No one knows how many ex-service personnel are suffering the symptoms of post-traumatic stress. The Government chooses to clinically isolate PTSD from associated symptoms of alchohol and drug dependency, thus ignoring the possibility of cause and effect.
The charity PTSD Resolution (www.ptsdresolution.org) is hosting a university research project to identify how many veterans are affected, to bring this to the attention of Government. If you are a Veteran please take part and go to http://bit.ly/daaoAX (it is entirely private and confidential).
Wednesday, 21 July 2010
Friday, 14 May 2010
Alcohol 'a problem for veterans' - I wonder why?
Some commentators see the new study by doctors from King's College London (May, 2010) on mental health in the forces as reassuring, in that it does not find an increase in the numbers suffering from PTSD (‘alcohol a problem for war veterans, study finds’ (Independent)). Others have pointed out that even if only 4% of Afghanistan returnees suffer PTSD that still means 7,000 troops will suffer (‘Tidal wave of Mental Trauma among Servicemen’ (Telegraph)).
Both these approaches miss the point: If, as the study suggests, some 13% of returnees report that they are ‘misusing’ alcohol, there will be a reason why they are doing this, and the reason, if they were not ‘misusing’ alcohol before going to Afghanistan, will be something to do with having served in the war zone.
Convention sees psychiatric disorders as separate entities, so someone might suffer from PTSD and be alcohol-dependent and the clinic, should he be lucky enough to attend one, would not necessarily connect the two.
In reality these things are intimately interconnected, as people tend to self-medicate with alcohol (or anything else they can get their hands on) in order to dull the symptoms that they suffer as a result of having been in combat.
Our experience at Resolution is that if you take a soldier who is having problems with alcohol you will almost always find post-traumatic symptoms as well – not bad enough to qualify for a diagnosis of PTSD but unpleasant enough to contribute to the drinking behaviour.
From this it seems fair to conclude that the figure for the number of PTSD cases is really not relevant to the problems that service personnel face after combat.
Proper care for returnees and later veterans requires that we ask the right questions of those who do not have a diagnosis and give those who have post-traumatic symptoms treatment that actually reduces the impact of their traumatic memories, to the point where they can get on with their lives without suffering from the anger, fear, depression and all the other symptoms that military service can produce.
The PTSD Resolution outreach programme helps veterans and TA struggling to reintegrate into a normal work & family life because of military post traumatic stress suffered as a result of service in the armed forces. http://www.ptsdresolution.org/
Both these approaches miss the point: If, as the study suggests, some 13% of returnees report that they are ‘misusing’ alcohol, there will be a reason why they are doing this, and the reason, if they were not ‘misusing’ alcohol before going to Afghanistan, will be something to do with having served in the war zone.
Convention sees psychiatric disorders as separate entities, so someone might suffer from PTSD and be alcohol-dependent and the clinic, should he be lucky enough to attend one, would not necessarily connect the two.
In reality these things are intimately interconnected, as people tend to self-medicate with alcohol (or anything else they can get their hands on) in order to dull the symptoms that they suffer as a result of having been in combat.
Our experience at Resolution is that if you take a soldier who is having problems with alcohol you will almost always find post-traumatic symptoms as well – not bad enough to qualify for a diagnosis of PTSD but unpleasant enough to contribute to the drinking behaviour.
From this it seems fair to conclude that the figure for the number of PTSD cases is really not relevant to the problems that service personnel face after combat.
Proper care for returnees and later veterans requires that we ask the right questions of those who do not have a diagnosis and give those who have post-traumatic symptoms treatment that actually reduces the impact of their traumatic memories, to the point where they can get on with their lives without suffering from the anger, fear, depression and all the other symptoms that military service can produce.
The PTSD Resolution outreach programme helps veterans and TA struggling to reintegrate into a normal work & family life because of military post traumatic stress suffered as a result of service in the armed forces. http://www.ptsdresolution.org/
Monday, 8 February 2010
Sir Richard Dannatt calls for more help for traumatised veterans
Sir Richard Dannatt spoke at the inauguration of PTSD-Resolution, as he helped us to launch the Resolution formally as an independent charity.
Sir Richard said cases of post traumatic stress diagnosed so far were only the tip of the iceberg. "These are hidden injuries," he said. He welcomed that serving soldiers were now trained to spot the symptoms of battle stress in comrades and contrasted that with his experience as a young officer, decorated for bravery in Northern Ireland.
