The war is over… now the battle against combat stress begins

Two major military campaigns came to an end in the last decade. In 2006, British forces pulled out of Iraq and Britain’s 13-year peacekeeping operation in Afghanistan finished in 2014. But the end of hostilities does not always mean that the men and women who took part can draw a line under their experiences. In around seven per cent of cases, military personnel who have been in direct combat roles come back with post-traumatic stress disorder (PTSD) which may not be diagnosed for several years. This isn’t usually because they develop the disorder gradually as they re-engage with civilian life. Instead, it seems clear that it takes years for sufferers to seek help, but thankfully that time lapse is shrinking. In the Cold War era, combatants suffered in silence for a dozen years before their symptoms were picked up.

In my experience, doctors, especially GPs, are pretty good at detecting mental health problems so long as people don’t try and hide their symptoms, usually because of the stigma that still surrounds these issues. The problem is what to do next. We know that therapies can help considerably, but again only if a patient is given access to them. Variations of Cognitive Behavioural Therapy, which encourage people to deal with intrusive, unwelcome memories, are effective. Unfortunately, many people get caught between primary and secondary care – too difficult for the former, but not severe enough for the latter.  Furthermore, it can be difficult to get the full picture if you are dealing with a taciturn individual who has spent a career developing a stiff upper lip.

I am patron of Combat Stress, an organisation which does offer CBT and other therapy to veterans who need the help, but we can only do such much, and many can and should be treated within the NHS. However, I would be the first to admit that there are problems there. We still don’t have waiting targets for mental health referrals and people can wait years to see a specialist. There are no rules as to how long someone needs to wait, although to be fair this should soon change as access and waiting times finally come into mental health.

Even with all the help provided, it is difficult to treat people with PTSD caused by military service. They often have comorbidities – other health issues which complicate treatment. Very often, we will see sufferers who abuse alcohol or suffer from depression. They also often have a disintegrating family life – it is all too common for a spouse or partner who insists that they seek help or divorce proceedings will follow.

The UK Military is a relatively concerned and compassionate employer in many cases, although no employer anywhere has properly thought through how to deal with the stigma associated with mental illness. At least, there is a genuine sense that someone has ‘earned their right to a breakdown’ if they have been in a conflict zone. I know that they are doing their best to encourage people to seek assistance in a supportive environment.

One thing that may become a greater issue as time goes on and more conflicts arise, is the higher number of reservists who develop PTSD. This could be due to a variety of reasons including the fact that Reservists spend less time in the military ‘community’ and there is less support in place when they return to their civilian jobs. We need to remember this when we plan to increase the number of Reservists in the Armed Forces – it may seem a cost-cutting measure now but with hidden costs for mental health services later down the line.

 

 

Professor Sir Simon Wessely

Sir Simon Wessely is Regius Professor of Psychiatry and Co-Director, King’s Centre for Military Health Research and Academic Department of Military Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London.He is a clinical liaison psychiatrist, with a particular interest in unexplained symptoms and syndromes.He has responsibility for undergraduate and postgraduate psychiatry training, and is particularly committed to sharing his enthusiasm for clinical psychiatry with medical students. He also remains research active, continuing to publish on many areas of psychiatry, psychological treatments, epidemiology and military health.
Professor Sir Simon Wessely is also President of the Royal Society of Medicine.
Professor Sir Simon Wessely
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