The British public has a long history of generous donation to military causes, from tiny local charities to national initiatives. Veterans’ mental health is a growing focus—this week given a huge boost by the Royal Foundation’s Heads Together campaign linking traditional royal support for the military with a focus on mental well-being. But how do we work out whether all this activity is making a difference?
The barriers to effective support
Impact measurement in mental health is always tricky, but particularly in the armed forces community. Reluctance to talk about mental health problems—and underestimation of the scale of the problem as a result—is significant. In a recent Big White Wall survey, almost 90% of veterans said shame or embarrassment has prevented them from seeking help for mental health problems. It’s hard for charities to have an impact on an issue that is so hidden.
Post-traumatic stress disorder (PTSD) is often believed to be the prevailing military mental health problem. Yet although serious and often devastating, PTSD is, thankfully, relatively rare. Recent research from King’s College London suggests that the most common problems among serving personnel are anxiety and depression—the same as for the general population. The possible presence of pre-existing conditions (probably not previously assessed) adds significant complexity to impact assessment.
On a practical level, it is difficult to keep track of people who have been in the armed forces: there is no central register. Younger men in particular may not associate with the term ‘veteran’, or even ‘ex-serving’, which adds a challenge to promoting services. In many cases, mental health care will be provided by the NHS—there has been some important research looking at outcomes from veterans’ talking therapies—but veteran status is not always disclosed or recorded.
Overcoming these barriers—together
As is so often the case, the best approach is to collaborate. This is not easy given the number of organisations in the field. But Heads Together is the most recent example of several charities getting together to bring mental health issues into the open. And real progress has been made with the formation of Contact, which draws major organisations working in military mental health under a single umbrella to share ideas and outcomes.
There are also signs of progress within the military itself: most veterans surveyed told Big White Wall that mental health stigma has reduced over the last five years. This is perhaps in part due to various campaigns by charities and forces organisations to reduce stigma around mental illness in ex-service people.
Most importantly, we must continue to listen to those who use services, and try and reach those who could but do not. This means a shared commitment to measuring the impacts that matter—not to providers or funders, but to beneficiaries themselves.