LIVE FREE Annual Review 2014
ABOUT US Combat Stress is the leading Veterans’ mental health charity. We provide specialist treatment and welfare support to former members (Veterans) of the Armed Forces, Merchant Navy and Reserves suffering from psychological illness or injury. e create integrated and individually tailored pathways W to recovery to meet each Veteran’s needs. Our free 24-hour Helpline and unique network of multidisciplinary Community and Outreach Teams provides nationwide support. Our three residential treatment centres provide world-class clinical programmes, including an Intensive Post Traumatic Stress Disorder (PTSD) Programme commissioned by the NHS, and comprehensive rehabilitation and well being services. Most Veterans come to us with multiple post-trauma psychological injuries resulting from their Service. Their mental health is complicated by pain and physical disability. We are unique in providing the necessary specialist, multi-disciplinary, long-term treatment. oday, the charity is helping more than 5,400 Veterans. Referrals T have been rising by 10% on average each year. More than 1,800 Veterans made contact with us last year for the first time.1 New referrals from those serving in Afghanistan increased by 57% last year, and we are now treating 662 Veterans who served there. 1. All figures relate to the 2013/14 financial year. 2 Combat Stress | 2014 Annual Review
Combat Stress Head Office, Leatherhead
Hollybush House Treatment Centre, Ayr
Audley Court Treatment Centre, Newport
Tyrwhitt House Treatment Centre, Leatherhead
CONTENTS
Introduction by Andrew Cameron, Chief Executive 4 Our Vision, Mission and Values
6
Three Themes for 2014
8
Commemorating our 95th Anniversary
10
A Legacy for Society
12
From Keeping Busy to Specialist Clinical Treatment
14
The 21st Century Journey to Recovery 16 Together for Veterans
18
Partnership in the Community
20
Raising Awareness to Improve Access to Services for Veterans
22
Striving for a Better Future
24
Straight from the Heart
26
Financial Summary – Where We Spend Your Money
28
Statement of Financial Activities
29
Thank You
30
Honorary Structure and Contact Details
31
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CHIEF EXECUTIVE ANDREW CAMERON – A YEAR OF FOCUS
THE LAST FEW YEARS HAVE SEEN RAPID IMPROVEMENTS IN OUR SERVICE DELIVERY, GOVERNANCE AND INFRASTRUCTURE. THIS HAS ENABLED COMBAT STRESS TO CREATE A UNIQUE, WORLD-CLASS SERVICE TO HELP OUR VETERANS IMPROVE THEIR MENTAL HEALTH. After all this change, in 2013-14 we made a decision to focus on making our services as responsive and Veteran-focused as possible. To this end, we consulted our Veterans and staff to help us develop a new vision, mission, and values statement. We also commissioned an in-depth study into our brand and culture, so that they support and reflect our values. It is important that the outcome of this evolution is a service for our Veterans which really appreciates their achievements and is focused on addressing their needs through timely, effective clinical treatment and welfare support. Veterans’ mental health is the big legacy-issue after 12 years of ‘asymmetric’ warfare (with terrorists, for example) in 4 | Combat Stress | 2014 Annual Review
Afghanistan and Iraq. For Serving men and women, the withdrawal of our Armed Forces from Afghanistan this year is significant, but for Veterans – already psychologically wounded – their battle to regain their health has yet to be won. We know that if we work at it together with Veterans and many other agencies in a joined-up way, to a large extent this battle can be won. At Combat Stress we are also reacting to the particular needs of the Reserve Forces’ community and a younger, more driven Veteran community, who are desperate to turn their lives around and provide for their families. In the coming year we plan to improve access to our services, with rapid, expert needsassessment and faster action to help our Veterans recover.
We take a long-term view, aiming to support recovery with multidisciplinary teams – right people, right place, right time. We aim to join up episodes of intense preparation and treatment, with confidence-building and well being support, to encourage progress along the path to a much improved, independent life. Building on the experience of delivering specially commissioned services on behalf of the NHS, we will be further expanding our therapies, so we can address Veterans’ mental health needs with more bespoke, residential care. Because substance misuse is often a barrier to NHS primary and secondary mental health services, we will also expand our own Substance Misuse Case Management Service which we are now piloting.
In the community, we are collaborating with the NHS to pool our specialist Veterans’ mental health expertise with their substance misuse skills to create, we hope, more successful recovery pathways. We are also collaborating with The Royal British Legion (TRBL), Help for Heroes, SSAFA, Armed Service benevolent charities and State organisations, to provide more effective, joined-up services for Veterans and their families. For those who can reach the new TRBL High Street ‘pop in’ centres, we want to encourage Veterans
to access our services there so that we deliver better treatment and coordination of support. The number of Veterans contacting us has risen a further 12% this year.
None of this would be possible without the generous support and help of our donors, as well as the NHS and the Ministry of Defence (MoD). As the number of Veterans contacting us has risen a further 12% this year (average 10% p.a. for the last five years), this support is vital
so we can do our work. With your help, we can achieve our vision of giving Veterans a real chance to again live a fulfilling life free from the harmful effects of psychological wounds.
5,473 Veterans are currently being supported.
Veteran, Michael Thornton embellishes broken slates with inspiring messages. 2014 Annual Review | Combat Stress | 5
Hollybush House Treatment Centre, Ayr
During the year, we introduced our new brand identity across the organisation, with clearer statements of our Vision, Mission and Values.
OUR VISION
is that Veterans will be able to live free from the harmful effects of psychological wounds.
We worked with key stakeholders including our staff, Veterans and supporters in a large research project which resulted in our new identity. Our brand expresses expertise, heritage and pride, as well as making us more approachable. It conveys hope, and the positive approach to recovery which will help Veterans rediscover the pride and self-belief that they found in themselves when they were in uniform.
