Mental Health Solicitors

By Lucinda Broad

The Reality for the Armed Forces

From October 2009 to September last year, 3,970 Armed Forces staff were diagnosed with a mental disorder. Of those, 235 suffered Post Traumatic Stress Disorder (PTSD).

Section 1 of the Mental Health Act 1983 (as amended by the 2007 Act) states that “mental disorder means any disorder or disability of the mind”. The section further states that “dependence on alcohol or drugs is not considered to be a disorder or disability of the mind”.

The ICD-10 (International Classification of Diseases and Related Health Problems) highlights that PTSD arises as a delayed and/or protracted response to a stressful event or situation of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone. Typical symptoms include episodes of repeated reliving of the trauma intrusive memories (flashbacks) or dreams, occurring against a persistent background of a sense of “numbness” and emotional blunting, detachment from other people, unresponsiveness to surroundings, anhedonia, and avoidance of activities and situations reminiscent of the trauma. Additionally, there is usually a state of autonomic hyperarousal or hypervigilance, and enhanced startle reaction, and insomnia.

Troops who do not get psychiatric help before quitting the services often end up ¬homeless, suffer drug or alcohol abuse and even drift into crime.

In January 2011, the Daily Mirror reported that 10 service personnel a day were being treated for psychological problems as a result of the conflict against the Taliban; this is only one of the major conflicts in which our Armed Forces are currently engaged.

In February 2011, BBC Panorama aired a documentary on the difficulties faced by soldiers returning to civilian life having seen active service in Iraq and Afghanistan. The programme revealed that 4% of those people who have served just in Iraq and Afghanistan will develop PTSD, and 13% are likely to have alcohol problems.

Small numbers one might think, until one realises that there are 220, 000 men and women who have served in Iraq and Afghanistan. These numbers do not include those personnel who have developed problems as a result of the conflicts in other jurisdictions such as Northern Ireland and the Falkland’s, such disorders may include:

o PTSD
o Clinical depression
o Anxiety states
o Adjustment disorders
o Phobic disorders
o Obsessive Compulsive Disorder
o Bi-polar illness (manic depression)
o Issues relating to past and present substance abuse/dependence (drug and alcohol)
o Psychotic conditions in a non-acute phase
o Issues relating to anger

PTSD may occur soon after a traumatic event or it may take several months before any symptoms become apparent. The longer the delay in the initial presentation, the longer lasting the symptoms and worse the prognosis. For those who have seen and been through horrendous events, such as the almost constant mortar fire, IED explosions and defusing, and the loss of friends and comrades, early onset is not as easy as one might hope. Many experience such events on a daily basis when on tour, giving no time for the mind to process what it has seen.

What is being done?

The Ministry of Defence recognises mental illness as a serious and disabling medical condition. Soldiers run the risk of operational stress through the pressure of deployment and their possible exposure to extremely traumatic situations and events. It is Army policy that mental health issues be properly recognised and treated, and that all efforts are made to reduce the stigma associated with them.

1. Minimising Risk, Recognising Onset
Personnel receive training and briefings to increase their awareness of mental health issues and stress management. This takes place throughout a career, but particularly prior to and after deployment on operations.

All Medical Officers, Combat Medical Assistants and Nurses are trained to recognise the signs of mental illness, and Officers, Junior and Senior Non-Commissioned Officers (JNCO/SNCOs) are routinely trained in methods of suicide prevention and stress management.

"Decompression" is provided. This is a scheduled period following a deployment on operations in which personnel are given time to mentally and physically unwind, with time to talk to colleagues and superiors - with whom they deployed - about their experiences.

Families of returning personnel are offered presentations and issued with leaflets to educate them about the possible after-effects of a deployment on operations. Welfare Officers, Padres and other associated organisations also provide information to families by email, through support groups, Regimental systems and so on.

Increasing use is made of Trauma Risk Management (TRiM), a model of peer-group mentoring and support for use in the aftermath of traumatic events.

2. Trauma Risk Management (TRiM)

Trauma Risk Management (TRiM) is not a medical process, or therapy - it is designed to identify service personnel at risk after traumatic incidents. Soldiers are often reluctant to talk to strangers when they are in difficulty, and often it is their friends whom they turn to for help. For this reason, TRiM is delivered by trained people already in the affected soldier's unit.

TRiM-trained personnel undergo specific training in the management of people after traumatic incidents. Those who are identified as being at risk after an event are invited to take part in an informal interview which establishes how they are coping. The process is repeated after a month and a comparison of the outcomes is made, allowing early identification of those who may be having problems so that help can be given early.

3. Delivery of Care

There are 15 military Departments of Community Mental Health (DCMH) providing outpatient mental health care in the UK. All are staffed by Psychiatrists and Mental Health Nurses with access to Clinical Psychologists and Mental Health Social Workers, offering a wide range of psychiatric and psychological treatments including medication, psychological therapies and environmental adjustment where appropriate

In Afghanistan, there are highly skilled and experienced uniformed Mental Health Nurses providing the necessary care and treatment for personnel that need it. A Consultant Psychiatrist visits every three months or so. Additionally, a permanently on-call Consultant Psychiatrist is available to provide specialist support. A team comprising a Psychiatrist and two Mental Health Nurses are at immediate readiness to go to Afghanistan to support if required.

If personnel need to leave the operational environment, their care - either outpatient or inpatient - continues in the UK.

4. Reserves’ Mental Health Programme

When mobilised, Reservists are treated exactly the same as Regulars.

Once demobilised, it is a long established tradition that Reserve forces' medical care becomes the responsibility of their own local NHS primary care trust and the majority of veterans' physical and mental health needs are met by these provisions.

However, the MOD recognised that it has an expertise to offer in certain specific circumstances and in November 2006 launched a new initiative, the Reserves Mental Health Programme.

Reservists, both TA and Regular Reserves, who have returned from operations since 1 January 2003 qualify for enhanced support for mental health problems.

The Reserves' Mental Health Programme, run in partnership with the NHS, is open to all current or forme