One for the lunatic attendants amongst you.

#1
By John J. Lumpkin / Associated Press

WASHINGTON - A survey of troops returning from the Iraq war found 30 percent had developed mental health problems three to four months after coming home, the Army's surgeon general said Thursday.

The problems include anxiety, depression, nightmares, anger and an inability to concentrate, according to Lt. Gen. Kevin Kiley and other military medical officials. A smaller group, usually with more severe cases of these symptoms, is diagnosed with post-traumatic stress disorder, or PTSD.

The 30 percent figure is in contrast to the 3 percent to 5 percent diagnosed with a significant mental health issue immediately after they leave the theater, according to Col. Elspeth Ritchie, a military psychiatrist on Kiley's staff. A study of troops who were still in the combat zone in 2004 found 13 percent experienced significant mental health problems.

Soldiers departing a war zone are typically given a health evaluation as they leave combat, but the Army is only now instituting a program for follow-up screenings three to six months later, said Kiley, speaking to reporters.

A pilot program for the follow-up screenings, conducted on 1,000 U.S. soldiers returning from Iraq to Italy last year, found a much greater incidence of mental health problems than expected, a fact Kiley attributed to post-combat stress problems taking time to develop once the danger has passed.

Only about 4 percent or 5 percent of troops coming home from combat actually have PTSD, but many others face problems adjusting, Kiley said.

The stress of combat, seeing dead and mutilated bodies, and feeling helpless to stop a violent situation are common triggers. In Iraq, truck drivers and convoy guards are developing mental health problems in greater numbers than other troops, Ritchie said, suggesting the long hours on the road, constantly under threat of attack, are taking their toll.

In Iraq, the military has about 200 mental health experts, grouped in what the Army calls "combat stress control teams." These teams are at many posts around the country and talk with troops after battles, try to prevent suicides and diagnose troops who should be evacuated from of the country because of mental health problems.

"They are worth their weight in gold," Kiley said of the teams.
 
#3
Did a few sums on the figures in the last but one paragraph. It means that there's a mental health specialist in theatre for every 675 US Troops. For the Brits it's one for every 3000.

How much did that WFR C/SGT get in court against the MOD...?
 
#4
Neuroleptic said:
"They are worth their weight in oil," Kiley said of the teams.
surely.
 
#6
Filbert Fox said:
Neuroleptic said:
"They are worth their weight in oil," Kiley said of the teams.
surely.
Depressingly Filbert, when alls said and done, I think you've probably hit the nail on the head there
 
#7
The symptoms described a similar to those many ex-prisoners have at about the same period after release. Is this in fact this evidence that the one year operational tour is too long. The symptoms prisoners have are thought to be due to being isolated away from family, poor institutional living conditions, daily life constrained by limited movement and the constant imposition of petty rules.
 
#9
RiojaDOC said:
The symptoms described a similar to those many ex-prisoners have at about the same period after release. Is this in fact this evidence that the one year operational tour is too long. The symptoms prisoners have are thought to be due to being isolated away from family, poor institutional living conditions, daily life constrained by limited movement and the constant imposition of petty rules.
I believe you're on the money here. The length of tours in vietnam were a year too. Probably explains the problems US ex-servicemen had post-war. I'm not sure anybody has done the research on this one, but it would be interesting to know if a lot of short tours were less psychologically harmful than one or two long ones.
 
#10
Can you sort your avatar out please!
 
#11
Much research has identified perceived danger as being an indicator for stress reactions - what one person would perceive as dangerous may be perceived by another as harmless. I believe that the high proportion of medical/nursing staff accessing CPN services was because of their proximity to the CPN team. As healthcare professionals some of us are consistently guilty of medicalising (is that a word?) what is essentially a normal response to extraordinary events. Not a psych nurse, but I know there used to be a minimum time period between exposure to stressor and exhibition of stress response for PTSD to be diagnosed - can any of the professionals enlighten me? Btw also worth noting that across the Army we have a lot of nucking futters in the first place, before you add enemy action into the equation!
 
