Speeches recovered from the Conservative party’s online archive More…

Liam Fox: We must defuse timebomb of veterans' mental health

I have long believed that the way in which society treats those least able to play a full role is a measure of how civilised that society is. It is also almost impossible to fix a broken society if you don't fix the broken individuals within it. That is why dealing with mental health issues is so important. 

For me mental health has always been a very important subject. As Shadow Health Secretary in 2002 I ensured that the Conservative Party made mental health a central part of our health policy agenda.

Now, as Shadow Defence Secretary, I want the debate about the mental welfare of our troops and veterans to be higher up the agenda -building upon the work carried out by the Military Covenant Commission headed by Freddie Forsyth and including Falklands veteran Simon Weston -which devoted a great deal of time and effort to the issue.  

Our Armed Forces have seen a lot of combat in recent years-the Gulf War, the Balkans, Sierra Leone, Iraq and Afghanistan. Improvements in body armour and vehicles have meant that many of the injuries that were once fatal are now survivable. We will see many disabled young veterans as a result-something our society will need to adjust to. But that is only the visible damage. What is invisible has to concern us too.

The TA solider in Helmand on Friday could be the local milkman on Monday-alone and isolated;

The young man who wakes up screaming in the night ten years after last seeing action;

The wife of the shattered marine may have no real understanding of the cause of mental illness-or where to get help.

We are potentially creating a mental health time bomb and we need to defuse it before it is too late.

<h2>The Current Picture</h2>

Here is a snap shot of the current situation facing our service members:

From January 2003 to December 2006, 2,333 regulars and reservists who served in Iraq during Operation TELIC were managed by the Defence Medical Services for mental illness attributed to their deployment.
In 2007, there were 1,898 new referrals to the MoD's Departments for Community Mental Health (DCMHs) who were diagnosed with a mental health disorder and had served in Iraq or Afghanistan or both in 2007.

I fear that, deployment after deployment and year after year, the mental health problem will become a mental health crisis. This is because our armed forces are operating at a tempo for which they are neither resourced nor manned.

There are some service members who have been on multiple deployments to Iraq and Afghanistan. Each deployment only makes matters potentially worse for the service member and studies have shown a nexus between the length of time on operations the possibility suffering from some form of mental health illness. 

In the U.S., a recent study found that soldiers on their third or fourth deployment have significantly lower morale, more mental-health problems and more stress-related work problems.

In the UK, a report in the British Medical Journal reported that of those troops serving 13 or more months in a theatre of operations, 5.2 percent suffered from PTSD; 21.8 percent suffered from psychological distress and 23.9 percent suffered from severe alcohol problems. 

The Centre for Suicide Prevention at Manchester University this month has looked at people leaving the Armed Forces and found that our young men are at increased risk of suicide.

As the legacy of the Afghan and Iraqi conflicts unfolds, the demand for proactive mental health care will be greater. In addition, as we start to get more robust systems in place to identify those coming back to the UK with mental health issues we will see the number of cases rise.

Look at America, for example. There, where a robust mental health programme exists-even sending so called Mental Health Advisory Teams into theatre of operations-the number of cases, on average is a lot higher than it is in the UK. 

Pentagon figures show that 40,000 troops have been diagnosed with PSTD since 2003. Furthermore, officials say one in eight American combat troops in Iraq and one in six of those in Afghanistan are taking prescription antidepressants like Prozac or sleeping pills.

Could this be a representation of what we may be facing in the future here once we really devote the time and resources in dealing with the mental health of our armed forces?

Are we as a society ready? I don't think we are. We seem to be in denial.

Mental health in the armed forces is only one piece of a very complex puzzle in terms of looking after our service personnel and our veterans. Many problems associated with our veterans, including the number of homeless veterans, domestic violence by veterans, veterans with alcohol problems, and the disproportionate number of veterans in our prison system-all have roots in an inadequate mental health care system.

In August 2008 the National Association of Probation Officers (NAPO) estimated that there were 8,515 prisoners who had served in the Armed Forces and it is believed that the vast majority of offences were violent and related to PTSD , drugs or alcohol abuse.

Post deployment monitoring of service members is vital if we are ever to catch the symptoms of any mental illness in its earlier stages. This must be done through adequate decompression immediately after leaving theatre but also whilst the troops are in theatre.

We must continuously adapt to the ever changing situation in Iraq and Afghanistan. For example, studies have shown that many times in theatre there are barriers preventing soldiers from obtaining the mental-health care they need. In Afghanistan, the dispersal of British troops over large and remote areas places troops further from the care providers at large bases. I recently returned from southern Helmand province where I visited a remote patrol base which didn't even have cooks and a kitchen-much less mental health specialists.  That is the reality on the ground.
For regular forces the strains are immense.

<h2>The Problems for the TA</h2>

Our servicemen and women in the TA experience a further unique set of problems.

When a returning member of the TA returns home from operations there is little or no formal support group, structure or camaraderie with fellow troops who experienced similar things to fall back on.  No familiar faces on the base. No friends to meet for a pint who understand what you are going through.

TA service members, more often than not, simply return to their civilian jobs and back to family life without the safety net apparatus that is provided by being a member of the active forces. 

Increased use of the TA means that we will encounter even more problems in the future. If the time bomb goes off we are simply not prepared for the explosion of cases, or the impact it will have on society.

As awareness increases amongst members of the TA and the social stigma attached to mental health decreases, the number of cases is likely to rise.

For those few Servicemen who need inpatient mental health services the MOD relies on a contract with the private Priory Group having closed down military psychiatry as a comprehensive service.  We find this unsatisfactory. Traumatised Servicemen have particular needs that differ profoundly from those of general mental health patients. They must benefit from healthcare professionals who have a first hand appreciation of the exceptional occupational context of their illness. They should be treated in surroundings and by people that are familiar to them and where they feel at ease. Other countries appreciate this but we have lost our way.

