New tactics to help mentally scarred troops

All have seen active service, some in Northern Ireland, the Balkans, Iraq and Afghanistan. But the conflict under discussion is not the battlefield sort but the one that rages inside their heads.

On the board is a list of rules. "No politics. No pensions. Confidential. Respect. Supportive. Phones off. No religion. No football. Break at 1.45." Below is today's topic: "Anxiety." Anna Reeve, mental health practitioner and session leader, is asking what the men can do to ease those feelings.

"Just being able to talk about it helps," says John Irvine, 56, a smiling bear of a man who left the army in 2009 after 38 years. "Before I started coming here, I couldn't speak to anyone about how I was feeling. Now I can." Around the table, the others nod agreement.

It may not look much from the outside, but this small group represents a sea-change in the way mental health issues affecting forces veterans are dealt with in Scotland.

This is a Combat Stress outreach session, one of several being run by two outreach teams to cope with the rapidly rising number of veterans seeking help for psychological problems - chiefly post traumatic stress disorder (PTSD).Until now, Combat Stress has treated veterans at its residential home in Ayrshire, Hollybush House. Usually referred by the NHS, they would arrive at Hollybush for two weeks to undergo intensive psychiatric treatment. But demand is so high - Combat Stress has seen a 66 per cent increase in referrals in five years - that many were only managing to be seen once or twice a year.

The two outreach teams, one funded by the Scottish Government, aim to change that. Instead of being treated for only a few weeks a year, veterans can attend group meetings on a monthly basis and undergo weekly one-on-one sessions with a mental health expert.

It also means that many more who can't attend Hollybush - either because they have young families or are in work, or are simply too traumatised to make the trip - can find support in their communities. For many Scottish war veterans, it is providing a much-needed lifeline.

"If I said I was very close to suicide before I came here that would be an understatement," says Irvine, who served as a Warrant Officer with the Royal Engineers in Iraq and Afghanistan and was subsequently unable to settle into civilian life.

"I was getting up in the middle of the night and sitting downstairs, crying all night, then lying in bed all day," he says. "But as soon as I started coming to Combat Stress I thought, 'My God, I'm not the only one'. I've never looked at myself as a weak man and I never cried in front of anyone until I came here, but I was just able to open up. It was like a safety net. It's as if you've fallen off the high trapeze and somebody's caught you."

The outreach groups are part of a wider change that will see the charity - known most often in Scotland as Hollybush House - rebrand itself north of the Border as Combat Stress In Scotland. It is a deliberate move to make the public, whose donations cover 35 per cent of its running costs, aware that it no longer offers just residential care.

"What we're saying is that we now work all year round in the community," says Clive Fairweather, former deputy commander of the SAS and now chief fundraiser for Combat Stress In Scotland. "We will still continue to get support and clinical advice from our base in England, but in day-to-day terms we are a separate charity in Scotland."

PTSD is still much misunderstood. Typified by flashbacks, nightmares and intrusive thoughts, it is often the result of trauma the person has been unable to process. As a result, behaviour can become increasingly irrational.

"We've got a man who will not stand at a set of a traffic lights because he feels so unsafe there because they remind him of Belfast [where it was unsafe]," says Fiona Manson, charge nurse and a member of the west of Scotland outreach team. "What they're seeing belongs in the past but to them it feels like here and now."

Just over a week ago, British former paratrooper and private security contractor Danny Fitzsimons was sentenced to at least 20 years in jail by a court in Baghdad for shooting dead two of his colleagues in Iraq in 2009. His defence team argued his actions were due to PTSD after his service in Afghanistan, Kosovo, Bosnia, Macedonia and Northern Ireland. The case suggests how dangerous PTSD can be if left untreated.

"There is still the basic problem of the individual themselves not admitting they've got a problem," says Fairweather. "One of the symptoms is that the individual doesn't necessarily recognise in broad terms what's wrong. They just know something's not quite right. Whether there's verbal or physical violence, there is a lot of anger involved. And sometimes that can spill over into more extreme acts."

Robert Lappin, a former Royal Engineer and now Combat Stress In Scotland's welfare officer, agrees that PTSD has not been effectively dealt with until recently. "If you happened to suffer anything, you brushed over things," he says. "Even though there are now trauma management processes, if a man is looking at his buddies and they're not admitting feeling something, the chances are he won't come forward."

Andrew Watson, 31, joined the army at 16 and served with the Royal Highland Fusiliers (2 Scots). He left 11 years later after sustaining three injuries. He found himself at Combat Stress's outreach programme after becoming depressed.

"The army teach you how to kill but not how to deal with what comes after. I had to strip down vehicles - I've taken in radio equipment covered in blood and bits of people and cleaned it. Nobody takes you to the side and says, 'This is how you deal with that'."

The leader in its field

Combat Stress was established in 1919 to care for soldiers traumatised by fighting in the First World War (1914-18).

It was founded by women who believed men could be rehabilitated from shell shock - as it was then known - through treatment, rather than being shut away in mental hospitals.

Today Combat Stress is Britain's leading mental health charity for veterans, offering short stay clinical treatment in Scotland at Hollybush House, Ayrshire, as well as community outreach treatment nationwide. Last year it launched its The Enemy Within appeal aiming to raise 30 million to fund 14 outreach teams across the UK.

• www.combatstress.org.uk