An analysis of the Armed Forces Compensation Scheme by "The Independent" newspaper shows that the annual number of pay-outs for veterans experiencing mental disorders has increased by 379% since 2009. In 2009-10 there were 121 pay-outs compared to 580 in 2015-16.
Health professionals believe this represents only a small percentage of the people actually affected. They believe that the increase reflects the fact that veterans of the Afghanistan and Iraq wars are now starting to show symptoms as a result of what they experienced during the conflict. It can take several years before the impact upon a person's mental health becomes fully evident.
As well as running a Suicide Crisis Centre, I run a Trauma Centre and I recall very vividly the first time I met Dan.
I was just walking out of the general hospital when I noticed a man slumped against the wall outside Accident and Emergency. It was late at night and I went to check whether he needed any help.
He told me that he had been brought to hospital by ambulance after a fall in the town centre. But his experience in A&E hadn't been good. He felt that A&E staff hadn't treated him well and he felt that this was because he had drunk a large amount of alcohol.
A security guard came out while we were talking and said that if he wasn't going to come into A&E then he should leave the premises. This concerned me because he was under the influence of alcohol, was having difficulty standing and had suffered a fall which had required hospital attendance.
Dan asked the security guard if he had ever served in Afghanistan or Iraq. He said that if he had, he might understand why he was in the situation that he was in now. I told the guard that I did not feel he was safe to leave hospital premises.
The guard went back inside and Dan and I had the opportunity to talk. He told me that he was haunted by nightmares and images of what he had experienced in the wars. He drank to block out these images and to prevent himself from thinking about them. These certainly sounded like possible symptoms of post-traumatic stress disorder. It was clear from what he was saying that he was receiving no help from mental health services or addiction services. He had been homeless until recently.
At that point an empathic nurse came out and encouraged him to come back into A&E. However he had told me where he was being housed temporarily, and I was able to check the next day that he was okay.
An NHS spokesperson said that there are plans to improve mental health care for armed forces veterans. This is extremely positive, but it relies on veterans feeling able to seek help. Dan expressed a reluctance to seek medical help. In particular he feared that it would mean that he would need to see a psychiatrist.
Dr Busuttil, the psychiatrist quoted in the article, said that "The biggest problem from Iraq and Afghanistan is a very high rate of alcohol misuse."
Dan's experience highlights this. He was using alcohol for his symptoms because he couldn't face seeking medical help. Dr Busuttil mentions that stigma can prevent veterans from seeking compensation for mental health issues and I wonder if it also prevents some of them from feeling able to seek help from their doctor. Dan also said that he was mistrustful of medics and psychiatrists. Severe trauma can lead to a profound loss of trust in other people. This means that all of us who come into contact with veterans in Dan's position can have a role to play in helping to rebuild trust. It was fortunate that I came into contact with him in a non-professional capacity, as a stranger with no agenda other than that of wanting to help someone who was clearly either unwell or injured. I think it was easier for him to trust me because he had encountered me under these circumstances. So, while the NHS commitment to putting more money into mental health care for veterans is welcome, I hope that they will consider how to ensure that they reach people like Dan, who may have a profound mistrust of the system and of people in general.
Dan felt more able to consider help from a charitable organisation rather than an NHS service, although that was extremely difficult for him, too.
Everyone who comes into professional contact with people in Dan's position can have a role in helping to rebuild trust, particularly if they encounter them unexpectedly, as I did and as A&E staff did that night. I'm grateful to the empathic nurse who noticed his absence, felt it was important that he was helped, and encouraged him to return to A&E.
"Dan" is not his real name.
More information about the Suicide Crisis Centre and the Trauma Centre can be found on their website: http://www.suicidecrisis.co.uk
Charities which focus specifically on helping veterans with mental health issues include:-
Combat Stress http://www.combatstress.org.uk
Save Our Soldier http://www.saveoursoldier.co.uk