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THE SCOTSMAN MAGAZINE - Saturday, September 8th, 2007.

Casualties of war


Photographer Angela Catlin and I interviewed a number of soldiers and sailors suffering from Post Traumatic Stress Disorder as a result of their experiences during war. We met with them at a place called Hollybush House in Ayr, a centre run by the charity Combat Stress. Sadly, and despite the rising tide of PTSD casualties from Iraq and Afghanistan, Hollybush House is one of the few specialist centres in the UK offering help to war veterans with mental illnesses.


GAVIN Barclay blinks and scratches nervously at a black tattoo of a lizard on his right arm. “I’d rather have had an arm blown off or a leg…losing your mind is the worst thing in the world,” says the 36-year-old former soldier. Barclay glances down at his feet then stares out of a window to summer in Ayrshire and miles of rolling green hills and woodlands. He has a touch of the sun but somehow appears pale and drained and as if his thoughts are somewhere else; perhaps back to the sectarian violence of Northern Ireland, or to the suicide bombers of Basra, or even to more recently when he would walk up and down the Erskine Bridge thinking of throwing himself off the 150 ft structure into the River Clyde. “I have horrendous nightmares and panic attacks. I walk down the street and feel as if I am completely separate from society, as if I am in a bubble,” Barclay says.


Until recently he had no idea he was suffering from post traumatic stress disorder (PTSD). He isn’t sure what exactly triggered his illness. Maybe it was the five years he spent with the Argyll and Sutherland Highlanders in Northern Ireland being shot at and pelted with bricks and petrol bombs. He mentions riots at Drumcree and the violence at Holy Cross School and talks about drinking in Belfast bars off-duty fearing a bullet in the head from a stranger. Or maybe it was the war in Iraq. Barclay was posted there twice, his first tour in 2003 at the outset of the second conflict. Perhaps it was having no protective nuclear, biological and chemical (NBC) suit or a respirator for the first few weeks while under daily threat of scud missile chemical attacks. Or maybe it was coming under friendly fire or the roadside bombs and suicide bombers in Basra. Barclay isn’t sure. But what he does know is that the army did not tell him anything about PTSD, when he joined, during his eight years service, or after he left. “With PTSD you lose everything. There’s no help at all from the army. I lost my life,” he says.


Barclay is just one of thousands of war veterans facing escalating mental health issues, alcoholism and family breakdown after serving in conflict zones. With thousands of more people expected to experience severe problems because of the wars in Afghanistan and Iraq, first identified as “shell shock” during the First World War, people like Barclay are predicting a mental health “time bomb”. But while stories like his are all too common there is mounting concern over the medical treatment available to the growing army of the psychologically and physically scarred. The situation is prompting fears that Britain could soon mirror America post-Vietnam and be dealing with a generation of seriously ill and embittered veterans.


This month (August), an extensive examination of the British military by King’s College in London found rising levels of PTSD and psychological distress in personnel exposed to prolonged periods of conflict in Afghanistan and Iraq. A study of 5,500 regular troops found that about 20% were on tour for longer than recommended and were at an increased risk of PTSD. The King’s College study came after it emerged in March that the Ministry of Defence has reduced manning requirement for psychiatrists from 25 in 2001, to 15 in 2006, despite the on-going conflicts that are stretching military resources to the limit. The MoD admits that 2123 troops have been treated for various mental health conditions related to their service since 2003, including 320 for PTSD. But Combat Stress, a charity that aids military veterans, the Royal British Legion and the National Gulf Veterans and Families Association, all claim that at least 10 times that number are seeking help for various psychological traumas. As many as 21,000 people could be affected.


Furthermore, there has been criticism that as the number of physically wounded grows by the day Britain’s capacity to deal with them in the long term diminishes. Since 2001, 223 (check for latest) soldiers have died, 573 have been wounded and more than 5000 have been airlifted from places such as Iraq and Afghanistan. With the numbers being treated having nearly doubled from 24,000 in 2002, to 45,000 in 2004, there are fears the NHS is being overwhelmed because the UK’s military hospitals were all closed in the late 1990s and replaced by a scattering of MoD NHS Units. In an unprecedented move the Royal British Legion has launched a campaign demanding that the government upholds the Military Covenant which says soldiers should always be able to expect fair treatment in return for the rights they forgo. The lack of medical support has left many former servicemen like Barclay in despair. “A lot of people feel completely abandoned by the army,” he says.


ON June 14h, 2007, Baroness Thatcher, Tony Blair and Gordon Brown were among thousands of people attending a ceremony at Horse Guards Parade in London to commemorate the 25th anniversary of the end of the Falklands War. To mark the occasion Baroness Thatcher also broadcast a speech on radio to islanders and British troops and said that Britain’s armed services are unmatched in their skill and professionalism. “The service they offer and sacrifice they make are an inspiration,” the former prime minister said. Her successors in Number 10 no doubt shared her sentiments.


