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 PTSD (post-traumatic stress disorder). 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 Ministry of Defence, 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 approach the Ministry of Defence (MoD) Medical Assessment Programme (MAP), a national service for veterans.
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 for veterans who have concerns about their mental health. The number is 0800 138 1619.
Talking2Minds was set up to help those suffering from PTSD or other severe stress-related conditions. The charity offers short one-to-one courses to help clients get to the root cause of the problem without revisiting the trauma as some traditional medical approaches do.
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 are due to be delivered during the course of 2011, 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.
Medical Assessment Programme
The Medical Assessment Programme (MAP) is based at Guy’s and St Thomas’ hospital in London.
If anyone has served at any time since 1982, including in the Falklands conflict, and has a mental health problem that they think might be related to service, they can contact MAP.
Veterans can be referred by a GP or can contact the MAP directly on 0800 169 5401. Anyone caring for a veteran can also contact the MAP if they have concerns about the mental health of someone in their care.
When a veteran comes to the MAP, their NHS and service medical records will be looked at in order to assist in any diagnosis and treatment plan. Any diagnosis and treatment plan will be communicated to the medical and mental health team involved in their care. The veteran is also given a written document outlining their situation.
Reserves' Mental Health Programme
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). 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 RMHP 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:
If you're a veteran and think you might need help, don’t be afraid to ask. Your GP, the MAP, a helpline or charity can help you get the support you need.
