Combat Stress Annual Review 2012

Annual Review 2012

“With Combat Stress’s support I have been able to get my life back on track.

It’s an amazing organisation, doing incredible work.”

FRANCO

CASE STUDY

Briefing

note

Name: Fr anco Served: N orthern Ir eland What hap pened: Fr anco was beaten so badly by a mob wh on patrol ile in Northe rn Ireland he didn’t that think he’d live.

“PTSD cost me my marriage, but at least now I’m super fit, love my job and get to spend time with my children.”

d to look How I use

FRANCO

Franco’s story The attack left him struggling with Post Traumatic Stress Disorder (PTSD) that manifested in many ways, including an almost - fatal obsession with food.

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Franco had to undergo extensive surgery and was hospitalised for two years. Despite all odds, Franco managed to walk again and started a new career as a personal trainer and professional bodyguard.

But the ordeal left his life in tatters.

Missing his Army buddies and suffering severe depression, his marriage fell apart and his wife and two children left.

“Some people turn to alcohol but I had become isolated, introverted and was eating myself to death,” explains Franco.

He ballooned to 27 stone with a body fat

mass of 68% (three times what it should be) and a 72 inch waist. “I didn’t know I had PTSD.” Franco says: “With Combat Stress’s support I have been able to get my life back on track. It’s an amazing organisation, doing incredible work.”

He also lost 16 stone within 18 months resulting in a stable weight of 11 stone, a 32 inch waist and 17% body fat.

“PTSD cost me my marriage but at least now I’m super fit, love my job and get to spend time with my children,” he adds.

Combat Stress

S upport i n g V eterans and t h e i r fa m i l i es

Introduction from our Chief Executive Combat Stress is undergoing a once in a lifetime upgrade.

The fundamental change programme we have embarked upon is being funded by our successful The Enemy Within Appeal, grants from major military charities, companies, trusts, private individuals and the Government.

The programme is trying, for the first time, to create a fully integrated mental health and welfare service for ex-Service personnel. This connects Combat Stress, other charities, the NHS and the MoD as never before.

The new philosophy and services are explained in some detail on our website and throughout this review; here, I want to highlight the speed and efficiency in which Combat Stress has been adapting to changes in mental health care for ex-Service personnel.

We are currently treating over 5,000 Veterans.

Recently, we have seen a rapid rise in young men and women who have served in Iraq and Afghanistan seeking our help. This makes up part of the 12% increase in new referrals we receive year-on-year. As a result, waiting times for treatment have increased.

We are addressing these issues by developing integrated services: a new NHS Englandcommissioned national PTSD care pathway; our Community Outreach Teams; the Combat Stress 24-hour Helpline; and by working with the Armed Forces Health Partnership. Our continued focus is to enable our Veterans to rebuild their lives with or without on-going symptoms. We want to replace despair with hope so ex-Service personnel can regain a sense of control and pursue their ambitions. In short, we provide a real opportunity to build a life beyond illness.

To do this, major cultural and organisational change is required at Combat Stress, including day-to-day management and leadership. We are changing our practice from reducing symptoms to rebuilding lives. We are creating, with partners, the conditions in which our clients can be supported throughout their recovery journey.

In this report we lay out some of the ways we are doing this. I hope you enjoy the read and support us on the journey of a lifetime. With your help we can rebuild the lives of so many brave and deserving ex-Service men and women.

Thank you.

Andrew Cameron Chief Executive

Annual Review 2012

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S upport i n g V eterans and t h e i r fa m i l i es

Why Veterans need our support

Recent research* shows that 20% of Veterans are likely to develop mental health problems from their time in the Armed Forces. Around 4% are likely to suffer from the more serious Post Traumatic Stress Disorder (PTSD), which can lead to alcoholism, depression and other problems.

From our recent conflicts in Iraq and Afghanistan alone, around 40,000 Veterans are expected to show symptoms of mental ill-health, 7,500 of these are

likely to display symptoms of PTSD – nearly twice our current case load.

However, this research doesn’t include thousands of Veterans who served in Bosnia, Sierra Leone, the first Gulf War, the Falklands War, Northern Ireland and other conflicts over the last 50 years. Many are suffering but have not yet sought our help.

