What we do

There is growing recognition of the need to improve the beneficiary journey for veterans seeking mental health services and, in particular, the linking of relevant data held by the principal statutory and third sector service providers. Following the first Contact Case Management workshop in Edinburgh in June 2019, Cobseo and Contact convened a Case Management Working Group of key stakeholders in autumn 2019 to consider the feasibility of a more holistic approach. The group’s report and recommendations were supported by the Office for Veterans’ Affairs (OVA), who agreed to fund a Scoping Study for the development of a Veterans’ Mental Health Information System (VMHIS), and to appoint an IT consultant to take this work forward.

The key principles identified by the Working Group are that:
– Veterans seeking access to mental health services should only be required to relate their history once.
– The existing silo approach, which often applies when veterans need to access multiple service providers, should be replaced by a process for effective data sharing, covering both statutory and third sector providers.
– The envisaged System should provide an immediate overview of the veteran’s dealings (if any) with mental health providers and welfare systems.
– Approved System users will have pre-determined editing rights, and access to confidential data should be limited to overviews (with links to seek further information where necessary).
– The System should be GDPR compliant, and underpinned by veterans’ consent for personal data to be utilised to support the coherent provision of mental health services.
– The new System should link existing systems, and avoid the wholesale replacement of local networks. It should also be embedded in existing local information networks.
– While the initial focus is on mental health, it is envisaged that the System can evolve at a later stage to incorporate other clinical conditions and physical health issues.
– Finally, and most importantly, the interests of the veteran must be kept at the heart of this project as it proceeds.

The Scoping Study addressed the IT development work needed to achieve these aspirations and included the development of a project specification that potential suppliers drew upon for their costed proposals.

The consultant completed a comprehensive fact-finding phase, involving engagement with key stakeholders and their front-line service providers, and then engaged with prospective suppliers. The information-gathering process was challenging, and revealed the many constraints that will need to be overcome, including: promoting understanding and buy-in of the aims beyond the immediate stakeholder community; addressing the challenges of operating across devolved boundaries (involving both data sharing and differing IT and/or non-IT business processes); getting a sense of beneficiary numbers, both now and looking ahead; and establishing a representative baseline (including at least three of the devolved administrations) for the initial implementation phase. 

The Customer Group that was established for and consulted during this process also recognised the importance of seeking input from clinicians before engaging with prospective suppliers, and a clinicians’ focus group was set up and consulted. 

The Scoping Study report was received in the first half of 2023, including a project specification and indicative costs from prospective suppliers, providing the basis for a business case and a discussion of the architectures being proposed. The report has been shared with primary stakeholders, with next steps to be discussed and agreed. Although the report, recommendations and VMHIS itself are designed specifically for the purposes of veterans’ mental health, it is hoped that the principles could be applied to other areas in future.

Related to this work, in March 2021, Contact hosted an online military mental health and case management conference (the programme and outputs are available at the link), as part of which the VMHIS aims and work were outlined and feedback was invited from attendees, many of whom were service providers. Feedback received to date has suggested that a VMHIS as described above would be welcomed by the sector. Feedback on the project is welcome at any time by contacting us. 

Work towards a National Armed Forces Community Digital Connected Care Record for use by both NHS and charity/independent military mental health treatment providers, was initiated and continues to be led by NHS England which also chairs a sub-group of Contact members and other relevant organisations working on this. It is envisaged that, as a result of providers using this system, especially for veterans moving between or accessing multiple services (both statutory and non-statutory), the common information collected and information-sharing capabilities will mean that veterans will not be required to repeat their medical and military histories multiple times, which can be traumatic, frustrating and time consuming.

The sub-group initially developed and refined a framework document in response to feedback, including about essential and desirable criteria, divided into separate sections and categories to aid providers who may carry out differing assessments at different stages. The main challenge then became identifying the best way to implement the system to suit different the providers. The group investigated the complexities involved, and also consulted with NHS England Op Courage providers. As a result of this, many of the potential challenges involved and some possible solutions were identified.

The work has now moved into a new phase, which has included an exploration of the electronic patient records and datasets used within NHS England, including the Shared/Connected Care Record and the mental health dataset, to see if they can be used effectively for the development of a National Armed Forces Community Digital Connected Care Record. Meetings of the sub-group, together with NHS England IT professionals, to explore this in detail were held. The next steps are for 4 pathfinder pilots to take place over 18 months (with continuous evaluation), starting during 2023, with opportunities for both charities and devolved nation health services to participate.

The work will be structured by four workstreams, each of which will introduce or explore a functionality, focussing on a specific cohort within the UK Armed Forces community:

• Pathfinder 1: Military Maternity Record for Serving Personnel and Families 
• Pathfinder 2: Armed Forces Family Health Record
• Pathfinder 3: Mental and Physical Health: parity of esteem
• Pathfinder 4: Integrated Personalised Care Shared Record

The aims and objectives of the programme are mapped against the 9 commitments in NHS England’s ‘Healthcare for the Armed Forces community: A forward view’, with themes including:

• Facilitating a reduction in the amount of times people repeat their histories unnecessarily to different health and care providers
• Supporting a personalised care approach
• Improving the continuity of care 

Engagement will be sought with local patient groups and lived experience groups, as well as the NHS England Armed Forces Patient and Public Voice Group. The findings of this will support the understanding of service user experiences, current models of care and where there may be scope for improvement. The programme will also work with stakeholders across statutory and third sector organisations to develop the digital capability.

