For medical professionals
I became Combat Stress's Director of Medical Services in 2007, having been a former military psychiatrist, and I served for 16 years in the RAF.
Our caseload is considerable. Last year we delivered 24,442 days of clinical care to Veterans in our three short-stay treatment centres.
Our recent clinical audits reveal significant high levels of physical illness, exposure to physical trauma, psychiatric illness, history of exposure to psychological trauma, high levels of past and present alcohol abuse or dependence, and lesser levels of illicit drug abuse or dependence.
These clinical audits reveal significant levels of difficulty in childhood and adolescence, including lack of proper care giving, poor attachments and exposure to abuse.
They also demonstrate high levels of unemployment, marital breakdown, self-imposed isolation and living alone.
In short, we are dealing with a patient group whose problems are chronic, complex and long term.
A new treatment model
To best meet our Veterans' needs, we have developed a treatment model that comprises four phases, as outlined below. It is based on the Australian and American Veterans' rehabilitation programmes, as well as on psychological trauma theory.
1. Initial preparation. This involves a home visit (or visits) from a Regional Welfare Officer who will explain the work of Combat Stress. The Welfare Officer will start the process of helping the Veteran apply for a War Pension and other Benefits (where appropriate). The Welfare Officer will also submit his Initial Welfare Report for clinical assessment. If treatment is necessary, it may be possible for this to be delivered locally by a Community Psychiatric Nurse or Mental Health Practitioner. However, on occasions, it may be necessary to admit Veterans to one of our treatment centres for stabilisation.
2. Stabilisation. Each treatment centre provides a unique therapeutic environment, which the Veteran notes on first admission (for assessment). The environment allows the Veteran to re-enter an empathetic military environment in a safe manner – enhancing his trust for the Services and helping him regain composure and self-esteem.
3. Disclosure and working through of traumatic material. This involves the use of trauma-focused psychotherapies, including Trauma-Focused Cognitive Behaviour Therapy (CBT), and Eye Movement Desensitisation and Reprogramming (EMDR). Some Veterans have difficulty verbalising what happened to them, in which case we use other techniques such as Art Therapy.
4. Rehabilitation and re-integration into society. At Combat Stress we start rehabilitation as soon as an individual meets his Regional Welfare Office for the first time. When the Veteran then attends a treatment centre, he is helped to socialise in a unique therapeutic environment. Veterans also have full access to our Activities Centre and Occupational Therapy.
Outside the treatment centres we run Outdoor Activity Weeks to help build team spirit and self-confidence, and to enhance trust between the Veterans themselves and our clinicians. Our community outreach service works to provide follow-up care and support with practical issues such as housing and training.
We are in the process of evaluating our treatment programme and we look forward to reporting on the results in due course. In the meantime, thank you for taking the time to read this.
Dr Walter Busuttil
