‘I began to drink and self-destruct’

[The_Rani]

http://www.timesonline.co.uk/tol/life_and_style/court_and_social/article6726678.ece

July 25, 2009
‘I began to drink and self-destruct’
Melissa van der Klugt

Four months after he returned from the Gulf, where he was deployed in September 1990, James Saunders, now 39, began to be haunted by flashbacks. Sights on the Basra road returned to him in his nightmares: one especially graphic image he saw was a giant scrapyard littered with body parts and decapitated heads, against a backdrop of burning oilfields.

Attempts to escape led Mr Saunders into deeper trouble. “I began to drink and self-destruct,” he said. “I hid it from my friends and family. I felt guilty and like I had let people down. I lost my self-worth.” He eventually found himself in prison.

Incarceration was almost a relief, a chance to step back and get a grip on life. Then Mr Saunders discovered Combat Stress, a charity that has been helping ex-servicemen with mental health problems for the past 90 years.

Though less tangible than body wounds, post-traumatic stress disorder (PTSD) can be as deep and painful as any physical injury. Founded in May 1919, Combat Stress has supported almost 100,000 veterans from every campaign that British Forces have been involved in since the First World War. At the moment it cares for 4,000 ex-servicemen and women suffering from PTSD, depression, alcohol and drug abuse, anxiety and phobic disorders. The majority of patients are male and served in the Army, while ages range from 20 to 80.

Like many of those being helped, it took time for Mr Saunders to get in touch with Combat Stress. As with others, his problems emerged later on, too. On average it takes someone about 14 years to contact the charity. “It is in the downtime years after leaving the service that problems occur,” says Mr Saunders.

Last year Combat Stress received 1,257 new referrals, up 66 per cent since 2005. While most served in the Gulf or Northern Ireland, 265 served in Iraq and 58 served in Afghanistan. This number may continue to rise dramatically. David Hill, the new chief executive, who served with the RAF for 29 years before working in NHS mental health services, says: “We don’t see demand for our services abating. What we are seeing from Afghanistan now is the tip of the iceberg . . . In times gone by some personnel never saw active service,” he says. “But now we have more people returning to the community and home life from high-intensity operations.” Few of those they meet in civilian life, moreover, will have any idea of the experience they endured.

John Bromley, who served in the Royal Navy for 25 years, is one of the 16 regional welfare officers for the South East. He meets new patients, refers them for treatment at one of the charity’s centres and follows up individual cases. He drives hundreds of miles a day to meet 277 patients, of whom 12 served in Afghanistan and Iraq.

“They are a lot angrier and the trauma in them comes out quicker,” he says. Many have been out of service for less than two years. “They suffer from the pressure of repeated tours, lack of support and lack of time to re-establish themselves in society. Hand-to-hand fighting and living with mortar attacks 24 hours a day is a long way from doing your shopping in Morrisons. They feel disturbed that people at home often do not know what they have been through.”

Earlier this year Lance Corporal Johnson Beharry, who won the Victoria Cross for valour exhibted while serving in Iraq with the 1st Battalion, Princess of Wales’s Royal Regiment, spoke out about the Government’s poor level of mental health care for ex-servicemen.

GPs are often ill equipped to understand many of the problems, says Mr Bromley, and the care that the NHS offers is patchy at best. “We’re all a bit institutionalised,” he adds. “When you leave the Army you lose that support, camaraderie and direction.”

He believes that people should be better prepared mentally for what they might face in combat. Many of his patients suffer guilt at having survived while colleagues died beside them on patrol. Though some need assistance with things as prosaic as form-filling, Bromley may spend hours discussing an individual’s life from childhood to Service before referring them on, if necessary, for treatment at one of the charity’s centres.

PTSD can be triggered by marriage breakdown. “The hidden victims are the families,” says Hill. “They don’t know where to turn or how they can help. Relationships, where they are still intact, are fragile.”

Combat Stress is establishing teams of clinicians in the regions to work more closely with patients’ families alongside the welfare officers, mental health practitioners and psychiatric nurses. But there are challenges ahead. This year the charity must raise £3.6 million in donations to meet operating costs, expected to rise to £10 million next year as work starts to upgrade the three treatment centres and improve clinical care. “We want to get people out more,” says Hill. “Veterans suffer from social exclusion as well as problems with confidence.”

At the treatment centres in Ayrshire, Shropshire and Surrey, where patients visit for several weeks at a time each year, there are art and craft workshops, fitness suites and sessions with psychologists, psychiatrists and other patients. “I came from a dark, dark place,” says Mr Saunders. At Combat Stress he met like-minded people and took up photography. He has learnt to tame his demons.