Examination of Witnesses (Questions 420
- 439)
WEDNESDAY 7 JULY 2004
PROFESSOR KEITH
HAWTON AND
PROFESSOR SIMON
WESSELY
Q420 Mr Hancock: Have the military
ever asked either of you for advice about how they should maybe
give a bit more support to NCOs or junior officers who will be
in charge, maybe not of training units but of actual fighting
units?
Professor Wessely: Yes, I have
been specifically asked for advice on spotting post-traumatic
stress in Iraq, for example, and other conflict situations. Yes,
they do ask for that kind of advice. The curriculum taught to
officers is changing and is kept up to date. They do not always
listen to what I say. Why should they? However, they do ask for
advice on that. I have not specifically on this particular issue,
no, but on other issues, yes.
Q421 Mr Hancock: Are you then both
surprised, being eminent in your field, that the military have
not made greater use of the sort of expertise which is out there,
both to help them during the initial recruiting stage and definitely
in the training stages, not you two in particular but your colleagues?
Professor Hawton: They have not
approached me, but I do not know whether they have approached
colleagues; I just do not know.
Professor Wessely: All I can say
is what I have done, which has not been on this particular issue.
I have, however, done a lot with the military on other issues
of psychological relevance.
Q422 Mr Cran: You may have answered
this question. I might have fallen asleep when you did, so I am
going to re-state it. It is simply this: I am unclear in my mind
whether the incidence of self-harm and suicide is any different
in the general population than any other population and in this
case we are speaking about the population of the Armed Services.
In that regard I think you, Professor Wessely said this. Where
you said it, I do not know, but it is in quotation marks, so I
am entitled to quote it. You said ". . . suicide during military
service is, thankfully, very rare, and like all rare events, almost
impossible to predict".
Professor Wessely: Yes. In general
suicide rates in both the US and the UK Armed Forces are lower
than in the rest of the population in general and there are many
reasons for that. The particular exception we know from the UK
is young men in the Army, where the rate is higher. Those are
the DASA statistics. That might be explained by the fact that
they take more dodgy people and it might be the fact that they
take people with higher risk factors.
Q423 Mr Cran: That is the Army as
distinct from the Air Force or the Navy.
Professor Wessely: That is the
Army. For the Air Force and Navy it is lower overall. On deliberate
self-harm there is no reliable data at all within the Armed Forces.
Keith is making an attempt. My training is epidemiology and we
should love to have that kind of data. It is very hard to get
and at the moment there is no data.
Professor Hawton: One of the problems,
particularly as people move further on in their Army careers,
is that they are more likely to go to civilian hospitals if they
commit a self-harm act and we do not have a national network for
collecting information in any case, let alone collecting it on
Army personnel. There is a real issue about collecting accurate
data which you can then compare with accurately collected data
in the general population, which is available.
Professor Wessely: Whenever we
have mentioned it even simple data protection and confidentiality
issues make you weep.
Q424 Mr Hancock: It is a very serious
issue, is it not?
Professor Wessely: It is very
serious; absolutely.
Q425 Mr Hancock: If you have a young
man or woman who can readily avail themselves of a weapon with
live ammunition, who has been having some sort of treatment in
a civilian hospital or even from their own GP and the Armed Forces
are not told about it, that must be an error somewhere in the
system and it must be something we ought to write in our report,
because it must be seen as something where we are very vulnerable.
Professor Wessely: It is such
a difficult area. As a researcher, I would love to have that data,
of course. On the other hand, if I were that young man who had
chosen to take myself to a civilian hospital because I did not
want specifically the Army to know that I was having trouble at
home and I had just taken an overdose, I would be completely opposed
to what you have just said. One of the papers I have sent to you
was when we did work on screening with the military and how many
of them said exactly that thing, that they did not want details
of their mental health . . . They were perfectly happy to tell
the military about their dodgy knees, but they absolutely did
not want sensitive data, and this is sensitive data, to get back
to the Chain of Command or to the military medical service.
Q426 Mr Hancock: My last question
was going to be on screening again, but both of you have convinced
me that is not an easy option and is not a viable one for the
Armed Forces. My question therefore really relates to whether
it is possible to look at some of the cases that we have been
asked to look at, not just on this Committee, but this Parliament
has been asked to look at, of the 100 or so young men and women
who have died over the last years and to see whether you can glean
from the information which is available on young men and women,
whether or not there was anything in what had happened prior to
the incident which took their lives, which might have signalled
a warning to people. Have you been asked to do that?
Professor Wessely: No.
Professor Hawton: I have not been
asked.
Q427 Mr Hancock: Would it be possible?
Professor Wessely: It is the kind
of thing we do.
