BBC News Wednesday Evening and TRiM(?)

Discussion in 'Current Affairs, News and Analysis' started by Tremaine, Nov 26, 2008.

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  1. BBC News reports that the number of troops contacting Combat Stress "has increased by "53%" over the past three years and troops in Afghanistan may be up nine times more likely to contract PTSD".

    Trauma Risk Management or "TRiM" is also mentioned, "preparing troops for mental trauma and spotting the signs of PTSD "earlier". quote:
    "TRiM is a ‘NICE-compliant’ model of peer group traumatic stress management. Although it began as a combat stress protocol within the UK’s Royal Marines, many other non-military organisations are now using it, including the Foreign and Commonwealth Office; the BBC and a number of police and ambulance services. The model bases itself on keeping employees functioning after traumatic events, by providing support and education to those who require it. Additionally, TRiM aims to identify those who are not coping after potentially traumatising events and it is designed to ensure that they are signposted to professional sources of help. In essence, TRiM aims to empower organisations to discharge their duty of care whilst promoting a pro-active and resilient stance to the effects of potentially traumatic events."

    "In essence, TRiM aims to empower organisations to discharge their duty of care whilst promoting a pro-active and resilient stance to the effects of potentially traumatic events".....One of the paragraphs containing less clinical and management gobbledygook.

    About time too, because we've seen the consequences for health, family and stability, if people don't get support before, during, and after events.

    However; people suffering with distress and mental health problems are still due a legal duty of care, and without the dismissive claim that PTSD "started somewhere in childhood" and dumbing PTSD down to a level with civpop events.

    Anyone have more gen up on "TRiM" ?
  2. Errrr Tremaine, the largest proportion of cases of PTSD in the UK come from childhood sexual abuse. Which has often taken place continuously over many years (17 is the longest I know of from practice). Military service caused PTSD is no different (and often a much less complex presentation) a condition than that suffered by 'civpop' (many of those abused, incidentally, find their way into the forces still with problems caused by abuse intact, meaning that some PTSD presentations ARE related to this) as you call them. It isn't a 'dismissive claim', it happens to be the true situation.

    The most complex cases that I've seen aren't caused by military service, they are the cases of prolonged abuse as a child. The numbers suffering from PTSD who have come to the attention of the DCMHs are actually fairly low (38 last year according to the King's College Team) and don't crop up that often in the NHS either. In two and a half years in my current role I've only had two funding requests for PTSD treament caused by military service, and I work for a large PCT. Whilst it's clearly a problem it's nothing like the epidemic some of the posters on here or sections of the press would have you believe.

    TRiM is a useful tool in identifying those who MAY struggle after a traumatic event and we had close links with the TRiM practitioners in the units we were away with. It also needs to be pointed out that whilst there is a study due out very shortly, there isn't a whole lot of evidence as to what its long term effects are on reducing combat stress presentations. That'll be the interesting bit! It still won't catch everybody though but it is a useful tool.

    The best bit about it is that neither myself or a doctor carries out the process (it's done by 'grown ups' in the organisation, not necessarily senior ranks or officers, just the more level headed members of the peer group who have had the correct training), meaning that it's mostly non-medical and doesn't involve a psychiatric assessment or visit from psych staff (though obviously it may generate referrals to us) . The Gren Guards were the big champions of this from the army's point of view.
  3. In case someone is worried about large scale claims and the extent of the true battle traumatised commmunity, we with PTSD manage
    fine thank you, because for too long we've kept quiet and the system failed us anyway. getting round to dealing with our PTSD took too long and we learnt to manage ourselves. And who'd admit to mental health problems anyway?

    Say what you like, PTSD sufferers are their own best experts. And PTSD is older than any of us.

    So according to psychobabble, "the largest proportion of cases of PTSD in the UK come from childhood sexual abuse." and the problem is nowhere as bad as some of the posters here or the media would have us believe.

    Would that be as "far as he knows", or is that the common view of mental health professionals, and qualified clinical psychologists? Well, I won't go there because I'm neither so I don't have the qualifications to comment.

    If enough people say the same, then it must be true and can't be argued.

    Basically, and correct me if I'm wrong, apparently the largest majority of people/veterans diagnosed with PTSD were abused as a child. "It isn't a 'dismissive claim', it happens to be the true situation."

    Aren't there also varying degrees and types of PTSD? : normal stress response, acute stress disorder, uncomplicated PTSD, comorbid PTSD and complex PTSD ? Are they all, all of them, related to childhood abuse?