"In South Armagh, where a company commander was blown up in front of us, we called in all patrols, opened the bar and got smashed. There has to be a better way," he said.
Sir Richard said cases of post traumatic stress diagnosed so far were only the tip of the iceberg. "These are hidden injuries," he said. He welcomed that serving soldiers were now trained to spot the symptoms of battle stress in comrades and contrasted that with his experience as a young officer, decorated for bravery in Northern Ireland.
"In South Armagh, where a company commander was blown up in front of us, we called in all patrols, opened the bar and got smashed. There has to be a better way," he said.
What does the success rate mean.
What percentage of clients actually get better? This is a big question for any treatment service, but there is no single answer because there are different ways of addressing the question. Does it mean what percentage of the whole population would get better using this treatment, or what percentage of those who make an initial enquiry to this service, or what percentage of those who start treatment, or what percentage of those who finish treatment in a planned way with a final assessment?
The picture is complicated by the specialised meaning attached to the word effectiveness. In medicine the word effectiveness relates to how well a treatment approach works in routine clinical practice, but efficacy is how well it works in specific conditions, for example in a clinical trial where certain patients, e.g. those with other disorders, are excluded because they would complicate the picture (and reduce the efficacy).
It is worth pointing out that the Resolution figure of better than 80% 'success' is not a measure of effectiveness in the clinical sense - it will take larger-scale research (for which we are now planning and raising funds) to establish that. Nor, on the other hand, is it a measure of efficacy, as we do not exclude people from the figures because they have other problems that might complicate treatment.
The Resolution figure of 80% is a measure of the outcomes from completed cases. We scale symptoms on first meeting, and scale them again at the last session. The data necessarily excludes those who come along for an assessment and then disappear, but it includes everyone else. If you are following this because you are interested in the outcome for this particular variant of trauma-focussed CBT you might well wonder whether there is something about the patient group that produces this result. It has been suggested, for example, that ex-military people might have more motivation to get better than the general population, and that might be true, and might be pushing the figure up. On the other hand, we could make it higher still by applying exclusion criteria to the service; refusing to take on people with drug or alcohol problems, or personality disorders, for example, and that we will not do.
This raises the question of what exactly are we measuring here, is it the clients or the treatment, and the answer is a combination of both. In other words, if you are an ex-military person with post-traumatic symptoms and you come to Resolution, present indications are that there is a strong probability that your symptoms will come down to a level where they are not considered to need further treatment.
The other question, perhaps more important, is what happens to the others, why do some people not go further than the initial assessment. At the moment we just do not know.
One of the main objects of Resolution is research, and this year we hope to see the first research project on this question.
The picture is complicated by the specialised meaning attached to the word effectiveness. In medicine the word effectiveness relates to how well a treatment approach works in routine clinical practice, but efficacy is how well it works in specific conditions, for example in a clinical trial where certain patients, e.g. those with other disorders, are excluded because they would complicate the picture (and reduce the efficacy).
It is worth pointing out that the Resolution figure of better than 80% 'success' is not a measure of effectiveness in the clinical sense - it will take larger-scale research (for which we are now planning and raising funds) to establish that. Nor, on the other hand, is it a measure of efficacy, as we do not exclude people from the figures because they have other problems that might complicate treatment.
The Resolution figure of 80% is a measure of the outcomes from completed cases. We scale symptoms on first meeting, and scale them again at the last session. The data necessarily excludes those who come along for an assessment and then disappear, but it includes everyone else. If you are following this because you are interested in the outcome for this particular variant of trauma-focussed CBT you might well wonder whether there is something about the patient group that produces this result. It has been suggested, for example, that ex-military people might have more motivation to get better than the general population, and that might be true, and might be pushing the figure up. On the other hand, we could make it higher still by applying exclusion criteria to the service; refusing to take on people with drug or alcohol problems, or personality disorders, for example, and that we will not do.
This raises the question of what exactly are we measuring here, is it the clients or the treatment, and the answer is a combination of both. In other words, if you are an ex-military person with post-traumatic symptoms and you come to Resolution, present indications are that there is a strong probability that your symptoms will come down to a level where they are not considered to need further treatment.