Professor Hawton: It is the sort
of thing we do. We are well versed in conducting what are called
psychological autopsy studies, which have been mentioned in some
of the official papers, in terms of trying to reconstruct what
has happened in suicide cases, but we have not been asked to do
this, no.
Q428 Mr Hancock: From our point of
view, do you think that would be something which would be worth
requesting the MoD to invest some money in?
Professor Hawton: It might well
be. If one were going to go down that route, I would suggest investing
the money as well or perhaps instead in investigating what I would
call failed suicides, in other words acts which were clearly,
as far as one could gather, intended to be suicide and did not
result in death, because then you can talk to the individuals
and glean a lot more information from it. That approach, perhaps
combined with looking at the actual cases where death has occurred,
would be the most valuable approach.
Professor Wessely: I should say
in defence of the Army that there is such a study going on. It
is not being done by us and it is on deliberate self-harm not
suicide but is being done at Imperial. That is just within the
Army.
Q429 Mr Cran: If I understood the
answers to my question, you said that the incidence of suicide
in the Armed Forces population is lower than that in the general
population.
Professor Wessely: Correct.
Q430 Mr Cran: But that the incidence
of suicide in the Army is higher than the other two Services.
Professor Wessely: In the Army
in young males.
Q431 Mr Cran: I just want to be clear
about these statistics. Is the incidence in the Army higher than
in the general population?
Professor Wessely: No.
Q432 Mr Cran: It is still lower.
Professor Wessely: It is still
lower, with the exception of that particular sub-group. That change
is significant, but it is based on very small numbers, not big
numbers. You are going to ask me what the numbers are and I have
forgotten.
Q433 Mr Cran: Are they statistically
significant?
Professor Wessely: Yes, they are
significantly increased in young Army males, though it is still
based on a small sample size but a significant one.
Mike Gapes: Perhaps you could send us
the statistics. Sorry, I am told we have them already.
Q434 Mr Cran: If I understood you,
Professor Wessely, you said that there are many reasons why the
incidence of suicide is lower in the Armed Services than in the
general population.
Professor Wessely: Yes.
Q435 Mr Cran: I should just like
you to canter over some of them.
Professor Wessely: One of the
things we are looking at very much is the protective effect of
military life. We are looking at the winners as well as the losers.
Sometimes, for example, they select, they screen, but they screen
on certain variables like IQ, major mental illnesses, physical
disabilities, all of which are risk factors. That is the first
thing. Secondly, for some people who are at risk the Army, the
military environment, is actually very protective. People do well
under that kind of institutional care. Some people do not, but
many people do. Then there is the employment aspect. This is a
job, this is giving people education, trade, and adult literacy,
all of these things. So there are many, many positive aspects
which might further reduce the suicide rate, particularly if you
took account of the risk profile. One of the most important things
we are doing at the moment, which we should really like to continue,
is looking at this issue of exactly what the risk profiles are
of people when they come into the Armed Forces. We do not do that;
the Americans do, we do not. How does that play out during people's
military careers and indeed when they exit into civilian life?
Can you spot the winners and losers at an earlier stage? If you
just take the crude statistics, they are very misleading. I am
sorry to harp on the point, but you have to bear in mind that
the Army is not a random sample of the UK adult population and
it is skewed towards difficult people. I should not say that on
the record, should I, but it is true?
Q436 Mike Gapes: Following on from
what you have just said, is there any evidence to suggest that
suicide rates decline in the Army as an individual's length of
service extends?
Professor Wessely: I do not know.
I am sorry, I do not know.
Q437 Mike Gapes: Is there any correlation
between suicide rates and frequency of operations for people in
the Armed Forces?
Professor Wessely: Suicide rates
are such a rare event that I do not think you could ever do that
statistically. If you can, our study will eventually give you
that information. I suspect it is too rare an event and they deploy
so often that you would find that very hard. The only other point
I would make on that is that evidence we do have is that a certain
number of deployments is good for mental health. Too many is bad,
but having no deployments at all is very bad for mental health.
We have evidence from the Iraq war to show that mental health
actually improved for those deployed during the Iraq campaign
compared with those who stayed behind. Some deployment is good.
Q438 Mike Gapes: Would you be able
to say that greater stability and job satisfaction and personal
success for young people within the Armed Services are actually
positive factors?
Professor Wessely: I am making
that as a generalisation. I hope, as our work continues, we will
be able to be more definitive on that, but I should be really
surprised if that is not the case. That is very much what we are
doing at the moment.
Q439 Mr Hancock: Then you raise a
very interesting issue. One of the things we discovered was that
in between training there was a very significant down period and
it was during that period that most of the incidents that we have
knowledge of occurred.
Professor Wessely: Yes; between
Phase 1 and Phase 2. Yes, I am aware of that.
| 
