Veterans Mental Health Pathway Advisory Group minutes: March 2025

Attendees and apologies

• Lynne Taylor (Chair), Principal Psychology Officer, Scottish Government
• Martin Bell, Health and Wellbeing Lead, Veterans Scotland
• Thelma Bowers, Head of Mental health, Addiction and Learning Disability services, NHS Ayrshire and Arran/North Ayrshire Health and Social Care Partnership
• 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 1st aider, War Disabled Veteran
• Linda Irvine Fitzpatrick , Strategic Lead, Scotland’s Veterans Wellbeing Alliance
• Lindsay Kirkwood, Veterans First Point Ayrshire and Arran Clinical Lead
• 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
• Linda McAuslan, Lead Nurse Psychological Therapies/Adult Psychological Therapies Manager, NHS Forth Valley
• Theresa Mitchell, Head of Hidden Wounds, Help for Heroes
• Dougie Morgan, Fighting with Pride LGBT+ Military Charity
• Julie Murray, Chief Officer, East Renfrewshire Health and Social Care Partnership; and Secretary of the Chief Officer Group for Health and Social Care Scotland
• Jenny Pope, Deputy Director of Workforce NHS Golden Jubilee
• Michelle Ramage, Veterans First Point Tayside Clinical Lead
• Robert Reid, Defence Medical Welfare Service
• Caroline Robertson, Head of Operations for Scotland, Combat Stress
• Mark Fergusson, Scottish Government (secretariat support)

Apologies:

• Jacqueline Berry, Allied Health Professionals/Occupational Therapy Lead, NHS Grampian
• Jennifer Borthwick, Director of Psychological Services and Head of Clinical Services, NHS Forth Valley
• Vicky Henderson, Aberdeenshire Health and Social Care Partnership
• Tommy Watson, Walking with the Wounded
• Pauline Winchester, Midlothian Local Authority Armed Forces and Veterans Champion

Items and actions

Welcome and recap of January meeting

The chair welcomed everyone to the meeting and asked the group if they were content with the minute of the previous meeting. One member suggested an amendment to section 5 (“Review of Veterans Link Scotland”): reference should be made in the peer support worker role of “accessing mental health support” rather than “providing” mental health support as stated in the draft minute. It was agreed that this would be amended.

Action: Amended version of January minute to be circulated to group members.

The chair informed members that she held a quarterly meeting with the Minister for Social Care, Mental Wellbeing & Sport on 11 March where she informed Ms Todd an implementation plan had been drafted by Scottish Government (SG) officials and would be reviewed by the group at this meeting.

The chair invited an SG official to provide an update on the current situation at NHS Lothian with regard to their veterans mental services. Following the announcement by NHS Lothian of their intention to withdraw their funding contribution to their Veterans First Point (V1P) service, SG officials have been actively engaging with NHS Lothian management and senior clinicians to identify a resolution.

NHS Lothian have conducted a consultation with veterans who currently access the V1P service to gather their views on the future redesign of veterans’ support services in Lothian. NHS Lothian have committed to updating Scottish Ministers on the findings of the consultation and their plans for the veterans service from April 2025 onwards. In the meantime, SG officials are actively assessing the policy options that can be offered following receipt of proposals put forward by NHS Lothian.

A couple of group members expressed concern about a perceived limited number of options offered in the survey that was used as part of the consultation process. Additionally, a group member commented that an equality impact assessment should be published by NHS Lothian following any service change. SG officials noted they are aware of concerns,

Update on test of change pilot pathway   

The chair invited an SG official to provide an update on the test of change pilot pathway. Funding for a three-tiered tests of change pilot veterans mental health pathway has been approved in principle and agreements with service providers are at an advanced stage. The planned three tiers for the pilot will include a basic tier of support (e.g. practical support and befriending); a middle tier of more intensive clinically-informed peer support which is likely to be the standard point of entry); and an upper tier of complex clinical support. The plan is for this test of change to run in three NHS health board areas: NHS Dumfries and Galloway; NHS Grampian; and NHS Greater Glasgow & Clyde. It is anticipated that the data captured from this will help inform some decisions taken by the advisory group as plans for the national pathway develop.

The chair invited comment for the group. A group member expressed concern that the evaluation process for this new development has yet to be agreed and pre-measurement should be considered.

Action: SG officials to arrange meeting with relevant colleagues to discuss the evaluation process for the pilot pathway. 

A couple of group members asked how the upper tier of the complex clinical support will be coordinated within the three health board areas and the governance process. An SG official stated that details on this will be shared with the group in due course.

Action: SG officials to provide group with more specific information about the upper tier of the pilot pathway.

A group member expressed concern that this test of change may launch before the implementation plan for the national pathway has been agreed by the group. Another group member added that the key concepts of the national pathway should be embedded in any pilot in order to ensure the evaluation is as informative as possible. The chair stated that SG officials have intended for the test of change pilot to be a way of testing different elements of the types of support, and to provide services where there currently are none, rather than to be a replica for the national pathway. Additionally, non-V1P areas were selected in order to fill a gap in service provision. However, learning from these new services will inform the development of the national pathway.