    Is a soldier or anyone exposed to traumatic military service going to be told they were "abused as a child?"

    Perhaps you'd like to tell them all that, would you psychobabble? Unless of course you have been diagnosed with PTSD yourself, as we have, and as have many others, and we won't be the last , according to statistics.

    But as you seem to imply that the problem isn't major, and that we don't have to worry, thanks very much for your reassurances.

    Those of us receiving war pensions after diagnosis and living with the effects of PTSD might have one answer: it's an often invisible condition and manifests itself arbitrarily, under certain trigger conditions.

    You may quote your own statistics til the cows come home. What we are being told here comes close to denial, but as I apparently must have been abused as a child I'll let my family know. IMHO you're close to discrimination, as much as denying a person's colour or physical disabilities. If you want to challenge that I'll consult my own research mate.

    Oh, and before I forget, don't patronise me either psychobabble, I had enough of that.
  4. Suspect the percentage figure quoted comes from Combat Stress Newsletter HERE

    From another website: October 2008

    There are people on this board who minimise the work done by Combat Stress. They speak from personal experience because it hasn't worked for them. As a non-sufferer I cannot reply. There is no 'magic bullet'. But Combat Stress [formerly the Ex-Services Mental Welfare Society] has been quietly doing their best to help since 1919.
  5. Trauma Risk Management is a workplace based risk assessment process designed to identify people who are at risk of developing psychological problems as a consequence of exposure to traumatic events. In the military, a percentage of members of a unit will be trained as risk assessors. Within a set time frame, they will carry out a risk assessment in the aftermath of an incident using a standard interview format and schedule. People identified as being 'at risk' are followed up and may be offered referral to mental health services, depending on circumstances.

    Points to note about TRIM-
    1) It is not designed to prevent mental health problems arising following trauma, merely to quantify the risk of them occurring.
    2) It is not used to treat mental health problems that have already developed.
    3) There is as yet no strong evidence to suggest that it works.

    The army has now established a training team to roll it out across the entire force, and it is in regular use in operational areas.
  6. My bold. From my practice and experience as a nurse, both in civilian and operational military settings and the academic literature on PTSD. It is absolutely not a military only affliction.

    I also said that it IS a problem for those people who suffered from it. To say anything else would be clearly ridiculous.

    Nowhere did I say that all PTSD sufferers have been abused as as children. What I said was the majority of presentations seen in the UK are from this source. The number of cases seen within the NHS is far higher than that seen by military services or Combat Stress, who make up a relatively small number (though high as a proportion, if that makes sense).

    PTSD comes from many sources, rape, RTA, abuse and military service are just examples but there are many others. The symptoms are exactly the same and so is the treatment. The military is not a special case in terms of clinical presentation or treatment.

    No, there aren't various forms of PTSD, it is a very clear clinical diagnosis which must be made by a psychiatric doctor under criteria laid down by either DSM IV or ICD-10, which are the clinical diagnostic manuals used by practitioners.

    Acute Stress Reactions are not PTSD and the vast majority don't develop into PTSD either, though some unfortunately do.

    There is no such thing as uncomplicated PTSD or complex PTSD diagnostically, it's either PTSD or it isn't, though those descriptors may be used to describe severity of the illness. The co-morbid prefix is used for people who have other problems as well, often depression or alcohol abuse in patients with PTSD.

    My own view is that labelling people with a diagnosis is often not very helpful and it is much better to concentrate on working with the patient to try to control or stop their symptoms, however diagnoses are necessary for many reasons.

    The statistics of current PTSD diagnosis in the military aren't mine, they're from respected academic sources and from my clinical experience of this would appear to be about right. There just isn't the epidemic that many thought we would have at this point. What happens in the future is difficult to predict but those are the most recent figures.

    Hopefully, given that the forces are much better now at recognising and dealing effectively with ASR and similar trauma related issues we may not see a huge rise in demand for services. One of the problems has always been is that as Combat Stress often point out, the average presentation to them (or the NHS) is in many cases is many years after the event.
  7. Tremaine, please don't use psychobable as a punchbag. Lay off him. He talks sense. Of course a large number of soldiers come from broken homes that have higher rates of abuse. And that may prime some for combat-related PTSD - although that's not what psychobabble was arguing. That's just as well, since I'm not so sure about the priming. We all have our weaknesses. Just because you aren't as resilient to one thing, at one point in time, doesn't mean you're less resilient elsewhere or will never become more resilient in your weaker areas.