OUR MISSION
This year, we have worked to align the Combat Stress brand to clearly define us as the leading Veterans’ mental health charity. We have applied our new identity, imagery and tone of voice to all our communications and to foster this culture across our organisation.
OUR VALUES
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is to provide timely, effective clinical treatment and welfare support to Veterans who suffer from psychological wounds. In order to realise this we must: • Be accessible to those who need help • Be expert at what we do and recognised as such • Work in partnership with others • Raise awareness of Veterans’ needs
are to:
• Always put Veterans at the centre of our work • Aspire to excellence in everything we do • Foster a culture of respect and integrity
VETERANS AT THE HEART OF ALL WE DO
1,086
Veterans were sufficiently well enough to need our active support no longer. 2014 Annual Review | Combat Stress | 7
IN THIS ANNUAL REVIEW 2014, WE ARE HIGHLIGHTING HOW WE FOCUS ON THE VETERAN, TO KEEP THEM AT THE CENTRE OF ALL WE DO. IN REPORTING ON THE IMPACT OF OUR SERVICES THIS YEAR, THERE ARE THREE RECURRENT THEMES:
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THREE THEMES FOR 2014 1. THE MENTAL HEALTH LEGACY TO SOCIETY We have been treating and caring for Veterans since 1919, Veterans who served in many conflicts, from the First and Second World Wars, Northern Ireland and the Falklands to more modern-day conflicts such as Bosnia, the Gulf War and 12 years in Iraq and Afghanistan. We know that, due to the stigma of mental health, Veterans of older conflicts have taken up to 13 years to come forward for help.
But now, as we continue to raise awareness of Veterans’ mental health, and the support available, we find they are seeking help sooner. This year, as troops draw down from Afghanistan, we need to consider the challenges society will face when a greater number of ex-Service personnel may need our support and services in the future.
2. COMBAT STRESS: EVOLUTION As we face the challenges ahead, we take a look back at our evolution and at the founders of Combat Stress, whose plan was to help those who suffered with ‘shell shock’. History shows that participating in meaningful activity was key to moving on from the painful memories of battle.
received National Specialised Commissioning from the NHS to deliver intensive clinical treatment for those with the most severe Post Traumatic Stress Disorder (PTSD). On page 16, we talk to Dr Charlotte Johnson, a clinical psychologist based at our treatment centre in Shropshire.
Today, we recognise this activity as Occupational Therapy. It is a large part of our holistic approach to treating Veterans. In the 21st century, we have evolved to deliver expert clinical treatment to Veterans who have suffered emotional trauma as a result of their Service career. In 2011, we
In the future, we will work to support those who need clinical services and offer more individually tailored solutions for multiple complex mental health symptoms and issues, including pain, anxiety, depression and substance misuse.
3. TOGETHER FOR VETERANS’ MENTAL HEALTH – A FOCUS ON PARTNERSHIP We could not achieve success alone; by working together with other organisations that help Veterans, we can provide much needed support. Through this collaboration we can provide quicker engagement, often in the Veteran’s own community.
On page 18 we highlight some key strategic partnerships this year, and on page 20 we find out how these relationships work at a local level.
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COMMEMORATING OUR 95TH ANNIVERSARY
As you read this Review we are marking the 95th anniversary of Combat Stress. We are immensely proud that, since the charity was founded just after the First World War, we have helped over 100,000 exService men and women rebuild their lives with their families and communities. But it is a sobering thought that our work remains as vital in the 21st century as it was in 1919. So throughout our anniversary year we will continue to raise awareness of our work with Veterans, to help increase understanding and support for those who need our specialist expertise. 10 | Combat Stress | 2014 Annual Review
In May 2014, to mark our anniversary, the news of an increase in Afghanistan Veterans seeking our support gained high-profile coverage across television, radio, the press and the internet. We want to continue that level of interest with ongoing media activity. We have also created a special 95th logo for 2014-15 and are holding additional events that highlight our heritage and mission for the future.
More details are available on our website: www.combatstress.org.uk
WITH YOUR HELP, COMBAT STRESS HAS ACHIEVED A GREAT DEAL IN 95 YEARS BUT THERE REMAINS MUCH TO DO. WE LOOK FORWARD TO NEXT YEAR WITH RENEWED ENERGY AND DETERMINATION.
Commemorating the service and sacrifice of Veterans in the First World War brings mixed emotions – pride, sadness and profound gratitude amongst them – but it also makes us think how much has changed in the past 100 years. Today, we recognise Post Traumatic Stress Disorder (PTSD) and the need to reduce the stigma of mental health problems. But for Veterans, recognising they should seek help often goes against the principles of selfreliance and resilience they have learnt in an Armed Forces career. For most who leave the Services, adjusting to post-conflict life means facing challenges one
can easily imagine: a less wellstructured life, living with family and not comrades, living at a less lively pace and having to find a new purpose. Most will make the transition smoothly, but for some it will be impossible to stop reliving the horrors of the battlefield or cope with the misplaced feelings of remorse and guilt for being the ‘one that got away’. Some may take a detour into drug and alcohol abuse, or become aggressive or angry through the sheer frustration of their situation. Eventually, friends and family may no longer want to be around them. Other Veterans will continue to perceive enemy threats where none exists,
maintaining a soul-destroying and draining state of hyper-vigilance. Some 20% of all Veterans will experience mental health issues – about the same as in the general population. The 2010 report by King’s Centre for Military Health Research shows that for of those returning from Iraq and Afghanistan, 20% will experience mental health issues. A fifth of these Veterans will develop more severe PTSD.
20% of all Veterans will experience mental health issues. A fifth of those will develop PTSD.