* King’s Centre for Military Health Research 2010

Our mission Our mission is to meet the needs of Veterans with mental ill-health, to aid their recovery and maximise their quality of life by delivering specialist mental health treatment and social and family support, alone or in partnership.

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Combat Stress

S upport i n g V eterans and t h e i r fa m i l i es

From our recent conflicts in Iraq and Afghanistan alone, c. 40,000* Veterans are expected to show symptoms of mental ill health.

Supporting, treating and helping Veterans We are the UK’s leading military charity specialising in the care of UK Armed Forces Veterans’ mental health. We help and support men and women of all ages who are suffering from a psychological condition related to their Service career. This might be depression, anxiety, a phobia or Post Traumatic Stress Disorder (PTSD).

How we help We work with each individual to decide on the best course of treatment and to provide support that helps each Veteran to understand and cope with their mental condition, and aspire to lead a full and productive life. We provide a range of services, free of charge, to UK Veterans. We work with each Veteran to decide which of these services are most suitable for them.

24-hour Helpline

Community Outreach

TA and Reserve Forces Liaison Team

(Page 10)

(Page 12)

(Page 15)

Short-Stay Treatment Programme

Annual Review 2012

Six-Week PTSD Treatment Programme (Page 16)

Well-being and Rehabilitation Programme

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OUR SERVICES

What we set out to achieve

In our 2011 Annual Review we laid out our aims for the next year that would enable us to increase the quality of our service to ex-Service men and women. These were: • To establish 14 regional multidisciplinary Community Outreach Teams to provide local support for Veterans.

• To develop and launch a new intensive residential treatment programme for Veterans with more complex presentations of Post Traumatic Stress Disorder.

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• To establish a dedicated TA and Reserve Forces Liaison Team.

• To better meet the health and welfare needs of the Veteran community by building stronger relationships with the NHS, together with other statutory and non-statutory services.

• To address the stigma that surrounds mental health and therefore reduce the time Veterans wait before coming to us.

Combat Stress

OUR SERVICES

What we achieved

2011–2012 The year in numbers

• All 14 Community Outreach Teams across the UK are now up and running. Read more about this on pages 12–13.

• In September 2011 we launched the Six-Week Veterans’ PTSD Programme at our Surrey treatment centre, Tyrwhitt House.

To find out how this is progressing, turn to page 16.

PTSD Programme has been commissioned by the NHS in England. And in partnership with Help for Heroes and The Royal British Legion, Combat Stress will now have a Regional Welfare Officer permanently based at the Personnel Recovery Centre at Tedworth House.

• On 10 October 2011, World Mental Health Day, we launched • 2011 saw the implementation of a the second phase of The Enemy dedicated TA and Reserve Forces Within Appeal. This phase is a Liaison Team, see page 15 for UK-wide campaign, largely more details. funded by Comic Relief, to raise • By working in partnership with awareness of the hidden wounds the Ministry of Defence, the NHS of conflict and to address the and the Department of Health, issue of stigma that surrounds Combat Stress has improved the Veterans’ Mental health. Turn to way Veterans’ mental healthcare page 18 to read more. Improving needs are addressed and dealt access to our services remains with. Turn to page 10–11 to read a key aim of the campaign, and about our helpline, funded by we are pleased to report that the the Department of Health.

Combat Stress 24-hour Helpline In addition, our Six-Week Veterans’ has also established a text and email support service.

Annual Review 2012

Veterans supported

by Combat Stress

4,929

Days of treatment delivered through our three Treatment Centres

24,042

Number of admissions for treatment

2,427

Number of beds in our short -stay Treatment Centres

75

Number of treatment centres

3

Number of volunteer fundraisers

1,056

Veterans attending our community support groups

3,532

Calls to the Combat Stress 24-hour Helpline

6,650

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OUR SERVICES

Looking ahead

Over the next year we will:

The introduction of the new services will:

• Develop both Audley Court and Hollybush House (inpatient Treatment Centres) in order to be able to deliver the Six-Week Veterans’ PTSD Programme for the whole Veteran population in the UK who are registered with Combat Stress. This will:

• Increase the number of patients who we can assess and treat.

–

Improve access to specialist treatment for all, wherever they live in the UK.