<h2>The Conservative Way Ahead</h2>

How should we treat those who are currently out of the Armed Forces but who have served on operations in a combat zone? For this, action, not reaction, is required. We can't afford simply to respond to a crisis when it arises-we must act now. 

To deal adequately with veterans' mental health there must be much more of a proactive response by the Ministry of Defence-in close coordination with the Department for Health, service charities and the existing Medical Assessment Programme that the last Conservative government set up - to address problems before they fully develop. 

There are two driving factors behind the need to be proactive. First, those who suffer from a mental illness are those who are least likely to seek professional help. Secondly, mental health in the NHS is neither resourced nor staffed to deal optimally with the particular needs of the Armed Forces. 

Let me give you one example.

Lance Corporal Johnson Beharry, the most decorated war hero in the British Army, recently went public by telling how he had to wait hours for NHS treatment. He went on to say in a recent interview that:

'The NHS don't have my record, so they don't know my problems, they don't know my trauma. So if I go with a problem I need to explain everything to them again. At the time I was in so much pain, I was so angry with myself, I was so angry even with the people around me because of the way I was feeling. I didn't want to have to explain anything."

Let me give you another example from the NAPO report on Ex-Armed Forces Personnel and the Criminal Justice System:

"A solider, now 23 years old, had previously served with the parachute regiment and had served two tours in active war zones. He left military service in late 2005 with no previous convictions, but since being discharged has 7 convictions, 5 of which resulted in periods in custody. He reports that he failed to readjust to life in the UK, finding it hard to 'reconcile the devastation, horror and distress of the war zone, with the comfortable life' he found himself and others taking for granted.

He did refer himself to his GP because of strong indications of post combat PTSD and was given a psychiatric appointment. Local psychiatric services are limited. He missed his first appointment and claims he was never offered another. At his most recent interview in June 2008 he stated he 'wanted to join up again - if the marines won't have me the foreign legion will'. He self medicated over a number of years using alcohol, became aggressive towards partners and others, and is currently serving four months for assault. Because of the short sentence he will have no post release supervision."

Don't get me wrong.  There are some measures in place to address the mental health problem among veterans such as the Reservist Mental Health Programme and the Screening and Medical Assessment Programme (MAP).

While these two programmes are helpful, they are flawed because they require the veteran to go to them-not the other way round.

As the all-party Defence Select Committee said in a report last year, 'the identification and treatment of veterans with mental health needs relies as much on good intentions and good luck as on robust tracking'.

Whilst I acknowledge that the King's Centre for Military Health Research has conducted some research and surveys into the mental health of Iraq veterans, and whilst this work is extremely important and it should of course continue, the Government needs to do more in order to reach out to a far larger number of veterans. Accompanying academic research, a system must also be put in place that will not only identify those veterans at risk, but also ensures that they get access to treatment.

What should worry us all is that there is little awareness that the various existing programmes even exist. Last year a Public Accounts Committee report stated that the Government 'has done little to advertise the provision to veterans'.

A Royal British Legion survey of 500 GPs across England and Wales found that 85 per cent knew nothing about the Reservist Mental Health Programme and 71 percent of GPs knew nothing at all about MAP.

Obviously, this presents a serious problem since it implies that a considerable number of veterans are not being assessed because their GPs are not referring them due to their own lack of awareness.

We need to take action-practical steps to put an end to this situation.

A future Conservative Government will set up a mental health follow-up telephone service-initially a pilot scheme-for our veterans who have deployed on operations or to places in support of operations.

It will draw from the U.S. Department of Defence's "Post Deployment Health Reassessment" programme and will require mental health professionals to call service leavers who have been on operations after a year to monitor their mental health.

I have agreed with my colleague Andrew Lansley that we will fund the one-year £400,000 cost of this pilot from the NHS Direct consultancy budget.

Upon leaving the armed forces those who have served on operations will be told to expect a phone call in the near future from a qualified healthcare provider. A questionnaire will be answered that, if necessary, will lead to a referral through the Medical Assessment Programme. 

It will be customer-service driven and at the convenience of the veteran. This will ensure maximum participation. This already works in America-our forces deserve no less.

It is vital that make every effort to contact them and not to wait and hope that they will contact us. The charity Combat Stress-which does outstanding work helping veterans with mental health issues-reports that veterans take, on average, 14 years between leaving the military and referring themselves to one of their treatment centres. (The average age of new referrals during 2007-8 was 42 years).

This is exactly why we have to act sooner and be more proactive in identifying and treating mental health issues in our veterans.

If this pilot is successful it will offer a way ahead of better assessment, provide referrals where required, and serve as the cutting edge of progressive social policy in terms of mental health.  There is no reason why the Armed Forces should not be first in line for what I hope will be a step change in the quality of mental health services available to this country.

This requires a cross departmental, co-ordinated approach. I have been working closely with our health team to ensure that we are ready to hit the ground running upon entering office and we get the pilot programme up and operating as soon as we possibly can.

There will not be a single day to lose.

<h2>Conclusion </h2>

The failure of quality provision for those with mental illness, military or civilian, in the United Kingdom, the worlds 5th richest country, should make us feel ashamed.

For our Armed Forces, who are willing to risk life and limb for our security, and who have even higher risks than other citizens we must act with special haste.

For all of the sacrifices made we owe it to our service members, our veterans and their families to ensure that they are well looked after.

We are not a land fit for heroes.

But we can be.

We should be.

And I believe we will be. 

Keyboard shortcuts

j previous speech k next speech