Military personnel: what help is available when leaving the services?

It is well known that military service often leaves people unable to cope on their return to civilian life. And conflict, currently experienced by thousands of UK service personnel in Iraq and Afghanistan, serves only to exacerbate these mental health issues. Terry Philpot reports

A former soldier who drinks to cope with flashbacks of war-time atrocities cannot work, sees his marriage fall apart and ends up homeless: it is the flipside to the tabloids cheering for “our boys” and politicians’ rhetoric about serving their country and protecting freedom.

Of the 20,000 people who leave the armed forces every year, between 120 and 150 are thought to end up sleeping rough.

While this number may not seem large, it doesn’t take into account those who are without a home of their own but are helped
by organisations for ex-service personnel. In 1999 the Social Exclusion Unit suggested that between a quarter and one-fifth
of rough sleepers in England had been in uniform at some stage. Other studies have placed the numbers at a quarter. Then in
2000, Crisis revealed a startling figure: 80 per cent of homeless people had been in the armed forces, many of whom would have left 10 or even 20 years before.

And just as homeless people also disproportionately suffer from mental illness (estimates range from 30 to 50 per cent), this is particularly the case for ex-service people. Ministry of Defence figures show that, although 24 service people died in the Gulf War, 107 died by their own hand afterwards.

Among more than 100 deaths in Iraq today, four have died through suicide. Military personnel are repeatedly exposed to traumatic experiences so the psychological injury that is sustained is often much more difficult to treat, says Leigh Skelton, director of clinical services for Combat Stress, the mental welfare society for ex-service personnel.

“Adjustment disorder, both to hostile and culturally alien environments while serving, and to civvy street, when discharged or after long deployments for the Territorial Army are very common.”

But while ex-service personnel often suffer multiple problems – isolation, alcoholism, self-harm and unemployment among
them – they are hindered by the fact that support after the services is patchy. Also, they often have no personal support on
which to rely because they may have joined up to escape domestic violence and abuse or have been in care.

“When they come out they are back to square one,” says Veronica Azua, therapist with Community Housing and Therapy, an
agency providing residential therapeutic communities for adults with severe mental health problems and a dispersed housing
scheme for homeless ex-service personnel.

Its work with ex-military personnel is largely funded through the Royal British Legion, the Army Benevolent Fund, the
RAF Benevolent Fund and Seafarers UK. It will soon be developing 20 flats in Southwark with the British Legion, backed
by £400,000 government money.

CHT offers a psychodynamic approach with a written action plan for each resident, reviewable every three months. There are
weekly group meetings and individual sessions. Accommodation is usually provided for just over a year, after which residents
are helped to find permanent homes, often with housing associations.

The agency works with people aged between 18 and 60, but most are in their early twenties to their late forties. Many will have become homeless straight after leaving the Army, but also sometimes as the result of marriage breakdown when they fail to adjust to life back home.

The background of CHT’s residents is probably not markedly different from others in the same situation: 50 per cent come
from a broken home; 31 per cent have a criminal conviction; 76 per cent have received no specialist help; 43 per cent have
abused alcohol; and 30 per cent have had depression. However, 25 per cent have an anxiety disorder and 14 per cent have posttraumatic stress disorder.

Yet in one year with CHT (April 2005- March 2006), 71 per cent had found a job and 79 per cent had entered a training
course.

But persuading ex-service personnel to acknowledge they have a mental health problem and then seek help isn’t easy. Azua says: “Some men find it difficult to accept any therapy, which isn’t surprising when you think where they’ve come from. There’s an element of institutionalisation: the army was a place where they were told where they were going and what they were going to do; what to eat and what to wear; and it housed them. They often look for jobs with security firms, the police, fire brigade and London Underground – again large organisations where you wear uniforms. There is also chauvinism and  machismo in the services and a culture that’s very masculine.”

Skelton agrees: “The stigma of mental health problems in the military runs even deeper than it does in society as a whole.
Admission of mental health problems while serving is still seen as a career stopper and is sometimes associated with cowardice or malingering. There is a strong drinking culture in the services which soldiers are encouraged to fall back on when troubled instead of calling for help.

“However, while statistics will tell you that post-traumatic stress disorder and neurotic disorders are generally more common
in women, our finding is that women seem to do better than men in the long term. This may be because they seek help more quickly and because they are much more likely to talk about their problems at an early stage with friends and family.”

Skelton says the war in Iraq has resulted in an increase in the number of veterans who have been on active duty seeking its
help. In two years numbers have reached about 60. Given that the average length of time between leaving service and seeking
the organisation’s help is about 14 years, it is unusual to be receiving referrals so soon.

Some new referrals are coming from reservists who make up 10 per cent of the troops in Iraq. In the past year Combat Stress has received 759 new referrals and now has about 8,000 registered veterans, of which 80 per cent are ex-army.

The root of some ex-service personnel’s problems may stem from what civilian life means psychologically and emotionally. It
is common after military life to feel loss of personal identity, with a sense of meaningless, while finding a new place in society can be stressful, fearful and lonely.

Military life encourages a sense of belonging. It promotes an effective and cohesive force that itself demands acceptance of
orders. The price for this may be a sometimes devastating sense of loss, fragmentation and isolation on civvy street when the
familiar supports are no longer there. But that is far from the front pages.

SOURCES OF HELP
● Combat Stress: 01372 841600
● Community Housing and Therapy: 020 7381 5888
● Soldiers, Sailors, Airmen and Families Association (SSAFA): 0845 1300 975
● Haig Homes provides for 1,250 exservice personnel in the UK: 020 8685 5777
● Spaces (Single Persons Accommodation Centre for the Ex- Services): 01748 83379
● Ex-service Resettlement Project offers an assessment and resettlement programme and runs an alcohol recovery project: 020 7837 0063

● Find out more about mental health

This article appeared on pages 36 & 37 of the 12 October issue, under the headline War Wounds