The other question, perhaps more important, is what happens to the others, why do some people not go further than the initial assessment. At the moment we just do not know.
One of the main objects of Resolution is research, and this year we hope to see the first research project on this question.
Wednesday, 9 December 2009
Resolution now an independent charity
PTSD Resolution is now an independent charity, registered no. 1133188. This is a big step forward as Resolution becomes independent of its former parent charity and is free to develop policies and services in accordance with its charitable objects. These are:
“For the public benefit the relief of the mental sickness of veterans of the armed forces with post-traumatic symptoms in particular by the provision of counselling, treatment, and support and by:
(1) promoting research into treating post-traumatic symptoms, and to promote new ways of providing services, for veterans of the armed forces suffering from post traumatic stress disorder (ptsd), across the uk;
(2) advancing the education of veterans of the armed forces and the public about the mechanisms of trauma and means of reducing the impact of ptsd on veterans of the armed forces and the population in general; and
(3) promoting social inclusion among veterans of the armed forces with ptsd in prisons through counselling, treatment and support.”
Resolution sets out to treat the people that other services do not reach, to promote more tolerable and humane treatments, to sponsor research that may find even better ways of working with PTSD, to educate the people, such as Police officers, who really need to know about the logic of the traumatised brain, and to tackle the appalling problem of trauma in imprisoned veterans.
“For the public benefit the relief of the mental sickness of veterans of the armed forces with post-traumatic symptoms in particular by the provision of counselling, treatment, and support and by:
(1) promoting research into treating post-traumatic symptoms, and to promote new ways of providing services, for veterans of the armed forces suffering from post traumatic stress disorder (ptsd), across the uk;
(2) advancing the education of veterans of the armed forces and the public about the mechanisms of trauma and means of reducing the impact of ptsd on veterans of the armed forces and the population in general; and
(3) promoting social inclusion among veterans of the armed forces with ptsd in prisons through counselling, treatment and support.”
Resolution sets out to treat the people that other services do not reach, to promote more tolerable and humane treatments, to sponsor research that may find even better ways of working with PTSD, to educate the people, such as Police officers, who really need to know about the logic of the traumatised brain, and to tackle the appalling problem of trauma in imprisoned veterans.
Friday, 30 October 2009
Criminal responsibility and PTSD - 2
There is a campaign underway now in the UK to make a verdict of 'not guilty on the grounds of diminished responsibility' plea to mentally ill people accused of crimes other than murder. The previous post relates the efforts of a similar campaign group working to protect veterans in the States. The problem with these efforts is that they are seen in some quarters as a 'criminals' charter', and it is unlikely the Ministry of Justice would embrace the idea of automatically giving veterans any privileged position in mental health defence cases.
The obvious way to resolve this dilemma is to have a proper tracking system that offers veterans the best possible services at the earliest possible moment when things start to unravel. There would be problems connected with privacy, data protection and (the real difficulty) cost, but how much does it cost to keep a man in prison each year, and what is the human cost down the line when families break up because of post-traumatic problems?
The obvious way to resolve this dilemma is to have a proper tracking system that offers veterans the best possible services at the earliest possible moment when things start to unravel. There would be problems connected with privacy, data protection and (the real difficulty) cost, but how much does it cost to keep a man in prison each year, and what is the human cost down the line when families break up because of post-traumatic problems?
Criminal responsibility and PTSD
A groundbreaking verdict for US Veterans with Post-Traumatic Stress Disorder (PTSD) was decided in Canyon City, Oregon on October 19 when former soldier Jesse Bratcher, on trial for murder, was found guilty by reason of insanity. It was the first trial in the U.S. where a Veteran's PTSD was successfully considered to mitigate the circumstances of a crime.
Bratcher was a model citizen before joining the Army, with no criminal or juvenile history. He strictly adhered to the rules of engagement in Iraq, twice refusing to fire on civilians. There, he witnessed the death of a friend from an IED explosion, which commanders reported drastically changed Bratcher's mental state.
The US National Veterans Foundation President Shad Meshad said "This is a significant decision, for Jesse and for Vets around the country, who were law abiding citizens before they went to war and who have been accused of crimes since returning home. The military and the VA have not done enough to diagnose soldiers and Veterans with PTSD and provide them with needed counseling and support to ease their readjustment to civilian life."
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