Combat Stress/PTSD

E

EScotia

Guest
#2
Good article that highlights a hidden problem (hidden from the general public that is). Still doesn't mean he cares.

At a time when the army is configured for expeditionary warfare it beggars belief that we have closed the military hospitals. It may have made sense to close the just after the Wall came down as we were still configured to fight the hordes of ruskis just waiting to come & visit us, but now :?
 
#4
Busterdog said:
It never ever made sense to close our military hospitals - for whatever reason.
Of course in made no sense - it was all about saving money. :roll:

Excellent article highlighting Combat Stress/PTSD.
 
#5
I see a lot of stuff like this on the ARRSE and in many ways it’s good because it’s raising the profile of these important issues.

But equally, given that it’s preaching to the choir for the most part, I also fear that ill-informed articles such as Dr Pemberton’s do as much damage as they do good by reinforcing myths.

Firstly any suicide is tragic, but what’s more tragic is the military culture that discourages young people from seeking help or support – for fear of seeming weak. How many more kids have to die like this before the grass-roots mainstream military is ready to accept the culture-change it needs? We in the Defence Mental Health Services stand ready to help, but we can do nothing until a problem is brought to our attention. It really is down to commanders to grip this – they are the ones who should know their troops.

Now to the good doctor...

The second point is that whilst there may (I'll check) only be 13 UNIFORMED psychiatrists working for MoD, there are quite a few more civilian psychiatrists and when I get back to the office I’ll tot ‘em up if anyone’s interested.

Thirdly, if the smug Dr Pemberton had spent a bit longer in psych outpatients – and maybe even paid attention – he would have noted that to all intents and purposes community mental health is a NURSE-LED service. Again, specific numbers will have to wait, but we have well over 60 specialist psychiatric nurses – in uniform across all three Services – and most trained in trauma-focused CBT, EMDR and other client-specific (that’s you guys) therapies designed to work specifically with psychological trauma. A standard community mental health service we are not. My current unit has 2 psychiatrists, a psychologist, a mental health social worker and 9 community mental health nurses. We cover a tri-Service population of around 24,000 personnel and all bar 1 (the new girl – give her chance!) of our clinical staff are specially trained in dealing with psychological trauma.

I’m afraid to say from my own experience of 2 of the 3 Services (you can guess which from my username) that the very existence of specialist mental health services within the military is not widely known about. I know that RAF officers get a 90 minute presentation on Intermediate Command and Staff Course (Air) but I also note that the Army apparently have no interest in delivering such a presentation to the guys and gals on ICSC(Land). Go figure. You either take this issue seriously or you don’t.

Over to you for the inevitable slagging-off!!
 
#6
My current unit has 2 psychiatrists, a psychologist, a mental health social worker and 9 community mental health nurses. We cover a tri-Service population of around 24,000 personnel and all bar 1 (the new girl – give her chance!) of our clinical staff are specially trained in dealing with psychological trauma.
Do you provide an out of hours emergency service, or is it like NI now - ring the helpline or send the patient to A&E and hope the military system can catch up later?
 
#7
ViroBono said:
My current unit has 2 psychiatrists, a psychologist, a mental health social worker and 9 community mental health nurses. We cover a tri-Service population of around 24,000 personnel and all bar 1 (the new girl – give her chance!) of our clinical staff are specially trained in dealing with psychological trauma.
Do you provide an out of hours emergency service, or is it like NI now - ring the helpline or send the patient to A&E and hope the military system can catch up later?
I'm not one hundred percent sure - but I'd bet on the latter. Not only that but it still seems to be a small number of people to cover a population that is, after all, spread out across the world. I don't doubt that this team are doing their upmost, but it sounds as if they are stretched to the limit. :(

These figures are comparable to civvie street - however, how many civilians have to go through what service personnel do?
 
#8
Lesleycape said:
ViroBono said:
My current unit has 2 psychiatrists, a psychologist, a mental health social worker and 9 community mental health nurses. We cover a tri-Service population of around 24,000 personnel and all bar 1 (the new girl – give her chance!) of our clinical staff are specially trained in dealing with psychological trauma.
Do you provide an out of hours emergency service, or is it like NI now - ring the helpline or send the patient to A&E and hope the military system can catch up later?
I'm not one hundred percent sure - but I'd bet on the latter. Not only that but it still seems to be a small number of people to cover a population that is, after all, spread out across the world. I don't doubt that this team are doing their upmost, but it sounds as if they are stretched to the limit. :(

These figures are comparable to civvie street - however, how many civilians have to go through what service personnel do?
I think you will find that this is one department in one location covering a population of around 24,000 (figure from Khakicrabs post). Each Department of Community Mental Health will be staffed with similar numbers. Of the top of my head I can't give you a figure for the number of teams - but I will look tomorrow when I get to work and post the exact number.

Sluice
 
#9
God, I'd love to have the manpower to cover out-of-hours!!!

Sadly, we'd have to triple our establishment (tri-Service) to be able to offer a 24/7 service. Currently we work office hours only. Out-of-hours cover is via a national on-call telephone helpline (which each DCMH takes it in turn to man), but this is for primary care clinicians rather than patients.

