David Powell, from the NHS Veterans' Mental Health Transition, Intervention and Liaison Service (TILS), gave a fascinating keynote presentation at our Annual Staff Conference on military mental health and the TILS.

TILS is a national service, but MHM plays a key part in the service in the Midlands and East of England by providing the 24-hour Single Point of Access. Various NHS Trusts, Walking with the Wounded, and MHM all work in partnership to deliver the service, launched in April 2017. The service provides rapid access to mental health support, in the right time, right place, from the right team. It is for veterans and armed forces personnel who are approaching discharge.

During 2007-2012, 4,439 Regular Army Personnel were medically discharged. At least 15% of these were due to mental health conditions. The way that data is collected means these figures don’t necessarily reflect the true extent of mental health problems in the military.

In the past, veterans have often found it hard to access NHS mental health services. There are issues and misconceptions on both sides. NHS services sometimes find it hard to place veterans in the ‘stepped care’ model. Their needs are too complex and high risk for IAPT, but aren’t seen as appropriate for secondary care either. There is also a fear by many NHS staff that they are not skilled enough to work with veterans. Veterans often think of civilian staff as ‘pink and fluffy tree huggers’. They worry that NHS staff could never understand what they have been through. There is still a problem of stigma and ‘machismo’ in the military which puts people off seeking help.

One issue when assessing and treating veterans is the military’s unique language and culture. It is common knowledge that ‘talking helps’ our mental health, but acronyms and jargon can get in the way. David showed us this slide as a perfect example:

“It wasn’t until I was on RNR that I realised how affected I was about being on Op Herrick. It was worse than Op Telic. I was at the FOB most days and felt at constant risk of RPGs and IEDs, little did I realise that it would be a blue on blue USG that would get me. I was casevaced to Bastion and then RCDM. My RSM came to visit me and the UWO did my WISMIS visits.  I was then in DMRC for 6 months, that helped a lot, but when I RTU’d I was drinking a lot and my full screw told me I should see the MO. I’m P0 and my PRO from the PRU is Capt Smith. He’s told me I’ve got a PSMB soon and I’m likely to be P8S8.”

If you have been in the military yourself, or know others who have, you might be able to easily make sense of this. For most civilians, this paragraph would be hard to decode. It doesn't mention a traumatic injury – that is only evident once you know that RPGs, IEDs and USGs are explosives, and to be ‘casevaced’ means evacuated from battle by helicopter with a severe injury. Behind the acronyms, this is a description of an incredibly traumatic time in someone’s life. Without knowledge of military language and terminology, it’s hard to make head or tail of exactly what happened. It is easy to see how NHS staff can feel out-of-their-depth when trying to support veterans - and why veterans get frustrated at having to ‘translate’ themselves. It means that they spend the time reliving the events, rather than being able to focus on receiving support. This is why there is such a clear need for the Veterans' Mental Health Transition, Intervention and Liaison Service.

The TILS is a vital part of the ‘Military Covenant’, the mutual obligations between the nation and its Armed Forces. The Covenant states that military personnel should experience ‘no disadvantage’ when accessing healthcare as a result of being in service.

The service works alongside the Defence Medical Services to support people who are in transition - approaching their discharge date – as well as veterans. This is the first time that personnel approaching discharge have been able to access specialist NHS support before leaving the military. This means there need be no gap between them leaving the forces and receiving support. The TILs service is there to help them through the transition to civilian life. This is a critical time for many veterans. They experience a lot of change and must adapt to a very different set of systems. Offering support at this point is crucial for recognising and treating problems early.  

Within two weeks of referral to TILs, each person will have an assessment. If they have complex mental health needs which need a specialist intervention, they are offered an initial appointment within another two weeks. This is with a clinician who has an expert understanding of armed forces life and culture. Advice and care is provided in a range of locations and settings, and via a range of methods, not just face-to-face. We even use Skype to support people remotely. For people with less complex issues who still need help, TILS liaises with the appropriate local NHS service to get them support.

We work with each person to develop tailored care packages. These cover support relating to mental health, employment, housing and alcohol. Where appropriate, we involve people’s families and carers in planning and assessing care. We know that families are often affected by their loved ones’ experiences in the armed forces, so they are also supported to access treatment for themselves if required.

The Single Point of Access (SPOA) that MHM provides is key. We accept and make referrals, making it as easy as possible to access and coordinate support. Health and social care professionals can use the SPOA to seek advice on support for veterans with acute mental health difficulties. The helpline is also there 24 hours a day, 365 days a year, to provide support to people in the event of an emergency.

We are very proud of the role MHM plays in providing this support to veterans in the Midlands and East. We thank David for attending our staff conference and reminding us of how vital this service is.

To access the service as a veteran, patients must be a resident in England, have served in the Armed Forces for a full day, be registered with a GP in England and be able to provide proof of their military service. Anyone meeting the criteria can self-refer or request a referral from a health care professional or service charity.

Find the contacts details for TILS in your area