|Chapter 3 - Health|
Tables 3.13 to 3.16 provide statistical information on mental health among the UK Armed Forces. They summarise all new referrals of Armed Forces personnel to the MOD's Departments of Community Mental Health (DCMHs) for outpatient care. DCMHs are specialised psychiatric services based on community mental health teams, closely located with primary care services at sites in the UK and abroad. Table 3.16 is a new inclusion in UKDS and presents new admissions to the MOD's UK in-patient contractor.
DCMH staff record the initial psychiatric assessment during a patient's first appointment, based on presenting complaints. The information is provisional and final diagnoses may differ as some patients do not present the full range of symptoms, signs or clinical history during their first appointment. Individuals may be seen at a DCMH, e.g. for counselling, who do not have a mental disorder. The psychiatric assessment data were categorised into three standard groupings of common mental disorders used by the World Health Organisation's International Statistical Classification of Diseases and Health-Related Disorders 10th edition (ICD-10).
A rigid pseudo-anonymisation process, and other measures preserving patient confidentiality, has enabled full verification and validation of the DCMH returns, importantly allowing identification of repeat attendances. It also ensured linkage with deployment databases was possible, so that potential effects of deployment could be measured.
Deployment data, used for deployment breakdowns and to calculate denominators, cover several operational deployments between November 2001 and December 2009, although person level deployment data for Afghanistan between 1 January 2003 and 14 October 2005 were not available. About 4% of the deployment records were not successfully validated against the "gold standard" personnel records held by the Service Personnel and Veterans Agency. Deployment markers were assigned using the criterion that an individual was recorded as being deployed to the Iraq and/or Afghanistan theatres of operation if they had deployed to these theatres prior to their appointment date. To be accurate, these tables compare those who had been deployed before their first appointment with those who have not been identified as having deployed before their first appointment.
The data are presented as numbers, rates and confidence intervals for those rates. The rates presented in this section relate to the whole population, rather than a sample. However, even in a population there is still random variation in the observed number of cases in a particular time period (particularly for rare events). Confidence intervals are useful in making inferences about whether observed differences (e.g. between two time periods or two subgroups of the population) are significant or are likely to be due to chance alone.
In order to calculate rates, an estimate of person time at risk is required for the denominator value. The estimate was calculated using a 13-month average of strengths figures (e.g. the strength at the first of every month between January 2009 and January 2010 divided by 13 for 2009 strengths). Strengths figures include regulars, Gurkhas, Military Provost Guard Staff, mobilised reservists, Full Time Reserve Service personnel and Non-regular Permanent Staff, as all of these individuals are eligible for assessment at a DCMH.
95% confidence intervals (95% CI) were calculated based on the Normal distribution, except where the number of observed events was fewer than 30, when they were derived directly from the Poisson distribution. CIs provide the range of values within which we expect to find the real value of the indicator under consideration, with a probability of 95%. If the confidence intervals of two rates do not contain any common values, these figures are statistically significantly different.
Interpretation of these figures requires caution. The data covers the activity of the formal professional mental health services in the Armed Forces and as such, does not represent the totality of mental health problems in the UK Armed Forces. These figures report only new attendances during the period, not all those who were receiving treatment. Information on patients only seen in the primary care system is not currently available. Mental health problems are present in both civilian and military populations and result from multi-factorial issues. The Headquarters Surgeon General (HQ(SG)) and Joint Medical Command (JMC) are striving to minimise any stigma associated with mental illness and foster the appropriate understanding, recognition and presentation for management of these issues in Armed Forces personnel.
Some mental health problems will be resolved through peer support and individual resources; patients presenting to the Armed Forces' mental health services will have undergone a selection process that begins with the individual's identification of a problem and initial presentation to primary care or other agencies such as the padres or Service social workers. A proportion of mental health issues will have been resolved at these levels without the need for further referral. The diagnostic breakdown in this report is based upon initial assessments at DCMHs, which may be subject to later amendment. For epidemiological information on mental health problems in the Armed Forces, reference should be made to the independent academic research conducted by the King's Centre for Military Health Research (KCMHR). This research, conducted on a large and representative sample of the UK Armed Forces population, provides a reliable overview of mental health in the UK Armed Forces.
Further analysis can be found in the UK Armed Forces Mental Health reports, which are published on the DASA website.