Skip to main content Accessibility help

UK extended Medical Assessment Programme for ex-service personnel: the first 150 individuals seen

  • Ian P. Palmer (a1)


Aims and method

To describe an interim service set up to examine the breadth of UK ex-service personnel's concerns in relation to their mental health and military service and provide a record of the first 150 individuals assessed following conformation of military service and examination of all available military and civilian medical records.


The majority of attendees were White male ex-soldiers. Average age, service and time to assessment were 44.5, 15.8 and 11.7 years respectively. Two-thirds were receiving help from the National Health Service and ex-service nongovernmental organisations. Rates of post-traumatic stress disorder were similar to previous UK studies. Obsessional symptoms were of relevance to the clinical presentation in a third. Fabrication and/or exaggeration occurred in about 10%.

Clinical implications

The spread of diagnoses and delay in help-seeking are similar to civilians. The link between mental disorders and military service is seldom straightforward and fabrication or exaggeration is difficult for civilians to recognise. Verification and contextualisation of service using contemporaneous service medical records is important given the possible occupational origin of mental health conditions.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      UK extended Medical Assessment Programme for ex-service personnel: the first 150 individuals seen
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      UK extended Medical Assessment Programme for ex-service personnel: the first 150 individuals seen
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      UK extended Medical Assessment Programme for ex-service personnel: the first 150 individuals seen
      Available formats


This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author


Hide All

Declaration of interest

I.P. is employed by the Pensions, Compensation and Veterans Department of the UK Ministry of Defence. The Ministry had no input into the completion or presentation of this paper and sought no changes.



