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psychological and social consequences of war


THE Government has sent British troops to war in Iraq without preparing services or making any provision for the large numbers of men and women that will return with severe psychological and social problems, research from the Mental Health Foundation reveals. The most conservative estimate shows that at least 10,000 of the 43,000 troops sent out to the Gulf will suffer from serious psychological problems.

In every conflict to date the Government has failed to provide adequate care for returning soldiers. More Falklands veterans have committed suicide than were killed during the conflict. More than five times the number of British troops killed in the last Gulf war have also committed suicide. Research by Shelter reveals that one in four homeless people are ex armed services personnel. Thousands live rough or in sheltered accommodation. Many also suffer from drug and alcohol abuse. Returning armed services personnel often end up in rehab, on the streets or with severe mental health problems. Nearly 5,000 ex-servicemen are in prison, often as a result of the trauma suffered in war.

The Government, the Ministry of Defence and the NHS do little to ensure that servicemen and women are protected from trauma. During the First World War soldiers were executed for cowardice when they could have been suffering from Post Traumatic Stress Disorder (PTSD). Today there is still a moral case for the Government to answer when it sends the military to fight its battles and then leaves soldiers to fend for themselves when they return.

Mike Sterba, a former medic during the Falklands conflict, has spent the last 20 years trying to cope with the severe depression and post traumatic stress disorder (PTSD) triggered by his experiences. Dedicated to saving lives, he operated on British and Argentinian soldiers, yet he watched 20 of his friends and fellow soldiers buried in a large communal pit following one of the most ferocious battles of the war at Goose Green. ‘I saw men as young as 18 and 19 zipped up in body bags, with gun shots wounds to the head, arms and legs blown away, brains spilling out on to stretchers.’

The consequent trauma has had a devastating affect on his life. ‘I have suffered nightmares, disorientation, periods of total exhaustion, vomiting and suicidal thoughts. I have sat in my garden and burst into tears for no apparent reason. I even lost the fruit farm I set up when I left the army because of the debilitating effects of the condition.’

During the 15 years since he left the army he has received little medical back-up or support. ‘The army views psychological problems as a weakness. I was told that “if you have a problem it is your problem, and if you can’t sort it out, write a letter of resignation and go.” There was a video going around at the time advising soldiers what to do in cases of battle shock. It told us to get back to a safe place, give them a cup of tea and a fag and send them as quickly as possible to the front again. There was no counseling.’

Mike Sterba’s experiences are the rule rather than the exception. Conservative MoD figures from the last Gulf war show that 19 per cent of troops have been diagnosed with a psychological problem. Yet these figures don’t take into account the fact that many soldiers don’t admit to psychological problems because of the services ‘macho’ image. Nor do they account for the fact that it was a war in which the ground offensive lasted only four days. This war has already lasted over two weeks. The psychological casualties are likely to be much higher this time round.

Yet the MOD claims only three per cent of troops will suffer from PTSD, suggesting that it isn’t a real problem. But their research contradicts all international evidence. The MOD’s research methodology is also flawed.
Recently, Tim Radford, The Guardian’s Science Editor covered a briefing from a navy psychiatrist saying that it would be unhelpful, in cases of PTSD, to intervene with formal psychiatric help. This flies in the face of the international evidence base, which proves that psychotherapy treatments such as cognitive behavioral therapy work. The same psychiatrist, Lt Commander Neil Greenberg, summed up the MOD’s approach saying, “We are trying to do our best to get the ones who are a little bit wobbly to get the support and help that they need, rather than going and trying to make everyone better…’ In other words, monitoring and early intervention is almost non-existent.
Professor Simon Wessley, head of the armed forces psychiatric services has said: ‘Soldiers are not random members of the public. They might receive counselling if they were conscripted, but we have a professional army who are up for it. They don’t need help.’

That view is dangerously complacent and is an example of the attitude endemic in the military that views real psychological problems as a sign of weakness. That attitude is directly responsible for the fact that more men who fought and died in the Falkland’s have committed suicide. Those men are the unspoken casualties of war and they should still be alive now.