During the Falklands War 255 British service personnel made the ultimate sacrifice while another 755 were wounded. But since then a staggering 300 veterans of the conflict have taken their own lives, the number of suicides now 45 more than the total killed in combat. As well as those who committed suicide, hundreds more have been forced into life on the streets, many huddled in doorways not far from the scenes of commemoration in London in June. It’s an unfolding tragedy and largely unnoticed by a society which, their comrades say, seems not to comprehend or care about the scars left by the war on the lives of soldiers.


Organisations such as the South Atlantic Medal Association (SAMA) charge successive governments, including that of Baroness Thatcher, of having failed to look after returning service personnel and refusing to acknowledge PTSD. Falklands veteran Rob Brady, from Ayrshire, served as a Royal Marine with 40 Commando and took part in the Battle of Two Sisters on June 11/12, 1982, during the advance toward the capital Port Stanley. He finds it almost impossible to talk about his experiences in the Falklands and says the memories have been particularly painful this year because of the 25th commemorations. In June he was in Edinburgh and laid a wreath at an event to mark the anniversary.

Brady is suffering from PTSD but was only diagnosed in 2005. “I never knew anything about PTSD or what the signs were. I’ve had lots of problems and my marriage broke up but I always thought my behaviour was normal. We are now involved in a block of wars and more people are having the issues I have. Although I think the government is trying to do its best it’s a bit like a local accident and emergency department trying to cope with a disaster on the scale of the Lockerbie disaster,” he says.


The MoD says it recognises “mental illness as a serious and disabling condition” but that the overall rate of mental illness in the armed forces remains low. In response to the King’s College report, Under Secretary of State for Defence Derek Twigg said: “We have taken great steps to raise awareness and we are studying the research to see how we can reduce even further the number of troops who suffer from mental illness.” On their return from operations, the MoD says, personnel can access out-patient care at one of the 15 military Departments of Community Mental Health in the UK and overseas. There is one in Scotland. In-patient care is also provided by the private Priory Group. The government added that a medical assessment programme set up to help Gulf War veterans would be extended to those who fought in the Falklands


But people like Brady ask why has it taken 25 years to do this. He is being treated for PTSD at a place called Hollybush House in Ayrshire, as is Barclay. The occupational therapy unit is run by a charity called Combat Stress and is the main centre in Scotland dealing with PTSD in ex-service personnel. In fact, it’s the only large specialist facility. Hollybush, partially funded by the MoD, covers not only the whole of Scotland but also Northern England and Northern Ireland. Gary Walker, head of clinical services at Hollybush and a former psychiatric nurse with 23 years experience in the army, says that in 2006 Combat Stress received 1000 new referrals, a rising toll he described as “unprecedented”. “Treatment on the NHS is a lottery and there are long waiting times. Services in the army are good but the problem is accessibility. The closure of military hospitals in the late 1990s has exacerbated the problem and there is the added problem of filling military psychiatry posts,” he says.


Spend some time at Hollybush and you’ll hear stories of broken marriages, prison, homelessness, suicide attempts, drug abuse and alcoholism. And you’ll hear that the government does little for ex-service personnel with mental health problems. “I asked but was never given any advice or help and I always thought the problem was myself…I had rage, depression and ended up standing in the loft with a rope tied round my neck,” says Stevie Gibb, 37, from Kilmarnock, who served in Northern Ireland and in the first Gulf War, before ending up in prison. Ex-sailor Alistair Parker, 47, left the navy in 1982 and has “PTSD sucks” tattooed on his arm. He ended up drinking a bottle of vodka a day to blot out memories of fishing bodies out of the sea. “I asked for help from the navy but was told to ‘get on with it’. I ended up running a pet shop in Ayr but since then I’ve never been able to hold down a job,” he says. Henry Battersby has been pretty much jobless and homeless since leaving the Coldstream Guards in 1991. “The army’s therapy is gallows humour or getting drunk. You feel alone and having no money is even worse because you can’t afford drink to get to sleep,” he says. And families of veterans suffer too. Hollybush offers a support service for carers like 25-year-old Janice MacDonald, whose husband Tom served in Bosnia. “We have no social life because Tom can’t go out…he has nightmares all the time and wakes up covered in sweat,” she says.


But medical treatment does save lives and all the above will attest to that. Since coming to Hollybush Barclay, Brady, Gigg, Parker and MacDonald have all had their lives turned round thanks to the expertise of the psychiatric staff and the camaraderie that Hollybush House offers. Individuals will come for two weeks stay at a time, up to three times a year and will participate in anxiety management classes and counselling from staff and importantly, other patients who understand their issues. Many patients also undertake Eye Movement Desensitization and Reprocessing (EMDR), a complex, highly specialized therapy used to overcome the effects of traumatic experiences. EMDR combines several therapeutic methods - psychodynamic, cognitive behavioural - with eye movements or other forms of rhythmical stimulation, such as hand taps or sounds. It involves recalling a stressful past event and “reprogramming” the memory in the light of a positive, self-chosen belief.


“Not so long ago I was lying in my billet in Basra hoping a mortar would land on me but now I have a job and I don’t walk the Erskine Bridge every day. It’s too late for many guys at Hollybush and it will take a long time us to fully recover. But if the army offers more help and early intervention then the guys fighting now may have a chance,” Barclay says.

Ends. Copyright, Billy Briggs.

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