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A LEGACY FOR SOCIETY
At Combat Stress we want to make it as easy as possible for Veterans to get help. We reach out to Veterans with our 24-hour Helpline and we offer a range of inpatient and outpatient treatments, therapies and interventions across Britain designed to meet the particular needs of each Veteran who seeks our help. Every week we speak to approximately 175 callers. In 2014 we handled some 10,000 contacts by phone, email and text. Trained staff on the Helpline are often the first port of call for those needing help with war pensions and housing issues, or being registered and accessing Combat Stress support. There has been an increase of 57% in referrals from Veterans of the recent conflict in Afghanistan.
We are now working with more than 5,400 Veterans and Reservists, our highest number ever. They have served in conflicts since the Second World War; included in this number are 662 Veterans from the most recent conflict in Afghanistan. The average age of our Veterans is 42 and typically they suffer alone or in silence for 13 years before seeking help. Post-
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Afghanistan, however, Veterans are approaching us far more quickly – within 18 months of leaving service. This means we can help them before the fabric of their lives is destroyed. It is excellent news that the Veterans of more recent conflicts are coming to us sooner, but it also means there is an increasing demand on our services. We have seen a 12% increase in new referrals from all conflicts in the past year and this trend seems set to grow. We have seen a 57% increase in referrals of Veterans from the war in Afghanistan and Iraq. With troops withdrawing from all but two bases in Afghanistan’s Helmand province in 2014, the number of Veterans needing our treatment is likely to continue to increase.
42
The average age of Veterans who have treatment with Combat Stress.
It is important to remember as we finally withdraw from Afghanistan that mental health is a legacy for society. With Veterans taking many years to approach us for help, we need to keep mental health on the agenda and continue to raise awareness of the specialist treatment we offer to those who need support. Veterans with mental health issues may find relief from depression, anxiety, pain, anger, sleepless nights and flashbacks through self-diagnosis and resort to self-medication, leading to substance misuse (drugs and/or alcohol) which compounds their mental health issues. Veterans may find it difficult to stay in employment and maintain relationships, ultimately increasing the welfare bill for the tax payer. We must remember that while serving their country, many gave themselves in a
way that many of us will never comprehend. So, it is important that today’s Veterans are able to access the many mental health services available to them. We offer specialist clinical treatment and care and an evolving programme to support Veterans in their own communities. But we cannot do this alone and we will continue to help Veterans to access services run by the NHS and other charities which complement our own and best serve their needs. We need to prepare for the continuing demand on our services over the next five years and beyond. But, we know this will be difficult without ‘modern day conflict’ and so we will commit to keep the mental health legacy of conflict alive, and our Veterans in focus, through our awareness -raising communications work.
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FROM KEEPING BUSY TO SPECIALIST CLINICAL TREATMENT
Basket weaving at Eden Manor
2014 marks the centenary of the First World War and we will all remember the sacrifices made by those who served in the UK Armed Forces and across the globe. For some survivors, the psychological scars were too much. Combat Stress (the Ex-Services Welfare Society as it was first known) emerged as a charity to help heal those with wounded minds. Our founders recognised psychological trauma and the need to deal with its aftermath, realising that many casualties of the First World War were overlooked and suffering from the condition described as ‘shell shock’. Contemporary accounts attributed shell shock to a head wound but many were affected 14 | Combat Stress | 2014 Annual Review
by the unprecedented scale and concentration of noise, destruction and death of modern mechanised war. Treatment offered by the Army was, in the first instance, designed to return soldiers to the battlefield. By the end of the war, the nation was faced with a large number of soldiers – many labelled as failures or cowards – who were unable to return to families and get on with normal life. They couldn’t earn a wage and families were often unable to cope with erratic, sometimes aggressive behaviour – now more widely understood as symptoms of Post Traumatic Stress Disorder (PTSD). FINDING A PURPOSE Many believe that the vocational rehabilitation techniques of 1919
were developed out of necessity, but the roots of what we now call Occupational Therapy go back to the Boer War when convalescing soldiers were occupied with quilt making. Vocational Rehabilitation, as used after World War I, also reflected the morality of the time, which demanded a high degree of social conformity and the idea that to be part of society a man had to be productive with regular work habits. Over several years, Army doctors learnt that their patients needed to be able to make purposeful, coordinated movements, in order to take the first steps back to working life. The tasks were introduced incrementally from simple crafts,
Woodworking Shop
or at Eden Man Leatherwork
such as basket weaving or knitting, progressing to vocational work such as typewriting or mechanical drawing. Over time and through many conflicts we have slowly refined the way we care and treat those who suffer with mental health problems. In 2007, Combat Stress employed the services of a full-time Medical Director. With this appointment came a new drive to deliver specialist clinical care and treatment for Veterans suffering with mental health problems. Combat Stress was awarded NHS National Specialised Commissioning to deliver a PTSD Intensive Treatment Programme based on proven clinical methods developed from an Australian
model. This programme is now available UK-wide. (You can read more about it on pages 16 and 17.) During the past year, we received 1,800 requests for help: of those, 60% went on to receive active intervention and treatment. This figure may seem low, but compares very well with counterpart services abroad, which only return an engagement rate of 30%. Nonetheless, we would like to see more Veterans engage with the Intensive Treatment Programme. More often than not, they present with multiple issues that co-exist with PTSD, such as chronic pain, anxiety, depression or substance misuse.
It means each Veteran needs a highly individualised treatment plan and appropriate care pathway. Our services are evolving all the time to meet their complex needs. Next year, we will be expanding our pilot Substance Misuse Case Management Service for Veterans who cannot access mental health care because of a substance addiction. It means they will be guided into appropriate substance misuse and mental health services – working together – for the first time in England and Scotland.
