My Lords, I think we all found that a fascinating discussion. I will say later in my remarks that I indicated during the passage of the
overseas operations Bill that I felt that some of these issues would be worth revisiting in the Armed Forces Bill. I am very grateful to the noble Lord, Lord Dannatt, for raising the issues. I will address the points on which he specifically sought clarification later in my speech, but I pay particular tribute not just to the content of your Lordships’ contributions but to the emotional sentiment and the calibre of that sentiment, as so eloquently expressed by the noble Lord, Lord Robertson.
These important amendments centre on the issue of service personnel and mental health. As I said, I am very grateful to be able to look at these amendments. I accept that the amendments in the name of the noble Lord, Lord Dannatt, are well intended. Amendment 48 is supported by the noble and gallant Lord, Lord Houghton of Richmond, the noble Lord, Lord Coaker, and the noble Baroness, Lady Brinton, while Amendment 66A is supported by the noble and gallant Lords, Lord Stirrup and Lord Boyce, with the noble Lord, Lord Coaker, lending his weight as well.
I also extend my gratitude to the right reverend Prelate the Bishop of St Albans, whose Amendment 60 highlights the potential harmful impact that addictive gambling could have on our service personnel. His amendment is supported by the noble Lords, Lord Browne of Ladyton and Lord Foster of Bath. The right reverend Prelate’s determined pursuit of the potential harm of addictive gambling is acknowledged and admired. I assure him that I have looked at the research he referred to, which I shall refer to when I address his amendment.
Amendment 48 seeks to ensure that the Government make provision for additional mental health support, including for service personnel affected by the United Kingdom’s withdrawal from and the Taliban takeover of Afghanistan in 2021. The noble Lord, Lord Dannatt, asked about Afghanistan and the effect of Operation Pitting on those who participated. I am not dodging the issue, but as yet there is no clear evidence to support what mental health impact the current Afghanistan situation is having. The MoD is prepared with comprehensive services and support for everyone who may have been affected by this situation.
The noble Lord, Lord Dannatt, specifically raised the issue of suicides. The MoD has begun the defence suicide register. It relates to all suicides across defence, including those relating to Afghanistan. It is anticipated that this review or register will be released in spring 2022. I hope that provides the noble Lord with some reassurance that active attention is being directed to this.
It is MoD policy that mental health should be properly recognised and appropriately handled, and that every effort should be made to reduce the associated stigma. The MoD recognises that mental ill-health can be a serious and disabling condition, but one that can be treated through education, training, diagnosis and specialist care. We have a resilient workforce and are focused on the prevent space all the time, not just with current events. I will explain to your Lordships what we do now. I thank the noble Lord, Lord Coaker, who said that, time was, we did not really talk about these issues. I say to him: we want to talk about them now, we can talk about them now, and that is what we should do.
Every year the MoD publishes the United Kingdom Armed Forces Mental Health bulletin, which provides a summary relating to Armed Forces personnel seen in all military healthcare services—primary care and specialist mental health care—for a mental health-related reason. It provides a wider picture of mental health among Armed Forces personnel. The noble Lord, Lord Coaker, justifiably asked about the level of need. That annual bulletin is a useful indicator of level of need.
The noble Lord, Lord Coaker, also asked for an overall figure of resource applied to the mental health support given to service personnel and veterans. I will inquire and see what I can find out. I undertake to write to the noble Lord, and I shall place that letter in the Library.
In June 2021, the annual UK Armed Forces Mental Health bulletin showed that the mental health of UK Armed Forces personnel is
“broadly comparable to that seen in the UK general population”
and that the rate of mental ill-health
“for those needing specialist mental health treatment was lower in the UK armed forces than that seen in the UK general population.”
The noble Lord, Lord Dannatt, referred to the helpful description that I believe my ministerial colleague for defence personnel and veterans used: the “gold standard” of what we try to do. I think we do have a gold standard in relation to the provision of mental health support for our Armed Forces and veterans. I am going to take some time to explain what we do, because it is important that I share with your Lordships as much information as I can. All Armed Forces personnel are supported by dedicated medical services, including mental health support. The MoD works with the single services, Defence Medical Services and other stakeholders to promote mental fitness, prevent ill health and reduce stigma. The noble and gallant Lord, Lord Houghton, and the noble Viscount, Lord Brookeborough, quite rightly raised that important issue.
