Military Health - psychiatric injury


Book Reviewer
The attached article appeared in the June edition of the MoD in-house journal 'FOCUS' - reprinted here by kind permission of Mr Roy Bacon.

I've posted it here, rather than under Health & Fitness because it would be interesting to have non-UK perspectives on this issue.

Interview with Professor Simon Wessely, co-director of the King's College Centre for Military Health Research.

Crown Copyright 2006

FIFTY years ago MOD had an enviable record in understanding psychiatric injury and in research. That knowledge was lost as they downsized after the Second World War. Most people forget that the Army invented group psychotherapy, in 1942. They had to: they had a huge army and lots of psychiatric problems. They also had a lot of psychiatrists; maybe 300. But it’s difficult to make comparisons with today. We had a conscript national service army. We also had a totally different war – a war of attrition – so the rates of psychiatric injury we had between D-Day and Normandy, or in Bomber Command, are inconceivable in a modern army. Also, when you have a small professionally trained army you expect them to be more robust and resilient, and indeed they are. We will never again see the scale of psychiatric casualties that we saw in the First or Second World Wars, or in Korea.

In general, military personnel are healthier than civilians, because they’re very carefully selected. That’s one reason why making comparisons between the military and civilians is a fairly useless occupation – you’ve got to make comparisons within the military, between the services, or between those who deploy on one operation and those who don’t.

In general, the military suicide rate is much lower than in the population as a whole. The exception is in young men in the Army: 16-19 year olds have a higher rate.

In the Op Telic study we have a cohort of 20,000 people, half of whom have been in Telic, half of whom haven’t. It’s the first ever large-scale study, and it’s about the whole of the armed forces. It looks at physical and psychological health in various aspects. We’re looking at things like exercise, families, careers, unit morale, work stress, and so on.

Our study followed soldiers as they went into civilian life. So we know from that particular cohort, most did very well. Eighty-five per cent went on to get jobs very quickly, and adjusted reasonably well to civilian life. But there was a group that didn’t, and among that group there were quite a lot of mental health problems: depression, alcohol, post-traumatic stress disorder (PTSD), social problems, and marital problems. PTSD is a complicated concept, and it is often used inappropriately as a blanket term. It’s not the most common mental health problem faced by the armed forces: depression and alcohol problems are more common.
The people who didn’t adjust at all to civilian life are a minority group. There’s quite a lot of help for them, but they don’t access much of what’s available. They don’t make much use of the NHS, and they don’t make much use of the veterans’ charities either. We’re looking at ways of improving that.
Pretending that you can prevent psychiatric injury is about as utopian as saying you can prevent physical injury. We’d like to, but it goes with the territory and can’t be totally removed. The only way to prevent PTSD is not to send people to war. There are things you can do to alleviate it, and most of those things the British military do very well. Overwhelmingly the biggest thing is training: making sure that people know what to do when they’re in a tight corner.

Unit cohesion and morale is the next huge thing, and that’s hardly news to those who have studied at staff college. Group cohesion is the best combat motivation, and it’s also the best protection against combat breakdown. Those are all things the military knows about. We’re pretty good at those kinds of things, and that’s why we don’t have much in the way of psychiatric breakdown: compared to other nations, we do pretty well.
We’ve made some advances in drug therapy, but most significantly in psychological treatment. The new psychotherapies, like cognitive behavioural therapy, have been shown to be quite effective in the treatment of PTSD.
Military culture does make it difficult for people to admit to emotional distress. Treatment is stigmatised, and there is a belief it will affect your career. In a macho culture, it’s hard to accept psychological vulnerability. That’s a real dilemma we have.

You have to trade off a military that is tough and at the same time to compassionately help people who have broken down within that culture.

It’s not an easy balance.
Incidentally, if you would like to support the work of the British charity - Combat Stress - who run the 3 PTSD treatment centres we have in UK , then please follow this link . The charity anticipates taking on an additional 700 new clients this year......VMTs.

Le Chevre