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THE 21ST CENTURY JOURNEY TO RECOVERY Dr Charlotte Johnson is a clinical psychologist at Audley Court, our residential treatment centre in Shropshire. She describes how Combat Stress is breaking new ground in the effective care of Veterans with PTSD. I joined Combat Stress at a really exciting time: October 2012, just two weeks before the launch of the Intensive Treatment Programme for PTSD at Audley Court. No other service provider was offering this kind of intervention in the UK. In the last year of my doctoral training, I did an elected placement within an NHS community mental health team in the Midlands. I was specifically dealing with the PTSD cases:
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the result of harrowing, one-off experiences among the general public. I knew then that I wanted to specialise in this area – but treating individuals who’d been exposed to repeated military trauma would present a whole new challenge.
dramatically over the past year. If a Combat Stress Community and Outreach Team thinks treatment at Audley Court might be appropriate, they will refer a Veteran to our Outpatients’ clinic where he will be assessed and diagnosed by a psychiatrist.
I’d come to the right place to find out. At Audley Court we see a huge range of Veterans of all ages and conflicts, though predominantly those who’ve served in Northern Ireland, the Falklands, Iraq and Afghanistan. Most have a diagnosis of PTSD; many have PTSD plus depression, an anxiety disorder and/or alcohol dependence.
Then he will meet a psychologist or therapist (I am one of a team of seven) who will map out his history in detail, where his problems originated, how they’ve developed over time and what’s maintaining them today. We will also explore the Veteran’s ability to engage in treatment – in oneto-one and group therapy – as well as his or her motivation to change and get better.
Developing clearer pathways for their care has improved
Once a week, the clinicians hold a multi-disciplinary meeting to discuss each assessed Veteran on an individual basis and decide on an appropriate care pathway. Some will be referred back to the community for treatment in the NHS, for example. Others will be offered a place on a two-week residential course at Audley Court. Those ready to address their PTSD will attend our Intensive Treatment Programme (ITP). Sixteen Veterans join the ITP at any one time. Over the course of six weeks, they take part in 42 sessions of group therapy and psycho-education. Each will undergo individual, traumafocused therapy with a clinician like me at least 15 times during their stay. The ITP is not something that is done to Veterans with PTSD: they are very much part of their own recovery process. They are consulted about their goals and treatment options throughout. Equally, they need to take responsibility for making changes and practising the therapeutic strategies learnt. Movingly, by day two of the programme, Veterans are bonding as brothers-in-arms – fostering acceptance of their condition and supporting each other’s progress with their own experiences.
Once Veterans have completed the ITP, they are invited back to Audley Court for follow-up after six weeks, six months and a year. For each programme, they are given a series of psychometric assessments to measure the reduction in their symptoms. Outcomes are looking good, which suggests we are really helping people. Moreover, thanks to the number of programmes now delivered at Audley Court, Tyrwhitt House and Hollybush House, Combat Stress has gathered considerable data for further analysis on the effective treatment of PTSD. In the meantime, a good day at the office for me is this: when a Veteran with PTSD has that ‘light bulb’ moment and finally understands what is going on in his life and knows a way to move forward.
1,802 total of new referrals in the year.
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TOGETHER FOR VETERANS Partnerships are key to the services we offer Veterans and are essential to ensure that we achieve a coordinated care pathway that is sustainable and does not duplicate what is available elsewhere. Over the last year we have sought to strengthen and widen our relationships with other charities and the NHS. Among the highlights are our arrangements with:
THE ROYAL BRITISH LEGION (TRBL) Building on the success of the Break Away Programme, which sees our clinicians offer Veterans and their families structured Occupational Therapy and well being sessions as a residential course at centres owned by TRBL, we are now joining together once again to provide a facility in the high street community to serve Veterans’ many needs. TRBL sites will be branded ‘pop in’. Centres now open include Liverpool, Plymouth, Manchester and Brighton. We are establishing our Community and Outreach Teams in the ‘pop in’ centres in areas where Veterans live, and we now have permanent space in both Liverpool and Plymouth. The majority of the other sites will have opened for business during the summer of 2014. HELP FOR HEROES Following the decision by Help for Heroes to deliver low-level mental health interventions to Veterans and their families (the Hidden Wounds Programme), we have worked with them to ensure the success of the project. Together, we will provide access to this service, or that of our own service depending on the needs of the Veteran. HELPLINE The Combat Stress Helpline continues to be provided by Rethink Mental Health and now,
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thanks to the Armed Forces Covenant funding, is secure for a further two years. The Helpline has expanded this year to cover out-of-hours calls to the Veterans UK Helpline and the service will be expanded in 2014 to include out of hours calls to the Help for Heroes Hidden Wounds helpline. This service handles some 10,000 contacts a year by phone, email and text. ARMED FORCES HEALTH PARTNERSHIP WORKING GROUP Combat Stress has joined together with The Royal British Legion (TRBL), SSAFA, the ex-Service benevolent charities, the Department of Health (DoH), Ministry of Defence (MoD) and the NHS to provide an overarching body in the area of Veterans’ health. This group, under the joint Chairmanship of Combat Stress and TRBL, will provide a consolidated response to discussion documents and advice to other bodies, such as COBSEO (Confederation of Service Charities) and Veterans Scotland. MENTAL HEALTH FIRST AID (MHFA) This programme is funded by the Armed Forces Covenant, and is delivered by MHFA England and governed by a partnership group comprising SSAFA, TRBL, Combat Stress and the DoH. It aims to provide the mental health equivalent of first aid training for those working in the Veteran community. Participants learn the skills and develop confidence
to give crisis first aid for suicide and self-harm. The core principles include spotting the signs of mental ill-health, helping to stop the distress from worsening and giving people confidence to help someone who is experiencing difficulties. ADVOCACY AND INFLUENCE During the course of the last year Combat Stress has provided both written and oral evidence to the House of Commons Defence Select Committee and the Northern Ireland Committee concerning the needs of Veterans and their families. We have also engaged with the Labour Party as they gather information about the Veteran community, Rory Stewart MP concerning Veterans in the Criminal Justice System,
met regularly with the Health Minister, Dr Dan Poulter MP, and contributed to the Ashcroft Report on Transition. Previous partnerships are not forgotten and we have refreshed our Memorandum of Understanding with The Warrior Programme, continued to develop our already strong links with the MoD, DoH, the NHS and Public Health England whilst seeking new alliances with other smaller and varied providers. Our aim is to provide Veterans with the widest array of linked services that together will meet their needs.
