Veterans mental care condemned - bbc news article

BBC article

Britain faces a "timebomb" of mental health problems among veterans of the Iraq and Afghanistan wars, best-selling author Andy McNab has said.

He spoke out ahead of the launch of his latest book, which examines the fate of the men he served with in the SAS.

Two of them have killed themselves and a third has shot his girlfriend dead.

The government said most ex-service personnel made "a smooth transition to civilian life", but "robust systems" were in place to help the remainder.

'Hung out to dry'

Andy McNab said care was "totally inadequate" and the NHS was woefully unprepared to deal with the estimated 15% of troops currently serving who will go on to suffer post-traumatic stress disorder.

"I've seen for myself the appalling way that our soldiers are hung out to dry," he said.

He was speaking before the launch of his book Seven Troop, which examines the fate of the men he served with until 1993. Two have killed themselves and a third is in prison after killing his girlfriend.

"The idea held by the government that the majority of service personnel experience a smooth transition into civilian life is delusional and largely false.

"Years of service institutionalise men and women who are then thrust back into society with minimal co-ordination and long term support.

"There is a pervading sense of literally being thrown out of the club."

McNab said responsibility for dealing with the problem lay with the government as a whole, rather than the Ministry of Defence which was doing its best with limited funds.

He also released the results of an ICM poll of 3,040 people which found that two-thirds thought the government's treatment of veterans was "disgraceful".

Some 49% said they would pay an extra penny in the pound of income tax to help returning service personnel with financial troubles.

The Conservatives said ex-soldiers often suffered "shabby treatment".
broken covenant, duty of care, negligence ..... Where do I start?

It is an interesting poll statistic though, "two thirds thought the government's treatment of veterans was "disgraceful"!
While I would like to think that the government would see there is an issue and do what is required to fix it, these issues have been known for a long time. The government has consistently done only the absolute minimum required politically. The fact that these issues get raised many times is important or nothing would be done.
The most pitiful thing about this story is that it is hardly new. The inadequacy of the NHS in this respect has been reported on for some time now and the warning that there is a "timebomb" of mental health issues has bounced around the media for years. (Trying to get the BBC to report the story when it was actually breaking was incredibly difficult - but that's for another thread).

NOTHING HAS BEEN DONE apart from giving the excellent Combat Stressa bit more money.

Hats of to McNab for highlighting the disaster again, but how many more times will we hear about this crisis before the government actually does something?

No point in even asking Liarbour about its shoddy approach to this now. They will shortly be swept from office. Time to start lobbying whoever will form the next government.
The more cynical, might say McScab is highlighting his forthcoming book rather than the treatment of ex soldiers by this w*nk government.
squiffy_parsons said:
The more cynical, might say McScab is highlighting his forthcoming book rather than the treatment of ex soldiers by this w*nk government.
Its not cynisim its reality...But if you look at the end of most articles of interviews you will have it pointed out to you that the Interviewees book/film/art/album is onroute

Fair one for him bringing it up, two birds with one stone, pimps his books piggy backing off a current/relevant issue of the day


Stay cynical, by all means, but the single most useful thing to those of us working in military mental health would be constructive suggestions about how to break down the stigma associated with mental health.

This might then improve the likelihood that personnel with MH problems would seek the help that is available whilst they are still serving, and perhaps get things squared away before they hit civvy street.

Unfortunately - and we see evidence of this all the time - the default approach most people seem to take is to keep a lid on their problems by deluding themselves that everything will be OK once they can get out of the Army/RN/RAF. That is patently not the case.

How do we get through to people that it's OK to seek help? What's the difference between a broken leg and a broken mind? Well, from my POV there is none, but for the majority of people there's a big difference - and that difference is stigma. Make no mistake, we're wracking our brains trying to figure out how we reach out to the people who need our help, but we don't experience the cultural problem of stigma to the same degree in the medical dodge.

Help us out! Give us some ideas as to how we can convince our warriors and warfighters that they shouldn't allow the system to make them feel ashamed or that their career and status will be adversely affected if they seek help from Mental Health Services.

Why you? Because it's the collective 'you' that perpetuates the culture of stigma! On the one hand, you laudably cry foul at the way service folk are mishandled, ill-advised and mistreated when it comes to their mental health, but if it was your mate, or your boss or one of your guys who put his/her hand up and said 'I can't cope - I need help!', how would you react?

