A message from the Director of Medical Services

Dr Walter Busuttil

I became the Director of Medical Services for Combat Stress in 2007. Before this my Career in Traumatic Stress Disorders started in 1989 during my 16 years service as a military psychiatrist in the RAF.

Our caseload at Combat Stress is considerable. We have seen a marked increase in Veterans and their families asking for our help. The number of Veterans making contact with has been increasing 12% each year.

Our clinical audits show that our Veterans come to us with significant problems, including chronic and severe combinations of psychiatric illness and social problems. Commonly this includes Post Traumatic Stress Disorder, depression, anxiety disorders and alcohol and substance misuse disorders.

Many also have a significant physical illness including chronic pain, and a history of exposure to significant psychological and physical trauma. Some will have had difficulties in childhood and adolescence, including being exposed to poor care giving and poor attachments and exposure to abuse. Many have had long periods of unemployment, marital breakdown and many tend to isolate themselves and live alone.

In short we have been dealing with a patient group whose problems are often chronic, complex and long-term. We deal with Veterans who have served in military operations since World War II and any other operation since that time - and those who received their psychological injuries away from combat.

On average a Veteran contacting us for the first time will be in his early 40s. We have found, however, that 80% of our new Veterans have tried to get help from the NHS before contacting us but that for some reason this help has not solved their problems. We have also found that for Veterans of the recent wars in Afghanistan and Iraq are younger and they are coming forward sooner than expected; on average at around two years after leaving the military.

During my time so far at Combat Stress my priority has been to help Veterans access appropriate clinical services as close to their home as possible. I have also worked hard to expand and develop expert clinical services and our clinical teams.

We now have skilled multi-disciplinary teams in our three Treatment Centres with expert Psychiatrists, Psychologists, Psychotherapists, Occupational Therapists, Registered Mental Health Nurses and Care Assistants. We have also set up 14 Community Outreach Teams populated by a Regional Welfare Officer, Community Psychiatric Nurse and a Mental Health Practitioner with experience in psychotherapy, family therapy or social work. This team is complimented by an office-based Welfare Support Team Administrator who offers telephone welfare advice to Veterans, coordinates the Community Outreach Team and provides administrative support. 

We continue to work with our strategic partners including the Department Of Health, The Royal British Legion and the MoD in order to join up clinical services available to Veterans and to produce easy to follow clinical pathways so that Veterans are able to access appropriate care and help. We are working closely with the new Veteran's Mental Health Networks in England that the government is setting up and their equivalent services in Scotland, Wales and Northern Ireland - in order to allow the development of seamless clinical care pathways which will make as many levels of mental health care as possible to be available to Veterans, wherever they live.

In August 2011 we started to offer outpatient clinics on a regular basis at Tyrwhitt House and we expanded these clinics to all of our Treatment Centres in Autumn 2012.

We have also set up new specialised clinical services and are continuing to do so.

In March 2011 we were awarded National Specialised Commissioning from the Department of Health in England to provide a cutting edge six-week rehabilitation programme. The Six-Week Veterans PTSD Programme will be available to those who require it through statutory funding in England and Scotland and we hope to be able to offer it to those who need it and who live in Wales and Northern Ireland. This programme is designed to treat the more severe and complicated presentations of PTSD.

We have also designed a Well-being programme aimed at helping Veterans with rehabilitation needs. We have gone into partnership with The Royal British Legion to provide a Recovery Pathway Programme that allows Veterans to practice their newly taught skills, outside a clinical environment, with our staff to support and guide them.

We are also reconfiguring some of the residential programmes to allow more targeted interventions to be delivered.

Our Community Outreach Service offers a variety of welfare and clinical interventions including welfare support and signposting, clinical assessment, trauma clinics, group work, joint working with the NHS and signposting to appropriate local services if required. They also offer ongoing follow-up care and support. The teams offer 'one-stop shops' in partnership with other ex-service and statutory organisations. These include psychology services, Improving Access to Psychological Therapies (IAPT) services and Veterans' mental health networks, in order to allow the Veteran to access mental health care as well as take advice about housing, benefits, pensions.

We are constantly evaluating the effectiveness of our treatments. I am pleased to report that we have been able to improve symptoms and function for many of our Veterans.

I am very grateful for all the help our benefactors and supporters have given us over the years. Together, we can continue to make a difference to the lives of our Veterans.

Dr Walter Busuttil

MB, ChB, MPhil, MRCGP, FRCPsych