The NHS has officially recognised the long-term side-effects of a controversial anti-malarial drug that has had devastating neuropsychiatric consequences for thousands of British veterans.
For decades veterans suffering from Lariam toxicity have been misdiagnosed as having psychiatric or functional neurological (FND) disorders, preventing them from accessing adequate care for their condition.
The recognition could enable these veterans to challenge misdiagnoses and ultimately pave the way for them to receive appropriate medical advice and support.
But Lariam veterans have warned that the development will have limited impact unless health authorities introduce new treatment approaches for the condition.
AOAV has previously reported how the refusal of the MoD to recognise the link between Lariam Toxicity and long-term brain damage has prevented veterans from accessing appropriate treatment and compensation. This was compounded by the failure of the MOD to properly document the drug’s use, despite its known severe psychological side effects.
Lariam, the brand name for mefloquine, has long been under scrutiny for its neuropsychiatric side effects, which can include nightmares, depression, hallucinations, and, in extreme cases, suicidal ideation.
Since 2016, the MoD has admitted that Lariam could cause minor psychiatric injury in certain individuals for a limited period of time but it has denied that the drug can cause long-term psychiatric injury.
Evidence submitted to a 2025 Defence Select Committee (DSC) inquiry into the Armed Forces Covenant referenced a case in which the NHS’s Op COURAGE service recognised the link between Lariam toxicity and long-term brain damage in its diagnosis of a military veteran in 2022.
But until recently UK medical authorities did not have an official medical benchmark for Lariam toxicity, lagging behind US and Australia, which both recognise Lariam poisoning as a distinct medical condition.
Since the publication of AOAV’s report, Kate Davies, NHS England’s National Director of Health and Justice, Armed Forces and Sexual Assault Referral Centres, has formally confirmed that the NHS recognises Lariam toxicity, the long‑term harm caused by the drug, and the need for screening and management of the condition.
“We hope that our recognition of the mefloquine toxicity; the introduction of screenings questions and the development of guidance that both NTEP [The NHS Armed Forces healthcare training and education programme] and RCGP [Royal College of General Practitioners] will use gives you some assurance that we take your concerns seriously and have acted on them,” she said in a letter to a representative for Lariam veteran David Rimmington, a former British Army Warrant Officer of the Royal Logistic Corps and seen by AOAV.
The letter also included an invitation for Rimmington to meet with Professor Shehan Hettiaratchy National Clinical Director for Armed Forces, NHS England, “about his experience and to discuss potential support.”
Rimmington described the recognition as “a significant and long overdue development”, adding that “it will become very interesting if the MOD doesn’t fall in line with the impending clinical narrative, especially with the MOD/NHS crossover of services by OP COURAGE/RESTORE, and now VALOUR.”
“For those affected, this recognition brings immediate relief: their symptoms are finally acknowledged instead of dismissed, and clinicians now have a legitimate framework to understand what they are seeing, instead of coercing them into accepting incorrect labels,” he said. “It also lifts a huge burden from families, partners, and loved ones who have carried the consequences of misdiagnosis for years.”
Enthusiasm around the official recognition was dampened by subsequent communications in which the NHS confirmed that it will continue to direct Lariam veterans towards psychiatric services rather than establishing new treatment approaches for Lariam toxicity.
“To ensure we had explored all avenues we have spoken to military mental health clinicians, Kings Centre for Military Health Research, Royal College of Psychiatrists, and the Maudsley Hospital,” said Hettiaratchy in a follow-up letter to Rimmington.
He added: “The overall suggestion has been to refer those experiencing toxicity into standard NHS psychiatric services,” citing the challenge of finding “clinicians with specific professed expertise in Lariam neurotoxicity” and the fact that “each patient presents differently.”
Rimmington said that the NHS must now “implement the clinician‑level screening it promised, develop a dedicated toxic‑injury pathway, and ensure access to neurologists, neuropsychiatrists, and toxicologists, to manage the injury.”
He also called for the MoD to officially recognise Lariam toxicity, audit historic prescribing practices, and “revisit cases where PTSD or ‘personality/adjustment disorder’ diagnoses were applied without screening for toxic or other brain injuries.”
Finally, he said that the government should provide compensation and redress for “systemic breaches of duty occurred at every level in this scandal, many of whom are unable to work as a result of the condition.”
He said that under this process, it should re-examine the historic class‑action settlements “where injured veterans were forced into global agreements without individual case even being reviewed.”
“Families who lost loved ones to suicide after Lariam exposure deserve answers too,” he said.
Dr Iain Overton, Executive Director of Action on Armed Violence, said: “This is an important and overdue development for veterans who have spent years trying to have their experiences taken seriously. Recognition is only the first step, and the real test will be whether it leads to appropriate clinical pathways, specialist expertise and meaningful support.
“Professor Shehan Hettiaratchy deserves particular credit for the open-minded and constructive way in which he has engaged with veterans and their concerns. Too often people affected by Lariam have felt that institutions were unwilling even to listen. His willingness to meet those affected, examine the evidence and engage seriously with difficult questions is precisely the approach that is needed if confidence is to be rebuilt.”
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