Each of the single services provides through-career mental resilience and stress management training, including a defence course for senior officers. Armed Forces personnel who experience a traumatic event are supported through the trauma risk management process. The MoD has also produced the HeadFIT website to encourage the good management of mental fitness. An online mental health fundamentals course is available to all Armed Forces personnel and, from 11 October this year, the annual mental fitness brief is mandated activity for all Armed Forces personnel, delivering an understanding of mental health and well-being, stress management, how to transform stress into mental resilience and where personnel can seek appropriate help.
The MoD provides a 24-hour mental health helpline for Armed Forces personnel and their families delivered by Combat Stress. Togetherall allows Armed Forces personnel access to its 24-hour staffed digital forum, and the Samaritans deliver bespoke workplace training and a peer support pocket guide providing guidance on how to talk to and support colleagues struggling to cope with mental ill-health.
One question that arose was: what processes are in place to identify those who are vulnerable and most at risk of developing mental illness? No system can detect every individual at risk of mental illness. Nevertheless—I
say this to reassure the noble Lord, Lord Robertson—measures are in place to increase awareness at all levels and to mitigate the development of operational stresses. These include pre and post-deployment briefing and the availability of support, assessment, and, if required, treatment both during and after deployment. This is available to all personnel, whether regular or mobilised reservists.
Going back to the important issue of stigma, what is the MoD trying to do to help address that and people’s reluctance to accept or seek help? Stigma is not, as your Lordships will understand, an issue only for the UK Armed Forces. It accompanies mental health issues among the general population. But, from September this year, all Armed Forces personnel receive a mandatory annual mental health and well-being briefing. It focuses on increasing awareness of mental health and the personal barriers that prevent some personnel seeking support.
We move on to the important issue raised by a number of noble Lords: the transition. What do you do when you propose to go from active service to the status of veteran? What support is given to service leavers with mental health issues to ensure that they do not slip through the gaps in that transition? Where personnel leaving the Armed Forces have an enduring need for mental health care, we work in partnership with the NHS to ensure continuation of care. The MoD’s departments of community mental health are accessible for up to six months after discharge to help veterans during their transition period.
An important question was raised by the noble Viscount, Lord Brookeborough: what are we doing to support the mental health needs of veterans? Wherever they live in the UK, all veterans are able to receive specialist mental health support if they need it. The MoD and the Office for Veterans’ Affairs work in close partnership with a variety of different organisations, including the NHS and the devolved Administrations, who are responsible for health care, including mental health care, for veterans, and service charities.
The through-life mental health support now provided to Armed Forces personnel will also have a positive impact on the veterans of the future. We are ensuring that Armed Forces personnel have the psychological resilience training they need to recognise mental ill-health in themselves and those around them and know how to manage it.
What about the supporting background, which is also critical? The majority of Armed Forces personnel who seek mental health care are actually managed by their GP. However, some with more complex needs will receive treatment from specialist mental health care providers. MoD specialist mental health services are configured to provide community-based mental health care in line with national best practice. This is done through 11 military departments of community mental health across the UK that provide outpatient mental health care. These DCMH teams comprise psychiatrists, mental health nurses, clinical psychologists, senior mental health practitioners and mental health social workers. A wide range of psychiatric and psychological
treatments are available, including medication, psychological therapies and environmental adjustment, where appropriate.
For those personnel requiring medical intervention, the Defence Medical Services provide a responsive, flexible, accessible and comprehensive treatment service. Some 10.5% of UK Armed Forces personnel were seen in military healthcare for a mental health-related reason in 2021. This figure includes both personnel seen by their GP and those who required the support of specialist mental health services. We also do more out in the broader community. The Defence Medical Services set up Project Rebalance, a self-referral provision for serving personnel seeking mental health care who are pregnant or are on maternity leave. In February 2021, the Defence Medical Services set up another self-referral provision—Project Direct Support—for DMS personnel seeking mental health care while being engaged in clinical front-line duties during Covid.
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If we look at single-service mental resilience programmes, we see there is much excellent work going on there. The Royal Navy uses a mixture of the Army’s Op Smart programme and the Royal Marines’ Project Regain to assist all ranks in seeking help if they have concerns about their mental health without the need to go through their unit’s medical officer first. Op Smart, to which the noble Baroness, Lady Brinton, referred—I thank her for her positive comments—is a system that the Army has developed. It is an evidence-based programme to improve mental fitness and resilience; for reference, Op Smart stands for “optimising performance through stress management and resilience training”. It is delivering a through-life, stepped education and learning programme for all Army personnel, grounded in psychological skills and mental fitness.
The RAF is also making its own contribution. Following on from the social, personal and emotional awareness of resilience, it has invested in research and development and has developed a comprehensive, whole-force, specialist mental fitness and well-being programme, Thriving at Work, which has replaced mental health first aid training.
