Page last updated at 10:17 GMT, Wednesday, 26 November 2008

Coping with the trauma of warfare

By Caroline Wyatt
Defence correspondent, BBC News

Coffins of British airmen
The loss of colleagues can leave soldiers traumatised

"I started drinking, I started fighting and I was more aggressive - but I didn't care. I couldn't sleep, my chest felt tight, I felt sick - and then there were the flashbacks.

"I got diagnosed with post-traumatic stress disorder by my unit's medical officer - and that was it.

"There was no treatment. And they still sent me to fight in Iraq."

Ian, a 27-year-old veteran of Kosovo, Sierra Leone, Northern Ireland and Iraq, was diagnosed with post-traumatic stress disorder (PTSD) in 1999, but went on to fight in several more campaigns.

Ian - not his real name - left the Army after Iraq, but he is sure many more British troops are silently suffering mental anguish from Iraq and Afghanistan than official figures suggest.

Soldiers who've been serving in Afghanistan are coming to us much faster
David Hill
Combat Stress

He believes many are reluctant to admit to having a condition which they fear could end their military career and endanger their prospects in civilian life.

"Out of my 16 lads we went out with in Iraq, we lost four," Ian says. "Seven of us came back with some form of mental injury, and out of the 10 of us who were married, only two of us are still married today."

He adds: "The Army medical staff are great at dealing with physical injuries, but for mental injury, there's far less out there."

Younger sufferers

Veterans' charity Combat Stress helped Ian deal with his PTSD, though he still suffers from flashbacks and other symptoms.

The charity has delivered its own warning on the mental health of soldiers returning from Afghanistan. It has already had up to 40 veterans of the conflict asking for help.

"We've seen some stark differences in the average length of time between people leaving the service and coming to Combat Stress for help," says its director of operations, David Hill.

"It is usually around 14 years, but soldiers who've been serving in Afghanistan are coming to us much faster, around two years after being discharged, and at an earlier age, 32 as opposed to 43."

British paratrooper in Afghanistan
Younger soldiers returning from Iraq and Afghanistan are seeking help

Combat Stress's medical director, consultant psychiatrist Dr Walter Busuttil, says it is easier to treat trauma-related disorders if they are identified early, but there is a reluctance to come forward.

"For military people, I think they feel stigmatised if they feel as though they are cracking up," he says.

"They think they can't tell anybody and that's a big problem. People who come to us come quite reluctantly sometimes, at first, and are often brought in by their wives, girlfriends or their children."

Adrian Weale, from the British Armed Forces Federation, also believes stigma is an issue.

"The armed forces have made great steps forward in this area, but until servicemen and women are completely reassured that reporting symptoms of PTSD won't have any impact on their careers, many who are genuinely suffering will refuse to come forward for treatment."

Changing attitudes

Mental health figures released in early November by the Ministry of Defence (MoD) showed a marked increase in the numbers of serving personnel diagnosed with PTSD on their return from combat zones.

The latest statistics, for October to December 2007, show that 38 service personnel who had been deployed in combat zones were assessed as having PTSD. Of those, 31 had served in Iraq and 17 in Afghanistan. Ten had served on both operations.

The military provides first-class treatment for those that need it
Surgeon Commander Neil Greenberg
Military psychiatrist

But Surgeon Commander Neil Greenberg, senior lecturer in military psychiatry, says the numbers with PTSD remain "fairly low" overall.

"What we know from the first issues in Iraq in 2003... is that overall the figure was about 4% of people who had probable PTSD whether you deployed or not," he says. "But in combat troops that figure rose to about 7%."

Those in charge of healthcare at the MoD are keen to emphasise that admitting to mental health issues does not mean the end of a military career, and that it is better to seek help at an early stage.

Surgeon Commander Greenberg argues military attitudes towards mental health have changed for the better.

"Historically, the armed forces had an issue with stigma, but that is becoming less prevalent now, and I am extremely confident that if someone asks for mental health care today, the military provides first-class treatment for those that need it," he says.

"The problem is getting those who need it to come forward."

Peer support

Awareness of PTSD has risen within the military, which is now training individuals from all units due to be deployed to Iraq or Afghanistan in 'TRiM' or Trauma Risk Management.

Treating people within the culture of the military is what works
Lt Col Pete McAllister
Head of army psychiatry

It gives someone from each unit the skills to identify who might be at risk after traumatic incidents.

One of the trainers, Major Richard 'Skid' Dorney of the Grenadier Guards, believes TriM ensures no-one is left struggling alone.

"My personal experience is that soldiers are very receptive of TRiM," he says. "It's peer support from their own friends and people they trust, and it's working because of that."

The head of army psychiatry, Lt Col Pete McAllister, also wants serving soldiers and others to be more aware that mental health services are available at the 15 UK military Departments of Community Mental Health.

"Treating people within the culture of the military is what works," he says.

Dr McAllister argues that the number of servicemen and women returning from Afghanistan with PTSD remains low, and that the disorder is "still relatively rare".

But, he adds, for those who do have it, treatment is available.

"We do know that there is maybe a reluctance in people coming forward for help, so we are trying to make sure there are as few barriers as possible to people getting in to see us if they do need help."

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