It’s time to make a fuss about Post Traumatic Stress Disorder

By Philippa Tuckman
Health, Notebook, Opinion
Monday, 30 July 2012 at 12:00 am

The British often make a fuss about nothing, and sometimes we’re afraid people will think that’s what we’re doing, but conditions such as Post Traumatic Stress Disorder (PTSD) can legitimately command our sympathy.

The recent Don’t Bottle It Up initiative by the MoD has been successful in encouraging soldiers, sailors and air force men and women with mental health problems to speak up and receive help, without their first thought being that their frankness necessarily has to end their military career – which it doesn’t. The hope is that a better understanding of the symptoms that they might experience and earlier identification of warning signs in the wake of a traumatic event will play a part in reducing any remaining stigma attached to mental illness in the Forces.

The success of the campaign has resulted in a massive increase in reported symptoms of PTSD and mental illness. This is a positive outcome. In 2010, a study partly funded by the MoD and published in The Lancet, reported that “deployment to Iraq has not adversely affected the mental health of regular UK military personnel”. This bold statement conflicted with research findings in the US, where more soldiers appear to suffer from PTSD. The MoD study findings seemed strange at the time and we now know that if UK soldiers were indeed “bottling it up” in 2010, then at least many more are now coming forward and getting the care they need.

So what are the signs of PTSD? There are the more dramatic symptoms, such as flashbacks (the vivid illusion of reliving the event), or nightmares, but in their absence a doctor needs to look at the all-round history of the individual – which isn’t always easy. This history could include participation in an active tour – either recently or in the past – excessive drinking, fighting, and perhaps reports of disciplinary problems where there were previously none, or very few.

Don’t Bottle It Up has increased awareness of mental illness and helped medics and comrades to spot potential PTSD sufferers at an early stage, often while they are still serving. But what else needs to be done? I regularly deal with cases where soldiers have not received what I would consider adequate care and support following an army career, and have suffered in silence as a result. A priority must be to provide support following their discharge. Recent reports that as many as one in ten prisoners are former service personnel suggest that we have little comprehension of the problems they face. We have seen clients who have been homeless and had problems with alcohol and drugs, where one problem feeds on another.

A more coordinated approach is needed. It is true that health records are handed over to local GPs, and that MoD doctors are now supposed to liaise with NHS mental health services when a member of the Forces with known PTSD is medically discharged. This is progress, but only part of what is necessary. A nominated person or organisation should monitor and stay in touch with army veterans and help with housing, employment or immediate financial worries to ensure that they don’t make matters worse. The Royal British Legion (RBL) has offered its services. If permitted access to the names of medically-discharged troops, they could offer support and guidance on housing, finance and employment. This joined-up approach would ensure that former military personnel do not fall through the cracks.

So what does the future hold? Army 2020, the Government’s restructuring programme, will see 20,000 soldiers shed within the next eight years. The stated intention is both to reduce cost, and to improve mobility and flexibility to react to conflict. To compensate for the cuts, it is hoped that the number of reservists will be increased to 30,000. There are worries that the support system currently available to regular troops is unlikely to be extended in its entirety to these reservist troops.

It is crucial to get it right. A further point highlighted in the Lancet article in 2010 is that reservists are more likely to suffer mental health problems than their regular comrades. The government has a duty to use this information to target adequate support and attention at protecting reserve troops from suffering the full consequences of PTSD in the future.