• Identify suitable patients for the six-week programme.

–

Reduce travel times.

–

Improve our patients’ experience of Combat Stress and improve their access to NHS services.

• Reduce waiting times for Veterans.

• Provide earlier sign-posting for those who we cannot treat or who do not need our services.

• Extend the initial trials of an outpatients service so that beds within the Treatment Centres can be prioritised for those who most need them.

• Continue our successful pilot of using other Service charities residential facilities for our low-intensity residential programme for Veterans on our two-week programme.

The diagram opposite shows how this new level of care fits within our existing services.

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Combat Stress

OUR SERVICES

Constantly reviewing and improving our services We are continually evolving in the way we work, finding innovative new approaches to improve the cost-effectiveness and quality of our services to Veterans.

High Intensity Treatment (Six-Week Comorbid* PTSD Programme)

NHS services

This diagram shows how we are developing our strategy for the most effective treatment of Veterans suffering from mental ill health.

Short-Stay Medium Intensity Treatment Programme (focused CBT** therapies inc.

EMDR***)

24-hour Helpline

Charitable Sector Welfare and Social Services partnerships

Other qualified service providers

Welfare support and advice in the community Low Intensity Residential Therapies (focused on maintenance and social integration)

Community Outreach Services (welfare and clinical) TA and Reserve Forces Liaison Team

Service charities

Outpatients (assessment, stabilisation, and preparation for treatment)

*The term comorbid refers to a disease or disorder that occurs at the same time as another disorder but is not related to it, such as depression, alcohol and illicit drug misuse.

High intensity treatment

Low intensity support

**Cognitive Behaviour Therapy (CBT) combines two effective kinds of psychotherapy: cognitive therapy and behaviour therapy. Trauma-focused CBT specifically helps the individual to confront his or her traumatic experiences. ***Eye Movement Desensitisation & Reprocessing (EMDR) involves prompting rapid eye movement with outside stimuli, while the patient reflects on the event that is causing distress. The procedure can eliminate or lessen the negative associations of the traumatic event and it has a calming, self-affirming effect.

Annual Review 2012

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W ork i n g i n partners h i p

Combat Stress 24-hour Helpline In its first year our Combat Stress 24-hour Helpline handled 6,650 calls!

A lifeline to Veterans In March 2011 we launched the Combat Stress 24-hour Helpline. The service offers round the clock telephone, text and email support to Veterans, their families and serving military personnel. This essential initiative is a three way partnership between Combat Stress, the Department of Health and mental health charity Rethink Mental Illness.

The Helpline staff understand the unique needs of Veterans and provide support and advice, as well as signposting callers to other organisations that can help them.

Big White Wall Combat Stress is proud to have joined forces with this award-winning online service, which complements the Helpline. Big White Wall offers a space to anonymously discuss any mental health concerns – and is free to serving personnel, Veterans and their families. It is monitored by trained ‘Wall Guides’ and offers peer support and clinical counselling. Visit www.bigwhitewall.com Findings from an independent review of Big White Wall found that: • 75% of members talked about an issue for the first time on Big White Wall

“It is good to be able to share with the community and know there are others out there with similar concerns and learn about how they deal with it. I feel much less isolated.”

Big White Wall member

• 80% self-managed their psychological distress • Two thirds of Big White Wall members said they used the site mostly to relieve stress and loneliness • Half said they used the site to relieve anxiety and a third cited depression as their main reason for using Big White Wall

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Combat Stress

W ork i n g i n partners h i p

5 Things I’ve learnt about the Helpline 1

Jason Parker is one of our Helpline advisors

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It takes years to seek help I have been told that it takes several years for a Veteran to seek help after leaving the Armed Forces. Working on the Helpline has really hammered this home. Most of the Veterans I speak to have been involved in Northern Ireland, the Falklands, Bosnia and the first Gulf War. These conflicts are long over but the devastating effects they have on some Veterans live on and should not be forgotten. I think it is important for people to realise that it is never too late to seek help.

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Talking helps!

It’s easy to forget just how helpful talking can actually be.

From my experience of talking with Veterans, the Armed Forces often instills a culture of silence that leaves many people feeling they cannot talk about their issues to family and friends. The Helpline is helping people to realise the beneficial power of talking.

