Urban Myths, Stereotypes, Narratives, Damn Lies & Statistics

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Reynold Peters
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1 Urban Myths, Stereotypes, Narratives, Damn Lies & Statistics NHS & the Mental Health of Ex-Service Personnel (Veterans) Information sparse but slowly growing

2 SINCE 1948, THE NHS HAS BEEN RESPONSIBLE FOR PROVIDING SERVICES FOR EX-SERVICE PERSONNEL Ex-Service Personnel (ESP) Mental health conditions are similar to those in the general population Seldom ever SEMI Treatments of mental health conditions are the same for serving, ex-serving and civilians Do as well as civilians when they engage Ex-service personnel can & do access NHS services 1 ESP with MH problem in 4-7 years (HASCAS) (Non) Help-seeking behaviour of males is the issue

3 Vetus miles militis es VETERAN: one who has had long experience in military service; an old soldier. L. vetus - old.

4 One days paid service

5 Ex-Service Man A Male 50 s Wife 2 25 years service in Army Combat Support Arm Childhood Adopted foundling Abusing violent father Military Family WW1 Flanders, PoW escaped, Mesopotamia WW2 Bomber Command; RAF Regt.; Airborne Forces. Arnhem Served with Infantry including 22 SAS & SSF (Middle East); Airborne Bde OPs include Exit NI, Germany; FRY, Africa Medical Discharge Delayed presentation Post Traumatic Mental Illness First Tri-Service Professor of Military Psychiatry

6 All civilians are

7 All doctors are

8 Mental illness is

9 They re all heroes

10 They re all soldiers killers

11 It s all PTSD PTSD is not black and white it's a spectrum of symptoms if you just have yes-or-no questions, you can miss a lot. Professor A Goenjian UCLA

12 No, it s not all PTSD NO simple PTSD Rates in Pilots Stafford 10% * Lothian 28% (* MAP 30%) Cornwall 40% London 40% TSC (Belfast 40%) N East 61% (Hull 67%) TSC Cardiff 71% TSC * Military records obtained Common things occur commonly Conditions may relate to events before, during &/or after service e.g. Attachment disorders & childhood traumas Can be understood through current axial diagnostic endeavour Anankastic traits No need to create specific diagnosis of complex PTSD

13 Veterans Mental Health Pilots Cases seen to Aug 09 N East - 30 London Cornwall Stafford Lothian Cardiff Hull TSC MAP Belfast Overseen by HASCAS Differing models University Sheffield Report due 2011 Males, lower ranks 40-49yrs old Latency 10 years Seldom SEMI Common mental health problems plus PTSD

14 MAP Data first 150 cases Army >80% Recruit from poverty Caucasian Male 45yrs Length of service 16 years Non-Commissioned Officers > Other Ranks > Officers >60% in stable relationship 12 years latency ( civilian rates) 60% in contact with NHS 40% no involvement by MHS before seen at MAP 20% see by military MHS

15 MAP Data first 150 cases Attribution to service clear in 20% MAP Drink 80% Mil/civil CJS involvement (unspecified) 30% Not in direct combat or violent action 60% 3 tours 30% Medical Discharge 25% 2 diagnoses 60% Employed 50% War Pension c50%

16 Narratives Irretrievable Loss of: Comradeship Purpose Belonging Identity/status Individuality Excitement History making

17 Mental Health Professionals Assessment and formulation are key Interest & understanding Military experience desirable, not necessary Takes time 6hrs (MAP & London Pilot average) 1-3 hrs face to face hrs reading notes and writing reports Seek corroboration Counselling in GP is unlikely to be effective Special Interest Group for IAPT Higher level direct input No tsunami of mental health problems Yet?

18 Mental Health Professionals Ask the question Conditions seen: The same conditions seen in daily practice Seldom SEMI May be complex Treatable Whenever Untreatable Check diagnosis More holistic assessment Its ok not to understand - You can still help You will need recourse to a Traumatic Stress Service Veterans alone have access to over 400 exservice charities Advocacy, financial, educational, welfare help and advice

19 Ex-Service Personnel No one will ever fully understand you Accept this Give civvies a break All clinical psychologists in DMS are civilians Never be enough exmilitary mental health professionals Treatment works PTSD is not incurable You may not have PTSD Take the risk of: Seeking help Engaging with help Staying the course

20 Exaggeration/Fabrication Malingering should be ruled out in those situations in which financial remuneration, benefit eligibility and forensic determinations play a role. DSM-IV 1994 Fabrication Veracity assumed Difficult to spot especially if not from military Approach in forensic way Seek corroboration Only 1/6 Pilot site gets Service Records MAP gets NHS & Service Medical records 10-15% likely Possibly higher in selfreferral services

21 Caveo vetus miles militis quisnam vires non dico verum Can t remember Service Number Conditioned reflex Can t talk having signed the Official Secrets Act Having been in the SAS Committed atrocities Vague &/or changing narrative Read old notes Seek corroboration Non-engagement with therapy Non-response to therapy

22 MEN & EX-SERVICE PERSONNEL WELCOME HERE FREE ADVICE for ANYONE & hdmap@btconnect.com

b. Potentially harmful alcohol misuse remains a common behavioural problem, but has declined steadily from 16% in 2004/6 to 10% in 2014/16.

b. Potentially harmful alcohol misuse remains a common behavioural problem, but has declined steadily from 16% in 2004/6 to 10% in 2014/16. THE MENTAL HEALTH OF THE UK ARMED FORCES (September 2018 version) This briefing note provides an outline of the current evidence on UK military mental health, including prevalence rates of mental health