Select Committee on Defence Written Evidence

Memorandum from Robin Short, Martin Kinsella and David J Walters

  In oral evidence to the Defence Select Committee's[36] inquiry into Recruitment and Retention in the Armed Forces, a statement was a made which suggests the existence of a much higher level of PTSD than has previously been admitted by MoD officials. We believe that the loss of personnel as a consequence of mental health problems will have a significant impact on the long-term retention of military personnel.

  Mr Jenkins, in the course of a question directed to Professor Strachan, made the following statement: "We recently found in our report on the Annual Report and Accounts that the failure of the Army and the RAF to achieve their Harmony Guidelines was unacceptable, so what can the Armed Forces do to improve observance of the Harmony Guidelines?"

  Professor Strachan replied, "They can do very little while they are under the operational pressures they are under. One of the absurdities of the report is the expectation that Harmony Guidelines can be sustained".

  And Professor Dandeker added, "On Harmony Guidelines, I think there is some important contextual information that needs to be remembered, which is that something between 13 and 20% of personnel are in breach of Harmony Guidelines .... The second point is that the Harmony Guidelines, so far as our own research is concerned, show that if you keep personnel within them their mental health does not suffer. It does suffer if you go over those guidelines, so I think the point to recall is that the great majority are within the Harmony Guidelines. I think that the Harmony Guidelines have been well constructed because the evidence suggests that if you stay within them they do not suffer; if you go beyond them there is a 20-50% likelihood that they will suffer in terms of PTSD."

  From the evidence offered by these two experts, we see that:

    —  The army and RAF have failed to meet harmony guidelines.

    —  There is little likelihood of achieving them with the present operational tempo.

    —  13-20% of personnel are in breach of the harmony guidelines.

    —  20-50% of those in breach of the guidelines suffer in terms of PTSD.

  According to the MoD factsheets 7,800 personnel are deployed in Afghanistan[37] and a further 4,000 in Iraq[38], amounting to a total of 11,800 personnel currently employed in theatre.

  Army harmony guidelines state that individuals should not exceed 415 days of separated service in any period of 30 months. At unit level, tour intervals should be no less than 24 months. So soldiers can be deployed for a maximum of 5.5 months out of every 12. This means that 25,745 troops will need to be deployed each year to ensure that the harmony guidelines are not exceeded.

  Based upon Professor Dandeker's evidence, it is possible to calculate the minimum and maximum rates of PTSD that can be expected to arise from a required annual commitment of 25,475 service personnel deployed to Afghanistan and Iraq.

    —  The minimum in breach of harmony guidelines is 13%, which equates to 3,347 soldiers.

    —  The maximum is 20%, equating to 5,149 soldiers.

    —  From this group, between 20% and 50% will suffer in terms of PTSD.

    —  So, the minimum number of British service personnel who can be expected to develop PTSD each year is 669, while the maximum is 2,575.

  In other words, at least 2.6% of British troops will develop PTSD, and in the worst case 10%. If we take the average of the maximum and minimum values, 6.3% of personnel deployed to Afghanistan and Iraq can be expected to develop PTSD. That equates to 1,605 new cases each year.

  This figure is higher than the Kings College study[39] cited in the Journal of the Royal Society of Medicine, which states that in a survey of 1,198 service personnel deployed in peacekeeping operations between 1991 and 2000, 3.6-5.5% developed PTSD. According to the NHS National Clinical Practice Guidelines for PTSD[40] "the risk of developing PTSD after a traumatic event is 8.1% for men and 20.4% for women".

  The US National Centre for PTSD reports "Numerous studies have since observed a dose-response relationship between trauma severity and PTSD"[41] and the American Journal of Psychiatry states "History of any previous exposure to traumatic events was associated with a greater risk of PTSD from the index trauma. Multiple previous events had a stronger effect than a single previous event"[42]. So, the greater the exposure to traumatic events, the greater the risk of developing PTSD. With 270 British fatalities since 2002 and the high intensity of the operations in Iraq and Afghanistan, the exposure to human death and life threatening experiences is much higher than would be experienced in a peacekeeping operation.

  Although we are not aware of any research into the root cause of premature voluntary release from the services, there is a strong indication from amongst the PTSD casualties we have contacted that the onset of PTSD symptoms prompts them to leave the service, or at least not re-engage to complete a full career. Given military training, it is reasonable to deduce that a decision to seek voluntary release is derived from a sense of failure, or shame, when service personnel realise they are unable to self-manage their symptoms (generally through alcohol and other substance abuse); these feelings are exacerbated by the knowledge that they cannot fulfil their operational obligations to their comrades.

  This then leads to a vicious circle—more personnel leave the service, which requires more frequent deployments for those who remain, placing more personnel outside the harmony guidelines and increasing their exposure to traumatic events. This in turn increases the probability of developing PTSD. So more choose to leave the service; thus the cycle continues.

  Whether the actual figure for those with PTSD amounts to 3.6%, 5.5%, 6.3% or 8.1%, the lowest figure is still much higher than the 1:3,000 (0.033%) of personnel diagnosed as suffering from PTSD during the second quarter of 2007, according to statistics provided by the Defence Analytical Service Agency. We believe that the DFSA figure lacks credibility because it does not include data on PTSD identified in those who have left the armed forces. As has been indicated above, there is strong anecdotal evidence to suggest that servicemen and women will seek voluntary release rather than admit they have PTSD symptoms. In other words, the true level of PTSD is not picked up in DFSA statistics because sufferers leave the armed forces before such a diagnosis can be made.

  In evidence to the Defence Select Committee's recent inquiry into Medical Care for the Armed Forces, we stated[43] that military personnel tend to present with PTSD 10-15 years after the exposure. A recent article in The Times[44] on trauma suffered by war-zone journalists stated that there is an average of seven years between the traumatic event and the onset of PTSD. After six years of intense operations in Iraq and Afghanistan, Professor Dandeker's figures suggest that the real number of service personnel and veterans becoming PTSD casualties is already in the region of 9,630 and rising at a rate of over 1,500 each year. Even if we assume a 50% margin for error, and that only 4,815 personnel have actually suffered from PTSD, the consequent loss of trained servicemen and women is having a significant, detrimental affect both on retention and on the operational capability of the armed forces. If these 4,815 personnel had been provided with effective support and treatment for their PTSD the MoD would not now have to acknowledge:

    —  That the British infantry is 1,280 men short of full fighting strength.

    —  That operational battalions were deployed with a shortfall of up to 100 soldiers.

    —  That the predicted trained strength of 99,300 is under the required level of 101,855 (a shortfall of 2,555, which is less than the number lost to PTSD).

  As has been previously identified[45] there is neither the capacity nor capability within the MoD or NHS to handle the 10,000 new PTSD cases which can be expected to occur over the next five years[46]. Ongoing failure to address the real level of PTSD experienced by our service personnel will only place an ever-increasing number outside the harmony guidelines, increasing susceptibility to becoming PTSD casualties and further damaging retention and recruitment in the armed forces.

  We believe, therefore, that the MoD needs to acknowledge the real rate of PTSD, as identified by Professor Dandeker, which will certainly have a negative impact on the number of Armed Forces personnel available for active service. The statistics supplied here clearly demonstrate that a failure on the part of the MoD adequately to deal with the forthcoming PTSD bow wave will have a significant adverse affect on the retention of military personnel.

3 May 2008

36 Question 22 Back

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40   National Clinical Practice Guideline Number 26 ISBN 1-904671-25-X Back

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44 1&leftEndIndex=10&submitStatus=searchFormSubmitted&mode=simple&sectionId=674 Para 22 Back

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46 Questions 48 and 96 Back

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