The Helpline is often the first step in seeking help. The feedback we’ve received has been overwhelmingly positive.

We provide an opportunity to talk.

Service-related issues don’t just affect the Veteran The friends and families of Veterans form the second biggest group of people who contact us with their calls and emails (Army Veterans being the first). Often they are trying to hold things together for a loved one who is struggling with mental health issues.

This can be a very stressful and upsetting situation for them. The Helpline gives friends and family the chance to offload, gain reassurance and find out how and where they can access the appropriate help. For many this makes a huge difference, helping them to carry on supporting their loved one and to find the right support.

6,650

667

number of contacts between 1st April 2011 – 31st March 2012

number of callers from a friend or family member of a Veteran

Improving health care professionals’ awareness of service-related issues We get quite a lot of calls from doctors, therapists, police, paramedics and other professionals wondering how to help Veterans under their care. It’s great that the Helpline can play a role in increasing awareness of the support available to Veterans.

504 number of callers who were from a professional background

Annual Review 2012

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5

Feeling understood is so important Veterans often tell me that their GP and other people involved in their care just don’t really understand. Sometimes just by listening properly, you can help someone to feel better because they have had a chance to explain their point of view without being judged or dismissed. The Helpline supports people through particularly difficult periods.

Those who use the Helpline often tell us they find it helpful because they feel understood.

The Helpline has made a huge difference, providing hope, empowerment, information and support to those who need our help.

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W ork i n g i n partners h i p

Community Outreach For many Veterans, our Community Outreach Teams are the first port of call …

Support in the community Our UK-wide network of Community Outreach Teams provide vital treatment and support for Veterans and their families across the UK. Thanks to our dedicated supporters, all 14 of our regional teams are now fully established!

Each team is made up of a Regional Welfare Officer (RWO), Community Psychiatric Nurse (CPN), Mental Health Practitioner (MHP) and Welfare Support Officer. Our RWOs and other members of the Community Outreach Team have military experience themselves, something Veterans tell us they find very reassuring.

The experience and skills of our teams equip them to meet the unique and varied needs of each Veteran. This can range from clinical assessments, trauma-focused therapies and support groups, to home visits and advice to families and carers. They also offer help with the practical issues that stem from a psychological condition, such as financial problems or relationship counselling.

The teams work closely with GPs, NHS services, social services and other Veterans charities in their local areas. Our regional teams aid recovery and improve social inclusion.

How do Veterans access our services?

Themselves 51% Through a family member

9%

Through their GP

4%

Through another charity

14%

Through another welfare organisation

22%

How the Community Outreach Teams work The Veteran will receive a registration form to complete A Regional Welfare Officer will then visit to assess and provide assistance based on the Veteran’s specific needs The Welfare Officer will then ask the Community Outreach Team to assess the clinical needs of the Veteran and may make a referral to one or any of the following:

A Combat Stress Treatment Centre for further assessment and treatment

Six-Week PTSD Treatment Programme Short-Stay Treatment Programme (stabilisation, preparation and rehabilitation) 12

The Veteran’s GP

An appropriate NHS service

The Combat Stress Community Outreach Team

Support groups One-to-one home visits Carer Support Groups Welfare support Combat Stress

W ork i n g i n partners h i p

Robert Lappin

Regional Welfare Officer, Scotland West

Photo courtesy of Herald and Times Group

“I served for over 20 years in the Army so I understand the pressures that soldiers are put under. This helps when I need to build rapport with a client.

The Veterans we support are usually very anxious. I reassure them it’s ‘okay’ if they get emotional during our session. I go through their childhood history, what their background was like and then through their Service life. We will then go back to the key traumatic incidents that happened and work through them. We also discuss what’s happened to them since leaving the Forces.

Gaining trust is one of the most important parts of my role. When I visit Veterans and they talk about a particular place, I understand: the

Robert Lappin

geography, the terms a soldier uses to explain his job, the equipment he’s been carrying, the tension, and the training. I can look someone in the eye and know what they are talking about without looking puzzled. Because of that shorthand, Veterans are more willing to talk about their Service experiences and what has happened to their lives since leaving the Forces.

