Five years on from the start of the invasion of Iraq, public and media attention has begun to fade as the horrific scale of the violence there slowly subsides and fighting in Afghanistan escalates.
Although there is likely to be a UK military presence in Iraq for some time yet, troop numbers are starting to fall. For the lucky ones their time in Iraq will be coming to an end. Many will be able to put it behind them. But for an increasing number of ex-service personnel, the mental scars left by their Iraq experience are harder to forget.
Until recently there was little specialist state-funded mental health provision for those who left the armed forces. Then earlier this year the government announced six primary care trusts were to pilot treatment centres recognition at last that there is a growing problem with the mental well-being of ex-service personnel.
They are right to be concerned. Figures from Combat Stress, a charity set up in 1919 to help shell-shocked veterans from World War One, show that in the last two years a “steady trickle” of around 150 Iraq and Afghanistan veterans have turned to it for help.
But this could be just the tip of the iceberg, says clinical nurse specialist Tony Letford (pictured top): “We see people with delayed presentation. It might take years for the people we see to come to us [after leaving the services]. They may carry on with life but then something happens that serves as a trigger for those intensive memories to come back.”
The trigger point will vary from person to person: the death of a loved one, an altercation in the street or even their child’s birthday. Unlike most of us, they struggle to cope with these triggers.
Letford explains: “We had a Gulf War veteran who while driving one evening saw another car without its headlights on. So he flashes his lights to let them know but only gets abuse in return. Most of us would carry on and not be bothered by it, but he does a u-turn, pursues the car and rams it. While this is going on he’s thinking of the mates he lost who fought for their country.”
Things are changing though: the length of time it takes for people to admit they have a problem and seek help is coming down as knowledge of post-traumatic stress disorder (PTSD) increases and the stigma of mental health problems reduces. This is born out by the fact that referrals to Combat Stress have doubled to 1,000 annually since the start of the Iraq War.
Those referred to Combat Stress are classed as having moderate to severe PTSD and are on average aged a shade under 33, with 10 years’ military service behind them. Of the 175 “active” cases it is currently dealing with, the youngest is 21 and the eldest 60. It is in touch with another 7,500 veterans on its register.
After an initial assessment veterans are referred to one of its three residential treatment centres in Surrey, Shropshire and Ayrshire, which have a total of 88 beds. In Letford’s opinion the most important aspect of the treatment at the centres is the peer group work. Here, veterans of different ages and from various combat zones share their experiences.
“Outside they may feel like they are the only person suffering but being here makes them realise they are not,” he says.
Being among other veterans who can empathise with their experiences is a vital part of the healing process and is the reason for Combat Stress’s uniqueness.
“In the NHS you are more likely to be in a civilian group: the veterans’ view is that we couldn’t possibly have any understanding of what they have been through.”
Hugh Forsyth agrees. An ex-Royal Engineer, Lance Corporal, who saw service in Northern Ireland, Cyprus and Bosnia, and a service user at Combat Stress, he says: “To become an armed service member we are all moulded quickly into smart, motivated and sharp-thinking assets. This transformation into military life gives every serviceman a common language and a deep “Esprit de Corps” which is not present in civilian life. This leaves ex-servicemen out on a limb when attending group therapy sessions within civilian communities.
“At Combat Stress all of us are instantly at ease when discussing our horrific experiences due to this common way of thinking. We all speak the same military language and mainly find that each of our traumas are remarkably similar. This bond between clients opens up the ability to begin to process the issues which have led to being here,” Forsyth says.
Northern Ireland parallels
Letford sees a lot of parallels between the experiences of Iraq veterans and those who served in Northern Ireland. Both conflicts were fought in urban environments by an unseen enemy that used guerilla tactics and posed a threat around the clock. “To be under constant pressure and not knowing whether today could be your day must have an impact on the brain,” he says.
With PTSD affecting around 5% of servicemen it seems inevitable Iraq veterans will be turning to Combat Stress for many years to come.
This article appeared in the 20 March issue under the headline “The conflict goes on”