How Combat Stress work with veterans

Are you an older veteran, or the relative of one, who’s struggling with your mental health? Have you or they started displaying clearer symptoms following a major life change? We talk to Walter Busuttil, Medical Director at Combat Stress, about how their services can help.

What is Combat Stress?

Combat Stress is a registered charity offering clinical community and residential treatment to former (and serving) members of the British Armed Forces experiencing mental health conditions.

Combat Stress has been around since 1919. It was established by a group of Suffragettes who were the wives, girlfriends, mothers and sisters of soldiers coming back from the First World War, and incensed by the fact 5,000 veterans were subsequently put in asylums, detained against their will, because there were no special services for veterans returning from the trenches.

Who uses Combat Stress today?

“By and large, people who come to Combat Stress have served in the military,” explains Walter. “Of those, 92% have been on active operations, while 75-80% have seen combat. 75% have a primary diagnosis of Post-traumatic stress disorder (PTSD); 62-65% will have co-morbid depression, and about 69% will have alcohol problems, past and present.”

“That’s still the case with older veterans too,” adds Walter. “We still have older veterans presenting to our services for the very first time. The issue is they’ve hung on and hung on, but then perhaps something’s happened, like the death of a partner who may have helped contain things for many years, meaning they suddenly need help very quickly.”

Evolving services

Over the years, Combat Stress has played a number of different roles in the lives of veterans, from respite care to occupational therapy, depending on the times.

“When I joined Combat Stress in 2007, my remit was to change it from respite care into cutting edge clinical services, because we had the conflicts in Afghanistan and Iraq going on,” says Walter.

What’s on offer now?

Today, Combat Stress delivers more active treatment, with community services with a community psychiatric nurse and occupational therapist across 15 regions. They also offer peer support, engaged with and run by veterans themselves, the majority of which are volunteers.

They also offer an outpatient service, generally for assessment and some follow up treatment, as well as an input into the community by getting people functioning and back to work.

‘Behavioural activation’ takes place in hotels owned by the Royal British Legions, known as ‘Breakaway Centres’, where veterans and their partners can have a paid holiday every two years.

“World beating” residential programmes are reserved for those that are particularly unwell, where people are taught how to cope with things like anger management.

Addictions nurses make sure people are case managed into addiction services, where they can receive detox and education on addiction, and then case managed back into mental health services to ensure they don’t get lost along the way. “We have a 90% engagement rate here, which is almost unheard of,” reveals Walter. “Engagement, in this context, means people don’t drop out of the process. Services like this for civilian patients can have dropout rates of something like 70%.”

Someone to call

At the front end, Combat Stress has telephone helplines for veterans and serving personnel, which receive 12,000-14,000 calls a year.

Older veterans

At the last count, two years ago, there were 400-500 veterans over the age of 65 within Combat Stress’ service.

“Delayed presentations of symptoms for conditions like PTSD are common in older veterans,” explains Walter. “These problems may have been contained, because the individual has been avoidant of anything that reminds them of their trauma, had good social support and a job, or problem solved along the way. Later, however, when they stop and think, or if there are big life events such as retirement or the death of a partner, that’s when previously coped with or suppressed things can strongly enter into your present thoughts.”

What to look out for

“There’s an alcohol culture within the military,” says Walter. “Alcohol has always been used to suppress emotions and bond the team, and is cheap within the military. But when people leave, alcohol is more expensive so perhaps consumed less, so where it would have previously covered up many psychiatric symptoms, they’re suddenly there to haunt you.”

Work plays a central role in the culture of the military. “If you have anxiety, don’t sleep well, or don’t get on with people well, you’ll find work is a huge distraction. Many of my older patients are working later in life than most, some with multiple jobs, and can’t stand to be in a cocoon at home with what they view as trivial responsibilities. Obsessionality can also creep in, because many tasks in the military, such as live weapon training or air traffic control, make people very careful.”

Dementia and PTSD

There is some evidence that the onset of dementia can cause someone to re-experience symptoms of PTSD, and that those who suffer from chronic PTSD can have a higher risk of dementia. “In both cases more research is needed as these relationships are not understood,” clarifies Walter.