Most ex-Service personnel have never had PTSD explained to them or what they are actually going through. Many are very angry and emotional. Yes, my job can be draining but it’s also very rewarding because I know that someone is in a far better place when I leave than when I first walked in.”

Visits

‘Inside Right’ Visits made

by Regional Welfare Officers

5,192

First time contact visits

817

Support Groups

445 Number held

Annual Review 2012

3,532 Veterans attending

98

Inside Right has been set up to help young ex-Service men and women with mental health problems. The initiative uses the hook of football and provides access to ongoing support and services.

The programme is a unique partnership between the military and mental health charities including Combat Stress, the Football Foundation and The Ministry of Defence.

The feedback received so far has been very encouraging. A Veteran who has been involved in the project said: “I can now see some light at the end of the tunnel instead of a train careering towards me. The light might only be a small candle flickering, but it’s something and it’s giving me hope.”

Carer support groups held

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CASE STUDY

Peter’s story Peter was just a teenager when he was deployed to Kosovo with the Royal Irish 1st Battalion to face weeks of fierce fighting.

Briefing

“Combat Stress basically saved our lives …”

PETER Doolan, mc

note

n, MC eter Doola Name: P , Iraq rra Leone osovo, Sie Served: K . nd hern Irela r and Nort ager Pete As a teen : d e n e g p p ghtin What ha rocious fi rienced fe erated p o d had expe a h e . By 21 h fore in Kosovo in Iraq be emy lines n e d behin in battle. engaging

Having completed four tours in five years, Peter had seen enough and left the Army. Back home he threw himself into building a business supplying boots and providing for his young family. But all the time he knew the turmoil was building inside him.

The tipping point came when, as a Reservist, he was called to serve in Iraq again. Peter was sent into his fiercest and bloodiest combat yet.

Such relentless fighting, which ended

in many colleagues dying or being injured, reduced him to a shattered shell of a man.

Discharged from the army, Peter worked 100 hour weeks and turned to alcohol to try to hide the symptoms of Post Traumatic Stress Disorder (PTSD) from his worried wife, Rachel. “I couldn’t keep a lid on it much longer,” says Peter.

It was while on a family break that he had his first flashback. “I thought I was on patrol in Northern Ireland,” he says.

“I was left shaking for days.” Peter can’t recall the next 10 months. He doesn’t remember sleeping under the dining room table, rocking himself all night on the living room floor, or putting on

his uniform and disappearing into the night. Nor can he recollect throwing his medals in the bin, including the Military Cross awarded for saving a wounded colleague from a vehicle while under attack.

Fortunately his doctor put him in contact with Combat Stress. Having lost his business, his health temporarily and almost his family, Peter is now back on his feet after receiving medical treatment, counselling and practical support from Combat Stress.

“Combat Stress basically saved our lives.

Their practical and medical help took the pressure off us so I could get myself together. I can’t thank them enough.”

Photograph by Sam Spurgeon 14

Combat Stress

W ork i n g i n partners h i p

Working in Partnership Shoulder to Shoulder To further support the transition from recovery to civilian life, Combat Stress has partnered with national volunteering charity Timebank to develop the Shoulder to Shoulder mentoring project. Through this, Timebank recruits volunteer mentors, ex-Service men and women and those who understand the issues through close family connections. The mentors are matched with an ex-Service man or woman suffering from mental health problems.

Andy Elliot, Shoulder to Shoulder Project Coordinator, explains: “The project gives the kind of support someone recovering from mental health problems may not find elsewhere. It’s the chance to spend time with someone who’s not involved with their care or knows their entire life story and, most importantly, someone who will listen to what they have to say without judging them – offering practical support and friendship.”

For more information, please visit www.timebank.org.uk/ shoulder-to-shoulder

Armed Forces Health Partnership The Armed Forces Health Partnership is a joint venture between Combat Stress and The Royal British Legion (TRBL), funded by the Department of Health. Together, we aim to improve knowledge of the mental health effects of service in the Armed Forces amongst health professionals (such as doctors, nurses and psychiatrists), as well as other organisations and charities, that can support Veterans. By increasing awareness of mental health needs we can greatly improve services at all levels.

