A: Yes, of course Service personnel expect to witness and be involved in extreme events, and to this extent PTSD could be viewed as an occupational hazard. They do, however, expect the condition to be recognised and dealt with appropriately. The problem is not helped if the sufferer does not recognise the problem he or she is experiencing or does not seek medical help. We believe that Veterans deserve the right to get the right mental health treatment and care, in the right place, at the right time.
A: The most common presentation in our patient group is PTSD. Our clinical audits consistently show a range of around 75% suffering from PTSD as the primary diagnosis. Some 62% of these individuals also suffer from co-morbid depression and a history of current or past alcohol abuse or dependence (addiction). In most cases the PTSD present is chronic.
The other 25% or so, suffer from alcohol misuse disorders, depression, anxiety disorders, and phobic disorders including agoraphobia. In addition to this, problems with anger and problems which reflect personality change following exposure to catastrophe are also evident - such as is illicit drug abuse and, more rarely, dependence (addiction).
A: It is, but the service appears to be patchy at present. In August 2010 the government produced a paper called 'fighting fit'. This paper was written by Dr Andrew Murrison MP. Dr Murrison is himself a Veteran. This paper instructed the NHS to provide local veterans' mental health networks in England. It also instructed the devolved governments to follow the lead and to provide Veterans' mental health services through the NHS which would work in partnership with the Community Service that Combat Stress has already set up.
These NHS services are currently being set up but they are not yet consistent across all NHS Trusts. It is hoped that it will be soon. Nevertheless with so many demands on the NHS, local facilities may not offer specialist trauma-focused services, or be able to manage Veterans in an environment that they are comfortable in.
Combat Stress is working closely with the Department of Health and the NHS as well as the MOD to facilitate the setting up of joint clinical pathways of care that will allow the Veteran to access meaningful treatment as close as possible to his or her home.
Combat Stress now runs a Six-Week Veterans' PTSD Programme - a new initiative which was made possible through NHS National Specialised Commissioning.
A: Some people are more resilient than others, but every individual has their breaking point. Exposure to multiple and sustained trauma, and lack of supportive structures (peer group and/ or family support) increase the risk of developing PTSD.
A: No. Although PTSD was first brought to public attention by War Veterans, it can result from any number of traumatic incidents that can affect civilians as well as Serving personnel and Veterans. The common denominator is exposure to a threatening event that has provoked intense fear, horror or a sense of helplessness in the individual concerned.
The sort of traumatic events that might be experienced by members of the general public include physical assault, rape, accidents or witnessing the death or injury of others - as well as natural disasters, such as earthquakes, hurricanes, tsunamis and fires.
In the case of Serving personnel and Veterans, traumatic events mostly relate to the direct experience of combat, to operating in a dangerous war-zone, or to taking part in difficult and distressing peace-keeping operations.
A: In the immediate aftermath of a traumatic event, it is normal for people to experience some of the typical symptoms of PTSD. However, if symptoms are prolonged for more than one month, a clinical diagnosis of PTSD would be made.
Many people may not report or even recognise the symptoms they are suffering from as trauma- or Service-related. An individual may suffer for years in silence before finally trying to get treatment. Often the death of a spouse, loss of a job, or anniversaries such as Remembrance Day can be the final straw that leads the Veteran to ask for help.
Delayed onset PTSD is rarer. In these cases PTSD presents many months or years after traumatic exposure, with no history of any prior mental health symptoms. Recent studies show that delayed onset PTSD is more common after the Service man has left the military, and usually manifests in the first year after discharge. Delayed onset PTSD is also more common in the Veteran population than it is among civilians.
A: Our latest figures show that it takes 13 years from Service discharge to making first contact with Combat Stress. The sad thing is that our clinical audits also show that 80% of our new veterans will have tried to access help through the NHS but this support was apparently not successful as they have had to contact Combat Stress for further help.
The good news is that those who have served in the more recent wars in Iraq and Afghanistan present to us in an average of 2 years after they leave the Forces. We hope this indicates that the message about not suffering in silence is getting through.
A: PTSD is easier to treat the earlier the person presents with it and gets help. The longer it has been present, the more chronic it becomes and the more difficult it is to treat. Many patients do well because they persevere in therapy and do not give up.
It is important to be patient and not expect an illness that has been present for many years to be abate within a few weeks or months. It can take some time but this is why we have designed intensive programmes for those who need them.
A: No. People can develop a whole range of other problems, which can exist alone or co-exist with their PTSD. Anxiety symptoms, depression, use of alcohol and illicit drugs, problems with relationships, work and family function are common. In addition, exposure to severe stress may exacerbate physical illnesses, such as some skin complaints, as well as chronic pain.
A: Referrals come from a wide variety of sources - but mostly directly from Veterans themselves, or their family members and friends. The War Pensions Welfare Service, Service charities and regimental associations, medical, health and social services, also refer Veterans to us.
A: Our Community Teams and outpatient clinics frequently come into contact with family members and will offer advice. We also have a small number of beds available at our Treatment Centres that allow carers to come with the Veterans.
Combat Stress runs a number of Carer Support Groups in Belfast, Ayr, Glasgow, Newcastle, Carlisle, Shropshire and Surrey. We have plans for further groups in Yorkshire and North Wales.
There are family days set aside during our intensive programmes and family members can also attend part of our Well-being Pathway which includes stays supervised by our clinical staff at Breakaway Centres. We arrange these with The Royal British Legion and RAF Benevolent Fund.
A: According to The Howard League, the number of Armed Forces Veterans in prison is lower than many people believe. That said, there are undoubtedly Veterans in Britain's prisons and Combat Stress accepts referrals from those with six months or less of their sentence left to complete. We then provide support and treatment to Veterans on their release.
Combat Stress is also a leading member of "Prison In-Reach". This is a government initiative, working in partnership with ex-Service organisations, to recognise the special difficulties Veterans have both during their sentence and on release.
A: No. We only provide our support and clinical services to veterans - those who have left the UK Armed Forces. Serving personnel can get help from the Service health authorities.
Serving personnel are welcome and encouraged to call our 24-hour Helpline (0800 138 1619 or text 07537 404 719 - standard charges may apply for texts) to discuss their mental health concerns, as are their loved ones.