As I said, most service leavers make a successful transition to civilian life, but this is not necessarily the public perception. In October 2019, the MoD introduced a new holistic transition policy to better co-ordinate and manage Armed Forces personnel and their families from military to civilian life. There is a new organisation called Defence Transition Services. Holistic transition support relates to a whole range of life-changing issues that affect both the serviceperson and their immediate family.
In relation to veterans, NHS England has expanded mental health services as part of the NHS long-term plan. More than 13,000 former troops have benefited from specialist care for lower-level problems such as anxiety and depression, while almost 2,000 more have received help for more complex problems such as post-traumatic stress disorder. That is in addition to improved mainstream access to psychological therapies services, which receive more than 23,000 veteran referrals per year.
As I have tried to explain, if you look at the panoply of support—I realise that many of your Lordships may not have realised how some of this links together and works—you see the tremendous level of support. I have not mentioned the Veterans Trauma Network, which is another source of support. I hope that your Lordships understand that the MoD, in conjunction with the NHS, is doing an enormous amount to ensure that we not only identify difficulties that may be encountered in the services but provide within them the support that people need, and anticipate, as these people prepare to leave service, what the pressures in their transition may be. If someone has experienced mental health challenges and difficulties, we ensure that their transition into civilian life is supported. I hope that, following these assurances, the noble Lord, Lord Dannatt, will agree to withdraw his amendment.
I will now address Amendment 66A, also in the name of the noble Lord, Lord Dannatt, which seeks to create a statutory duty of care towards all service personnel, all veterans and their family members. I have stated this before and will state it again: it continues to be the Government’s view that it would not be practicable or desirable to define a legally binding duty of care.
We discussed this at length on numerous occasions, and I am not averse to discussing it again. I say to the noble Baroness, Lady Smith of Newnham, that the MoD already has a duty of care in law for service personnel and veterans, which it takes very seriously. Over the years, we have established a comprehensive range of legal, pastoral, welfare and mental health support for service personnel and veterans. These were articulated at length during the passage of the overseas operations Act, and they were also clearly laid out in the Defence Secretary’s Written Ministerial Statement of 13 April, which, again, I urge your Lordships to read carefully. It sets out the full range of measures and support that are available to service personnel.
I will restate a couple of points. First, service personnel are entitled to receive legal support where they face criminal allegations that relate to actions taken during their service and where they were performing their duties. Legal advice and support are also available whenever people are required to give evidence at inquests and inquiries and in litigation.
Secondly, as I have indicated at length, a range of welfare and mental health support is routinely offered to all our people, regardless of where and when they served. The potential impact of operations on a serviceperson’s mental health and well-being is well recognised—a number of your Lordships alluded to that, and I absolutely accept that connection. There are policies and procedures in place to help manage and mitigate these impacts as far as possible. This support is available both while someone is serving and then through the dedicated support for veterans available through the NHS’s Op Courage in England and its devolved equivalents.
Since it is specifically mentioned in the amendment, I reiterate that such support is available for those affected by the events in Afghanistan, as it is for all those affected by service in other conflicts—my noble friend Lord Lancaster quite rightly alluded to that.
It is there for all our Armed Forces, wherever and whenever they need it. Furthermore, it should be noted that £5 million has recently been made available by the Prime Minister specifically to support serving personnel and veterans, including those affected by the events in Afghanistan.
We acknowledge that such support does not stand still, but I believe that continued improvement can be achieved without legislation. We have carried out work to improve signposting and awareness of support for those individuals who are involved in legal proceedings arising from their service. The Army Operational Legacy Branch provides help, support and further signposting of support to those involved in legal matters relating to past operational deployments. I remind noble Lords that this support is available to both the serving and the veteran communities, and of course it may also be accessed by family members acting as help seekers for a loved one in crisis. Since I last updated the House on these issues, the AOLB has created the veterans visiting officer role. These officers are specially trained serving officers tasked with providing tailored support to individuals involved in legacy processes in Northern Ireland, Iraq and Afghanistan.
Welfare support ranges from the intangible nudges that ensure that factors affecting well-being are addressed before they negatively impact on an individual, right through to the tangible interventions, when a person’s well-being is at risk. Proving delivery of the intangible is challenging, and focusing only on the tangible risks distorting the support that is available. Whether an individual wants or needs legal, pastoral and mental health support is a personal issue, and providing this through policy allows for the type and delivery of support to be appropriately flexible.