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PARTNERSHIP IN THE COMMUNITY Philip Shuttleworth MBE joined Combat Stress in April 2013, after a 37-year career in the Royal Marines. Here he explains why working in partnership means working smarter – and all in the Veteran’s best interests. I am a Regional Welfare Officer in our South Central Community and Outreach team: the first person that Veterans meet once they’ve been referred to us. Our patch is made up of six 20 | Combat Stress | 2014 Annual Review
counties: Hampshire, Wiltshire, Dorset, Buckinghamshire, Gloucestershire and Oxfordshire. We are a Team of five with a current caseload of about 350 clients. The road to recovery often begins as a partnership of two, usually in a Veteran’s own home, opening up – perhaps for the first time – to the Welfare Officer who has to win his trust. Telling him about my military background
350
We are a team of five with a current caseload of about 350 clients.
helps immensely: it’s not what I say, it’s what I know. It means I can empathise and understand. Empathise – and hopefully engage – but not sympathise: a Veteran must want to rebuild his life; it’s a two-sided relationship. Based on my written assessment of that meeting, we in the Community and Outreach Team can start to develop a bespoke clinical care and welfare programme for the Veteran. This is where the partnership of two begins to open up. With the Veteran’s consent, our team’s Community Psychiatric Nurse or Mental Health Practitioner will carry out an initial psychological assessment, liaising closely with the individual’s GP and with clinical colleagues at Combat Stress for possible residential treatment at Tyrwhitt House. If more appropriate, they will liaise with the Veteran’s local NHS and other mental health service providers and/or deliver therapy in the community itself. I help with the practicalities of life, improving a Veteran’s overall wellbeing. This may involve assistance with finances, housing and applying for a war disablement pension. I will signpost Veterans to The Royal British Legion, SSAFA, the SPVA (Service Personnel and Veterans Agency), benevolent charities and many others to ensure they are supported from every angle. The long experience of these organisations is invaluable.
Increasingly, however, we are seeing our network of partners expand and diversify. It means that we at Combat Stress can reach and better support more Veterans in the community, and Veterans can more easily engage with us. Thanks to Help for Heroes, for example, we are able to use its Tedworth House Recovery Centre in Wiltshire as a ‘drop-in’ venue for a well-attended monthly Outreach meeting. Veterans come for additional welfare guidance and one-to-one therapy. Their partners can accompany them, and we arrange for specialist guest speakers to talk on subjects that matter to them both.
51% of our income is through donations.
49% of our income is earned through statutory providers – partnership is key!
Combat Stress now has a Regional Welfare Officer based at Tedworth who provides help between monthly Outreach meetings and carries out the initial welfare assessment and follow-up of some of the growing number of new referrals. Oxford City Football Club is hugely supportive too, providing facilities for a monthly Outreach meeting at its stadium. Again, Veterans can engage one-to-one with a Combat Stress clinician and Regional Welfare Officer. Other charities, support agencies and local council representatives attend too, ensuring that clients are able to access many agencies at once in a ‘one-stop shop’ environment.
FOR AN EX-SERVICE MAN TO ASK FOR HELP IS A TOUGH CALL; FOR A VETERAN WITH MENTAL HEALTH PROBLEMS, HARDER STILL. FIRST WE MUST GAIN HIS OR HER TRUST IN THAT FIRST ENCOUNTER IN THE HOME. WE WILL THEN ENGAGE WITH ANY ORGANISATION IF IT WILL HELP THE VETERAN LEAD A MORE FULFILLING LIFE. 2014 Annual Review | Combat Stress | 21
RAISING AWARENESS TO IMPROVE ACCESS TO SERVICES FOR VETERANS All charities need to find ways to communicate with those who use their services and support them. This includes a mix of advertising and public relations (PR), which helps us to interest the media, and their coverage raises awareness of our work – which in turn supports our fundraising. This year at Combat Stress we secured thousands of pieces of media coverage, ranging from radio to television reports, articles in newspapers and comments in online social media. This coverage serves to improve people’s understanding of the issues faced by Veterans, and the support that we offer. In particular, powerful and moving stories from Veterans about their journey to recovery help the public to understand the challenges ex-Service personnel face and the respect they deserve. Those in the public eye help us to tell our stories, and we were delighted to have Downton Abbey actress Joanne Froggatt become a charity ambassador, alongside actor Sir Patrick Stewart. In January, Sir Patrick fronted a BBC Lifeline television appeal about our work, raising thousands of pounds for Combat Stress. We also featured on BBC Celebrity Mastermind when London Olympic gold medallist Sophie Hosking competed in aid of Combat Stress. In November musician Bryan Adams published 22 | Combat Stress | 2014 Annual Review
a book of photographs featuring UK Afghanistan Veterans with psychological and physical injuries and we hope the book will raise up to £50,000 for Combat Stress. We also worked with BBC Sport Relief to create a short film that millions of people saw on their appeal night in March.