    I was diagnosed with childhood abuse-caused PTSD well beyond my childhood. Something during routine surgery triggered it by accident, although looking back I can tell that I was too easy to dismiss my frequent anger as a trait of my youth, rather than search for a specific cause. It's all about denial, isn't it?

    No one in the British Army ever spotted my latent PTSD. My family didn't. My friends didn't. I didn't. We all have our weaknesses. I've seen a girl lying by the side of a road with half her skull missing and, while I find that image a little haunting and sad, I can't say it affected me more than it should. Being buggered *********** when I was twelve, on the other hand, did (emphasis on did).

    Tremaine, in all your posts you sound like you're already angry and looking for targets here on the internet, where social inhibitions are lowered and it's easier to release your anger. I understand you're frustrated by the authorities' response to PTSD. It's horrible to be saddled with something that we're innately ashamed of; something that makes us worry about how people will react and whether we'll ever be able to do fun jobs again. A feeling that you've sacrificed without reward. But the one thing that prolongs PTSD is anger. I sometimes liken PTSD to substance abuse, because those chemicals that your brain releases - the anger, the sadness, the pride, the self-loathing - can easily become addictive.

    When you suffer from PTSD, you're in a heightened state. Just like after leaving the excitement of military service, it becomes hard to live a "boring" normal life - in this case an emotional one. Don't let your anger drive away from the path to healthiness which, believe me, is certainly achievable. Outside factors, people and treatments, can only take you so far. Servicemembers with PTSD need to remember the inner strength they've found through sacrifice and service. If anyone can overcome this and get back to the benchline of our choice, it's us. No matter how great or weak our support mechanisms, what we do in the next moment of our life is our choice alone. And what we do in the next moment has to be calm, rational and propelling us towards inner peace. Being angry on ARRSE won't make you peaceful in real life, trust me.

    Now, psychobabble, I have a question for you: when are we going to see effective criteria for post-PTSD persons? We seem to be focusing a lot on diagnosing and treating, but very little on the desired end state. Every fiber of my being tells me I'm fine - in fact better, smarter, calmer, happier, more resilient and reliable than I've ever been in my entire life - but I just don't know how to prove it. I don't know how government employers will respond when I apply. I don't even know how the army will respond if I try to re-enter. I can live with this uncertainty. But those who are currently displaying symptoms deserve benchmarks by which to measure their progress towards total recovery. In other words, they need hope.
  8. Balls, that's a very pertinent and interesting question and not one I have a concrete answer for I'm afraid.

    Whilst I can't comment on what will happen when you try to re-enlist what I can say is that there are serving soldiers who have had (or have, I'm not convinced it ever entirely disappears, more that you work through it and understandand know the feelings and emotions attached to it so that it's under control. Quite happy to be disagreed with though) PTSD who are now serving in an effective manner and on front line duties.

    You are absolutely right about needing hope and I suppose the best I can offer is the soldiers who have been through the treatment process and are now back doing the job.

    Outcome measures in mental health are always difficult, but I would say from an Army standpoint the desired endstate is that we get a functioning effective soldier at the end of it. The NHS would take the view that the end state is what you (as the patient) would like it to be, whether that's back doing the job you want or merely that you are able to sleep at night.
  9. Quote: "For most this mean their condition is chronic and complex, with poor physical health further compounding their poor mental state. With the scale and nature of the fighting being experienced in Iraq and Afghanistan being equated to the worst during WWII and Korea, Combat Stress is under no illusions. Psychological casualties are being generated. We know because we are seeing them. We are gearing ourselves up to meet an ever increasing demand and a great deal more hard work in the future."

    Doesn't that rather contradict your posts?

    Psychobabble, you appear to be resident spokesman for PTSD . Forums are for postings, and to express views. But not patronising.

    Our experiences and views differ, so we'll agree to disagree. And no, all my posts are not angry rants.

    Those professionals who work in community support see many people every day, including serving and ex service people. They don't always have a voice.

    So you will be challenged.
  10. Tremaine, I went back over the topic and I believe all psychobabble disagreed with was that line of yours about "the dismissive claim that PTSD "started somewhere in childhood" and dumbing PTSD down to a level with civpop events". And then he related how many military-related PTSD cases he's come across. That's all.

    I think you've shifted your argument and now you're accusing psychobabble of downplaying the numbers. Is that your only accusation, or are there more?

