Last week a new memorial was unveiled honouring the service and the sacrifice of the many thousands of British troops and civilians that were involved in the First Gulf War, Iraq and in Afghanistan. Such a memorial usually marks a nation committing an event to history, but for many who served in those theatres, the battle is still ongoing.
At Combat Stress, the UK's leading mental health charity for veterans, we have seen a 71% increase in the number of ex-servicemen and women seeking mental health support over the last five years, an increase largely driven by those who served in the more recent conflicts of Iraq and Afghanistan. Their military experiences may be varied but many, around 80%, share a common story - they have sought help from the NHS and found it unresponsive, and lacking a recognition and appreciation of the impact that the horrors of fighting wars and peacekeeping roles can have on mental health.
There is no escaping the fact the NHS remains under enormous strain. We need to work together - public, private and charity - to meet these growing demands. One of the most effective ways it can be more efficient and impactful is to make sure it is not offering services that could be better provided by commissioned third party organisations. To some, this idea may set alarms bells ringing but we have a long tradition in the UK of charities campaigning for reform - and providing services - when the state falls short. This should be no different for veterans care.
It is poorly understood by NHS mental health service planners and front line practitioners that former servicemen and women often see themselves as different, having built close bonds formed during military service, and as result prefer to only share details as intimate as their mental health condition with each other.
Many veterans simply do not engage with health services that are not culturally sensitive to the military community, for fear of being judged by unsympathetic GPs and other allied professionals. The treatment programmes that are effective for the general population are frequently not sufficient for those who have multiple traumatic memories from military service - a more specialist understanding is required.
Serving personnel form a unique identity during their service and use dark humour to get through the challenges. This greatly determines help seeking behaviours and treatment engagement and completion patterns. Mainstream NHS mental health services are aimed at dealing with common mental illness and severe psychotic presentations. They are less equipped to adequately address the needs of veterans who suffer potentially life threatening, and isolating complex mental illness caused by their military service.
A behemoth such as the NHS, which is set up to look after the general needs of the population, cannot be expected to obtain the same level of specific cultural and medical sensitivity as an organisation created explicitly to cater to these needs. Collaboration is therefore key.
Whilst excellent in many areas, the NHS could do more to educate and train allied professionals working across primary and secondary care and to refer them more quickly to appropriate services.
Just as we encourage veterans to overcome their fears of seeking support for their mental injuries, NHS Trusts, the Ministry of Defence and Local Government organisations should not be afraid to use charities with long histories as specialist service providers. A mixed economy of care is the best way to use today's stretched resources.