Veterans Mental Health and Wellbeing Pathway Advisory Group minutes: March 2024

Attendees and apologies

• Lynne Taylor, Principal Psychology Advisor, Scottish Government (Chair)
• Jacqueline Berry, Allied Health Professionals/Occupational Therapy Lead, NHS Grampian
• Thelma Bowers, Head of Mental health, Addiction and Learning Disability services, NHS Ayrshire and Arran/North Ayrshire HSCP
• Geraldine Collier, HR People Partner, Argyll and Bute HSCP
• David Dent MBE, Vice President (Global Head of Integrated Strategy) Clinical Research, Board Advisor Help for Heroes, Trustee RBLI, Professor (Hon), former Army Nurse, Lecturer RDMC, and CISD practitioner and mental health first aider, War Disabled Veteran
• Vicky Henderson, Service Manager, Aberdeenshire HSCP
• Lindsay Kirkwood, Veterans First Point Clinical Lead, NHS Ayrshire and Arran
• Linda McAuslan, Lead Nurse Psychological Therapies/Adult Psychological Therapies Manager, NHS Forth Valley
• Kari Magee, Veterans’ Lived Experience Group
• Gerri Matthews-Smith, Director of the Edinburgh Napier University Centre for Military Research, Education and Public Engagement/Scottish Armed Forces Evidence and Research (SAFE&R) HUB
• Theresa Mitchell, Head of Hidden Wounds, Help for Heroes
• Dougie Morgan, Operations Manager Scotland and Northern Ireland, Fighting with Pride LGBT+ Military Charity
• Neil Morrison, Health and Wellbeing Lead, Veterans Scotland
• Julie Murray, NHS Greater Glasgow and Clyde Armed Forces and Veterans Champion/Chief Officer of East Renfrewshire HSCP
• Jenny Pope, Deputy Director of Workforce NHS Golden Jubilee
• Michelle Ramage, Veterans First Point Clinical Lead, NHS Tayside 
• Robert Reid, Director of Services Scotland and Overseas, Defence Medical Welfare Service
• Caroline Robertson, Head of Operations for Scotland, Combat Stress
• Tommy Watson, Director for Veteran Affairs, Walking with the Wounded
• Pauline Winchester, Midlothian Local Authority Armed Forces and Veterans Champion
• Mark Fergusson, Scottish Government (Secretariat support)
• Aleksandra Brokman, Scottish Government (Secretariat support)

Apologies

• Jennifer Borthwick, Director of Psychological Services and Head of Clinical Services, NHS Forth Valley
• Jennifer Ring, Veterans First Point Clinical Lead, NHS Lanarkshire 

Items and actions

Actions and items

The chair welcomed the members to the advisory group. She gave an update on membership and introduced the agenda for the meeting. She also thanked the members who engaged with her through one to one meetings and advised that she has shared the themes that emerged from these discussions with the policy teams.

The chair explained the background to the creation of the advisory group. She reaffirmed the Scottish Government’s commitment to implementing the principles of the Veterans Mental Health and Wellbeing Action Plan and to developing the veterans mental health pathway. She acknowledged members’ concerns that previous work would be lost and reassured them that it would not be the case. The advisory group is to identify what aspects of the previous implementation plan are to be retained and to take forward the development of the pathway.

Introductions

The chair invited group members to introduce themselves.

The representative from Veterans Scotland advised that he represents over 30 third sector organisations from the Veterans Scotland Health and Wellbeing Group. He noted that he has some questions from the third sector that he would forward to the Chair for information..

Dougie Morgan, the representative from Fighting with Pride, emphasised that LGBT+ veterans are often not offered support. He also raised a point that veterans living in remote areas of Scotland often cannot get proper support. Others added that neurodiversity also needs to be considered, since some interventions don’t work as effectively for neurodivergent people.

It was suggested that Nicola T. Fear, Professor of Epidemiology at the Academic Department of Military Mental Health and Co-Director of the King’s Centre for Military Health Research be invited to join the advisory group. Her work on epidemiology of mental health among veterans could provide valuable insights. Others agreed with this suggestion. It was also suggested that Neil Kitchener from NHS Wales be invited to bring his experience developing a good model of veterans mental health support in Wales. This to be agreed under terms of reference section within the meeting.

Several members expressed hope that the work would now gather pace.

Introduction to the advisory group

The chair shared the common themes that emerged from one to one meetings with former implementation board members. The themes were:

• having and acknowledging realistic expectations
• ensuring all the work done to date is not lost
• needing true meaningful stakeholder engagement
• building honesty and trust
• how all partners can work well together (what is the niche thing they do that no-one else can do)
• ensuring veterans have veterans as first point of contact and as ongoing support
• a recovery, person centred and empowering approach
• equity across Scotland

The chair emphasised that they want to ensure that work would move forward in a transparent and collaborative way. She invited members to reach out if at any point they felt that the group was not working well.

The chair suggested agreeing common principles to integrate the group through shared values. She proposed the following principles and invited members for views:

• veterans’ needs will be at the centre of all decision making
• all stakeholder views will be valued
• any model proposed needs to be safe, deliverable, and governed
• a whole systems whole person approach should be taken

One group member suggested replacing the word “model” with “approach”, as it might not be possible to implement the same model in everywhere across Scotland. It was, however, noted that NHS England had not specified enough detail on their model of delivery, which caused issues. It was suggested, to ensure equity, that there should be a common framework of delivery. Another group member noted that the word “pathway” covers what the advisory group wants to achieve.

A group member suggested replacing “veterans’ needs” with “needs of the Armed Forces and Veterans Community.” It was advised that the lived experience group had different views on whether families should be included in this work but that the Covenant mentions families. Another group member agreed that family members should be seen as individuals worthy of treatment and asked group to consider what is the definition of family. It was added that many services don’t offer treatment directly to family members.