Lots of people would react very well and get the person the help they needed - but lots wouldn't, and it is those who continue to see MH problems as a sure sign of weakness and failure and thus, however subliminally, discourage folk from seeking help when they need it, that are the true architects of this problem. :evil:
The problem is that until you get to places like Combat Stress and realise that you are not the only one to have PTSD/Mental Health problems you do feel ashamed.

The stigma is always going to be there IMO.
KhakiCrab - I think there's less of a stigma than you might think. The tough part is to let people know what support is out there and to let their families know as well. More information would help.

In my experience the NHS is'nt equipped to cope, so once you are out of the forces, you are pretty much on your own until things get really, really bad. That's when the need for proper information kicks in - not just for patients but for medical staff. GPs aren't good at spotting the early signs.

They do notice when symptoms of clinical depression present or when a patient has turned yellow and distended with ascites. Then they give you Seroxat and tell you to come back next week or pack you off to a liver unit and dry you out, if there's still time. But the underlying problems go unnoticed far too often in the NHS.

I don't think there's a stigma while you're in and there's certainly not one among those who, like Combat Stress pick up the pieces when you're out.

I think it's about awareness and it's about resources.

Quite often you can have PTSD and not even know it. I'm sure that thousands of people who have been in have nightmares and weep over certain memories; some can cope with it, many more believe that they are coping with it when they're actually not and some obviously can't cope. No shame there and you won't find many on this site who would chastise those who can't. No stigma here on arrse.

Perhaps it's an issue about debriefing? I don't know. But I do think it's shoddy for the government to leave charities to pick up the pieces once people leave the forces.
firstly, I'm a civvie, so my opinion must be weighted accordingly.

1. soldiers are trained to carry on regardless. If they can go on, they will. this needs to be so, so there will always be an issue with people not wanting to 'wuss out' with a condition which cannot be 'seen'.

2. wrt stigma. talking about it. Considering what a lot of soldiers go through, how can they not be affected? I read "shake hands with the devil" by the canadian general who was in charge of the UN mission in rwanda while the genocide was going on. I was upset by that for several weeks, just by reading it, so i can completely understand anyone witnessing that first hand having a really hard time. It will be the same for many situations soldiers are put in.

3. Training the officers to spot 'the signs' and to encourage people to see 'the shrink'.

4. perhaps my perspective is a little different from the average person as I had a psychologist for a parent. I have been through a situation where, over the period of 7 hours, i faced being beaten to death by an angry mob (in a foreign country). Understanding what post traumatic stress is, helped me to deal with this and also arrange care for my two collegues, but it didn't stop it affecting me. Understanding the stress responce is very helpful when dealing with it, especially if you know that others are going through the same thing. (sleep loss, dreams, anger etc...)

In short, talk talk, talk, ...
King_of_the_Burpas said:
But I do think it's shoddy for the government to leave charities to pick up the pieces once people leave the forces.
It is shoddy, even with the extra funding thats been put into places like Combat Stress.

I've been going to Combat Stress for 10 yrs, on paper I'm meant to be funded for 6 weeks a year treatment, I'm lucky to get 14 days and now with the Iraq/Afghan vets filtering in through the system there's pressure to cut the 14 days to 10, in order to allow more to get into the Combat Stress system.


Isn’t there a saying that “any publicity is good publicity” ?

I think that’s appropriate here. I’ve no doubt that “Andy McNab” does feel genuinely concerned about the treatment of service and ex-service personnel with mental health problems. The fact that his new book covers this subject should be seen as good publicity for a worthy cause by all those who share that concern. The fact that it provides Mr McNab with some publicity for his book is a happy accident as far as I’m concerned.

I was lucky ( depends on your point of view – don’t consider myself lucky to have PTSD... ) to be taken on by Combat Stress and treated. At the time I first went, I was fighting to keep myself sane, going through the usual gamut of symptoms associated with PTSD and depression. At first I didn’t realise anything was wrong. Who the hell WOULDN’T have nightmares after some of the stuff that service people see... I daren’t tell anyone, even my wife, because I was scared about what people would think. the fear of this real or imagined stigma prevented me from seeking help until it was almost too late.