3,768 new donors joined us in 2013/14
Following the launch of our new brand ‘identity’ in 2013 we worked with marketing agency, Arthur London, to create a hard hitting advertising campaign – the ‘bullet’ – focusing on suicide prevention. This reached more than 26 million people over four weeks. It featured on Classic FM radio, in posters on trains and the Underground, and in the national press including the main weekend broadsheets. Our radio ad was so powerful that digital station UK Health Radio ran the campaign for an additional month free of charge: perhaps you heard it…
Many people also engage with Combat Stress online – by visiting our website, following us on Twitter or as part of our Facebook community. We aim to let people know what’s happening through the internet and really appreciate seeing your comments, but we know that many people also still like the traditional ways of staying in touch. This year, we kept supporters up to date with how their money makes a real difference to Veterans’ lives through our mailings. We launched a new ‘Support Works’ newsletter during the year which resulted in an additional £61,000 in donations. As we improve our digital communications and gather supporters’ email addresses, we’ll be able to stay in touch more easily. We realise we must work harder still to communicate with new audiences. The more people are aware of, and understand our work with Veterans, the more we can do to help them rebuild their lives.
For every £1 we spend talking to our existing donors, we make £5.50
The remarkable Walk on Wales, organised by Jan and Fiona Koops and Dai Graham was an 870-mile, seven-week test of endurance that raised over £300,000 for Combat Stress and the Welsh Guards’
Afghanistan Appeal. Walking through some of Britain’s most stunning coastal scenery and involving hundreds of participants along the way, this was a brilliant, successful fundraiser and community event. 2014 Annual Review | Combat Stress | 23
STRIVING FOR A BETTER FUTURE
As part of our Strategic Plan, we aim to develop integrated Community and Outreach Services for all our Veterans, whether they attend our outpatient or residential programmes. Building on our progress to date, we asked Dr Walter Busuttil, our Medical Director, to look forward to the year ahead… here are his thoughts. Combat Stress has achieved a great deal during the course of the last financial year. Our clinical treatment programmes have been very successful, and we are continuing to refine and implement change to our service delivery for the benefit of our Veterans. During the course of the next year, we will need to continue to consolidate this work, refining, updating and striving for perfection in our clinical delivery model. We are trying to create an integrated service, to make sure that those who need help receive the right support in the right place, at the right time, with the right people. From a clinical perspective, we are going to realign our Community Service to offer high street clinics and group
24 | Combat Stress | 2014 Annual Review
meetings. This will happen gradually as we work with The Royal British Legion as it rolls out its ‘pop in’ centres. We will of course continue to do outreach work: our Welfare Officers will see Veterans in their own homes; for those who absolutely need it, they can also receive clinical help at home. Outpatient services are proving successful and are led by Consultant Psychiatrists and Psychologists. Looking ahead, there will be scope for some of these clinics to move into the community in due course, as part of our partnership with the Royal British Legion ‘pop in’ centres. With regard to new programmes and joint care pathways, we will continue the roll-out of our pilot case management service for substance misuse. For the first time, Combat Stress Veterans in England and Scotland will be guided into appropriate substance misuse and mental health services working together. The service has been working with Glasgow and Clyde NHS Trust to give better access to both voluntary and statutory substance misuse services in England and Scotland. We will expand the case management service to cover more regions
and this should be complete by early 2015. At our treatment centres, we are introducing new programmes to prepare Veterans for change. Support including stabilisation, alcohol and illicit drug education, anger management, and the trans-diagnostic programme will be coming on line. Of course, we are still running our PTSD Intensive Treatment Programme, which lasts for six weeks to treat Veterans with severe chronic and complicated presentations of PTSD. All these programmes are running well, and we hope to publish the results - our clinical findings - in the next few months. The programme outcomes will be submitted to appropriate medical journals for peer reviewed publication. As part of an effective evidence base we should evaluate outcomes for all our programmes. To this end we will appoint an Honorary Lecturer in Clinical Psychology for Combat Stress, who will also be working with the King’s Centre for Military Health & Research (KCMHR) at King’s College, London. This is an innovative appointment. It means there will be a true collaboration between our clinical work and our outcome clinical audits
and research. This in turn will mean that all our findings will be available to the Veteran community once published. It will allow for greater service planning not only for Combat Stress but also other third sector Veterans’ charities, as well as the NHS and the Ministry of Defence. Alongside clinical treatment, we will continue to offer Occupational Therapy-led Wellbeing and Rehabilitation as encouraging participation and building skills and confidence is an important part of recovery. We will continue to run our Break Away Rehabilitation Centres for Veterans and their families in the year ahead. Overall, Combat Stress is doing well from a clinical service point of view. Our strategy now, in the next twelve months, is to consolidate what we have
started. The next 12 months will prove to be both interesting and challenging. PATIENT ADMINISTRATION SERVICE A key part of our drive to improve all aspects of the service we provide to Veterans is the complete replacement of our Patient Administration System (PAS) as we move to implementing one of the leading solutions in the industry. At its core, this new approach will transform the ability of any of our staff to securely access and update the information they need to ensure the very best continuity and quality of care for Veterans regardless of location. This will also enable us to deliver the highly detailed level of outcome monitoring we need for optimum service delivery, reporting and research.
293
Veterans have benefited from a BreakAway with their families (provided in partnership with The Royal British Legion).
2014 Annual Review | Combat Stress | 25
STRAIGHT FROM THE HEART My name is Gary Driscoll and I was in the Army for 16 years. I served on five operational tours of Northern Ireland and reached the rank of Colour Sergeant. In 1979, when I was 19, I joined the Royal Green Jackets and my first posting was to the 2nd Battalion in North Armagh. Within hours I was out on patrol following an ambush. A couple of years later, during a tour of West Belfast, I was on patrol on a Saturday afternoon. Children were playing in the streets and mums were pushing their prams to the shops, when suddenly all hell broke loose. Three shots were fired directly at me, missing my head by inches and hitting the wall behind. I had become the target of an IRA sniper. It was very frightening, especially as it was not on a foreign battlefield but in a housing estate in Belfast. It was impossible to see where the terrorist was firing from. During these tours, soldiers had to hide their fears and not show any emotions or signs of weakness.
