Troops leaving the Armed Forces may be put through psychological profiling in a new effort to identify those at risk of developing mental disorders linked to their experience on the frontline. The Secretary of State for Defence, Liam Fox, who has described the impact of mental illness among service personnel as a "time bomb", believes developments in science means more could be done to stop the most vulnerable "falling through the safety net". Some 180,000 troops are thought to have been deployed to the two conflicts since 2001. The long-term impact of their experiences in Iraq and Afghanistan on those who return to civilian life is not known; in some cases, symptoms from past trauma may not emerge until many years later.
However, Combat Stress, the ex-services mental welfare society, reports a 72 per cent rise in referrals in the past five years. On average, veterans are waiting 14 years between discharge and seeking the charity's help. Comparisons to US forces show Britain has not yet experienced the sharp rise in serious mental conditions and suicide rates seen in America.
A study by King's College London earlier this year found 4 per cent of British armed forces suffered from post-traumatic stress disorder (PTSD), but 20 per cent had symptoms of common mental disorders. Research of 10,000 soldiers showed 13 per cent were misusing alcohol, but those who had served in Iraq or Afghanistan were 22 per cent more likely to abuse alcohol than those who had not.
But Dr Fox is damning of the service offered to those suffering from mental health problems and is concerned about the unknown impact of the recent conflicts on the state of veterans' health, especially those of reserve forces. "There is an excess vulnerability there which we will pay a very high price for, and if we are not careful and we do not try to identify people who might be at risk, we will be as a society potentially sitting on a mental health time bomb," he warned.
Plans are being put in place by the Ministry of Defence to set up a clinical trial of post-deployment screening, which would examine how effectively those who have been adversely affected can be identified and provided with help as early as possible. "In this country, frankly, the quality of care we give to people with mental illness we simply would not accept for any other sort of illness that afflicts one in four of the population," Dr Fox said. He believes it is a "measure of how civilised we are as a society" how the most vulnerable, including those with mental illness, are treated. Too often it is a "Cinderella service" in healthcare because "they are the very people who will least be able to complain or least want to make their voices heard".
Conservative MP Dr Andrew Murrison, a former medical officer in the Royal Navy, who served in Iraq in 2003, is conducting an independent study into the health of serving personnel and veterans, with a particular focus on mental health. Ministers have received his initial findings, and full publication is expected shortly.
Ministers are particularly concerned that there is not enough co-operative working between the MoD, the NHS and social services. It could mean dropping what Dr Fox regards as "some of the less than justifiable medicals at the point of discharge from the Armed Forces", to examine advances in science and move towards "psychological profiling to see who might be most vulnerable and to proactively follow them up rather than waiting to see if they fall through the safety net".
He told the Commons defence select committee he is particularly concerned about troops from the reserve forces adjusting to an abrupt return to non-military life. "If you are coming home with a group of comrades who have been through the same experience, at least you have people to talk to who have been through the same thing. If you are in the reserves, you can be in Helmand on Friday and you can be the milkman in Dorset the next Friday, on your own with no one to talk to, and potentially an uninterested population that cannot understand."
The MoD provides community psychiatric nurses in Afghanistan to provide care and treatment on the frontline. There are also two UK-based teams of psychiatrists and mental health nurses who are available to deploy to Afghanistan at short notice. Across the UK there are 15 military departments of community mental health across the UK.
Labour MP John Woodcock, a member of the defence select committee, said spending cuts in the public sector should not hamper work for veterans. "We do absolutely need to do more. Our duty to the troops is fundamental. The resources have to be found."
The Labour government set up community mental health pilots for veterans at six NHS trusts across the UK. The MoD is also working with the charities Royal British Legion and Combat Stress to promote the specialist support available to veterans.
A spokesman for Combat Stress said: "Efficient planning of veteran services and joined-up working between statutory and voluntary sectors are crucial if service providers are to rise to the challenge of meeting the mental health needs of British veterans." A good model has been established in Scotland, where public bodies, veterans and charities work more closely together, he added. Combat Stress has launched a fundraising drive – the Enemy Within Appeal – to raise £30m for mental health services for veterans.
Corporal Webster filmed a group of fellow British soldiers chasing and beating four Iraqi youths. Webster could be overheard laughing and saying, "Oh, yes. Oh, yes. You're going to get it." He resigned from the Army soon after the film was broadcast round the world. A documentary, Diary of a Disgraced Soldier, followed Webster for 18 months showing his post-military life in which he contemplated suicide and found himself homeless. His PTSD causes him to have a split personality: he talks of Martin – the normal guy – and Webby – who does all the mouthing off and unpleasant behaviour.
Alcohol abuse and violence
The former soldier is awaiting trial in a Baghdad jail for allegedly murdering two fellow security contractors. He said he had drunk more than half a bottle of whisky. His lawyers claim he acted in self-defence and was suffering from PTSD, so wasn't fit to have been employed by British security firm ArmorGroup. Fitzsimons had been receiving psychiatric treatment since 2004, when he was still in the Army. He was consulted again in 2008 and 2009, with a psychiatrist confirming his condition had worsened. The last diagnosis was made two months before he was hired to return to Iraq.
Mahoney, a father of four, was a long-distance lorry driver and reservist, employed by the Army as a specialist truck driver. After 13 months in Iraq in 2003, ferrying medical supplies and injured soldiers between the frontline and field hospitals, he returned home a shadow of his former self. He became short-tempered and made outspoken racist comments. Increasingly, he sought solitude before finally taking his own life. It wasn't until his wife found a ripped-up leaflet about psychological trauma caused by war – issued to soldiers by the MoD – that she realised her husband had been suffering from PTSD.
Homeless and convicted
Sergeant Major Dale was discharged after 20 years in the Army in 2009, on medical grounds. He had been traumatised after clearing a building in Basra in March 2003, only to find it was a family home and seven children had died in the attack. On returning home he battled with alcoholism and nightmares. He felt he was a danger to his family, and so invented a story about wanting to kill his wife in order to be jailed. His conviction meant that his war pension was stopped, resulting in the couple losing their home and having to camp in the back garden of his brother-in-law's house.
Victim turned saviour
The founder and chief executive of the charity Talking 2 Minds is a former sufferer of PTSD. His illness developed once he had left the SAS; during one episode he drank a full bottle of whisky and put a loaded pistol into his mouth. Paxman credits his recovery to the charity's co-founder, Mick Scott, whom he met while still working in Iraq as a security adviser. Through sessions of talking to a like-minded person who could understand his experiences, he found his nightmares and flashbacks ceased. Paxman has since helped out 200 active-duty soldiers and veterans who suffer from PTSD.
Unable to work
The Lance Sergeant served in the Scots Guards for 10 years between 1990 and 2000. He was sent to Iraq for the first Gulf War and completed three tours of Northern Ireland, where he was hospitalised for 18 months by a crash. In 2002, however, he joined the Territorial Army and was deployed to Afghanistan where his vehicle was hit by a rocket grenade. He has ongoing surgery on his back, flashbacks, anxiety and temper problems. He has now set up a project to help similarly affected servicemen and women.
Less than three years after he was discharged from the Logistics Corps, Andrew Watson jumped to his death from the block of flats where he lived in south London. Serving in Iraq, he had seen two friends blown up by landmines in Basra and had to move their remains. Similarly, the 25-year-old private had to endure carrying dead babies out of war-wrecked buildings while on duty. Even on leave, there was no respite. The man who replaced him in Iraq was blown up. The death shook him terribly. In July 2009, TV footage of the coffins of eight colleagues who lost their lives in Afghanistan pushed him over the edge: he is believed to have timed his suicide with his 5am army roll call.