The aims of the national programme are to help local organisations move from a position where each health and care organisation holds separate records for the individuals they care for, to one where a single record is shared across the health and care system. This will bring together data from the various sources involved with an individual’s care, enabling health and care professionals to use information safely and securely as individuals move between different parts of the NHS and social care.

Improved quality and accreditation of veterans’ mental healthcare will assist members of the armed forces community to more easily identify and access services that are operating according to recognised best practice and agreed quality standards. With Prof Neil Greenberg of King’s College London and the Royal College of Psychiatrists (RCPsych), the Contact Group has produced the Contact Guiding Principles for the delivery of veterans’ and service families’ mental healthcare.

Contact has also collaborated with RCPsych to develop the first sector-specific quality network and accreditation programme for military mental healthcare providers, the Quality Network for Veterans Mental Health Services (QNVMHS).

A clinical advisory group for the network, comprising expert clinicians from the UK military mental health sector, helped to draft the first set of quality standards for the network which were tested in a 12-month pilot funded by the DHSC/NHS England in 2020-21. Ten pilot teams participated, including from the NHS in England, Scotland and Wales and charities from across the UK. The annual review cycles consist of a three month period of self-review, followed by peer reviews of services, reports on each service for their own use, and finally the publication of an anonymised, collated report of the overall findings. At the end of the pilot, the quality standards were reviewed and some adjustments made in response to feedback. The network’s first online annual forum was held in summer 2021 at which the findings of the pilot and collated report were presented.

The second review cycle (2021-22) included all 10 pilot teams and a significant number from both the NHS (in England, Wales, Scotland and Northern Ireland) and the charity sector, around 30 teams in total. The participation of selected teams was supported with funding from DHSC/NHS England and the Veterans’ Foundation (for small charities). During the course of this cycle, the QNVMHS published two newsletters, with articles about different aspects of military mental healthcare contributed by many of the participating teams. The network’s second annual forum was held in summer 2022, with a range of speakers from the sector and presentation of the second collated report of review findings from the cycle.

The network’s third annual cycle (2022-23) has now completed, with continuing engagement from NHS England, Wales, Scotland, Northern Ireland and many UK charities. The participation of a number of small charities was supported by a 3-year grant from the Lloyd’s Patriotic Fund which will continue for the next two annual cycles. The network’s third annual forum was held in summer 2023, with a range of speakers from the sector and initial results from the collated review findings. The third collated report, which will focus on the impact of network membership for participating teams, is due to be published soon.

Ten teams are now accredited by QNVMHS, including from: Icarus, PTSD Resolution, Walking With The Wounded, Help for Heroes, Combat Stress, Veterans NHS Wales, Veterans First Point Lothian, Veterans First Point Lanarkshire, Op Courage Leeds & York Partnership NHS Foundation Trust and Op Courage Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, with many more currently under review. Accredited teams will benefit from increased reputational profile among both potential beneficiaries, funders and partner organisations. Contact is delighted that NHS England, the Scottish Veterans’ Mental Health and Wellbeing Action Plan and the Armed Forces Covenant Fund Trust (as part of their Afghanistan Veterans Fund) have recognised the value of network participation as an indicator of service quality.

The network is open to all UK military mental healthcare providers/teams that would like to participate in the current review cycle. An annual membership fee of £2,700 +VAT per team is payable to RCPsych (with support available for small charities). Further details and registration instructions for teams interested in joining can be found on the QNVMHS pages on the RCPsych website. Please contact us or email veterans@rcpsych.ac.uk with any queries or for further information.

The Ministry of Defence (MoD) health statistics team assisted Contact in the initial development of a UK military mental health data dashboard, and we are grateful for their support in the first stages of this work. The MoD continues to provide data and analysis on the mental health of serving personnel for current editions of the dashboard. The Executive Lead and primary support for the dashboard is now the data analysis team at the Office for Veterans’ Affairs (OVA), which produces quarterly updated editions of the dashboard for member discussion.

The aim of the data dashboard is to present a picture of the strength and nature of demand, capacity and outcomes across the UK military mental health sector using available data on veterans and serving personnel accessing clinical mental healthcare in the UK, including from MoD, NHS and charity/independent providers.

The dashboard is updated on a quarterly basis, where data allows. Editions of the dashboard to date have focused on available MoD, NHS and charity data. The latest edition of the dashboard included annual MoD data on serving personnel, annual NHS England and Veterans NHS Wales data on veterans seen within their specialised veteran mental health services, together with charity demand and outcomes data. As expected, there are differences in the collection and types of data available, especially outcomes. Work is currently underway with Contact members to explore their available data with the aim of more fully incorporating a comparable range of demand, capacity and outcomes data in future dashboards.

