SATURDAY is Armed Forces Day: a day the nation can collectively show its support for all those associated with the armed forces who serve their country – from cadets and currently serving personnel, to service families and veterans.
This time, it also marks the anniversary of the assassination of Archduke Franz Ferdinand on 28 June, 1914, which a month later provoked the outbreak of the First World War.
Although the First and Second World Wars were quite different, many veterans of both suffered mental wounds – what we now call post-traumatic stress disorder (PTSD).
In 1919, at the end of the First World War, when our organisation was founded as the Ex-Serviceman’s Welfare Society, attitudes to mental welfare were not enlightened. Troops suffering from mental breakdown were accused of lacking moral fibre and there was little proper treatment. Indeed, soldiers suffering from mental breakdowns during the First World War that led to failure to obey orders faced a firing squad.
Throughout the war, thousands of soldiers returned home suffering from shell-shock. The poets Wilfred Owen and Siegfried Sassoon were among the more high-profile sufferers who were sent to Edinburgh’s Craiglockhart War Hospital for treatment. Less well-publicised were the crippling effects on the sanity of those soldiers who never fully recovered from being gassed. Many soldiers incarcerated in Mental War Hospitals also faced the prospect of being sent on, without appeal, to asylums.
The founding mothers of Combat Stress – and they were mainly women – believed these men could be helped to cope by talking out their trauma and through a work rehabilitation programme. Doctors also believed this to be excellent therapy, as work was seen as being essential to the masculine identity and provided the men and their families with some financial security. So, for many years, Combat Stress created real work opportunities for veterans.
The nature of conflict has changed substantially since the 1914-18 war. Since then, we have supported well over 100,000 veterans from every campaign the United Kingdom has fought. Sadly, the traumas suffered by many soldiers have not changed. Indeed, recent statistics from the Ministry of Defence reveal that PTSD is on the rise. A decade of war has resulted in about 11,000 serving members of the military being diagnosed with mental ill-health, which include PTSD and depression (according to a Ministry of Defence report March 2013).
This figure represents a significant proportion of the 177,000 armed forces personnel currently serving our country. In particular, there has been a notable increase in PTSD cases over the past four years. But while the MoD has worked hard to minimise post-traumatic stress and improve care for sufferers, the real challenge is the growing number of people leaving the armed forces who might go on to develop PTSD and do not have access to the necessary support and treatment.
Robert Gordon University’s recent report for the Scottish Government on the needs of ex-service personnel and their families in Scotland, highlighted that it can take veterans up to 14 years after leaving the armed forces before they seek help for any mental health issues – well above the national average we saw last year of ten years.
Our fear is that with 20,000 service people in the forces expected to lose their jobs over the next two years – the army announced 4,500 personnel had been made redundant just a few weeks ago – an increasing number of people will suffer some form of mental ill-health without access to the military’s internal support network.
Of the 25,000 who leave the armed forces each year, most transition successfully to civilian life, but of this number 4 per cent are at risk of developing PTSD, with 20 per cent possibly developing a common mental health problem.
An increasing reliance on reservists in future could see these figures rise still further as research from the King’s Centre for Military Health Research shows that reservists deployed to Iraq and Afghanistan are 25 per cent more likely to develop PTSD compared with their “regular” counterparts.
While regular soldiers have access to decompression, or “untraining” – an opportunity to be with their mates and talk everything out – reservists are often specialists deployed on their own who then go back to their normal lives where they may have no-one to talk to about their experiences.
At Combat Stress we see about 1,700 new people each year and that figure is going up 10-12 per cent each year. In Scotland, we are treating 839 ex-service personnel, many of whom suffer from more than one trauma. It can often be difficult to identify mental ill-health. Unlike physical injuries, which you can see, mental wounds can easily be minimised or dismissed as anti-social personality disorders.
The trigger for getting help is usually a close family member who knows what to look for and can help the veteran to find someone or an organisation, such as Combat Stress, that they can trust or some specialist clinicians in the NHS.
Fortunately, the Scottish Government’s thinking is enlightened in how to tackle this problem and is identifying specialists around the country to deal specifically with veterans so that they can be treated closer to their homes. Unfortunately, there is a dearth of knowledge about the problems veterans might have, as these can be difficult cases that clinicians do not encounter that often.
This autumn, Scotland is also introducing a pilot scheme, funded from the Scottish lottery and UK Libor fines, to stabilise ex-service personnel who misuse addictive substances to “help cope with their condition”. At the moment, we can’t treat the underlying mental health problems of 25 per cent of the veterans because of their dependence on alcohol and other substances.
There is no quick fix for any mental health condition. The good news is that the majority of the people we treat get significantly better or make a full recovery and we can help others, who can’t forget, to cope.
As we approach Armed Forces Day, I would like people to understand that we can’t deploy our young people to war zones and not expect that some will be traumatised. Most of them can and want to work and lead fulfilling, productive lives again. These brave veterans have given significant service to this country and we owe a debt to them, which we can repay by understanding what they’ve gone through and by giving them the necessary support to get their lives back on track.
• Commodore Andrew Cameron, Royal Navy, is the chief executive of Combat Stress