26 | Combat Stress | 2014 Annual Review
I was more concerned that my commanders might think that I was not up to the job of being a good soldier. We all thought the same; no one ever shared their feelings, as we believed that it was bad for morale or could affect chances of promotion. Besides, there was no counselling offered back then. Whenever I returned home from a tour of Northern Ireland, I would still be ‘switched on’ – hyper alert – and looking out for any signs of potential danger. In restaurants and pubs I would have my back to the wall. I was already experiencing mental health issues but just accepted it as a way of life for a soldier who has been to Northern Ireland. My worst memories of these tours are of losing friends who were killed – friends I will never forget – and the hatred that I and my fellow soldiers felt from some of the people who lived in the hard republican areas of West Belfast. If I had been on operation in a foreign country, I could have
Gary during his time in Northern Ireland
In restaurants and pubs I would have my back to the wall.
understood it better. But here in the UK, where the surroundings and the language were much the same as where I grew up in London, it had a bad affect on me. I was beginning to lose patience with lots of things, like spending time with my children, and I would get agitated when I was in my car and stuck in traffic. I began to find it very stressful to be in crowded shops, pubs and clubs. I was constantly arguing with my wife and eventually we split and got divorced. After marrying for the second time I decided to leave the Army; it was about two years later that my problems got worse. I started to drink more excessively and would become very emotional when watching the news or documentaries which featured anything to do with war. I was also starting to experience nightmares: I would dream that someone was trying to kill me while I lay asleep in my bed. My wife insisted that I seek help. I wouldn’t listen, insisting that anger and drinking to excess was normal for an ex-soldier. I kept telling myself that I had to keep ‘switched on’. A few years later and still suffering, my wife Maria found out about Combat Stress and I eventually agreed to a visit from one of their Welfare Officers. He suggested I attend the charity’s Surrey treatment centre.
I went along for an assessment. I had a one-to-one with the psychiatrist and I was diagnosed with PTSD. Although it came as quite a shock, I then finally accepted it and could move forward with treatment. I stayed at the Centre for several two-week courses over a period of three years. I attended an assortment of group therapy sessions: for example, on anxiety, alcoholism, depression, anger management, and mindfulness. The mindfulness sessions were my favourite: they helped me keep calm whenever I began to get agitated or angry. At Combat Stress, ex-Service men can learn how to cope with their symptoms of PTSD in a safe environment, surrounded by likeminded people who can relate to one another. Thankfully, due to the support of my wife, family and work colleagues in seeking help from the charity, my life is as normal as most people’s. I have a good job, great friends and a great life. I am still very much connected to my regimental family – I am Secretary of the London branch of the Royal Green Jackets Regimental Association – and at weekends I am an entertainer. I sing at social clubs, weddings and charity nights. Singing is a wonderful form of therapy, although I’m not sure if my audiences would agree.
HAVING ATTENDED TREATMENT WITH COMBAT STRESS, I HAVE BEEN ABLE TO TALK MUCH MORE OPENLY TO PEOPLE ABOUT MY PTSD, AND THANKFULLY I AM NOT UNDER ANY MEDICATION FOR MY ILLNESS OR HAVING TO RELY ON A WAR PENSION TO PAY THE BILLS. MORE IMPORTANTLY, THOUGH, I HAVE LEARNED HOW TO ‘SWITCH OFF’. 2014 Annual Review | Combat Stress | 27
FINANCIAL SUMMARY – WHERE WE SPEND YOUR MONEY WHERE OUR FUNDING CAME FROM – £17,385K During the year voluntary income included a grant of £2m to cover the costs of running a new pilot Substance Misuse Case Management Service. This income has been received in advance and must be spent carefully and efficiently to cover expenditure over the three year duration of this pilot service. Excluding this £2m, the remaining income available for spending in 2013/14 totalled £15.4m. However, our actual expenditure came to £16m, £0.6m being funded from our reserves.
£6098k
Clinical Services
£7k
Other Income
£14k
Trading Company
£98k
Events
£160k
Corporates
£396k
Statutory Grants
£402k
Major Donors
£598k
Investment Income
£1011k
Volunteers & Community
£1324k
Individual Giving
£1695k £3382k
Trusts and Service Charity Grants
Legacies
£2200k
Armed Forces Covenant
… AND HOW WE SPENT IT – £16,002K £57k Substance Misuse Case Management Service
£195k UK Reserve Forces
£209k Governance
£210k £9148k
Helpline
Residential Treatment Programmes
£440k
£3459k
£2284k
Community & Outreach Services 28 | Combat Stress | 2014 Annual Review
Raising Awareness and Improving Access Cost of Generating Funds
STATEMENT OF FINANCIAL ACTIVITIES (incorporating an Income and Expenditure Account) for the year ended 31 March 2014.
Incoming resources Incoming resources from generated funds Voluntary income Activities for generating funds Investment income Incoming resources from charitable activities
Unrestricted Restricted Totals Totals Funds Funds 2014 2013 £’000 £’000 £’000 £’000
10,584 8,335 98 49 598 421 6,098 6,698
5,711 98 598 6,098
4,873 - - -
Other incoming resources
7
-
7
64
Total incoming resources
12,512
4,873
17,385
15,567
Resources expended Costs of generating funds Cost of generating voluntary income 2,216 - 2,216 1,614 Investment management fees 68 - 68 53 2,284
2,284
-
Charitable activities Clinical services Community Outreach Services Helpline Raising awareness and improving access Substance Misuse Case Management Service
8,237 2,185 10 341 -
911 1,469 200 99 57
10,773
2,736
13,509
12,083
209
-
209
183
13,266
2,736
16,002
13,933
(754)
2,137
1,383
1,634
(2,312)
2,312
-
-
(3,066)
4,449
1,383
1,634
241
-
241
564
(30)
-
(30)
78
Net movement in funds
(2,855)
4,449
1,594
2,276
Fund balances brought forward at 1 April
24,496
257
24,753
22,477
21,641
4,706
26,347
24,753
Governance costs Total Resources Expended Net incoming / (outgoing) resources before transfers Transfers between funds Net incoming resources / (resources expended) before other recognised gains and losses Increase/(decrease) in value of investments Actuarial surplus/(loss) on defined benefit pension scheme
Fund balances carried forward at 31 March
1,667
9,148 8,265 3,654 3,154 210 195 440 469 57 -
All activities relate to continuing operations. There are no gains and losses for either the current or prior years other than those recognised above. All items in the Statement of Financial Activities would appear in the Income and Expenditure Account with the exception of the realised and unrealised gain/(loss) on investments. There is no difference between the net incoming resources before other recognised gains and losses and their historical cost equivalents.