#12
captainchaos said:
Much research has identified perceived danger as being an indicator for stress reactions - what one person would perceive as dangerous may be perceived by another as harmless. I believe that the high proportion of medical/nursing staff accessing CPN services was because of their proximity to the CPN team. As healthcare professionals some of us are consistently guilty of medicalising (is that a word?) what is essentially a normal response to extraordinary events. Not a psych nurse, but I know there used to be a minimum time period between exposure to stressor and exhibition of stress response for PTSD to be diagnosed - can any of the professionals enlighten me? Btw also worth noting that across the Army we have a lot of nucking futters in the first place, before you add enemy action into the equation!
As a TA nurse, in my civvy role, the consultant used to reckon 6-12mths (no absolutes in this). As an interesting aside my dissertation was on the effect of immediate post trauma counselling. Every single piece of reliable research out there (4yrs ago) showed that immediate counselling made psychological sequelae much more likely and much worse.

It is us trying to medicalise something. It's often better just to tell people that what they are experiencing is entirely normal (in immediate aftermath) and go and have a chat with their mates about what's happened.
 
#13
invisiblehelper said:
Ah Psychobabble, you mean just as they do for all reservists (Army) just now, and have done for the last 3 years? What a bldyoo good idea!
Apologies, didn't write that terribly well. I meant in the immediate aftermath of an incident rather than on Demob back at Chilwell. It is apparent, again from civvy work (I work for Crisis Resolution team) that we (as local providers) aren't being informed when/if Army psych services have concerns about someone from our catchment area, and neither are the soldiers being sign-posted in the right direction.

Slight lack of joined up care there, methinks (sure I'm not the first person to say it either!)! Not entirely sure how it could be addressed that wouldn't be a fair amount of extra work.
 
#14
Interesting how we have come full circle on this! Is it a case of the Army forgetting lessons learned in previous conflicts all too soon and then having to reinvent the wheel. I know that Mitchell's (the geezer what advocated debriefing) work is now discredited due to him making a load of it up. As someone that has sat on both sides of the fence, as a healthcare professional and a PTSD sufferer I know that the old approach did me no favours. I owe my sanity to a fantastic Army CPN, and the fact that I was clued up enough to recognise that things weren't right and having the guts to admit that I had a problem and access the service. I have severe misgivings about the outsourcing of inpatient psychiatric services to the Priory group, that however, is another thread altogether!
 
#16
ViroBono said:
captainchaos said:
I have severe misgivings about the outsourcing of inpatient psychiatric services to the Priory group.
You are not the only one.
I've actually just changed roles from crisis work to being what our PCT calls an assertive case manager. Basically I look after all our out of area and non-NHS stuff, both clinically and financially (interesting conflict that...).

With non NHS providers they don't have the imperatives to move people on, as while they are an inpatient the provider is being paid money (and lots of it, I have four cases where the care costs £800 A DAY). As I'm sure most are aware , Priory group aren't that brilliant at care provision anyway....
 
#17
I raise the target. we've just bought somebody back from the private sector who was costing £40000 a month to care for. The costs now they're back in the NHS is now only £25000 a month. Mind you youre getting your moneys worth as in one week the patient in question put 6 staff off injured
 
#18
Sounds like in that case it was justified. I am questioning the sense of admitting soldiers to these places when all they need is a discreet eye keeping on them and maybe someone to talk to. E.g. a medically well soldier, post overdose with alcohol and paracetamol, that is not psychiatrically ill, but needs a bed for place of safety as it is (invariably) a weekend and he might be at risk of further DSH if he returns to the block in a nice part of the world such as Catterick or Tidworth. In the past we could look after these guys ourselves and keep them in the system. I understand that now they go to the nearest Priory or associated facility where they disappear for aeons and cost the taxpayer a fortune to boot.
 
#19
captainchaos said:
Sounds like in that case it was justified. I am questioning the sense of admitting soldiers to these places when all they need is a discreet eye keeping on them and maybe someone to talk to. E.g. a medically well soldier, post overdose with alcohol and paracetamol, that is not psychiatrically ill, but needs a bed for place of safety as it is (invariably) a weekend and he might be at risk of further DSH if he returns to the block in a nice part of the world such as Catterick or Tidworth. In the past we could look after these guys ourselves and keep them in the system. I understand that now they go to the nearest Priory or associated facility where they disappear for aeons and cost the taxpayer a fortune to boot.
You make a very good point.
 

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