Veterans and Mental Health: A Care Staff Guide to Op COURAGE

Around 2.4 million veterans live in the UK, according to NHS England, and most are in good mental health. But some carry the effects of service, such as post-traumatic stress, anxiety, depression or problems with alcohol, and many find it hard to ask for help. Health and care staff will meet veterans in GP surgeries, care homes, hospitals and community services, often without knowing they served. This guide explains what is available through the NHS Op COURAGE service and how staff can support veterans sensitively. It sits alongside our guide to PTSD awareness for care and health staff.

Why veterans can find it hard to speak up

NHS England reported in January 2024 on a survey carried out in April and May 2022 with 3,095 responses. It found that 60% of respondents found it difficult to ask for help with mental health, 52% had or previously had mental health problems and 54% had or previously had physical health problems. NHS England used these findings to promote its veterans' mental health service. The headline of its news release was that more than half of veterans say it is hard to speak up. Staff who understand this reluctance can lower the barrier by asking directly and respectfully.

What Op COURAGE is

Op COURAGE is described on the government's Valour website as a dedicated service giving mental health and wellbeing support to veterans and their families, created by the NHS. It operates through six regional teams across England. According to NHS England's January 2024 release, it also includes enhanced addiction support, and it reported more than 4,500 referrals between April and November 2023. About 44% of referrals were self-referrals.

Who can use it

The Valour site sets out the eligibility conditions. A person must:

• live in England;
• have completed at least one full day of service in the UK armed forces;
• be registered with an English GP, or be willing to register; and
• provide their military service number.

The local NHS trust page for Op COURAGE services in the East of England makes the same point and adds that it does not matter how long ago the person left the forces, their rank, their gender or why they left. The East of England service accepts non-mobilised reservists, service leavers and former personnel.

How to refer

The Valour site lists three routes: contacting a regional Op COURAGE team directly, a GP referral, or a referral from a veterans' charity. The East of England service also accepts family and professional referrals as well as self-referrals. Care staff can help a veteran to make contact or ask their GP to refer, and should check the contact details for the region the person lives in because each of the six teams has its own opening hours.

What the service offers

The East of England service describes its offer as including:

• an initial mental health assessment by registered professionals;
• specialist PTSD treatment when appropriate;
• signposting to NHS services such as Talking Therapies or community mental health teams;
• guidance to veterans' charities on employment, housing, money, relationships and substance use;
• family-focused support, education about PTSD for supporters and carer's assessments.

It describes its approach as military-sensitive and trauma-informed, and its team members have military backgrounds or armed forces experience. The service notes that it does not provide an immediate crisis response. If someone is in immediate danger, call 999, and for non-emergency medical help use NHS 111.

How to support veterans in your service

• Ask about service. A simple question such as "Have you ever served in the armed forces?" can open the door to the right support. Record the answer with consent.
• Be trauma-informed. Explain what you are doing, offer choice and avoid unexpected noise or touch. Our guide to trauma-informed care sets out the principles.
• Look beyond mental health. The service signposts to charities for housing, employment, money and relationships, so ask about wider needs.
• Consider alcohol and substance use. Op COURAGE offers enhanced addiction support, and our guide to alcohol-related harm in care settings covers recognition and response.
• Involve families and carers. The service offers support and carer's assessments for those supporting veterans.
• Do not assume. Many veterans are well, proud of their service and have no mental health difficulty. Ask what the person wants.

A note on the evidence

The figures above come from NHS England and local NHS trust pages as published, and service arrangements, contact details and eligibility can change. Always check the current Op COURAGE information before referring.

Frequently asked questions

Do veterans need a GP referral? No. Self-referral is possible and accounted for about 44% of referrals, according to NHS England.

Is it only for people who served in combat? No. Eligibility is based on at least one full day of UK armed forces service.

Where can staff train? Learnsignal's CPD courses for health and care staff include trauma and mental health awareness.