Marie-Louise Sharp, TRBL’s policy adviser for health and care, explains: “By combining our expertise in welfare support with Combat Stress’s skill in mental

health treatment – along with other voluntary sector organisations and the NHS – we can create integrated ‘whole-person’ services which produce outcomes for Veterans and their families that are far and above the sum of our parts.”

Since the launch of the partnership, we have achieved a great deal including: the Shoulder to Shoulder project (see left); a number of conferences with health professionals; as well as the production of the GP guide ‘Meeting the healthcare needs of Veterans’. This is available to download from our website www.combatstress.org.uk

Since the TA & Reserve Forces Liaison initiative was launched in June 2011, our dedicated team has engaged with over 1,200 Reservists, military staff, and professionals.

How we are helping Reservists Just like their full-time ‘Regular’ colleagues, Reservists can also suffer from PTSD and other mental health problems. The King’s Centre for Military Health Research suggests that UK Reservists deployed to Iraq and Afghanistan are more likely to experience PTSD than Regular personnel.

Just like Veterans, Reservists can use all our specialist services and the King’s Centre research highlighted the need to develop this area of our work. In June 2011, with funding from the Westminster Foundation, we launched a TA and Reserve Forces Liaison Team, which encourages Reservists with mental health problems to seek help.

Many Reservists face a very different situation from that of Regulars. Many

Annual Review 2012

have been sent overseas on their own and can find it difficult to integrate into ‘tight knit’ Regular units. After coming home they often won’t see these people again.

Some feel that they have ‘done their bit’ and leave the Reserve Forces for good, whilst others resume civilian life and do not return to Service for many months.

This means Reservists are often isolated from those within the military, who they might be willing to confide in when their memories begin troubling them.

Back in civilian employment, many find that colleagues and managers don’t understand what they have been through or simply don’t care. Some are resented by colleagues who perhaps shouldered extra work while the Reservist was mobilised. Once the euphoria and happiness of homecoming wears off, family life can become strained as the

Reservist settles back to ‘normal’ work and family life. Home life can seem boring and hum-drum compared to the pace and adrenalin of operational military life. The enormity of this difficult transition is such that Reservists often feel isolated and find it difficult to cope – particularly if they are also struggling to come to terms with traumatic experiences they may have witnessed or been directly involved in whilst mobilised.

The team’s role is to liaise with the military chain of command and Reserve Forces of all three Services – as well as relevant NHS and Veterans’ organisations – to raise awareness of Reservists’ mental health issues and of the assistance and treatment available to them through Combat Stress.

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W ork i n g i n partners h i p

Six-Week Veterans’ PTSD Programme A review of the programme by Combat Stress Director of Medical Services, Dr Walter Busuttil Our newly established SixWeek PTSD rehabilitation programme is designed to treat Veterans suffering from severe forms of PTSD and another condition or conditions, such as depression, alcohol and illicit drug misuse.

Our programme has three main therapeutic mechanisms: group psycho-education, group skills training and individual trauma-focussed therapy. It is based on the Australian Veterans’ rehabilitation programmes, which have been in place for Veterans will need initial many years. There is a large stabilisation by clinicians evidence base of over 4,000 before they can be admitted to Australian Veterans who were the programme, ensuring that suffering from chronic PTSD their depression and substance 5pm during week days; with and other conditions including ‘homework’ tasks and some misuse are under control. substance misuse, depression therapy in the form of practical with social and relationship The programme is run by work being done at weekends. complications, benefiting two full-time equivalent Two half days for family/ from such programmes. The psychologists/Cognitive carer involvement are also Australian treatment outcomes Behavioural Therapy-trained scheduled. The Veterans on the are: one third of Veterans on mental nurse therapists; programme have a workbook the programmes will do well supported by Consultant which they work through and need little help at one psychiatrists, registered during the programme. year follow-up; one third get mental health nurses, better but need some help, one Veterans can use all facilities occupational therapists, third don’t do so well but need in the Treatment Centre psychotherapists and other less help than they did at the including the activity centre multidisciplinary Treatment outset.

Centre staff – ensuring that the and gym. We also have an Occupational Therapy-led Veterans on the programme Treatment outcomes so far are Well-being Programme to help are appropriately supervised. promising for Veterans treated Veterans with the ‘homework’ at Combat Stress.