    As for numbers, I think you partially made his point when you followed up with "[a]nd who'd admit to mental health problems anyway?" That's the problem in the military community, which also happens to be quite small. In percentage we might be more likely to have it, but in absolute terms we're just a tiny part of the population. So civvies are more abundant and more likely to seek treatment for PTSD.
  11. 'Psychobabble' seems very aptly named...Reminds me of the social workers of thr mid 80's who found a new method of making themselves even more self important.
    You and 'Balls' (strange how he appeared when Tremaine ridiculed Phycobabble) should practice RAD on each other.
  12. As I've stated twice now, the statistics are not mine they are from respected academic sources who have no reason to lie about the numbers, especially as a Freedom of Information request could easily show whether thay are correct or not. As it happens they are correct.

    So no, it doesn't contradict my posts at all. If there are others the we (either military or NHS) don't know about them. If people come forward then we'll treat them and include them in any statistics we have. One of the problems, as you correctly point out, is that many people won't come forward when they do need help.

    My last post was simply answering your questions in a factual manner.

    HVH, Balls is not me, sorry!
  13. Psychobabble, having now read what you are saying i understand your point. I see that the majority of cases of PTSD in the UK as a whole are related to issues other than military service. Fair point. However this being a military community i would suppose that statistic is intended to down play what military sufferers are going through (i may be wrong but it did come across a bit sort of, what are you complaining about most sufferers have been abused (all my own words not quoted)) Hence the backlash.

    Balls this may be a weakness of mine, but i feel it necessary. I and im sure other sufferers resent the continual reference "not being as resilient" offensive. I do not know what you went through as a child and so can not comment. I do however know what i went through and my colleagues went through (i am coming out so to speak in order to try and give some support to those that i know are members here and may be having troubles.) At no time did we stop performing., at no time did we let any one down through under-resilience. In fact i would suggest the complete opposite but i am not going to spell it out on here because some of what i would say also belongs to others.

    In my case the dust had settled on my experiences, and i started becoming ill as a result of the adrenalin running around my body with no outlet, and this was the start of a spiral downwards. I cut myself off from the world because i did not know who was going to be on the receiving end of my rage. So im strongly stating that i really don’t want to hear any ex service person referred to as "not resilient".

    Psycho, you refer to the NHS being ready to deal with sufferers as they come forward. My experience and through meeting other sufferers i know the NHS were not ready and infact i was informed that by my NHS head shrinker that they "were not equipped" to deal with cases such as mine and asked me to go and give Combat Stress a call.

    Balls, lay off tremaine, you do not know what hes going through, and if you do then even more so (lay off). I was given a similar piece of advice the other day (as you have given tremaine) i.e. ARRSE was not the place for a PTSD sufferer etc. well I say the opposite. I came back to ARRSE for a number of reasons, the witty banter and the ability to talk to people who understand being just 2.
  14. TFR, I have to be careful when I say 'we' as I have two hats on, NHS and military, point taken about the NHS and in other threads I've alluded to the fact that psychological treatment availability is generally rubbish (it is where I work for instance). The simple fact is that PTSD whether ex-military or from anything else, should be within the remit of a core NHS service and I suppose this is another instance where civilians suffer just as much as military people, it's not just veterans who get a raw deal, everyone with PTSD is.

    I guess my NHS point really refers to the amount of presentations we get and (as I've also said in a different thread) the only two funding requests for private ex military PTSD treatment I've had we've approved, though it should really have been carried out by an NHS service.
  15. Psycho,

    Does the NHS psych services liaise or communicate with combat stress? I appreciate from the statistics (i.e. mil PTSD being a very small proportion of PTSD cases) that this may not be high on the priority of work.

    I was wondering if some of the facilities techniques etc may be transferrable to the wider community.

    For me the biggest obstacle in the NHS system was the apparent skill fade on anything which did not involve drug abuse (which is a priority in this area) they seemed lost when my history showed a negative on ever having touched coffee let alone the hard stuff.

    I suppose that is what it comes down to. Priority! If the majority of the service users are drug addicts, the sytem will be geared for drug addicts. If the sytem is geared for military related PTSD they will probably be non too conversant with other issues.

    (thinking out loud) Or (as i never got deep enough into the NHS system) the NHS does have similar facilities but just a varying mindset. It is possible that the success of combat stress is purely the fact they understand servicemen.

    On the subject of liaison, my GP certainly holds them in high regard and is very onside, litteraly doing the enforcement of combat stress treatment plans.