No matter what else I got from visiting CS, the single biggest and most important thing to me was that suddenly I wasn’t alone. That I was “normal”. I’m lucky, in that at present, my PTSD is mild enough that I don’t need regular trips to Audley Court. I say lucky with reservations, as there are many more deserving cases that could use the week allocated to me. Even as mild as my symptoms currently are, they still affect life to a great degree. Even when I went in 2005, they were under tremendous pressure to cope with existing levels of clients. Given the current tempo of our forces, they must be fit to burst by now.

I look forward to the visits from my CS local support... It helps me remember that I’m not alone, even without having to go back to experience it. It’s a helpful way for me to touch base with someone that understands what I’m going through.

If this new book can highlight even further the plight of those who have in the past and those who still do defend us, and shame this shocking government into allocation some additional funds to CS and other organisations, then it’s a big thumbs up from me.

Sorry for waffling... It’s a subject dear to my heart !

This is something I say in every thread regarding PTSD. Unfortunately the interface between the MOD and NHS is woeful in this respect. There don't seem to be any sensible protocols for making sure that those who leave the forces with MH problems are brought to the attention of the PCT/provider trust in the area in which they live (or are going to be temporarily resident). Certainly, getting information from an FMed4 is almost impossible and we need to be able to do this.

The sensible way of tackling this would be that once the NHS IT project is up and running (whilst it's late and over budget, what I've seen of it is reasonably impressive in terms of functionality) it is cascaded into DMS Primary Care so at least we have a simple way of finding out clinical presentations during service.

Secondly, and probably more importantly, there is a lack of PTSD provision throughout the NHS as we haven't put the effort into CBT training (the only really effective therapy, even with EMDR there's still a lot of CBT in it). This is changing slowly but will take time so don't expect vast improvements quickly. Even if the funding was increased dramatically the effect wouldn't be instant as you'd have to train people.

Whilst it might appear better for forces people to be treated by forces people, it isn't necessary. There are civilian presentations of PTSD (notably sexual abuse as a child, which may have gone on for 10 years plus), that are at least as complex as most of the military presentations. The treatments are fundamentally the same whatever the cause of the trauma (within the context that everyone is slightly different as a person).

It's certainly an area that my PCT is looking at closely, but in reality the figures for military caused PTSD per PCT are very low. I can recall two funding request for PTSD work for ex-soldiers, both of which were agreed.

Would also agree whole-heartedly with KC's comments about stigma. There are, sadly, still examples of young soldiers being called wasters and ostracised by their mates for presenting with a MH problem that required them to not perform combat duties for a period of time.
I agree there is no doubt about this being a pulicity thing for McNab? but being older and more socially spirited I would like to think the new book was brought about to highlight this ridiculous situation, We all forked out 350mil as tax payers last year to get 170 scumbags off of drugs how much was spent on our boys and girls?

When I grew up my grandad was my hero, now everyone young and old worship cnuts on tele. ban tv unless it is our boys and girls going/returning from Ops or a ceremonial for our fallen HERO'S
It sounds to me that the problem with PTSD is akin to that with drug awareness in the army that we had to tackle inBAOR in 1969. Yes, a long way back but it did seem to work. We adopted the view that SNCO and above knew FA re drugs whereas the blokes were at it every week-end and on leave. The seniors did not appreciate the size of the problem or know the signs to look for.
We set up a roadshow of a DALS major, a RAMC major and me as a sybil WO. We had a very good presentation with assistance from US Drug authority and US Crime Lab in Frankfurt. We went to every garrison, camp and scout hut from border to border and Berlin. As our tour spread, we got invited to wives clubs, messes SNCO and officers, and the WVS, Kirk o'Jocks, all sorts. We burned cannabis by the hundredweight so they knew the smell and to enthuse them. Show took the form of a film, slide show, tablet etc. show around and questions from the floor. Nothing dramatic - we made the point that the lads knew more about something than they did and were they happy with that?. We dealt with the "coffee is a drug" type questions honestly.
The referrals rate went up after our trip round Germany that lasted about 3 months. Not so much knock-offs but SNCO and up passing on concerns and blokes who fessed up when questioned by someone who knew a bit of what was what after the roadshow.
I can see the idea running with PTSD very well where you could have a few guys who had worked through it on the team.

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