By Ian Millen, CEO, Veterans Outreach Support (VOS) – this article is adapted from a speech delivered by Commander Ian Millen Royal Navy (retd) at the Trafalgar Night Dinner held at the Royal Maritime Hotel, Portsmouth, on 16 October 2026.
‘We rightly remember courage under fire.’
At the Battle of Trafalgar, as in every conflict since, sailors faced danger, injury, loss and the uncertainty of battle. But there is another kind of courage that is less often discussed: the courage to live with what has been experienced, to admit when life has become difficult, and to accept help.
That is the theme I was asked to explore at this year’s Trafalgar Night Dinner: what mental-health support was available to sailors in Nelson’s Navy, and how different the picture is today.
It is a subject close to my heart. I served as a gunner in HMS Antrim during the Falklands War, and I now lead Veterans Outreach Support (VOS), a Portsmouth-based charity providing welfare, wellbeing and mental health support to Armed Forces and Merchant Navy veterans and their families.
For me, this is not simply history. It concerns people I served alongside, people I know, and people that VOS supports today.
Trafalgar: the wounds that were harder to see
We can picture the crowded decks of a ship of the line: gunpowder, smoke, noise, injury and confusion.
What is much harder to picture is what an individual sailor carried away afterwards. A friend’s death. The trauma of the immediate danger. The thoughts that returned when the sailor tried to sleep.
We cannot interview those men, and we cannot diagnose them across more than two centuries. Georgian medical terms such as “melancholy” and “mania” covered a range of conditions and, just as today, not every mental disturbance was caused by battle.
Nevertheless, naval records show that mental suffering existed and was recognised in Georgian times.
The language and treatments of 1805 were different. The humanity was not.
What help was there in 1805?
The good news is that the answer is not “none”.
But neither was there anything resembling the support we can provide today.
A sailor whose mental condition became apparent might come to the attention of the ship’s surgeon. Depending on circumstances, he could be treated on board or sent ashore to sick quarters or a naval hospital.
The Royal Naval Hospital Haslar, just across the water of Portsmouth Harbour, was part of that system.
Some men were sent to London asylums, including Hoxton House and Bethlem -better known as Bedlam – where the Navy paid for their care. In these establishments, treatment could include confinement, restraint, bleeding, purging and cold baths. By today’s standards, some of those approaches were brutal, but were the extent of medical thinking at the time.
Yet the story is not entirely one of neglect.
Families sometimes brought relatives home. Officers re-employed men after illness. Doctors believed recovery was possible.
So, care and understanding existed. But treatments were inconsistent, medically limited and far from comprehensive. Furthermore, many whose distress went unrecognised have left little trace in the records.
A local story of change
One important milestone lies close to the Royal Maritime Hotel.
In 1818, thirteen years after Trafalgar, part of Haslar was dedicated to mentally ill naval personnel. It reflected a growing belief that care should promote recovery rather than merely contain illness.
The period called this “moral management”: a move towards more humane surroundings, individual attention and purposeful occupation. Practice varied, and restraint remained an option, but the positive direction of travel was significant.
Later accounts describe Haslar patients gardening and fishing.
Those activities were not modern therapy. But they reflected an enduring principle: recovery needs connection, purpose and an identity beyond illness.
That principle still matters in veterans’ support today.
From shell shock to the Falklands
The First World War brought ‘shell shock’ into public consciousness. The experiences preserved by the Imperial War Museums show how varied the suffering -and the responses to it -could be.
In 1919, the organisation we now know as Combat Stress began its work. That was an important recognition that the psychological consequences of service did not necessarily finish when the fighting stopped.
When PTSD became a formal diagnosis in 1980, medicine gained a recognised framework for trauma, rather than treating its effects as a personal weakness.
Two years later, in 1982, many of my generation were in the South Atlantic, fighting in the Falklands War.
Morgan O’Connell, later one of VOS’s founders, served there as a Royal Navy psychiatrist. We believe he was the first naval psychiatrist deployed in a combat operation, on board the requisitioned troopship SS Canberra. Psychiatric expertise was therefore available, in situ, during the campaign.
But recognition of mental health conditions and seeking help for them are not the same thing.
From VOS’s work with Armed Forces and Merchant Navy veterans, and from my own conversations at HMS Antrim’s annual reunion, I know of many people from my generation who carried difficulties for many years before seeking support.
