Millions will honour Britain's fallen today, Remembrance Sunday, with wreaths at the Cenotaph and poppies worn proudly on lapels. But the nation faces a new wave of casualties – the majority bearing no obvious sign of injury – men who will need help for decades after the last battalions return from Afghanistan in 2014.
Experts warned last night that thousands of soldiers are and will be struck down by post-traumatic stress disorder (PTSD). Vast numbers will see their lives destroyed by alcohol and drug abuse as they try to self-medicate against horrific memories of what they have seen and done in the name of Queen and country. Many will end up homeless or in jail.
In the most extreme cases, sufferers commit savage crimes, up to and including murder. Earlier this year, a 24-year-old Afghan veteran, Aaron Wilkinson, was jailed for a minimum of five years for shooting dead his 52-year-old landlady, Judith Garnett. Wilkinson was suffering from PTSD after a tour in Afghanistan in 2009, and admitted manslaughter on the grounds of diminished responsibility.
According to the military charity Combat Stress, record numbers of soldiers are returning from overseas needing treatment for PTSD: the latest figures reveal a new high in referrals of veterans of Afghanistan. The number has gone up fivefold in the past four years – from 94 in 2008-09 to 481 in 2011-12.
Soldiers are coming for help far earlier than before, reflecting both an increased awareness of help being available but also more severe distress. Previously, on average, veterans waited 13 years before coming for treatment, but those who have served in Afghanistan are asking for help just 18 months after leaving the forces, according to the charity.
Dr Walter Busuttil, director of medical services at Combat Stress, said: "It means that people are more able to say that they have a problem, and are more educated to know a mental health problem is something to take seriously."
He described the treatment available for veterans as "patchy" and added: "The Government is trying to make sure that veterans have appropriate bespoke services, but we are still not there." He warned: "If we don't move forward and continue to increase the number of services, and continue to fund these services, we will go back to square one. We are coming out of Afghanistan very soon but the mental health issue will continue for many years to come – for 10 to 15 years."
As of September 2011, at least 191,000 soldiers have been deployed to Afghanistan and Iraq. Conservative estimates suggest there could be more than 13,000 PTSD cases in the next decade or so.
Nearly 7 per cent of regular solders who have seen combat will fall victim to PTSD, according to studies by the King's Centre for Military Health Research at King's College London. But the true problem is greater than official figures suggest, with many who spend years, or lifetimes, suffering in silence. "The true numbers [of PTSD] will be higher than an epidemiological study can tell us," Dr Busuttil said.
The plight of injured veterans – those returning with missing limbs or shattered minds – prompted The IoS to call on the Government five years ago to honour the Military Covenant. Much has changed for the better since then. The Armed Forces Act, passed a year ago, placed into law the principles of the Military Covenant – a commitment to care for serving personnel and veterans. In addition, the Government has set up a network of 15 military Departments of Community Mental Health across the country – but it has allocated a paltry £7.2m to fund them over the next five years.
PTSD is part of a wider picture of mental trauma: according to a Ministry of Defence (MoD) report released in July, the number of soldiers returning from Afghanistan and needing treatment at mental health clinics rose from 389 in 2007-08 to 1,733 in 2011-12.
And while the needs of veterans have come to the fore much more since 9/11 and the wars in Iraq and Afghanistan, service charities fear they could again be forgotten once troops pull out of Afghanistan in 2014. Brigadier Robin Bacon, chief of staff at ABF The Soldiers' Charity, said: "To remember the living, those who have been through all the stresses and strains and who face uncertainty in the future when their physical or mental injuries manifest themselves, that's absolutely part of remembrance for us."
Uncertainty remains over the long-term ability of a cash-strapped NHS to prioritise the treatment of veterans. In addition, finding work and a home after leaving the forces both remain "big issues", according to service charities.
"I think it would be unrealistic to say that everything we want to be in place is there for everybody," said Sue Freeth, director of operations at the Royal British Legion. "There is still quite some way to go."
In an attempt to make it easier for veterans to get help, the charity hopes to open 16 walk-in centres in high streets across England and Wales next year.
Ironically, the toll on those who serve in the armed forces is expected to worsen as they are removed from the dangers of active service. Many will struggle to cope with planned MoD redundancies and a massive increase in reservists announced by the Defence Secretary, Philip Hammond, last Thursday. The size of the Territorial Army is set to double to 30,000 – to compensate for a 20,000 cut that will reduce the regular Army to 82,000.
A new documentary being broadcast on Sky 1 tomorrow will air growing calls for the Government to do more for traumatised veterans who face a postcode lottery of treatment. Invisible Wounded, produced by the actor-turned-documentary-maker Ross Kemp, centres on lives shattered by PTSD.
"We are not prepared in any way, shape or form for the onslaught I think we have coming," he told The IoS. "The feeling from some I speak to in the Army is that we have a bigger problem than we admit to."
Even as we pay tribute today to the men and women who have made the ultimate sacrifice, for some veterans, the only way of coping will be to lock themselves away.
Take Simon Peacock. He joined the 1st Royal Anglian Regiment aged 19 and was blown up by a grenade in 2007 in Afghanistan. He nearly died. Yet his struggle to survive was just the start of a battle he has fought ever since.
"I wake up in the middle of the night screaming," he said. "I can't go out of the house sometimes, you feel someone is out to get you ... After the war, you come back and you are fighting another war to get on with your life. Often, this is worse than the war in Afghanistan, it's harder."
'It got to a point where I wasn't able to wash myself or change my combats. I was a zombie'
Edward Bland, 34, London
Tipped as a future leader, the Sandhurst graduate rose from the rank of second lieutenant to captain in the Royal Anglian Regiment in two and a half years. But his Army career was cut short when he suffered a nervous breakdown and was flown back to Britain from Iraq in 2006.
"I went out to Afghanistan in 2003, which is where my PTSD started. There was one time when a coachload of German soldiers was blown up by an IED. I was back in camp and really struggled with the sight of my soldiers coming in covered in blood and body parts and looking utterly shocked. I remember the feeling of utter helplessness and became very short-tempered and withdrawn."
In 2006, he was deployed to Iraq. "We were doing very aggressive missions almost nightly, trying to capture corrupt Iraqi soldiers or police. It was 'hard entry', kicking in doors, breaking through windows and all that kind of stuff." After one such "strike op", Mr Bland cracked. "The thing I found most stressful was the collateral damage. There were a lot of tearful, scared and panicked women and children in the house. I knew I was a broken man. It got to the point where I wasn't able to wash myself or even change my combats, I was like a zombie." He was flown back to Britain and medically discharged in 2007. Last year, he completed a treatment programme at Combat Stress and is now rebuilding his life. "There are lots of veterans who are physically intact but mentally damaged. There are going to be more of us coming out of the woodwork in the next few years."