Frontline: Nerves of War

An increasing number of veterans and reservists suffer crippling post-traumatic stress disorder when they return home from service. Indira Das-Gupta visited Combat Stress, the charity that helps pick up the pieces.

At the end of January, the UK reached a tragic milestone when the 100th British soldier was killed in Iraq. Those who make it back home may be considered the lucky ones, but for the more than 1,300 servicemen and women who have developed psychiatric problems, the battle often starts only on their return.

Combat Stress is there for those who find themselves in this position.

It offers pioneering treatments that simply aren't available on the NHS - it is the only organisation of its kind in the UK. Those who are treated by the charity suffer from a full range of mental health problems, most of which come under the heading post-traumatic stress disorder. Symptoms can include anxiety, depression and obsessional behaviour.

The charity was set up by a group of female volunteers who were originally concerned that veterans of the First World War with mental health problems were hidden away from society and locked up in so-called 'lunatic asylums'.

Nearly 90 years later, little has changed, according to Peter (not his real name), one of the charity's clients.

"We are like a scar on the services," he says. "If people knew what we have been through, they would not join up. We are an embarrassment to the Government, but we fought for our country. Twenty to 30 years ago you were held in high esteem if you were in the services -that's not the case any more."

The charity's services cost £5.8m a year to run. The Veterans Agency, which is part of the Ministry of Defence, pays for six weeks of treatment for those who are entitled to a war pension - this contribution was valued at £2.8m last year. But the charity does not receive a penny from the MoD for those who are not entitled to a pension. Changes to the qualifying process this year mean that fewer men meet the criteria - so there is less state funding for the charity.

Peter feels the Government should accept some responsibility for the shattered lives of ex-servicemen. "The army spends thousands of pounds making us aggressive so we can do the job, and the only thing that keeps us in control is the discipline of the commanding officer," he explains.

"When that's taken away, there's nothing to control your aggression and you can end up taking it out on your family.

"You become institutionalised, and you get used to the daily routine.

You have to be a certain sort of person to take orders, but it can be hard when you no longer have orders to follow. If the MoD spent just a fraction of what it spends on arms on caring for veterans, it would be a completely different story."

The charity has centres in Leatherhead, Shropshire and Ayrshire, and 12 welfare officers who cover the whole of the UK. It sees about 900 new cases a year and until five years ago the vast majority of clients were veterans of the Second World War, with their average age 65. That figure has fallen to 45 as the charity sees an increasing number of veterans from the Falklands, the Gulf, the Balkans and, of course, Iraq.

"Peace-keeping exercises such as the one in Iraq can lead to more casualties than a war," explains Leigh Skelton, director of clinical services at Combat Stress. "They are under constant pressure, dealing with an unpopular cause, and then have to worry about being sued for shooting Iraqis. It's the same with men who served in Northern Ireland."

The MoD is keen to play down the scale of the problem and says "only 1.5 per cent" of those who have served in Iraq have been diagnosed with mental health problems. But that translates into nearly 1,500 lives that will never be the same, not to mention the effect on loved ones. To make matters worse, Skelton predicts the problem will only become more prevalent.

"We are getting more and more referrals from the Territorial Army and reservists because they are being deployed in greater numbers than ever," he says. "They are allowed to go straight back home without decompressing, whereas it's compulsory for other men to do so. When they return, they are not going back to barracks, but into an environment in which nobody understands them."

Another reason the MoD figure is so low is that it takes 14 years on average before most servicemen (less than 3 per cent of the charity's clients are women) seek help. Skelton believes this is mainly due to a reluctance to be seen as weak. "About 70 per cent of the men who come here have alcohol problems because they use it to self-medicate," he says.

"By the time we see many of them, they have been drinking and sleeping rough, their families have broken down and they have hit rock-bottom. There's still a stigma attached to mental health problems - even more so in the army."

It is clear from talking to clients at the Combat Stress centre in Leatherhead that they all depend on the treatment they receive, and even look forward to their stay there.

Adam (not his real name) is another client. "You can never be cured but you have to learn to live with it - and things do get better," he says.

"We are actually the lucky ones because thousands more are not even in the system.

"When you come here, you realise that you are not alone. Camaradarie is the best tonic - it's like a retreat or a safety bubble here."

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