A group member underlined the importance of educating the healthcare community. It was stated that identifying as a veteran to GPs doesn’t work as it doesn’t streamline access to services. The group were advised to think about the journey of the patient and emphasised that often it’s not the intent and services that are missing, but understanding and effective application. A concern was added about other people making assumptions about what the veterans’ needs are, rather than the veterans themselves. Another group member agreed that education of healthcare staff is critical and that the work on the pathway must include training and education to help staff better support veterans.

It was advised that in Ayrshire and Arran, it took several years of culture work with services to identify why it was critical to have a tailored approach and to understand how veterans seek help. It was stated that addressing culture will be critical in improving veterans’ mental health care across Scotland.

One group member suggested mentioning that services will be credible to people who use them, while another added that they should also be evidence-based.

A question was asked what is meant by “views of stakeholders” given how many key stakeholders there are beyond this group. It was then suggested that members should bring the views of other stakeholders to this advisory group. The chair agreed that stakeholders should be understood as a wider group and advised that all members should consult as widely as possible.

Action: The chair to redraft the principles based on members’ feedback and circulate ahead of the next meeting.

Terms of reference

The chair invited members to comment on the draft terms of reference.

The members were content with page one.

A question was asked about how often the work of the short life working group will come to the advisory group for review. The relationship between the two groups was not felt by some members to be clearly outlined in the terms of reference.

Action: The chair and SG policy team to clarify the relationship and reporting mechanism between the two groups in the redrafted terms of reference.

Members confirmed their organisational affiliations and roles. They confirmed they were content with the membership section. It was agreed that there would be two V1P clinical leads represented on the group.

Action: V1P colleagues to confirm who will be the second V1P clinical lead sitting on the advisory group.

Members than discussed the points in the roles and responsibilities section:

• to provide oversight to the Veterans Mental Health and Wellbeing Pathway implementation by offering expert advice and guidance on the strategic direction and proposed model of delivery to meet the agreed principles within the Veterans Mental Health and Wellbeing Action Plan
• to provide expert advice and support to Scottish ministers on the model of delivery and implementation of the Veterans Mental Health and Wellbeing Pathway and on the wider strategic direction of veterans mental health and support provision in Scotland
• to identify the priority commitments within the Veterans Mental Health and Wellbeing Action Plan and provide guidance to the Veterans Mental Health Development and implementation group on the strategic direction required to meet those commitments
• to make recommendations to ministers on the alignment of resources required to implement the priority commitments within the Veterans Mental Health and Wellbeing Action Plan
• to identify and monitor issues and areas of risk and highlight significant risks to the minister
• to provide guidance on key indicators and performance measures to evaluate the effectiveness of the Veterans Mental Health and Wellbeing Pathway to ensure improved access to mental health services for all veterans in Scotland
• to oversee an engagement and communication strategy which will encourage and ensure effective communication and engagement with stakeholders, veterans and across all relevant areas of Scottish Government throughout the development and implementation of the Veterans Mental Health and Wellbeing Pathway
• to agree the project priorities, timeline and delivery plan for final approval by the minister

On point one, the use of the word “model” was questioned, with a suggestion it change to “mode of delivery.” Members were content with this change.

Members asked for more clarity on the role of the advisory group. The chair agreed that stronger wording was needed in point one. SG officials advised that this point will be clarified together with the role of the short life working group.

On point three a group member asked if it was already confirmed that there would be one working group. It was suggested multiple groups might be useful to make the best use of members’ expertise. Another group member recommended avoiding slitting the work into too many groups, for the work to benefit from bringing different perspectives together.

A group member asked if point four referred to new or existing resources. Another group member added that the quantity of resources should also be mentioned and considered.

Members were content with point five.

On point six, a question was asked around the final point of advisory group’s work. It was suggested identifying measurable KPIs. One suggestion was to reword the point to state: “key outputs, performance standards and indicators.” There was a suggestion to consult the Magenta Book and to consider value for money and the evaluation strand of this work. “Pre, during and post” need to be considered to evaluate if the plan implemented by the advisory group is making a difference. It was also posited that the group could simply use an evidence-based approach and contribute to available evidence by making recommendations and identifying research gaps.

It was advised that point seven should mention people who will be responsible for delivery of the pathway. It was suggested that someone with communications background might be needed to help with engagement and communication strategy.

Members were content with point eight.

Action: The chair and SG policy team to redraft the terms of reference, clarifying points raised by the members, and circulate it to members for comment.

It was suggested that the group meetings be held under the Chatham House Rule, to ensure discretion for difficult conversations. It was, however, noted that as some members represent organisations and wider networks, they need to be able to discuss the progress of the work on the pathway in those settings.

Action: group members to consider this further and come back to the group with proposed wording to reflect how information is shared beyond the group.

A group member asked that a detailed agenda is produced, to enable her to ask other members of the lived experience group their opinion on the topics to be discussed.

Members were content with sections on page four of terms of reference.

Frequency of meetings

The chair asked members opinion on what should be the frequency of advisory group meetings.

A group member suggested that this would depend on the how often the short life working group is meeting. It was stated that the previous implementation board didn’t meet often enough and proposed meeting every six to eight weeks. A group member asked for the meeting to be held virtually, to avoid some people needing to travel long distances. Some members agreed on a preference for virtual meetings while others stated that it would be good to have occasional face to face meetings to gel the group together.

A group member stated that he would prefer to have the meetings for the whole year in his calendar.

The chair suggested that the next meeting takes place in six weeks to finalise the terms of reference. Following that, meetings would be held every eight weeks.

Action: SG policy team to circulate a poll asking members what day of the week suits them best for the meetings.

The chair thanked members for their time, enthusiasm and participation.