And we should always remember the critical part played by their partners and families: the people who may see, first hand, the disturbed nights, the withdrawal, or the changes in someone they love. These loving supporters are often the real first responders.
The war may belong to history, but its consequences can remain part of someone’s present.
What is different in 2026?
The difference today is not that help is always immediate, or that every problem has an easy answer. Waiting times, complicated systems and reluctance to come forward can still get in the way. But our understanding and our options are profoundly different.
Today we have trained professionals and evidence-based treatments for PTSD, depression, anxiety and other difficulties. People do not need a dramatic combat story -or a formal diagnosis -to seek help. Indeed, the Armed Forces Covenant definition of a veteran is someone who has served a day in uniform, and we know that the majority of mental health conditions have their roots in adverse childhood experiences, not just conflict.
There are many routes into support:
- A GP or NHS Talking Therapies can provide a starting point.
- Eligible veterans in England can contact Op COURAGE directly, or be referred by a GP, charity, family member or friend.
- Specialist organisations such as Combat Stress, PTSD Resolution and VOS offer trusted, veteran-aware support.
- Practical issues – housing, debt, employment, relationships and family pressures – matter too and often need to be addressed alongside mental health.
The right response is often a combination of support, not a choice between problems. Effectively, person-centred, holistic and partner-enabled support.
VOS: help starts here
When I say VOS is “here”, I mean it literally.
The Royal Maritime Hotel is our headquarters and main delivery venue. Help is closer than some people imagine.
VOS’s monthly drop-in began here in July 2008, founded by naval psychiatrist Morgan O’Connell, veterans Joe Erskine and David Watts, and Ann Townsend, the mother of a deceased soldier, following the twenty-fifth-anniversary Falklands pilgrimage. During the pilgrimage, they identified a need for community-based support for veterans and their families in Portsmouth.
Eighteen years later, we continue to combine welfare, wellbeing and clinical support for Armed Forces and Merchant Navy veterans and their partners.
That includes therapy, practical assistance, peer activities and social groups.
The first step can often be a conversation with a professional who understands. It can be reconnecting with others in a social setting. Or it can be recognising that a partner needs support too.
You can contact VOS directly, without a referral and without knowing which service you need. Beginning simply with “I’m finding things difficult” or “I’m worried about someone” is enough to open a pathway to support.
We will listen and help identify the next step.
VOS is also a first door into a wider network: a gateway to more than 40 specialist delivery partners and one of 14 VALOUR Recognised Centres across the UK.
Beyond the Trafalgar Night Dinner Speech
I would like to leave readers with three requests.
First, if any of this sounds familiar to your challenges, please do not rule yourself out because others had it worse, because you left years ago, or because you have become accomplished at convincing others that you ‘are fine’.
Speak to someone. Contact VOS. You do not have to wait for a crisis.
Second, please consider supporting VOS through your time, skills, fundraising or, if you are able, a donation.
Third – and most importantly – spread the word.
Think of a former shipmate, an oppo, a mate, a neighbour, colleague, partner or someone who has quietly stopped joining in. This article may have begun because of the celebration of the Battle of Trafalgar in 1805, but our services are open to all branches of the UK Armed Forces and Merchant Navy, as well as their families and carers.
If you know someone in need, you do not need to diagnose them or find perfect words.
You might simply say: “There are people in Portsmouth who can help. Shall we contact them together?”
A final thought
Looking back from 2026 to 1805, the Navy’s medicine was limited, its language unfamiliar and its support uneven.
But care existed.
People noticed. Families wanted loved ones home. Doctors believed recovery was possible. And some men returned to sea.
That is a reminder that compassion is not a modern invention.
What has changed is our ability to understand, to treat, and to reach people earlier.
Help is available, much more than people think and much closer than people think.
The help is not reserved for crisis. It is for anyone who served, anyone who supported them, and anyone who needs help finding their way back.
The guns of Trafalgar have long since fallen silent.
But the duty of care continues.
And if this article leaves you with one thought, let it be this:
‘None of us has to face the difficult parts of life alone.’
How to contact VOS
- Telephone: 02392 731767
- Email: admin@vosuk.org
- Website: vosuk.org
- Address: Veterans Outreach Support, Royal Maritime Hotel, 75–80 Queen Street, Portsmouth, PO1 3HS
For urgent mental-health support, contact NHS 111 and select the mental-health option. In an emergency, call 999 or attend A&E”.