My noble friend Lord Lancaster hinted that, for him, there may be some areas of anxiety—he is reflecting on that, and I shall leave him to do so and come to his own conclusions—but I have to say to your Lordships that notions of pastoral and moral duties are extremely difficult to adequately define in law. There is a real risk that attempting to do so will lead to more, rather than less, litigation and greater uncertainty. I wish to reassure the noble Lord, Lord Dannatt—I say this with absolutely no doubt about either the commitment or the passion with which he has pursued these matters—that we have looked with great care at his amendment, including the potential legal consequence. I stress again that we are deeply concerned about the potential unintended negative effect of this amendment, if it is included in this legislation.
The Written Statement already provides a public commitment to the provision of support to personnel in these circumstances and the department can be held to account in Parliament, and indeed in public, for this commitment. In addition, pursuing a statutory approach could result in other unintended and, I suggest, undesirable consequences. A legal duty of care standard would be challenging to draft, given the diverse needs of different individuals, and the result may leave personnel without the right support for them at the time that they need it.
Furthermore, the creation of a requirement to have a legal standard of something of such an intangible nature would mean that whether the department has
set the standard properly, and then in an individual case whether it has been met, would be capable of being tested only in the courts. This is a particular risk, given how vague some of the terms in this amendment are. It will be hard for the department to know exactly what is meant by a duty of pastoral or moral support in order to report on it, and hard for service personnel and veterans to know exactly what they should expect from it. As I have previously stated, this will have the paradoxical outcome that time better spent delivering the highest standards for our service personnel and veterans will instead be time spent engaged in resolving complicated legal issues and litigation with lawyers.
I believe the amendment is unnecessary. The MoD is absolutely clear on its responsibilities to provide the right support to our personnel, both serving and veterans, and to seek to improve and build on this wherever necessary. As I have set out, I do not believe that setting a duty of care standard in the Bill is necessary or desirable, and I urge the noble Lord not to press this amendment.
I turn now to the final amendment in the group, Amendment 60. This new clause intends to place a duty of care on the Secretary of State to conduct and publish research on the prevalence of gambling disorder among servicepeople. I shall therefore address the text of the amendment which is about servicepeople. We have seen no evidence to suggest that service personnel are more prone to problem gambling than any other group in society.
As I have indicated, the Ministry of Defence is committed to the mental health and well-being of its Armed Forces personnel and provides dedicated and comprehensive services, including support for gambling-related disorders. We take problem gambling seriously and provide welfare support and financial awareness training for our people. All Armed Forces personnel receive comprehensive, through-career briefings on the importance of financial security and the values and standards expected of them. There is signposting to a full range of support and assistance for gambling-related issues.
Although I am satisfied that our existing approach to the reduction of gambling-related harm is appropriate and proportionate, the MoD continues to improve the support packages available to all service personnel. I wish to reassure the right reverend Prelate that I have listened to his contributions over many months. They are informed and very helpful to the debate. He was kind enough to forward the American studies to which he referred, and I had a look at them. I thought the lapse in time slightly weakened their relevance to the UK, not least because they were in a different country.
Having said that, I want to ensure that we are not being complacent. I want to make sure that we have up-to-date data. I say to the right reverend Prelate that we are looking at how we might be proactive in monitoring the situation. At my request, we are proposing including a section in the annual continuous attitude survey to invite comment on problem gambling. As far as I am aware, it has not surfaced in the survey returns, but I quite understand that people probably answer the questions they are asked. We are proposing
to do that. I shall oversee that addition, and I undertake to report back to your Lordships on the progress we make on that.
With reference to our veterans, who are not specifically included in the amendment, we shall look carefully at the recent Forces in Mind Trust-sponsored study, which was published on 23 September. The noble Lords, Lord Browne of Ladyton and Lord Browne of Belmont, both referred to that. We will have a look at it. We do not collate specific statistics on levels of gambling among service personnel, but any that are assessed as having a mental health-related addiction, including to gambling, will be captured in the mental health official statistics, which, as I said, the department publishes annually.
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The noble Lord, Lord Foster, asked a specific question about gambling machines on bases. I asked the officials if there was any more information on that. I am informed that direction has been given by the Army for them to be removed from bases but this process is not yet complete. Again, I undertake to make further inquiries for the noble Lord and report on progress.
Finally, the right reverend Prelate the Bishop of St Albans has written to me. I read the letter with care but have not had time to respond to it. I thank him for his committed interest in these matters, and I undertake to respond to his letter. I hope that, following these assurances, the right reverend Prelate will agree to withdraw his amendment.