PTSD and the after-care of armed forces veterans
“If the number of people dying of work related suicide were from Tesco rather than the MOD, questions would be being asked”. So says Karla Stevenson, campaigner for Veteran’s Mental Health.
Karla is one of a number of people Heather Beach and Dr Dominic Cooper spoke to as a result of their investigations into the number of ex-military suicides as a result of PTSD and other mental health related conditions.
On 20 Sunday October, I was in London and came across a van and a loud hailer on a side street, with a group of veterans protesting about the perceived lack of support for PTSD in Civvy Street. The small numbers beside the van were particularly poignant given the big People’s Vote march going on in the neighbourhood, and my old friend and sometime political adversary, Dr Dominic Cooper challenged me that looking at this would be a more useful outlet for my energies!
On the same day, it was reported in the Times that there had been five suicides within six days among ex-military. Further research showed that 47 lives had been reported to have been lost to suicide from this demographic so far this year – more than one a week. Note that the UK government, unlike some other countries, do not record deaths by suicide of ex-military specifically so figures are often tracked by the community itself.
The cry of the man on the loud hailer protesting with the veterans, was that there was “no support”. How could this be so, when just a short amount of research shows over 2,400 military charities working in the UK in this area – all of which can be accessed via www.veteransgateway.org.uk? This is many more than, for example are available for the police.
Dr Dominic Cooper and I decided to look into this paradox and the article below is a result of our collaborative efforts:
What is PTSD?
Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder caused by very stressful, frightening or distressing events. No surprise that we normally think of ex-military suffering from it, given the events they witness, it in fact used to be called “shell shock”.
PTSD is not limited to ex-military and in fact may be suffered by anyone who has experienced or witnessed a trauma, but it is characterised by nightmares, flashbacks, insomnia, lack of concentration, and feelings of isolation, irritability and guilt. It may take some time for symptoms to emerge and it may be triggered by a secondary, far less severe event than the first – where the first event has not been properly “processed”.
Whilst the MOD has excellent mental health help whilst someone is in the service, and for six months following discharge (with somewhat qualified personnel), as discussed above, it can take some time for the symptoms of trauma to emerge and there does appear to be no formal assessment follow up.
Once you pass that six-month period of receiving direct transition support, you are referred to the NHS or the charities mentioned above. This has not always been a good experience for veterans. As one commentator stated “I was on a waiting list to see someone for two years. I wasn’t homeless or divorced so wasn’t deemed “bad enough”. When I finally saw someone, she had no understanding or experience of what I had undergone, and I lost trust very quickly. I finally saw someone via a charity called PTSD Resolution and got 6 sessions which helped provide me with a few coping mechanisms”. We asked what finally worked for him. “I don’t say it has” he says “I work 15-hour days, I can turn from good to terrible within an hour. If it were not for my wife I would be dead”.
Another veteran stated it took six months after a GP referral to be seen by a MH organisation dedicated to combat stress, to then be told his symptoms were too severe for them to help.
Karla Stevenson, campaigner for support of ex forces post discharge, says “It’s a bit like a pinball machine. You may be really lucky and hit the right support or the right referral, but it is not always the case. More often than not you are unlucky”. Karla also referred to the general difficulties faced by the transition anyway, with a disconnect between their own code of ethics “CDRILS” (Courage, Discipline, Respect for others, Integrity, Loyalty, Selfless commitment) and the way the world outside works…
Lateness, lack of follow through, dishonesty can all lead to ex forces finding it difficult to accommodate the lax nature of their fellow workmates. This added to the vulnerability of being out of the comfort zone of what they know they are good at, adds stress to a condition which is already anxiety related.
It is fair to say that these issues have been recognised by both the government and charitable institutions association, and that there is a shift in coordination and communication. It also seems very clear that this shift has not reached the ears of most veterans who have been struggling nor is it always easy to access the list of help available.
The recently launched Veteran’s Gateway brings access to charities into one place. It is deemed to be a very good start and needs more development. It does not deal directly with crisis however – refers veterans to services which do, such as the Samaritans – and has a 48-hour turnaround for responses – which was deemed inadequate by some of the veterans we spoke to. It should, you would have thought, contain access to all of the resources available, including those referred to below from the NHS and local authorities. A further suggestion was made that users should be able to rate the services through a service such as trust pilot – that those with the best ratings should be given more funding.