Hide All
1 Barnett, C. Britain and Her Army: 1509–1970. Orion Publishing, 2000.
2 Anderson, B. The British admire their Army – but they don't understand it. Independent 2009; 20 July.
3 Dandeker, C, Wessely, S, Iversen, A, Ross, J. What's in a name? Defining and caring for ‘veterans’. The UK in international perspective. Armed Forces Soc 2006; 32: 161–77.
4 Iversen, AC, Greenberg, N. Mental health of regular and reserve military veterans. Adv Psychiatr Treat 2009; 15: 100–6.
5 Freuh, BC, Elhai, JD, Gold, PB, Monnier, J, Magruder, KM, Keane, TM, et al. Disability compensation seeking army veterans evaluated for posttraumatic stress disorder. Psychiatr Serv 2003; 54: 8491.
6 Woodhead, C, Sloggett, A, Bray, I, Bradbury, J, McManus, S, Meltzer, H, et al. An estimate of the veteran population in England: based on data from the 2007 Adult Psychiatric Morbidity Survey. Popul Trends 2009; 138: 50–4.
7 NHS Choices 2011. Veterans: Mental Health. NHS Choices (
8 Brian, B. The Unquiet Western Front: Britain's Role in Literature and History. Cambridge University Press, 2002.
9 Macintyre, B. British soldiers victims of a mental conflict without end. The Times 2009; 28 March.
10 Herbert, I. British soldiers go AWOL because Army ignores mental health problems. Independent 2007; 26 March.
11 Midgley, N. Col Tim Collins: Afghanistan is a ‘fashionable New Labour war’. Telegraph 2011; 21 February.
12 Hotopf, M, Hull, L, Fear, NT, Browne, T, Horn, O, Iversen, AC, et al. The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study. Lancet 2006; 367: 1731–41.
13 Defence Analytical Services and Advice. Estimating the Proportion of Prisoners in England and Wales who are Ex-Armed Forces – Further Analysis. DASA, 2010.
14 Iversen, A, Dyson, C, Smith, N, Greenberg, N, Walwyn, R, Unwin, C, et al. ‘Goodbye and good luck’: the mental health needs and treatment experiences of British ex-service personnel. Br J Psychiatry 2005; 186: 480–6.
15 Iversen, A, Nikalous, V, Greenberg, N, Unwin, C, Hull, L, Hotopf, M, et al. What happens to British veterans when they leave the armed forces? Eur J Public Health 2005; 15: 175–84.
16 HM Government. New Horizons: A Shared Vision for Mental Health. HM Government, 2009.
17 Dent-Brown, K, Ashworth, A, Barkham, M, Connell, J, Gilbody, S, Hardy, G, et al. An Evaluation of Six Community Mental Health Pilots for Veterans of the Armed Forces: A Case Study Series. University of Sheffield, 2010 (
18 Murphy, FM. Gulf War syndrome. BMJ 1999; 318: 274–5.
19 Pankratz, L. The misadventures of wanderers and victims of trauma. In Malingering and Illness Deception (eds Halligan, PW, Bass, C, Oakley, DA). Oxford University Press, 2003.
20 Iversen, AC, van Staden, L, Hacker Hughes, J, Browne, T, Greenberg, N, Hotopf, M, et al. Help-seeking and receipt of treatment among UK service personnel. Br J Psychiatry 2010; 197: 149–55.
21 The Howard League for Penal Reform. Leaving Forces Life: The Issue of Transition. The Howard League (
22 Hoge, C, Lesikar, SE, Guevara, R, Lange, J, Brundage, JF, Engel, CC, et al. Mental disorders among US military personnel in the 1990s: association with high levels of health care utilization and early military attrition. Am J Psychiatry 2002; 159: 1576–83.
23 Lee, HA, Gabriel, R, Bolton, JPG, Bale, AJ, Jackson, M. Health status and clinical diagnoses of 3000 UK Gulf War veterans. J Royal Soc Med 2002; 95: 491–7.
24 Palmer, I. The emotion that dare not speak its name? Br Army Rev 2003; 132: 31–7.
25 Slater, E. The neurotic constitution: a statistical study of two thousand soldiers. J Neurol Psychiatry 1943; 6: 116.
26 Moes, GS, Lall, R, Johnson, WB. Personality characteristics of successful navy submarine personnel. Milit Med 1996; 161: 239–42.
27 Christen, BR, Moore, JL. A descriptive analysis of ‘not aeronautically adaptable’ dispositions in the U.S. Navy. Aviat Space Environ Med 1998; 69: 1071–5.
28 Fu-Rong, W, Ya-Lin, Z. Psychosomatic symptoms and coping style of military officers in space base. Chin Ment Health J 2006; 20: 392–3.
29 Karno, M, Golding, JM, Sorenson, SB, Burnam, MA. The epidemiology of obsessive–compulsive disorder in five US communities. Arch Gen Psychiatry 1988; 45: 1094–9.
30 Zohar, AH, Pauls, DL, Ratzoni, G, Apter, A, Binder, DM, King, R, et al. An epidemiological study of obsessive–compulsive disorder and related disorders in Israeli adolescents. J Am Acad Child Adol Psychiatry 1992; 31: 1057–61.
31 Apter, A, Fallon, TJ, King, RA, Ratzoni, G, Zohar, AG, Binder, M, et al. Obsessive–compulsive characteristics: from symptoms to syndrome. J Am Acad Child Adol Psychiatry 1996; 35: 907–12.
32 Maina, G, Albert, U, Bogetto, F, Ravizza, L. Obsessive–compulsive syndromes in older adolescents. Acta Psychiatr Scand 1999; 100: 447–50.
