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.

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.

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.

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?

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."

Resolution Sponsors - Thank you SCS

At the recent Defence Systems and Equipment International exhibition in London's Docklands, business consultancy SCS agreed to sponsor treatment of an Iraq or Afghanistan returnee with post-traumatic symptoms.

SCS is a leading independent consultancy providing a range of technical services primarily but not exclusively for the defence and security sectors. Its main client is the MOD and its agencies; other clients include NATO, major defence contractors, other Government Departments and a range of blue-chip non-defence businesses.

Resolution would like to thank SCS for this support, and would very much like to hear from other defence-related businesses with an interest in the welfare of our servicemen

Call for action by the National Council of Women

The following resolution on Service Personnel and Post-Traumatic Stress Disorder was passed by the NCW at its conference:

The National Council of Women, in Conference assembled, mindful of the emotional distress suffered by returning service personnel and their families, urges the Ministry of Defence to:

1. take steps to remove any stigma from acknowledging post-traumatic stress;

2. take the necessary action to treat Post-Traumatic Stress Disorder early (however late it may manifest)

3. note the high success rate claimed by the charitable organisation RESOLUTION, staffed by civilians and some ex-soldiers who have trained as counsellors, and

4. recommend the inclusion, in the funding of community mental health initiatives, of some funding for a small and closely-monitored pilot study into RESOLUTION.

Submitted by: NCW Health Committee

Proposer. Valerie Alasia, Chairman, NCW Health Committee.

Seconded by: Dr, Maureen Beauchamp, Secretary, NCW Health Committee

Proposer's Speech:

In the light of media reporting of the suffering of returning serving personnel and their families and, eventually, the wider public, the Health Committee has researched the provision of help and counselling for our servicemen.

Commonsense, kindness and thrift would suggest that those returning from combat zones should debriefed and for offered help as soon as possible. But it is recognised that post-traumatic stress may take years to manifest in these proud people, whilst causing deterioration in quality of life and behaviour. Unlike the days of the troopship, those returning now are flown in, perhaps from scenes of carnage, directly to the company of family and friends who cannot share those experiences. They should be given a clear explanation of potential difficulties and available treatments, and told that there is no stigma attached to the condition.

The Government, correctly, wishes to use methods and organisations approved by NICE. Approval, understandably, requires an assessment of efficacy - usually a two-year survey with a statistically positive outcome.

The waiting time for National Health appointments is governed by NHS guidelines. Returning combatants may take some time to refer themselves; thus their Post-traumatic Stress Disorder may be more deep-seated and more difficult to alleviate. The cost to society through anti-social behaviour, addictions, imprisonment and hospital admissions should be weighed against the cost of wider and earlier intervention.

The Health Committee learned, at its recent Seminar on Maternal Mental Health issues, that to be mentally ill is still regarded by many as weak or shameful, instead of being an illness to be acknowledged and treated in the same way as any physical disorder. How much more difficult must it be for those whose occupation is to be brave and uncomplaining in the face of unimaginable horrors (and for their families) to recognise problems and to ask for help.

We heard speakers from "Resolution" a charitable, nationally based organisation staffed by civilians and some ex-soldiers who have trained as counsellors. They spoke of the relative ease with which early, or late, post-traumatic horrors can be faced and dealt with, but for which they have only empirical and anecdotal evidence to demonstrate the effectiveness of their treatment. A course costs £600. A week in an NHS hospital or HM prison costs much more, and not just financially.

We note that Government has promised 300 more counsellors for returning servicemen. Perhaps they will look at the success-rate for "Resolution", investigate the treatment correlation with NICE guidelines, and recognise the potential for delivering wider, better, cheaper treatment now.