Scroll down to read more, or go straight to the sections on mental health issues, post-traumatic mental illness, stigma, trauma risk management, mental health facilities, veterans, the Reserves' Mental Health Programme or physical injuries.
Mental health issues
Most mental health problems treated in the military are adjustment disorders, anxiety, depression and alcohol problems similar to those experienced by the civilian population. An adjustment disorder is a difficulty coping with something that has happened to you, such as a relationship ending. This can create tension, anxiety or depression.
Of the 3,942 mental disorders diagnosed in military personnel in 2010, 1,568 were adjustment disorders, 835 were a depressive episode and 249 were PTSD.
Members of the army, women, people in lower ranks and those on frequent or extended deployments have a higher risk of mental health problems. The forces has set guidelines, known as the harmony guidelines, on the length of time for which an individual can be deployed. This is to reduce risks to the mental health of troops.
In addition to the common mental health problems to which we are all vulnerable, servicemen and women are more likely to be exposed to violent and traumatic events while serving.
Dr Ian Palmer, a professor of military psychiatry, wants to clear up a common misconception about mental health in the military.
“There's a myth that serving in the armed forces damages you psychologically and everyone who has served gets post-traumatic stress disorder (PTSD). They don’t,” says Dr Palmer, who served during the Falklands War and in Rwanda and Bosnia.
“Being part of the armed forces is good for your mental health. It’s good for your employment prospects and gives you discipline. Most people don’t have problems, and for those who do there are excellent psychiatric services in the forces.”
Post-traumatic mental illness
After a traumatic event it's normal to experience anxiety or nightmares, and these usually go away within a few weeks. However, some people can experience lasting psychological problems, resulting in post-traumatic stress symptoms including depression and anxiety.
Post-traumatic symptoms include feeling anxious and being unable to relax, re-experiencing intrusive and unwanted thoughts of traumatic events, having difficulty sleeping, feeling irritable or angry, pulling away from relationships, avoiding things that trigger unpleasant emotions and self-medicating with alcohol.
“Re-experiencing isn’t just remembering,” says Dr Palmer. “In PTSD, remembering is an emotional, intrusive, unwanted and vivid re-experiencing of events (thoughts, sights, sounds and smells), which is very distressing. Some people feel as if they're back at the event, although this is uncommon.”
There are effective treatments to help people to cope with the psychological consequences of exposure to traumatic events. Guidelines from the National Institute for Health and Clinical Excellence (NICE) state that people with PTSD should be offered:
- trauma-focused cognitive behavioural therapy (CBT), which may help to change negative thought processes
- eye movement desensitisation and reprocessing (EMDR), which uses eye movements to resolve traumatic thoughts
Read the NICE information on the treatment of PTSD (PDF, 84kb), for people with PTSD and their carers.
If any post-traumatic mental illness, including PTSD, is left untreated it can interfere with relationships, friendships and employment. Fortunately, mental health professionals in the military are well placed to spot it.
“As a military psychiatrist, in every case you see you ask, 'Is this PTSD?'” says Dr Palmer. "Generally, it isn't."
Stigma
The main challenge, however, is not diagnosing or treating mental health problems, it’s getting people to come forward for help. Stigma surrounding mental health issues has historically been a problem in society, and this includes the military, where people are trained to be strong and resilient.
Someone might worry that they’ll be seen as weak or untrustworthy if they appear not to be coping. Surgeon Commander Neil Greenberg, senior lecturer in military psychiatry at the Academic Centre for Defence Mental Health (ACDMH) at King’s College London, says personnel often believe they’ll lose their job.
“People do worry that it will affect their career, but it won’t,” he says. “What’s almost certainly true is that if people don’t seek help it’s going to interfere with how well they do their job. That will make a difference to their career prospects.”
Treatments for mental health disorders include general supportive measures, occupational adjustments, therapies such as CBT and in some cases medication.
The aim is to treat the person as soon as possible, where they are, as a normal part of forces life rather than removing them from their unit. Inpatient care is given if someone needs it but care within the unit works in most cases.
