Service-related mental ill health
PTSD: Frequently Asked Questions
Q: Some people are sceptical about PTSD amongst our Armed Forces. Surely if you "sign up" you should expect to see some terrible things?
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.
Q: How many of your clients have PTSD?
A: The commonest presentation in our patient group is PTSD, with our recent clinical audits showing a range of between 71% and 81%. Most of this PTSD is chronic in nature. It is usually present co-morbidly with other disorders, especially depression, and a history of current or past alcohol abuse or dependence (addiction). Anxiety disorders, phobic disorders, problems with anger and problems which reflect personality change following exposure to catastrophe are also evident, as is illicit drug abuse and, more rarely, dependence (addiction).
Q: Why is the NHS not treating people with PTSD?
A: It is, but the service appears to be patchy at present. With so many demands on the NHS, local facilities may not offer specialist trauma-focused services, or be able to manage Veterans in a contextually sensitive environment. There are currently very few specialist services to meet the treatment needs of this Veteran group.
Recently, Combat Stress has signed a partnership agreement with the MoD and the Department of Health: this aims to strengthen local NHS provision in areas where we know that a high proportion of Veterans live.
Q: Is there a particular type of person who is especially vulnerable to PTSD?
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.
Q: How long does it take to show signs of PTSD?
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 release. Delayed onset PTSD is also more common in the Veteran population than it is among civilians.
Q: What is the average length of time it takes for Veterans with mental health problems to seek YOUR help?
A: Our latest figures show that it takes more than 14 years from Service discharge to making first contact with Combat Stress.
Q: Is PTSD curable?
A: PTSD is easier to treat the earlier the person presents with it. 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 cured within a few weeks or months.
Q: Is PTSD the only response to trauma?
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.
Q: How do Veterans find their way to you?
A: Referrals come from a wide variety of sources – directly from Veterans themselves, the War Pensions Welfare Service, Service charities and regimental associations, medical, health and social services, and family and friends.
Q: How do you help the families and friends of PTSD sufferers?
A: Our Welfare Officers frequently come into contact with the family and will offer advice. We have a small number of beds available at Audley Court and Hollybush House so that carers can come with the Veterans.
We have also established a number of Carer Support Groups in Belfast, Ayr, Edinburgh, Glasgow, Newcastle, Carlisle, Shropshire and Surrey. We have plans for further groups in Yorkshire and North Wales.
Q: What are you doing to help Veterans in prison, especially those who reportedly have PTSD?
A: Combat Stress accepts referrals from those with six months or less of their sentence to complete. We provide welfare 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.
Q: Does Combat Stress treat serving members of the Armed Forces?
A: No. We only look after Veterans. We advise Serving personnel to seek help from the Service health authorities, and that we will help once they have left the Armed Forces.