The number of serving and ex-forces personnel being awarded compensation for mental disorders has hit record levels, leading to fears that we are now starting to see the true cost of the Afghanistan and Iraq wars in the form of the mental scars left on those who had to fight them.
Analysis of Armed Forces Compensation Scheme statistics by The Independent shows that the annual number of mental disorder pay-outs has increased by 379 per cent, from 121 in 2009-2010 to 580 in 2015-16, to reach the highest total in the 11 years the scheme has been running.
The claims are not broken down by type of mental disorder or whether a claimant saw combat, but mental health professionals say the timing of the increase mirrors the expected time lag before Afghanistan and Iraq veterans start to experience symptoms and seek help.
They admitted to being worried that the numbers are likely to increase further and we are still only seeing “the tip of the iceberg” in terms of those traumatised by their experiences in Afghanistan and Iraq.
Veterans have also told The Independent that unlike those with visible injuries, the men and women left with the “hidden wounds” of mental trauma are being left to struggle against an Armed Forces Compensation Scheme determined to give them as little as possible.
Dean Upson, 36, an Iraq and Afghanistan veteran with Post-Traumatic Stress Disorder (PTSD), said: “They don’t care. The fact that you have fought for your country, done three combat tours, that counts for nothing.”
The former Royal Engineers corporal added: “The visible injuries that they can’t argue with – the lost limbs – they will pay straight away.
“But the non-visible injuries, they don’t want to give you a thing.”
He also predicted that given that many soldiers tried to “crack on”, seeking help only when they were at breaking point, he expected a “tidal wave” of traumatised veterans to come forward in the coming decade.
Dr Walter Busuttil, director of medical services at the charity Combat Stress, said that given that mental symptoms can take years to surface and many veterans only start experiencing them after leaving the forces, it was “highly likely” the increase in compensation claims was driven by Afghanistan and Iraq veterans.
Describing the numbers seen so far, he said: “It’s the tip of the iceberg. We just don’t know how big the iceberg is. If it’s a small iceberg, we are going to be really, really busy. If it is a big iceberg, we are going to be overwhelmed.”
He added: “This is not going to go away for some years. The indications are people will keep coming forward.
“I am not predicting for how long and how many. I am not saying it’s out of control, but it has increased every year, so I am worried.
“We need funds, we need help, from any direction.”
Dr Busuttil, a consultant psychiatrist who served for 16 years in the RAF, said that both the armed forces and NHS were working increasingly hard to help minimise the trauma experienced by veterans, and treatments were proving ever more effective, especially for those seeking help early.
He added, however: “The services are good but there aren’t enough of them. There is a lack of expertise all round. Many doctors have never served in the military. There is a lack of understanding of military culture.
“Training is really important. The NHS needs to ring fence funds for veterans’ mental health.”
The Armed Forces Compensation Scheme, administered by Veterans UK on behalf of the Ministry of Defence, replaced the previous War Pensions administration in 2005. Since then there have been 2,400 successful claims for mental disorders, but 1,466 – well over half – of these were awarded in just the three years between April 2013 and April 2016.
In a further possible indication that the true scale of the mental trauma caused by Afghanistan and Iraq is only starting to emerge, the number of claims rose by 35 per cent in the last year, from 429 to 580.
Dr Busuttil added that the numbers awarded compensation represent only a small subsection of those traumatised. He said that despite his charity usually helping the most severely traumatised veterans, only 4 per cent of ex-forces personnel seen by Combat Stress had ever applied for compensation.
“Either they don’t know compensation is available, or they are too ashamed to apply. Stigma is a big thing in the military.”
Combat Stress’s own figures show a 26 per cent increase in the number of veterans seeking the charity’s help for mental health problems between 2014 and 2015, followed by a further six per cent increase to 2,472 referrals in the financial year 2015-16.
The Ministry of Defence has consistently argued that the rates of PTSD among forces personnel generally is low. This appears to be confirmed by a 2014 study by the King’s Centre for Military Health at King’s College London, which found that PTSD rates among UK regulars returning from Iraq or Afghanistan ranged between 1.3 per cent and 4.8 per cent – comparable to the 3 per cent rate found in the general civilian population.
Those figures, however, included the many forces personnel who were deployed to Iraq and Afghanistan but did not directly experience combat or were in non-combat roles.
Among the minority who directly experienced fighting, the study found, PTSD rates were much higher, at about 7 per cent.
Dr Busuttil added: “It’s not just PTSD. The biggest problem from Iraq and Afghanistan is a very high rate of alcohol misuse, and then there are common mental illnesses – a bit of depression, a bit of anxiety, a bit of panic.”
The Independent, which began investigating after being contacted by a veteran who wished to remain anonymous, has also been told that many ex-forces personnel have to struggle to get adequate compensation for their hidden, mental injuries.
Mr Upson, who fought during the invasion of Iraq and did two tours of Afghanistan, said on leaving the Army in June 2011 he was initially awarded just £3,000 for complex PTSD that was so severe it has left him suicidal and unable to do a full-time job.
He said: “After 14 years’ service, tours of Iraq and Afghanistan and an entire life messed up by PTSD it was a joke.”
Mr Upson said he eventually received a maximum award of more than £160,000, but it took him four years and the involvement of lawyers to get it.
His experience and that of others seeking compensation for mental illness, he said, was: “They will fight and question everything.
“They will even try everything they can to discharge you before you get your diagnosis of PTSD.
“I’ve known guys discharged on the grounds of ‘personality defect’ or ‘burn out’. Because they didn’t get their diagnosis of PTSD before they were discharged, they got nothing.”
His views were echoed by the solicitor Hilary Meredith, whose law firm specialises in representing forces personnel.
She said: “I have seen a turn in the Armed Forces Compensation Scheme. When it first started in 2005, far more awards were going through, on an easier basis.
“Then something happened. A lot of the applications were turned down and had to go to appeal.
“The people we help usually get a proper award on appeal, but the fact that they have to go to appeal in the first place adds to the distress they are already feeling.”
A Ministry of Defence spokesman said it has introduced “anti-stigma” campaigns to make it easier for service personnel to seek help for mental health problems, and had encouraged the submission of claims so they could be properly considered.
He said: “We are absolutely committed to the mental health of our armed forces and this increase in successful claims shows our campaigns are encouraging those who need help to come forward to get the compensation they deserve.”
The spokesman added that the Armed Forces Compensation Scheme had awarded more than £600m in compensation since 2005.
The Department of Health said £7.5m was invested in specific veterans’ mental health services over the course of the last Parliament, and NHS England intends to invest an additional £8.4m over the next five years.
An NHS England spokesperson said: “On leaving the armed forces, most people successfully transition back into civilian life. But some individuals can experience very traumatic situations, which can take a severe toll.
“While mental health awareness is improving, we can do more to identify issues, not just with PTSD but with wider problems linked to anxiety and depression. We have listened to feedback from veterans, their families and NHS specialists and will be announcing plans to improve mental health care for armed forces veterans shortly.”
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