Trauma risk management
If someone is feeling under pressure they can talk to someone in their unit. This could be a medical officer, chaplain, colleague or trauma risk management (TRiM) practitioner.
TRiM is a relatively new tactic for protecting mental health and reducing stigma. A non-medical person from each unit is trained to be a point of contact and support, particularly after a traumatic event. They can assess whether someone is at risk and arrange for further help if needed.
“The basic principle is that a TRiM practitioner, while they’re still a peer and a colleague, has some training in recognising where there’s a problem and addressing it in the unit. This means that when someone is in distress we don’t simply fly them off away from their friends and their unit,” says Commander Greenberg. “There's a lot of TRiM work going on in Iraq and Afghanistan right now.”
Decompression is another technique that's used to help personnel returning from operational duties to cope with the process of coming home. Decompression involves a unit spending around 36 hours together between leaving the combat zone and going home. This gives them the chance to think and talk about their experiences if they want to.
Currently, for most units, decompression takes place in Cyprus. This provides relaxation time for troops who would otherwise travel from an operational theatre to home in a matter of hours.
Mental health facilities in the UK
A review of defence mental health in 2001 resulted in treatment moving from inpatient to community-based services in the form of military Departments of Community Mental Health (DCMH).
In 2010, staff at these departments assessed more than 5,500 personnel and diagnosed 3,942 with a mental disorder. This is around 2% of the military population.
There are 15 DCMHs across the UK, as well as sites in other countries including Cyprus, Germany and Gibraltar. They offer specialised psychiatric services similar to NHS community health teams, and include psychiatrists, community psychiatric nurses, clinical psychologists, mental health social workers and occupational therapists.
Inpatient care in the UK is provided by the NHS, contracted by the Ministry of Defence (MoD), with close liaison between military mental health professionals and the NHS. In 2010, the armed forces had 315 new inpatient admissions.
For personnel who are on operations abroad, Field Mental Health Teams visit all operations. These are made up of mental health professionals who liaise with unit commanders, seeing anyone who needs help.
Veterans
There are around 5 million veterans in the UK. When people leave the services, their healthcare transfers to the NHS. Some veterans need specialist care if they develop mental health problems related to their service.
The Medical Assessment Programme (MAP), based at Guy’s and St Thomas’ Hospital in London, works to improve care for veterans.
The MOD, UK departments of health and charities are working together to improve services for veterans. Find out more about veterans: mental health.
In addition, a 24-hour helpline for veterans (0800 138 1619) has also been set up.
Reserves' Mental Health Programme
The NHS provides care for reservists who are not currently deployed. “Research from the first two and a half years of operations in Iraq showed that reservists suffered more, in terms of mental health, if they deployed to Iraq than if they didn’t,” says Commander Greenberg.
To address this, the MoD and NHS set up the Reserves' Mental Health Programme (RMHP) in 2006. It’s open to anyone who:
- has seen active service as a volunteer or reservist since January 1 2003
- is now demobilised, and
- has mental health problems that might be linked to service on operations.
Find out more about the RMHP in the information about veterans' mental health.
Physical injuries
Personnel with physical injuries who are receiving medical treatment automatically receive a mental health assessment.
Major Peter Wink is senior nurse in the mental health team at Queen Elizabeth Hospital in Birmingham. The team provides support to injured personnel and their families, and can identify individuals who aren't adjusting normally to their situation.
“For those who have been injured, there may follow a number of sensory and emotional reactions in the early days,” he says. “These might include nightmares, re-living the experience, irritability, anger and relief. However, these reactions generally settle down within the first week or so.”
If they don’t, the mental health team works closely with the patient, doctors and nurses to find out why and to provide treatment. “We can refer people directly to military mental health services if required,” says Major Wink. “In the two years I’ve been working here, the number requiring this has been very low.”
For anyone who thinks they need help, whether they're a regular, reserve or veteran, the key is to tell someone.
“The biggest myth is that nothing can be done,” says Commander Greenberg. “The worst thing you can do for yourself is not to ask someone for help. There is much that can be done and getting help really makes a difference to you, your colleagues and your family.”
