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Keeping to the Military Covenant

This Wednesday's King's College London Veterans' Mental Health Conference, coming as thousands of British troops return from deployments unprecedented in recent history, is a good moment to reflect on how well we are supporting those who need mental health support after serving their country. Concern for the mental health of our armed forces is high, especially given recent press coverage, and it is hugely positive that supporters of Help for Heroes and other organisations are willing to fund mental as well as physical health care. But ultimate responsibility for the health of serving personnel and veterans lies with the government, and is at the core of the military covenant between the armed forces and the state.

And keeping to the covenant matters: recent research from King's College London shows that anxiety and depression are twice as prevalent among military personnel as in the general working population - making them more common than either post-traumatic stress disorder or alcohol abuse disorders. Given that the military population and the comparator population were pretty similar apart from their jobs, it seems that the difference comes from specific risks related to military life: the authors cite more stressful life events, and separation from friends and family. Treatments are out there and can really work - but all too often, help is either unavailable or inaccessible.

Chair of the Royal College of Psychiatrists, Prof Simon Wellesley, recently pointed out, there would be an outcry if two thirds of people with cancer got no treatment - but we seem to accept this for people with mental health problems. Both inside and outside of the armed forces, part of the solution must be cultural: making it easier for people to ask for help from friends, colleagues and healthcare professionals.

But even in a perfect system, some people will prefer not to disclose their mental health needs. At Big White Wall, we've been offering anonymous online support to serving personnel, veterans and their families since 2011. It's affordable and our members tell us that it works. For 2015, we're adding one to one talking therapies -available online seven days a week, morning to night. We know that talking therapies for depression and anxiety really work, and hope that this help us support more people who have been hurt while serving their country - and also the families who support them.

It's one of the toughest working environments out there, and it's been difficult to change deeply-engrained cultural assumptions about help seeking, but in some ways the military offers a good model for changing cultures around mental health support. We have seen a high profile report from Dr Andrew Murrison MP (2010's Fighting Fit) and real government response to its recommendations. We have quality research on the prevalence of mental health conditions among the armed forces, and good data on the utilisation and effectiveness of talking therapies for veterans. Military leaders, welfare officers in the services, and NHS mental health trusts are all taking the problem seriously.

But the hardest discussion is often around how best to deliver effective help in straightened times - particularly for the most vulnerable in our society. To help everyone who needs mental health support, we need to be open to learning from successes in improving access, in research and in practice, across our systems of care. Digital is only one part of the puzzle, and the challenges remain significant. But as the covenant says, we can and must persevere in supporting those who serve and have served.

Ileana Welte, Big White Wall UK MD, is joining a panel session at Veterans' Mental Health - Facts Fiction and Future on the 11th February 2015

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