33 Abramowitz, JS, Taylor, S, McKay, D. Obsessive–compulsive disorder. Lancet 2009; 374: 491–9.
34 Lochner, C, du Toit, PL, Zungu-Dirwayi, N, Marais, A, van Kradenburg, J, Seedat, S, et al. Childhood trauma in obsessive–compulsive disorder, trichotillomania, and controls. Depress Anxiety 2002; 15: 66–8.
35 Brown, TA, Campbell, LA, Lahman, CL, Grisham, JR, Mancill, RB. Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. J Abnor Psychol 2001; 110: 585–99.
36 Watkins, E, Brown, RG. Rumination and executive function in depression: an experimental study. J Neurol Neurosurg Psychiatry 2002; 72: 400–2.
37 Robinson, MS, Alloy, LB. Negative cognitive styles and stress-reactive rumination interact to predict depression: a prospective study. Cognit Ther Res 2003; 27: 275–91.
38 Ehring, T, Frank, S, Ehlers, A. The role of rumination and reduced concreteness in the maintenance of posttraumatic stress disorder and depression following trauma. Cognit Ther Res 2008; 32: 488506.
39 van der Houwen, K, Stroebe, M, Schut, H, Stroebe, W, van den Bout, J. Mediating processes in bereavement: the role of rumination, threatening grief interpretations, and deliberate grief avoidance. Soc Sci Med 2010; 71: 1669–76.
40 Dunn, NJ, Yanasak, E, Schillaci, J, Simotas, S, Rehm, LP, Souchek, J, et al. Personality disorders in veterans with posttraumatic stress disorder and depression. J Traum Stress 2004; 17: 7582.
41 Bollinger, AR, Riggs, DS, Blake, DD, Ruzek, JI. Prevalence of personality disorders among combat veterans with posttraumatic stress disorder. J Trauma Stress 2000; 13: 255–70.
42 O'Toole, BI, Marshall, RP, Schureck, RJ, Dobson, M. Posttraumatic stress disorder and comorbidity in Australian Vietnam veterans: risk factors, chronicity and combat. Aust N Z J Psychiatry 1998; 32: 3242.
43 Riggs, DS. Treatment of concurrent PTSD and OCD: a commentary on the case of Howard (Response paper). Cogn Behav Practice 2000; 7: 130–2.
44 Palmer, I. Soldiers, learning and fear. Br Army Rev 2004; 135: 64–7.
45 Iversen, AC, Fear, NT, Simonoff, E, Hull, L, Horn, O, Greenberg, N, et al. Influence of childhood adversity on health among male UK military personnel. Br J Psychiatry 2007; 191: 506–11.
46 Moller-Leimkuhler, AM. Barriers to help-seeking by men: a review of sociocultural and clinical literature with particular reference to depression. J Affective Disord 2002; 71: 19.
47 Langston, V, Greenberg, N, Fear, N, Iversen, AC, French, C, Wessely, S. Stigma and mental health in the Royal Navy: a mixed methods paper. J Ment Health 2010; 19: 816.
48 Noone, JH, Stephens, C. Men, masculine identities, and health care utilisation. Soc Health Illness 2008; 30: 711–25.
49 Wang, PS, Berglund, P, Olfson, M, Pincus, HA, Wells, KB, Kessler, RC. Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62: 603–13.
50 Mackenzie, CS, Gekoski, WL, Knox, VN. Age, gender, and the underutilization of mental health services: the influence of help-seeking attitudes. Aging Ment Health 2006; 10: 574–82.
51 Turner, MA, Kiernan, MD, McKechanie, AG, Finch, PJC, McManus, FB, Neal, LA. Acute military psychiatric casualties from the war in Iraq. Br J Psychiatry 2005; 186: 476–9.
52 Boman, B. Combat stress, post-traumatic stress disorder, and associated psychiatric disturbance. Psychosomatics 1986; 27: 567–73.
53 Johnsen, S, Jones, A, Rugg, J. The Experiences of Homeless Ex-Service Personnel in London. University of York Centre for Housing Policy, 2008 (
54 Gillan, A. The fantasy life and lonely death of the SAS veteran who never was. Guardian 2009; 24 January.
55 Burkett, BG, Whitley, G. Stolen Valor. Verity Press Publishing, 1998.
56 Frueh, BC, Elhai, JD, Grubaugh, AL, Monnier, J, Kashdan, TB, Sauvageot, JA, et al. Documented combat exposure of US veterans seeking treatment for combat-related post-traumatic stress disorder. Br J Psychiatry 2005; 186: 467–72.
57 Frueh, BS, Grubaugh, AL, Elhai, JD, Buckley, TC. US Department of Veterans Affairs disability policies for posttraumatic stress disorder: administrative trends and implications for treatment, rehabilitation and research. Am J Public Health 2007; 97: 2143–5.
58 Baggaley, M. ‘Military Munchausen's’: assessment of factitious claims of military service in psychiatric patients. Psychiatr Bull 1998; 22: 153–4.
59 Spence, SA. Reading about deception. Psychiatrist 2010; 34: 146–9.
60 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Forth Edition (DSM-IV). APA, 1994.

Related content

Powered by UNSILO

UK extended Medical Assessment Programme for ex-service personnel: the first 150 individuals seen

  • Ian P. Palmer (a1)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.

UK extended Medical Assessment Programme for ex-service personnel: the first 150 individuals seen

  • Ian P. Palmer (a1)
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *