combat Stress is a UK charity supporting people with service-related mental illness. It gives practical support, such as help with housing or employment matters, and a clinical assessment of mental health needs if necessary. It also has short-stay residential facilities offering rest and treatment, and community psychiatric nurses who can provide care at home.

Combat Stress, working with mental health charity Rethink, runs a 24-hour helpline (0800 138 1619) for veterans who have concerns about their mental health.

Support and treatment

There are treatments to help people cope with the psychological consequences of exposure to traumatic events, including trauma-focused cognitive behavioural therapy (CBT).

Dr Andrew Murrison MP was asked by the government in 2010 to look at the provision of mental health services for the armed forces and veterans. His report, Fighting Fit, made four main recommendations. Three of these apply to veterans and their families:

an increase in the number of mental health professionals working specifically with veterans via mental health trusts, in partnership with a leading mental health charity
a veterans information service (VIS) to be deployed 12 months after a person leaves the armed forces
trial of an online early intervention service for serving personnel and veterans: Big White Wall offers free, anonymous online psychological support for veterans, serving personnel and their families

These were due to be delivered from 2011 onwards, and additional services are already in place to help veterans with mental health problems.

The important message is to seek help from somewhere, whether it's from a GP, local NHS services or a charity.

Veterans and Reserves Mental Health Programme

The Veterans and Reserves Mental Health Programme (formerly known as the Medical Assessment Programme) is based at the Department of Community Mental Health in Chilwell, Nottingham.

Anyone who has served at any time since 1982 and has a mental health problem that they think might be related to service, can contact the VRMHP.

Veterans can be referred by a GP or can contact the VRMHP directly on 0800 032 6258. Anyone caring for a veteran can also contact the VRMHP if they have concerns about the mental health of someone in their care.

VRMHP provides veterans with a full mental health assessment by a consultant psychiatrist. The results of this assessment, along with advice on further treatment and care, will be passed to the veteran’s GP or other local health professionals involved in their care.

Help for reservists

When reserve forces are demobilised, their medical care becomes the responsibility of the NHS. In November 2006, the MoD and NHS launched a new initiative called the Reserves' Mental Health Programme (RMHP) – now part of the VRMHP. It is open to anyone who:

has seen active service as a volunteer or reservist since January 1 2003
is now demobilised
has mental health problems that might be linked to service on operations

Of those who have used the RMHP, most received the help they needed simply by contacting the professional team members, but some individuals have attended the Reserves Training and Mobilisation Centre in Chilwell, Nottinghamshire to be assessed.

Reservists who are eligible and who would like an assessment can ask their GP for a referral. This is the preferred method of contact, to ensure the GP and assessors are aware of all the factors affecting the individual’s health.

Referrals from civilian psychiatric services (such as Combat Stress) are also accepted, but the patient’s GP will be informed. Individuals can contact the assessment centre directly, but Defence Medical Services (DMS) staff will liaise with the individual’s GP before offering a mental health assessment at the Reserves Training and Mobilisation Centre.

If an individual is diagnosed with a combat-related mental health condition, outpatient treatment is offered at one of the MoD’s 15 military Departments of Community Mental Health (DCMHs). If acute care is needed, the DMS will help provide access to NHS inpatient treatment.

The Improving Access to Psychological Therapies programme acknowledges that it's important for veterans to be able to access mental health care through whichever route they feel most comfortable with. Work is being done to raise awareness and capacity in the NHS to help veterans who are concerned about their mental health. There are many service charities that can also provide support, including:

The Royal British Legion's Legionline (08457 725 725, Monday-Friday 9am-4pm)
The Soldiers, Sailors, Airmen and Families Association (SSAFA)'s Forcesline (0800 731 4880, 10.30am-7.30pm)
The Combat Stress 24-hour helpline (0800 138 1619)

If you're a veteran and think you might need help, don’t be afraid to ask. Your GP, the VRMHP, a helpline or charity can help you get the support you need.

Last reviewed: 09/06/2011

Next review due: 09/06/2013

More articles on: Military and veterans' healthcare

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3 Comments about ‘Veterans: mental health’

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Comments are personal views. Any information they give has not been checked and may not be accurate.

MAS1478 said on 24 December 2012

Government after government, Prime minister after Prime minister have let veterans and serving members of the Armed forces down generation after generation – just as the human guinea pigs for the Atom Bomb experiments. Just ask the veterans with years of experience of poor equipment and on many occasions being injured by the very equipment they use. This is not politician led but MOD led. Its time politicians stood up for veterans against the faceless bureaucrats in the MOD.

Politicians will stand up and with the Union Flag in one hand and say how proud they are of our armed forces and in the other they are slashing budgets and suppressing the need for more and better equipment.

This country would fall apart if the charities and volunteers stopped giving so freely – the burden would have to fall on the people ie heavier tax – is that a bad thing?
The amount of forces charities out there is immense and appears to be growing by the week – especially if governments or the National lottery set a focus on a group or illness or trendy counselling service. The issues with this wide variety of charities is the dilution of expertise and greater numbers looking for shrinking public and private funding – the whole thing needs managed. My experience of "some" of the negative practices of "some" of the charities are the can be very selective about which veterans they will support – and which veterans they will not – it can be more like an exclusive club.
Where does this leave us? God knows its so complex – lets just stick to what's best Dads Army style – breaking at the seems and stuck together with masking tape.
Hey - but we are still the "best armed forces in the world".

MAS1478 said on 24 December 2012

I'm surprised you say the armed forces is good for your mental health - basic training completely changes a person fight and flight response and when people return to Civy street this can cause issues by it self.

Then there is the bullying that goes on-extreme? – many of the veterans that I have treated speak of this.

When people in the armed forces have high levels of stress they attempt to cope with this by drinking to access – perhaps this has changed – the reality is the that places like Cyprus are being used for "depressurisation " and continue the link "de - stressing by drinking alcohol" So where is the logic in this, especially as there is a massive issue with alcohol in society as it is – many veterans suffer form alcohol problems, the ones that come to the notice of NHS services are the tip of the iceberg.

Many will end up in the legal system because of drink and violence – a proportion of them will end up on the street – homeless and addicted to alcohol or drugs.

So please show me the evidence that links good mental health to serving in the armed forces. The good feelings you presume to link to their mental health are feelings of loyalty and camaraderie for friends and history of a badge. The other issue that seems to go un researched is the level of "suitability" of some of the people who are recruited. Some veterans who show classic signs of PTSD. However, when given a safe environment to explore their issues have came from very difficult and distressing backgrounds – some already have trauma and PTSD from childhood events. Why allow some one with this history into service where the chances of stressful events is just about guaranteed. Recruitment needs to be more robust.

charm101 said on 05 May 2010

Veterans really need this for their mental health proposes. In their field as a military there are trauma and fear that most of them encountered. With the support and treatment that the government will give to them surely it will be a successful one. Give the chance for them to be treated and fulfill their days with their family and friends.

Charm Stevenson