Coordination of the charities has been headlined by COBSEO (the Confederation of Service Charities) has facilitated the seven military charities working together to build joint case support, however with the numbers of charities involved it is going to be impossible for them to be entirely coordinated and the quality of support may be variable, as referred to above. There is a suggestion also that only a small number deal with mental health issues explicitly. Almost all of them to some extent are providing implicit support however.
Two further projects have been underway for a couple of years yet not adequately communicated. One is the NHS TILS project which provides specialist care for veterans and offering support via the GP, the charity or through direct approach.
The second is the requirement for each of the local authorities to provide an “Armed Forces Champion”. There is an Armed Forces Covenant that is a promise by the nation to ensure that those who serve or who have served in the armed forces, and their families, are treated fairly. All 407 local authorities have signed it, and each local authority therefore has an Armed Covenant Lead – the “Champion”. This role is not even known about among many veterans. Lists of these have been built by veteran support organisations but are still patchy – and some regions there has been a failure to identify who that champion is. Your own local authority should know who yours is and Dr Dom is building a list to disseminate to anyone who is interested, based on work started by Karla Stevenson.
A further initiative by MOD, is a programme by the Employer recognition awards which encourages the hiring of ex forces and provides awards for companies which invest by doing this.
Background of lack of resources
In spite of the efforts by government and the charities to provide specific veteran support, we cannot ignore the fact that this is against a background of diminishing and scarce resources. Mental health services are failing to meet rising demand, according to a new report published by the TUC Trade Union recently. which shows that in the last five years the number of patients accessing mental health services in England has risen by a third (540,000). However, over the same period the number of mental health nurses, doctors and beds in the country has fallen. The research reveals for example that in 2013 there was 1 mental health doctor for every 186 patients accessing services. In 2018 this ratio had worsened to 1 for every 253 patients.
Veteran community support
Veterans are brilliant at supporting each other and are working together to establish the best routes through the system (e.g. tracking down their local authority covenant lead, starting local Facebook groups for support). The suggestions they had which would support further included [a] MH assessments forming part of a resettlement programme when exiting the military; [b] asking veteransgateway.org.uk. to keep a current list of ‘compliant’ charities by geographical area, names and contact details of the local Authority Armed Forces Champions [c] Have a veterans referral officer in every local authority who would be responsible for ongoing checks on new and current charities but also map their specialism so the veteran is directed to the most appropriate; [d] make GPs more aware of the specialised Charity options instead of just an automatic referral to the NHS.
There is a sense that only veterans can understand each other – and therefore that any support for them needs to be specialised. Whilst the aspect of being a community which has its own code and can support each other, can be incredibly helpful – a real sense of tribe – with a shared vocabulary and experience, it may cut others out from feeling they can contribute in any way at all, or even start to understand the issues they face.
With a similar demographic to construction – with the machismo often discussed there in terms of the inability to open up and talk, ex-military may be also particularly prone to issues with drink and substance abuse due to culture.
Health and Safety
Karla Stevenson pointed out that PTSD was an illness brought about by work just as other long latency diseases under the aegis of HSE. Is there a case for tackling it as we tackle asbestosis and COPD?
At the very least, we know that a number of health and safety professionals are ex-military, and that in our workforces there are ex-military. What can we, as the HSE profession do to ensure MH after-care? At the very least, every HSE professional should try to identify veterans in their organisation and check how they are feeling.
From a positive perspective, this issue is now firmly in the public domain and we are talking about it. The input from the royals specifically, has been seen as integral in supporting the armed forces
If you would like to discuss this issue further please comment in the box below, or contact [email protected] or [email protected].
Sleep and Fatigue: Director’s Briefing
Fatigue is common amongst the population, but particularly among those working abnormal hours, and can arise from excessive working time or poorly designed shift patterns. It is also related to workload, in that workers are more easily fatigued if their work is machine-paced, complex or monotonous.
This free director’s briefing contains:
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- Case law;
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