This attitude was still prevalent in the last Gulf war. Barry Donnan, a former soldier during the 1991 Iraq war, experienced it head on after driving his army motor bike into a mass grave. The psychological breakdown this caused led him on arriving back in the UK to desert the army and live on the streets. ‘A doctor diagnosed me with severe post-traumatic stress disorder. I was still only 19. I was sleeping rough on a beach and in the forest. I lost about two stone. I handed myself in. They sent me back to my regiment. They stripped me down to my underpants and hosed me down. They screamed at me, ‘You’re not going anywhere. You’re a fucking scumbag’ all that kind of stuff.’ The army ignored his psychiatric reports and put him on court martial twice and in solitary confinement. It wasn’t until his local MP intervened that he was released from the army without charge.

The Government’s attitude is similar. Recently in Parliament the health minister Jacqui Smith admitted that: ‘there are no funds specifically earmarked for the provision of additional specialist mental health services following any military action in the Gulf.’

In a question about whether the NHS response to the needs of ex-servicemen meets international best practice, the Secretary of State has said: ‘The spectrum of mental health disorders in the United Kingdom armed forces is broadly the same as in the match civilian community.’ This is obviously not the case for armed forces in armed service.

Yet agreeing on the scale of the problem isn’t the only problem. Recent research by Dr Roger Gabriel, consultant physician at the Gulf Veterans’ Medical Assessment Programme, reveals that it can still take over ten years to get a correct diagnosis. ‘Veterans with a delayed diagnosis are often more severely ill than those recognised soon after the initial experience,’ says Dr Gabriel. He has treated a nurse who suffered a psychological breakdown in the last Gulf conflict. ‘On leaving the army she could not keep jobs because of poor time keeping and disproportionate responses to minor adversity. She developed fatigue and anorexia and solitary alcohol bingeing. Civilian consultations proved unhelpful because no one asked about her experiences during the conflict to learn the origins of her dysfunction,’ he says.

Although health authorities claim they can look after former soldiers, most GPs and consultants have little or no experience of this area, and many soldiers drop out of treatment programmes because they believe staff cannot understand the traumas they have been through. Dr Andrew McCulloch Chief Executive of the Mental Health Foundation reveals that, ‘people suffering from post traumatic stress disorder triggered by military conflict have specific needs that require specific services that are just not available on the NHS.’

Yet many health authorities remain reluctant to fund the ex-servicemen’s treatment, as Labour MP and Secretary to the Treasury Ruth Kelly highlighted in a Commons adjournment debate recently. One in five applications for funding were rejected.

This leaves the voluntary sector to pick up the pieces. Leigh Skelton, Clinical Services Director at Combat Stress reveals that the charity is just about coping now with the level of demand for treatment. “We are finding that our waiting lists are increasing rather than decreasing. This means that there is a gap in services in the NHS. We are still having people who served in the Gulf coming through for treatment. The Government is still playing catch up with services. We will certainly struggle to cope with another conflict.’

The Ministry of Defence argues that the problem isn’t their responsibility. Passing the buck seems to be their best response to the treatment of serious mental health problems. A spokesperson from the MOD outlined their dilemma: “Once a member of the armed services leaves the forces their medical care becomes the responsibility of the NHS. It is logistically impossible for the military to provide this. We do provide briefings before the troops go out and debriefing when they get back, alerting them to signs of PTSD and ways of coping. We tell them to talk to their friends about their worries. This can help.”

A recent study, however, by Dr Martin Deahl, a consultant at St Bartholomew’s Hospital, London, has shown that these briefings offer ‘no clear benefit’ in preventing post-traumatic stress disorder in soldiers. At best they are useless.

Leigh Skelton from Combat Stress believes it is logistically possible to treat these men properly, ‘If the Americans and Australians give their service men and women constant support during and when they leave the services so can we. The MOD needs to become more proactive. They can’t just dump these men on the NHS. They need specialist help. Combat Stress was set up after the First World War to deal with psychological problems, so far we have treated over 75,000 men from various conflicts. I think it’s about time that it wasn’t just charities left to deal with this real and debilitating problem. It’s no longer 1918 when psychological problems were ignored.’

Mike Sterba puts it bluntly, ‘Combat Stress has given me the skills and support to cope with PTSD. I can talk my problems through with other ex-servicemen who know what I’ve been through. That aspect, the peer support, of the treatment is essential. If it wasn’t for their help, I would still be suffering now.’

William Little

Originaly published in PeaceMatters

For more information visit the Mental Health Foundation’s website at www.mhf.org.uk



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