Contact work in the area of research includes the monitoring of relevant recent and ongoing military mental health (MMH)-related research and interpreting it for the benefit of Contact work, its member organisations and the wider sector, as well as identifying and monitoring potential gaps in the relevant research.

This is the specific role of the Contact Research sub-group which consists of a selection of Contact Research Associates. The group has twelve members of which nine rotate annually and is currently chaired (for 2022-24) by Dr Alan Finnegan from the University of Chester’s Westminster Centre for Research in Veterans. The group meets quarterly and provides input for Contact meetings.

The group’s work so far has included identifying the following potential gaps in military mental health research, all of which continue to be monitored and explored in further detail:

– Minorities’ access to healthcare
– Ageing veterans (especially women) and dementia 
– Bereaved military communities, including the needs of service widow/ers (distinct from war widow/ers) and other groups
– The scope and nature of research on families, children and carers
– Complex grief, including that as a result of violent or traumatic death
– The impact of the pandemic on military mental health clinical practice
– The impact of the August 2021 Afghanistan withdrawal on military (veterans’ and families’) mental health
– The impact of the current deterioration in young peoples’ mental health on future military recruits and veterans

The group has held initial deep-dive discussions on many of the identified research gaps, including ageing veterans and dementia. The key findings/questions that were identified for further exploration/monitoring within this theme included:

– Planned research to look at experiences in the forces and early onset dementia
– Potential links between PTSD and Parkinson’s disease and between MTBI, PTSD and dementia
– How we care for veterans with dementia and/or PTSD in care home settings
– Caring for elderly relatives with dementia whilst also serving

The group also held a discussion on complex grief with specialist guest speaker for this area, Dr Michael Duffy from Queen’s University Belfast.

The group’s most recent deep-dive discussions were into the areas of bereaved military communities including service widows, the scope and nature of research on families, children and carers, and the deterioration in young peoples’ mental health and its impact on future recruits and veterans. Further deep-dive discussions on identified research gap areas are planned. 

In addition to this work, the group also aims to capture the quantity and variety of ongoing relevant UK postgraduate research, as well as develop activities with and for UK postgrad, PhD and ECR researchers engaged in MMH-related research. This includes collaborating with other groups in this space, such as the Defence Research Network. Some of the group’s ideas to be explored further include the organisation of a conference for and featuring PhD researchers, and the development of new questions for PhD research with potential cross-university supervision, to help build future multidisciplinary research programmes. Further updates about these activities will be shared when available.

Contact associate membership is currently available for Cobseo member organisations that can demonstrate direct and established involvement in the provision of mental healthcare (clinical treatment) or mental wellbeing (non-clinical) services to serving personnel, veterans and/or families (this does not have to constitute core activity). The aim is to bring these organisations into Contact as associates to complement Contact’s core membership. Associate membership is free of charge and associates benefit from involvement in Contact’s ongoing military mental health-related workstreams (where opportunities arise), relevant consultations, information-sharing and other communications about Contact, its work and the wider sector. Associate members are also featured on our associates webpage where a summary of activities and links are included.

If your organisation is interested in becoming a Contact associate, please read the associate membership criteria to check eligibility and if eligible, submit a completed application form via email. Applications are welcome at any time and will be considered by the Contact membership panel with reference to the associate membership criteria, and the information provided on the application form, which must be completed in full. The membership panel meets on a quarterly basis, with meetings planned for Feb, May, Sept and Nov each year. When your form is submitted, it will be acknowledged and you will be informed when the panel is next due to meet, and subsequently informed of the outcome as soon as possible. Associate members will be reviewed at least once every three years, when evidence of continued organisational suitability for membership will be requested. There is also an obligation for associate members to inform Contact of any adverse accreditation, regulatory, legal, financial or other reputational issues or complaints from the past 3 years, or at the time should any arise in future.

For any queries about associate membership, please feel free to contact us. Please note that Contact is not a regulatory body and does not monitor, regulate or necessarily endorse the actions, services, outputs or views of its Associate members. 

Contact work in the area of communications is aimed at improving awareness, sector-wide and beyond, of both Contact and its work, and that of its members and associates, through the use of various communications channels including the Contact website (the redesign and development of which was made possible through a grant from the Veterans Foundation), social media, newsletters and other information-sharing, and the hosting of online and in-person events.

During the Covid-19 lockdowns, Contact worked with partners to help coordinate regionally-focused online meetings for military mental healthcare providers. The aim was service information-sharing and networking, as well as signposting for beneficiaries. The first meeting, focused on SW England, was hosted by Contact member Togetherall. The second and third meetings, both focused on NE England, were hosted by Contact member Walking With The Wounded. If your organisation is interested in co-hosting or participating in a future online or in-person regional networking meeting for military mental healthcare providers, please do contact us.