Waging war on stressOn 1 Mar 2003 in Military, Personnel Today Related posts: Features list 2021 – submitting content to Personnel TodayOn this page you will find details of how to submit content to Personnel Today. We do not publish a… Previous Article Next Article Comments are closed. Preparationsfor a possible war with Iraq are under way, yet many veterans are still feelingthe psychological ramifications of the last Gulf war. How much can the Army’sOH department teach us about dealing with very stressed personnel? By Nic PatonAdecision is expected soon in a court action that could have pro- foundramifications on how the British Army manages stress among its troops.Ithas been estimated that the class action taken by some 1,900 veterans of theFalklands, Gulf War, Northern Ireland and peace-keeping operations in theBalkans, could result in compensation payments of more than £500m.Theaction, which has been running for the best part of two years, revolves aroundthe veterans’ claim that they are suffering from post-traumatic stress disorder(PTSD) because they were not properly treated by the Army.Longgone are the days when soldiers suffering nervous or mental conditions weresimply accused of cowardice and shot, but some of the cases being heardcertainly do not reflect well on the military authorities.TakeRoyal Highland Fusilier Barry Donnan, who, as a 17 year old, was sent to theLockerbie plane crash site in December 1988, where he was instructed to pick uppieces of bodies, but was offered no counselling afterwards. Threeyears later, he was equally traumatised during the Gulf War, when he witnessedthe burial of hundreds of Iraqi soldiers in a mass grave. On his return, hewent absent without leave, was court-martialled and sentenced to 112 days inthe Military Corrective Training Centre in Colchester. On his release – againwith no offer of counselling or mental assessment – he was deployed to NorthernIreland.Repercussionsof combat stressSymptomsof combat stress can include feeling tense and shaky, appearing dazed orconfused, loss of concentration, a loss of morale, insomnia, fear and anxiety.In severe cases, soldiers feel depressed or suicidal and have slower reactiontimes. Stress can also have a severe impact at home, leading to marriagebreak-up, alcoholism, violence and mental breakdown.In1998, the Government’s Social Exclusion Unit estimated that one in fourhomeless people was a former member of the armed forces. And in 2000, anotherUK charity, Crisis, published a study which estimated that up to 25 per cent ofrough sleepers were once part of the UK armed forces. Yet,the British Army is one of the few organisations of its size that has a stressmanagement policy, says the Ministry of Defence (MoD), as well as having acomprehensive OH service in place.TheMoD’s deputy adjutant general drew up a stress-management policy in 2001 thatrecognised stress as a debilitating condition for the first time, and thatmanaging it was a core function of leadership among commanders. The policy alsomade it clear that there is a difference between stress and stress-relateddisorders.Healthand safety training is now mandatory, including presentations on recognisingand preventing stress and how individuals in command can deal with it.UKMinister for Veterans’ Affairs Dr Lewis Moonie, discussing the court action inthe House of Commons last year, emphasised that PTSD (see box, p18) had beenrecognised internationally as a medical condition since the 1980s.”Measuresnow in place to combat PTSD in the armed forces have evolved and been enhancedover a number of years to reflect our improving knowledge of the condition, itseffects and the best methods of remediation. Each service runs activeprogrammes aimed at prevention and treatment. Measures include pre-deploymentand post-deployment briefings and, when practicable, availability ofcounselling,” he explained.Headded that two new defence community psychiatric centres have been establishedin England and Scotland. Additionally, parts of the armed forces, particularlythe Royal Marines, are exploring ways of detecting PTSD at a very early stage.TheMarines’ Combat Stress Project – under retired captain Cameron March – islooking at ways of training front-line troops, NCOs and commanders to recognisethe symptoms of stress in both themselves and their colleagues, and to react toit. Training can also help them differentiate between a soldier who is simplybeing ill-disciplined and one who is suffering from a stress-related disorder.Army’sapproach to OHTheArmy’s approach to occupational health as a whole was put under the spotlightlast February in a study published in the Journal of the Royal Society ofMedicine.Itlooked at the Army’s decision in 1998 to introduce ‘gender-free’ training andwhether it had had any effect on levels of medical discharge, particularly ofwomen compared to men. The research found women recruits were up to eight timesmore likely to be discharged with back pain, tendon injuries and stressfractures than their male counterparts.Whenit comes to managing OH, the Army has what it describes as “an integratedprimary healthcare service”, linking Army GPs with OH support through unitmedical staff.Thereare specialist occupational medicine staff available higher up the scale, atcommand level in some regions. It also plans to establish OH staff at primarycare level.Themilitary loves its acronyms, and it is no exception for OH.Assessmentsare carried out through a process known as PULHHEEMS – Physical capacity, Upperlimbs, Locomotion, Hearing, Eyesight, Mental capacity and Stability.Duringmedical examinations, grades are given that are matched to a PULHHEEMSemployment standard (known as a PES) which is used to outline any functionallimitations on a soldier’s employment because of a medical problem, but withoutdisclosing confidential medical information to the employer.Soldierscan be temporarily downgraded and put on light duties if the condition is nottoo bad or, if it is more serious, permanently downgraded through a medical boardassessment, although the Army stresses this is not in itself a bar to promotionand progression.Ifa soldier is deemed medically unfit to carry out any form of military duties,and is unlikely to become so for the foreseeable future (usually 18 months), heor she is medically retired or discharged.ManagingstressOutsidethe medical arena, the Army established a UK Army Welfare Service (AWS) inApril 2000.Whilea similar service existed before, the AWS in its current form now has 20 teamsof volunteers across the UK, comprising three to four soldiers