Rockliffe Court Surgery

Veterans' mental health services

Whilst there is often an emphasis on veterans with post-traumatic stress disorder (PTSD), the actual rates are not high (around 6.2%), which is broadly equivalent to the incidence amongst civilians. More common issues include other mental health difficulties, such as anxiety and depression, as well as problems related to alcohol. However, for those veterans who deployed when serving, rates of PTSD are higher at 9% and up to 17% for those who deployed in a front-line, infantry combat role.

There is growing evidence that a range of mental health conditions may appear (or patients may present) some years after individuals have left the armed forces. These conditions may relate to combat, training or other military experiences, transition out of service or indeed pre-service vulnerabilities.

The historical issues of stigma associated with mental health and a traditional culture of reluctance to admitting to a perceived weakness or being in a position of having to ask for help means that a substantial number of unwell veterans are unlikely to access the appropriate support and services. This is further compounded by a lack of awareness amongst veterans of what services are available to them, as well as varying levels of awareness across the NHS on the health needs of this patient group. In addition, the widespread public perception, often fuelled by mainstream media, that all veterans are damaged by their military service and all of them have PTSD is not only wrong but harmful.

In support of those individuals who require care and treatment for mental health conditions, the Veterans' Mental Health Transition, Intervention and Liaison service (TILS) and the Veterans' Mental Health Complex Treatment Service (CTS) have been set up.

Veterans' Mental Health Transition, Intervention and Liaison Service (TILS)

This is a dedicated out-patient service for serving personnel approaching discharge from the Armed Forces and veterans who are experiencing mental health difficulties. The TILS provides a range of treatment, from recognising the early signs of mental health problems and providing access to early support, to therapeutic treatment for complex mental health difficulties and psychological trauma. Help may also be provided with housing, employment, alcohol misuse and social support.

The service comprises three elements:

• Transition: service for those in transition, leaving the armed forces The service works with the Ministry of Defence (MOD) to offer mental health support for Armed Forces personnel approaching discharge.
• Intervention: service for veterans with complex presentation Service personnel approaching discharge and veterans will have an assessment within two weeks of a receipt of referral. Where appropriate, the TILS will aim to see patients two weeks after this. This will be with a clinician who has an expert understanding of Armed Forces life and culture. They may also be supported by a care coordinator who will liaise with other services and organisations to ensure a coordinated approach to their care.
• Liaison: general service for veterans Patients who do not have complex presentations, yet would benefit from NHS care, will be referred into local mainstream NHS mental health services where they will receive treatment and support.

If an assessment finds that an individual has significant mental health difficulties that are service related and have not improved with previous treatment, they will be referred to their local CTS.

Veterans' Mental Health Complex Treatment Service (CTS)

This is an enhanced out patient service for ex-forces who have military related complex mental health difficulties that have not improved with previous treatment. The service provides a range of intensive care and treatment that may include (but is not limited to) support for drug and alcohol misuse, physical health, employment, housing, relationships and finances, as well as occupational and trauma focused therapies.

Access to the CTS is via the TILS. This ensures that any previous treatment and support has been considered. Once referred to the CTS, the service aims to see patients for their first appointment two weeks after this. They will be supported by a military aware team who will develop a personalised care plan with them, which will include arrangements for crisis care.

Access to both of these services is through the TILS. GPs and patients can contact the service direct (see below) for a referral:

• North of England services:
  • call 0303 123 1145
  • email vwals@nhs.net
• Midlands or East of England services:
  • call 0300 323 0137
  • email mevs.mhm@nhs.net
• London or South East of England services
  • call 020 3317 6818
  • email cim-tr.veteranstilservice-lse@nhs.net
• South West of England services
  • call 0300 365 0300
  • email sc.veterans@nhs.net