Armed forces and mental health
Most British military personnel do not experience mental health problems while they are in service, or afterwards in civilian life.
However they face unique risks in service and, if they do experience mental health problems, they may require particular treatments and particular mental health services.
The mental health problems experienced by military personnel are the same as the general population, although experiences during service and the transition to civilian life mean that their mental ill health may be triggered by different factors. Post Traumatic Stress Disorder (PTSD), depression, anxiety and substance abuse affect a significant minority of service personnel and veterans.
What are the risks for people in service?
A number of UK studies have found links between active service and mental health problems in armed service personnel involved in recent conflicts. A very recent study of 10,000 serving personnel (83% regulars; 27% reservists) found lower than expected levels of PTSD. Common mental disorders and alcohol misuse were the most frequently reported mental health problems among UK armed forces personnel. In particular, levels of alcohol misuse overall were substantially higher than in the general population.
The main findings were:
- 4% reported probable post-traumatic stress disorder
- 19.7% reported other common mental disorders
- 13% reported alcohol misuse
- regulars deployed to Iraq or Afghanistan were significantly more likely to report alcohol misuse than those not deployed
- reservists were more likely to report probable post-traumatic stress disorder than those not deployed
- regular personnel in combat roles were more likely than were those in support roles to report probable post-traumatic stress disorder
- experience of mental health problems was not linked with number of deployments.
Fear NT, Jones M, Murphy D et al (2010). What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study. The Lancet (2010) 375 (9728): 1783–1797.
What are the risks for veterans?
There are an estimated 5 million veterans in the UK, and a further 20,000 personnel leave the forces each year. When staff leave HM Forces, their healthcare transfers from the military to the NHS.
Only around 0.1% of regular service personnel are discharged annually for mental health reasons. However some veterans develop mental health problems after leaving service, many of whom will be experiencing PTSD.
Until recently, little was known about these veterans. What is known is that only half of those experiencing mental health problems sought help from the NHS, and those that did were rarely referred to specialist mental health services.
Veterans’ mental health problems may be made worse or caused by post-service factors, such as the difficulty in making the transition to civilian life, marital problems, and loss of family and social support networks. Younger veterans are at high risk of suicide in the first two years after leaving service. Ex-service personnel are also vulnerable to social exclusion and homelessness, both of which are risk factors for mental ill health. Alcohol misuse is also high.
What services are available?
A number of special mental health projects have been set up by the Ministry of Defence with the NHS, in recognition of the difficulties veterans face accessing help.
The Medical Assessment Programme (MAP), based at Guy’s and St Thomas’ in London, offers help and treatment to any veteran of any conflict, no matter how long ago, and their carers.
There is also a Reserves’ Mental Health Programme (RMHP) open to anyone who has seen active service as a volunteer or reservist since 1 January 2003 and is now demobilised, and has mental health problems that might be linked to service on operations.
You can contact the Medical Assessment Programme (MAP) on 0800 169 5401.
You can contact the Reserves’ Mental Health Programme on 0800 032 6258.
The MoD and NHS are also running six Veterans Mental Health pilot projects across the UK. The aim of these projects is to increase knowledge and understanding of veterans' mental health needs among mainstream NHS staff , to improve access to mainstream NHS services.
The projects provide treatment and referrals to community mental health services, social services and specialist assessment and treatment elsewhere, including the residential centres run by the voluntary sector veterans’ support organisation Combat Stress.
Each project has a community veterans mental health therapist and the projects also have links with local veterans' organisations to reach out to people who may need help.
Some local NHS Talking Treatments services are developing skills in working with veterans. Ask your GP about a referral for talking treatments, but be sure to check that they are confident and skilled to work with you.
The Service Personnel and Veterans Agency (SPVA), part of the MoD, acts as a single point of contact to provide advice for serving military personnel, ex-service personnel and their dependents.
The SPVA is responsible for the War Pensions Scheme and Armed Forces Compensation Scheme for armed forced personnel who experience illness as a result of service.
Outside the NHS, the charity Combat Stress provides specialist residential and community outreach mental health care for veterans. You can contact them on 01372 587 000 or email firstname.lastname@example.org.