in each.Theyare designed to provide back up for the community psychiatric nurses who aredeployed on operations to brief soldiers. The AWS will begin work once asoldier has returned to barracks.Thereis also a network of information centres similar to Citizen Advice Bureaus thatstarted up in the late 1980s. There are approximately 80 centres the UK –mostly based near family accommodation and barracks – which are able to answerquestions and provide information. WithinNATO, innovative work is taking place to manage stress that could haveimplications for UK forces.TheUS Army, drawing upon lessons learnt from the Gulf and Balkans campaigns, isdeveloping a programme of intervention to improve psychological resilienceamong troops and lower the number of psychiatric casualties.Thisincludes developing tools to measure stress in the field, establishing asuicide surveillance system, identifying factors that lead to high rates ofmental disorders and developing psychological screening and debriefing in thefield. Furtherdown the line, the programme intends to develop ways of identifying vulnerablesoldiers within both training and operational environments, strategies ofassessment and intervention and ways of implementing these strategies acrossthe military.TheUS Army is also working with the Austrian and German armies to develop aprotocol to assess voice changes under stress, making it easier to separate thephysical from psychological when it comes to measuring stress.NATOhas also set up an exploratory team of psychologists and psychiatrists to lookinto issues of stress and psychological support. The work is still at an earlystage, as the terms of reference and a programme of work were only drawn uplast September.NextApril, the group will meet to unveil its views on psychological support inmodern military operations. Areas set to be addressed will include assessingpsychological stress, the psychological preparation of military personnel,screening, psychological support during and after deployment, support forfamilies and how best to organise support.Pressuresof peace-keepingIthas been recognised that the increased pace of operations since the end of theCold War has added to stress levels, and that peace-keeping operations can bejust as stressful as combat operations, according to Dr Martin Deahl, civilianconsultant psychiatry adviser to the RAF and a consultant at Shelton Hospitalin Shrewsbury.Deahlexplains that soldiers might witness atrocities against women and children andbe powerless to intervene, and may also be away from their families for longperiods of time.Researchby the Canadian Army found that its veterans of the peace-keeping operation inCroatia suffer from stress-related illnesses at rates at least three timeshigher than those found in the population at large.Oftensoldiers suffering from stress are not even given a medical discharge and,consequently, slip through the net, says Commodore Toby Elliot, chief executiveof the ex-Services Mental Welfare Society, also known as Combat Stress.”Wehave far more people on our books with clinical depression than PTSD,” hesays.”Itis the commanders who are responsible for identifying this [stress]. If theythink they have a chap with a problem, they can get help early on and getdoctors involved. If not, before you know it, you have a badly damaged man onyour hands,” he adds.Themilitary is hamstrung by the fact there are so few health professionals to turnto. According to UK MoD statistics from the beginning of 2002, there were only11 fully-trained consultant psychiatrists and 81 registered mental healthnurses serving in the Defence Medical Services. The‘warrior culture’ of stiff upper lip, inability to recognise that someone iswounded unless there is something physically wrong and a refusal to discussemotional problems still remain, even if barriers are beginning to be brokendown, argues Deahl.Puttingstrategies, protocols and systems in place all help but, at the end of the day,the best solution to tackling stress is to get mental health professionals asfar forward and accessible as possible, he says.”Weare trying to work along the lines of coaching rather than the medic teachingpeople,” adds Deahl. www.army.mod.uk/soldierwelfare/supportagencies/aws/AWS_Home_Page.htm– Army Welfare Service homepagewww.combatstress.com – The Ex-ServicesMental Welfare Society, Combat Stress, which specialises in helping those of allranks from the armed forces and the Merchant Navy suffering from psychologicaldisability as a result of their service.www.ncptsd.org – The National Center forPost-Traumatic Stress Disorder (PTSD)Post-traumaticstress disorder – the factsAccordingto the US-based National Center for Post-Traumatic Stress Disorder (PTSD), oneof the leading research bodies on the condition, the definition of PTSD is:”a psychiatric disorder that can occur following the experience orwitnessing of life-threatening events”.Thesecan include military combat, natural disasters, terrorist incidents, seriousaccidents, abuse (sexual, physical, emotional, ritual), and violent personalassaults such as rape.Sufferersoften relive their traumatic experience through nightmares and flash-backs.They may have difficulty sleeping and feel detached or estranged.Symptomscan be severe enough and last long enough to significantly impair their dailylife.Othercommon symptoms include survivor guilt, irritability, marital disharmony,sudden angry outbursts, depression, nervousness and anxiety, joint and musclepains, emotional numbness, poor concentration and phobias about dailyactivities.Treatmentnormally begins only when the survivor is safely removed from a crisissituation. Strategies generally include educating trauma survivors and theirfamilies about how people get PTSD, how it affects survivors and loved ones,and other problems commonly linked to PTSD symptoms. Familiesand sufferers are also taught to understand that PTSD is nothing to be ashamedof; it is a medically-recognised anxiety disorder.Othertreatments include exposure to the event via imagery, allowing the survivor tore-experience the trauma in a safe, controlled environment, while alsocarefully examining their reactions.Patientswill be encouraged to examine and resolve their strong emotions – such asanger, shame, or guilt – common in PTSD, and there will be teaching to copewith post-traumatic memories, reminders, reactions, and feelings withoutbecoming overwhelmed or emotionally numb. Accordingto the Center, trauma memories usually do not go away entirely as a result oftherapy, but become manageable with new coping skills.