Op COURAGE: How to Self-Refer to the NHS Veterans Mental Health Service

Op COURAGE is the NHS mental health and wellbeing service for veterans, service leavers and reservists in England. You can refer yourself by phoning or emailing the team for your region, with no GP letter needed, as long as you served at least one full day, live in England and are registered with (or can register with) a GP. Scotland, Wales and Northern Ireland run their own services, covered below.

What Op COURAGE is

NHS England launched the service in 2017. It brought together three earlier services, the Transition, Intervention and Liaison Service (TILS), the Complex Treatment Service (CTS) and the High Intensity Service (HIS), under one name. In January 2024 NHS England reported more than 30,000 referrals since launch, including over 4,500 between April and November 2023. Staff are ex-military or have military experience.

According to the NHS, Op COURAGE provides:

• support with the move from military to civilian life, working with Defence Medical Services for those still serving
• recognition and treatment of early signs of mental health problems, advanced conditions and psychological trauma
• support and treatment for substance misuse and addiction
• referral to other NHS services, such as NHS Talking Therapies and eating disorder services
• liaison with charities and local organisations on housing, relationships, finances and employment
• support for armed forces families affected by mental health problems

Why self-referral matters

NHS England's spring 2022 survey of 3,095 veterans, serving personnel and others, reported in the same January 2024 release, found that about 60% of respondents found it hard to ask for help with their mental health. Of those who did seek help, about 44% used self-referral, the most common route. Around 52% reported a mental health problem, now or in the past, and 54% a physical health problem.

Those figures explain the design of the service. You can make the first contact yourself, by phone or email, without waiting for a GP appointment, and the staff you speak to understand service life. If making the call is the hardest part, ask someone you trust to make it with you or for you. The service accepts contact from family and friends.

Who can use Op COURAGE

• You served in the UK armed forces for at least one full day, as a Regular or a Reservist.
• You live in England.
• You are registered with a GP surgery in England, or are willing and eligible to register.
• You can give your military service number.

There is no time limit. You can contact Op COURAGE whether you left last month or decades ago, and serving personnel with a confirmed discharge date can use it before they leave.

How to self-refer in England

Contact the team for the region where you live. You can call yourself, or a family member, friend, GP, other health professional or charity can contact the service for you. These are the contacts on the NHS Op COURAGE page:

Have your service number, GP details and a short note of what you want help with ready before you call. If you are unsure which region covers you, call the nearest number and the team will redirect you.

What happens after referral

1. Assessment. The service arranges an assessment to understand your situation and what care would help.
2. A care plan. Depending on need, that can mean treatment within Op COURAGE, specialist trauma or addiction treatment, or referral to another NHS service such as NHS Talking Therapies.
3. Practical support. The team works with armed forces charities and local organisations on problems that affect mental health, such as housing, debt, relationships and work.
4. Family involvement. Families can be supported and linked to local services.

The NHS does not publish a standard waiting time for Op COURAGE. Ask about expected timescales at your first contact, and tell the team if things get worse while you wait.

Scotland, Wales and Northern Ireland

Health is devolved, so Op COURAGE covers England only. Each of the other nations has its own route.

In Wales, the Cwm Taf Morgannwg team describes the process after self-referral: screening, an opt-in and consent form, a face-to-face assessment with a Veteran Therapist, then either brief therapy based on NICE guidelines or signposting to another service. Veterans NHS Wales focuses on mild to moderate common mental health problems linked to service.

In Scotland, the Scottish Government's primary care mental health resources list V1P alongside Combat Stress, which works Scotland-wide and accepts self-referrals. Your GP can also refer you to local NHS mental health services anywhere in the UK.

Other veteran mental health services

If your experience involves guilt or betrayal around events in service, our article on moral injury and PTSD explains the difference and why it matters for treatment.

US veterans living in the UK

US veterans resident in England who also served in the UK forces can use Op COURAGE on the same terms as anyone else. US-only veterans living in the UK use NHS services through their GP and can call the Veterans Crisis Line from Europe on +1 844-702-5495. VA can pay for treatment of service-connected conditions abroad through its Foreign Medical Program; see our guide to VA disability compensation abroad.