If I ruled the world (ha!) we'd cover 24/7, do assertive outreach and crisis intervention and be able to accept direct referrals (currently, punter has to go via primary care and then be referred to us before we can get involved). But right here, right now we have to work with what we've got.

Also, (as you know, VB) in addition to the 3 RMNs at TMW, RAF Psych Nurses from the DCMHs cover for worldwide psych aeromed on an on-call basis, 24/7. It usually works out at around 6 weeks-worth of on-call duty per annum.

My current DCMH provides an ad-hoc out-of-hours cover over Christmas/New Year - (for the record I was on-call Christmas Eve/Christmas Day this year) - but that's down to individual DCMHs. Others just go with the national on-call arrangements.

So, if the grown-ups ever had a siezure and decided to give us more resources we could do the 24/7 gig. The fact that they have literally just concluded a major, high-level tri-Service establishment study and essentially left us as we are indicates that the grown ups don't want us to do that, for some reason.
 
#10
Save yourself the trouble, SD. There are 15 DCMHs across the UK, a further 5 in BFG and 1 in Cyprus (we gotta have a sunshine tour!).

Staffing varies depending upon population. I work in the second largest. The biggest is Portsmouth, but then they're covering a fair wodge of the surface fleet from there.

All the details are in SGPL 11/05 (which should be accessible via Defence Intranet) if anyone is interested.
 
#12
Khakicrab said:

So, if the grown-ups ever had a siezure and decided to give us more resources we could do the 24/7 gig. The fact that they have literally just concluded a major, high-level tri-Service establishment study and essentially left us as we are indicates that the grown ups don't want us to do that, for some reason.
Don't be stupid, they have to spend that money on important things, like 3 hour lunches, £1, 000 chairs and artwork for MoD buildings! 8O
 

seaweed

LE
Book Reviewer
#13
KhakiCrab, OK, but this answer doesn't recognise the problems related by others on this site when AFTER leaving the Services they are cast off onto the NHS, where aparently neither most GPs nor counsellors seem to understand the problem at all. Indeed it doesn't deal with the issue of PTSD cutting in after - maybe long after - people have hung up their uniform for good. And of course referring THEM to the Defence Intranet doesn't get them very far.

I don't see how calumniating the author of the article (who from other editions of his column seems to be a hospital psychiatrist) actually helps move the game along. My point in posting this was merely to point out that at last SOMEONE outside the Services has some understanding of the problem, and some sympathy for its sufferers.

However I necessarily defer to those who have actually been exposed to trauma to move this discussion along.
 
#14
Seaweed, you're right. But the doc's article doesn't make clear whether or not he's referring to serving personnel, ex-serving, reservists or TA. There has been no small degree of scurillous reporting (and commenting on this and other websites) that intimates or even blatantly states that we don't offer ANY mental health support, even to serving personnel. Therefore given how vague the doc was with regard to who he was talking about I felt the need to point out that we actually offer a bloody good mental health service to serving personnel (and to demobilised reservists via Chilwell) but I share your disquiet about services offered (or not) to ex-military personnel.

I suppose the central issues of my post were these:-

We have a (reasonably) well resourced and highly trained mental health service standing ready to meet the mental health needs of serving personnel.

A hell of a lot of serving personnel don't even know we exist.

A hell of a lot of serving personnel won't come and see us while they are serving for fear of being labelled a fruitloop or something.

Therefore a lot of ex-military end up seeking support once they've left the service.

So my solution would be twofold -

Provide more, better services for veterans (over and above the six centres the govt are setting up).

Put more effort into de-stigmatising mental health matters amongst the serving population and thus encourage engagement whilst serving, so that we send less out into civvie street with 'hidden' mental health problems that can blight their civilian lives.

Speaking for my profession, we do go out and 'evangelise' by talking to people as much as we can. If anything can be done to encourage people to actually listen, that would be helpful.

In the immediate run-up to TELIC 1 I was in Germany, and every single DCMH in BFG had been tasked to deliver a pre-op stress brief to deploying troops. However, less than 15% of the deployed force actually got the brief, because the COs of the other 85% didn't want us psycho-wierdos filling their brave boys heads with pink 'n' fluffy psychobabbble before they rolled off into battle. Like I said in my first post on the matter - go figure. You either take this issue seriously or you don't :evil:
 
#15
Couldn't agree more KC, a sensible and reasoned series of posts indeed.
 
#16
You are never going to de-stigmatising mental health problems in the forces as long as the CoC are still back in the time when they join up, they can not help them self's. See below

This is from the Sunday Express Dec 2nd

Bonkers' general tells of his regret"

The HEAD of the ARMY's Mental Health Policy was under fire last night after describing soldiers traumatised by the horrors of war as "Bonkers".

Lt-Gen Robert Baxter stunned members of the Commons defence committee last week when he talked of soldiers suffering from conditions like post traumatic stress disorder after serving in Iraq and Afghanistan.