A group member stated that, with regard to making connections with statutory services, a training plan should be in place which includes details on information sharing.

Update on Veterans Link Scotland

The chair invited an SG official to provide an update on Veterans Link Scotland, the veterans lived experience group hosted by SG.

The advisory group in January gave approval for Veterans Link Scotland to work on updated peer support specification. Veterans Link Scotland have established a sub-group to work on this. The group will focus on governance arrangements and training needs. A draft terms of reference has been written and a first meeting is to be arranged soon. The chair confirmed that interim chair of Veterans Link Scotland, Kari Magee, will provide written updates to the advisory group on this work.

A group member suggested that Louise Christie from the Scottish Recovery Network should be invited to provide input as she has considerable experience of peer training and supervision and career pathways for peer workers.

Action: Veterans Link Scotland to contact Louise Christie.

A group member asked the group if they felt that peer support workers for veterans should include the spouses of veterans. He added that spouses may have to be included to widen the pool of possible support workers. It was stated that the tentative view of Veterans Link Scotland based on limited discussions so far is that peer support worker can come from the wider veterans community which includes reservists, family members and service children.

A couple of group member stated that available evidence suggests that veterans prefer a peer worker who is connected with the serving community. If there is no peer relationship with the veteran, the person should instead be viewed as a support worker. Another group member stated that feedback from veterans who have used the V1P service is that they greatly value peer support from someone who has also served. This connection is essential as the peer relationship is built on a shared experiences and understanding.

A group member commented that there are some circumstances in which a veteran may not be comfortable engaging with a peer support worker with direct lived experience of serving in the forces. For example, a female veteran may not wish to engage with a veteran who was part of a unit who did not view female veterans in high regard.  

Another group member stated that an appropriate recruitment strategy may be to offer both peer support workers with direct lived experience of serving and peer support workers in a wider sense including spouses and family members. This way, veterans can decide who they engage with.

A group member stated that, if the peer support worker definition were to be too broad, there would be a risk that services offered will vary little from wider mental health services already available.

The chair shared this this can all be discussed further as we agree the finer details of the national plan, and that we await feedback from the lived experience group.

Review of the risk register

The chair invited comment from the group on the latest draft of the risk register. It was agreed by the group that the third mitigation in risk entry 9 should be amended to make it clearer that V1P services becoming a national clinical resource has only been discussed as a possibility and remains subject to a full options appraisal.

A group member commented that a new risk should be created around organisations who are participating in the pathway who suffer financial challenges not flagging this quickly enough to SG and other key stakeholders. The chair agreed that this risk should be added.

Action: SG officials to redraft risk register.

Review of milestone chart

The chair invited comment on the project milestone chart. The chair drew the group’s attention towards two areas:

• the development of a digital hub specification; securing a digital hub developer; and agreeing information sharing protocols
• the development of performance measures and standards

For both of these areas, the chair proposed creating two short life working groups who will report back to the advisory group (and feed into the operational working group and stakeholder network). While SG will look for volunteers across the advisory group and the two sub-groups to participate, the chair’s preference would be for advisory group members to co-chair each working group with her. SG will co-ordinate both short life groups and provide secretariat support.

Action: SG officials to send out an e-mail after the meeting inviting expressions of interest.

Review of draft implementation plan

The chair thanked group members for providing written feedback on the draft implementation plan and invited further comment.

A group member commented that equity should be considered in terms of geography. Although digital service offerings have an important place and are preferred by some veterans, the absence of other resources locally will continue inequality. This issue will need to be considered in greater detail by the group. The chair agreed and commented that regional-level support will have to be carefully considered and protected (in addition to local-level and national-level support).

Another group member cited the plan’s proposal for three regional hubs. Although there have been tentative discussions about creating a national V1P service with SG officials, no detailed proposals have yet been produced by SG. Additionally, discussions would have to include Heads of Psychology Services Scotland and V1P heads of service.

A group member commented that the SG procurement process needs to run concurrently with the development of the pathway to avoid timescales being delayed.

Another group member stated that clarity on SG’s long-term budget allocation for veterans mental health is needed to assess the implementation plan proposals fully.

Action: SG officials to share details on costings for the implementation and operation of the pathway as set out in the plan.

A group member stated that NHS health board veterans champions should be provided with regular written briefings as plans for the pathway develop so that they can update their boards, corporate management teams and intergrated joint boards. Additionally, the pathway needs greater visibility with NHS health boards so they feature in board development plans and SG need to work to raise the profile of the pathway in this area.

Several group members expressed a desire for a day-long in-person session to discuss the implementation plan more thoroughly. The chair stated that although there had been broad agreement on general principles, she agreed that a longer in-person session would be beneficial to discuss topics in greater depth.

Action: SG officials to organise an in-person workshop session.

Any other business

The chair thanked Julie Murray for her participation in the group ahead of her retirement in April.