2014 Annual Review | Combat Stress | 29
THANK YOU
Combat Stress is widely respected as the leading charity delivering mental health services to Veterans. To meet this growing demand, we must maximise our own capabilities and ensure that we forge strategic and funding partnerships wherever we can. For many years we’ve built strong links with organisations that help fund our work and provide services in partnership with us. These collaborations are broadly based and include the Government, the NHS, and a wide range of charities and other organisations. With much gratitude, we acknowledge the support we receive from Service charities, without whose help the needs of Veterans suffering with mental ill-health cannot be met. We also express our sincere thanks to all those foundations, companies and trusts who generously support our work among whom are: ABF The Soldiers’ Charity Armed Forces Covenant (LIBOR Panel) Big Lottery Fund Comic Relief Corporation of Trinity House Help for Heroes Irish Ex-Service Trust Newman’s Own Foundation Oak Foundation Dr Chai Patel Royal Navy and Royal Marines Charity RAF Benevolent Fund
Our supporters include Service charities, grant-making trusts, companies, the Government and many individuals throughout Britain and beyond.
Scottish Government Sir Jules Thorn Charitable Trust Victims & Survivors Service Northern Ireland Westminster Foundation
30 | Combat Stress | 2014 Annual Review
HONORARY STRUCTURE AND CONTACT DETAILS PATRON His Royal Highness The Prince of Wales KG KT GCB OM AK QSO PC ADC PRESIDENT General Sir Redmond Watt KCB KCVO CBE VICE PRESIDENTS Mr Dennis Bailey MCSI Air Vice-Marshal Nigel Baldwin CB CBE Mr Robert Bieber MBE MA General Sir Edward Burgess KCB OBE Lieutenant General Sir Roderick Cordy-Simpson KBE CB Air Chief Marshal Sir David Cousins KCB AFC Vice Admiral Sir Geoffrey Dalton KCB Commodore Toby Elliott OBE DL RN
Major General Sir Evelyn Webb-Carter KCVO OBE His Grace The Duke of Westminster KG CB CVO OBE TD CD DL General Sir Roger Wheeler GCB CBE Air Marshal Sir Robert Wright KBE AFC FRAeS FCMI Vice Admiral Peter Wilkinson CB CVO BOARD OF TRUSTEES Lieutenant General Andrew Graham CB CBE (Chairman) Mrs Jenny Green OBE MA (Vice Chairman)
Mr Peter Allen Air Commodore Dusty Amroliwala OBE MA MBA FCIPD Colonel Philip Baxter
General Sir Charles Huxtable KCB CBE DL
Mrs Mary Molesworth-St. Aubyn DL
The Hon Bernard Jenkin MP
Mr Adrian Pollitt OBE MA Mr Trevor Royle MA FRSE
Air Marshal Sir Ian Macfadyen KCVO CB OBE
Mr Stephen G Smith FCA BA
The Lord Moonie
Mr Russell R Thompson OBE FInstF
Richard Nunneley Esq Sir Malcolm Rifkind KCMG MP Derek Twigg MP
Director of Fundraising & Communications Mr Tim Brawn BA
Director of Medical Services Wing Commander Walter Busuttil MB ChB MPhil MRCGP FRCPsych RAF
Mrs Jessica Hughes Mr Christian K B Melville WS NP TEP LLB Dip LP
Surgeon Captain Morgan O’Connell RN FRCPsych
Deputy Chief Executive and Director of Strategic Planning & Partnerships Lieutenant Colonel Peter Poole MBE MILT
Colonel Robert Ward RM (Honorary Treasurer)
Brigadier Charles Grant OBE
Lieutenant General Sir John Kiszely KCB MC DL
Chief Executive Commodore Andrew Cameron MA FCMI RN
Dr Suzy Walton BSc MSc PhD CPsychol CSci CDir FRSA Professor Sir Simon Wessely MA BM BCh MSc MD FRCP FRCPsych FMedSci FKC
Director of Operations Mr Richard Miller-Holliday RGN BA(Hons) DMS Cert Ed (Joined Combat Stress July 2014) Director of Finance, Information Management & Governance Ms Victoria Reynolds FCCA
Director of Corporate Management Miss Natalie Styles MSc MCIPD
CONSTITUTION Ex-Services Mental Welfare Society Company Limited by Guarantee Registered in England and Wales No. 256353 Charity Registration No. 206002 Scotland No. SC 038828 Tyrwhitt House, Oaklawn Road, Leatherhead, Surrey KT22 0BX www.combatstress.org.uk 2014 Annual Review | Combat Stress | 31
VETERAN’S EYES IN MY EYES I SEE A HORRIBLE MAN LOOKING BACK AT ME THE BLACKNESS THE FEAR OF A MAN OF WAR WHO CAN SHED NO TEAR FOR THE HORRORS HE SAW THE EYES OF A MAN THAT CANNOT TAKE PRAISE WHO FINDS LOVE DIFFICULT IN SO MANY WAYS HE SCARES HIMSELF OF WHAT HE SEES THE EYES OF A VETERAN LOOKING BACK AT ME Bones, Falklands Veteran 1982