He is one of the most senior figures in the Army tasked with framing health policy for all three branches of the Services.

His comments threaten efforts to "de-stigmatise" mental health issues in an attempt to persuade troops with problems to come forward.

Willie Rennie, a Lib Dem defence spokesman, said the general's language was "unfortunate".

He added:"How can we expect others in the Armed Forces to understand the need for better and more sympathetic approach to mental health."

General Baxter insisted last night he had not meant to make light of problems.
He said: "I regret the language I used at the select committee hearing if it caused offence. It is by no means a reflection of how seriously I take the issue of mental health problems."

An MOD spokesman said he was doubting the benefits of long stays in clinics where £14million has been spent on treating 1,200 troops in five years.

General Baxter told MPs: "We make them feel as normal as possible as early as possible rather than keeping them together and they are all feeling Bonkers together."

Health Minister Ben Bradshaw winced in response, then joked: "Its is so refreshing to know that political correctness is alive and well in the military."
 
#17
Gen Baxter is, if memory serves, a scaley in origin and is merely occupying the 3* DCDS(Health) billet that was wished upon us a few years ago because our 3* Surgeons General needed someone from the 'real' military alongside to hold their hands.

He is only the Head of the Army's Mental Health Policy in the same way that he is the head of the Army's Sexually Transmitted Diseases policy, or orthopaedics policy, or ear, nose and throat policy etc, etc, i.e. he's a 3* bureaucrat who knows very little about that for which he reports to CDS. It's also worth noting that his post is purple, not Army-only. Personally, I think we could infer too much from Gen Baxter's ill-considered use of a fairly innocuous colloquialism.

Nevertheless you are right, there do need to be some fairly major changes in culture throughout the organisation and it would be nice to see leadership from the top being applied to the issue as well as the earnest endeavours of those of us at the bottom.
 
#18
seaweed said:
KhakiCrab, OK, but this answer doesn't recognise the problems related by others on this site when AFTER leaving the Services they are cast off onto the NHS, where aparently neither most GPs nor counsellors seem to understand the problem at all. Indeed it doesn't deal with the issue of PTSD cutting in after - maybe long after - people have hung up their uniform for good. And of course referring THEM to the Defence Intranet doesn't get them very far.

I don't see how calumniating the author of the article (who from other editions of his column seems to be a hospital psychiatrist) actually helps move the game along. My point in posting this was merely to point out that at last SOMEONE outside the Services has some understanding of the problem, and some sympathy for its sufferers.

However I necessarily defer to those who have actually been exposed to trauma to move this discussion along.
I dont see how people being 'cast off' into the NHS is the real problem. The problem is the NHS is not well enough provisioned for mental health support across the board, PTSD, Psychiosis, personality disorder et al. As a CPN you dont have to have personally experienced every single problem of any client you are reffered to. If you did you wouldnt really be up to the job. Agreed, if you are at the mercy of your average GP to refer you on then you are in the poo, but thats not the only way 'to get in' As Khakicrab says, this doesnt just materialise when you leave. it must be there in some shape. people dont want to parade declaring PTSD as it might be embarrasing at the time :oops: so it needs acceptance from serving troops as being real and not a sign of weakness.
Im sad to say in my job I come across men who served between 1939 - 45 and their trauma has remained with them all of this time, usually unsupported by anyone other than family. :cry:
I dont think the same will be occouring in 2060.
 
#19
From a scholarly article in Military Medicine Vol 172 Sep 2007 (my bold):

"We conclude that the organizational barriers to care which operate in the military are not insignificant. There is substantial evidence that stigmatizing attitudes are present in many military personnel and physical barriers to asking for and receiving care exist. Many personnel describe substantial concerns that being labelled as a psychiatric patient will be detrimental to their career. Perhaps most importantly are the hidden barriers created by camaraderie and peer support which may make it difficult for individuals to seek help from the outside.

In the U.K. Armed Forces, there are numerous military mental health professionals, both uniformed and civilian. Their mission is to treat those who present with psychological problems and to educate the Armed Forces to accept that it is more detrimental to a sailor, soldier, or airman's career if problems due to the effects of a mental health disorder go untreated than it is to go and get help. We suggest that Western militaries currently face an uphill struggle to combat the organizational barriers to care that exist. Perhaps the real patient is not the individual who has mental health problems but is instead the military culture itself. There can be no doubt that an effective fighting force requires robust and resilient personnel to undertake the arduous duties which are a feature of operational deployments. Senior officers need to address the balance of making the accessing care acceptable with the maintenance of fighting efficiency. We suggest the "therapy" is likely to take many years and will require a gradual cultural shift."
 
#20
Chief Exec of Combat Stress in uncorrected evidence to the Defence Select Committee Jun 07 (my bold):

"We have a lot of very experienced and battle-hardened veterans coming to us, but, sadly, they are not being attracted to us until on average 13 years after discharge. Therein lies a real challenge in service as well as after it to try to pick up these men and women much earlier, because the earlier they are picked up the more effective the help we can give."
 

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