Up to eight Veterans tasks set by the main six-week participate in each group. The programme, as well as to keep Dr Walter Busuttil work day is full and we expect them engaged in activities and the Veterans to participate in situations that they need to the whole of the programme confront. which runs between 9am and

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Combat Stress

W ork i n g i n partners h i p

Briefing Name: B

note

rian Served: Fa lkland Isla nds What hap pened: A t just 21 B was onbo rian ard HMS Sheffield was hit. Tw when it enty of Bri an’s comra died that day. Afte des r despera efforts to te fight the fi res, the sh abandone ip was d and eve ntually sa nk.

“It was like living with a new person, as though our relationship had started all over again.”

Brian’s story

MELANIE

Falklands Veteran Brian Jones was just 21 in 1982 when British ship HMS Sheffield was hit by an Argentinian missile.

Every second of that traumatic day and the subsequent weeks are still seared into Brian’s mind. When he returned from the Falklands, the enthusiastic welcome for British forces only left him feeling more guilty that he had survived when others had not. “It was like a hero’s return, but I didn’t feel like that at the time,” he says.

Brian tried to repair his life but was badly affected and continued having “episodes,” even after leaving the Royal Navy in 1985.

For years afterwards, Brian drank too much and withdrew from friends and family, feeling “angry, frustrated, even violent at times.” It was only in 2009 that Brian finally sought treatment and was diagnosed with Post Traumatic Stress Disorder (PTSD) at Combat Stress.

Annual Review 2012

Our therapists helped him to cope with transformation. “It was like living with a his guilt and the mental images that still new person, as though our relationship had paralysed him. His partner for the last six started all over again.” years, Melanie Williams, says that while it has been “hard,” things could have been Melanie no longer worries when Brian worse. The treatment has transformed “draws into himself,” knowing “everything their lives. “Brian hasn’t hit the bottle and will be fine.” For Brian, seeking help has he hasn’t hit me,” she says. “He used to made all the difference, giving him the snap at me for no reason and I did find strength and tools “to break the cycle that very upsetting.” of depression and the black thoughts.”

The intensive six-week course of therapy at Combat Stress proved a turning point.

At Tyrwhitt House in Surrey, Brian was surrounded by tranquil gardens and fellow ex-Service men and women who understood what he was going through. “Brian was completely different,” smiles Melanie, describing his “amazing”

“I was able to talk about the guilt, the shame, the anger that I felt about surviving and going home. I will still have them, but I can cope and carry on.”

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W ork i n g i n partners h i p

Raising funds and awareness The Enemy Within Appeal In March 2010 our Patron HRH The Prince of Wales launched The Enemy Within Appeal on behalf of Combat Stress. This three-year fundraising campaign will help us to treat the escalating number of Veterans with mental health problems who are turning to us.

The Enemy Within Appeal is being used to: • Enhance clinical treatment at our three short-stay residential centres and provide access to specialist clinical support in the community • Raise awareness of the plight of Veterans with mental health issues • Reduce the stigma that surrounds Veterans’ mental health, encouraging both Veterans and their families to seek help early

© Crown Copyright/MOD, image from www.photos.mod.uk

“Everyone who serves their country should be able to get help for mental problems without delay and without shame or stigma.”

Combat Stress supporter

Launch of the Anti-Stigma Campaign Last year, Combat Stress saw yet another rise in the number of ex-Service men and women turning to it for help. Despite this, it is a sad fact that Veterans still wait an average of just over 14 years after leaving the Services before seeking our help.

This is far too long. During this time Veterans and their families suffer and the delay often leads to additional mental health and social problems.

Relationships falter, marriages break down and, in a few cases, Veterans succumb to suicidal thoughts. Many suffer in silence and don’t know where to turn for help.

We need Veterans to come to us sooner for the help that they so desperately need.

To achieve this, we must address three key issues: • The lack of education and understanding about mental health issues.

• The fear of stigma and discrimination that surrounds Veterans’ mental health.

• The isolation of Veterans with wounded minds, who feel alone and are too ashamed or embarrassed to seek help.

On 10 October 2011, World Mental Health Day, we launched the second phase of The Enemy Within Appeal.

This phase is a UK-wide campaign, largely funded by Comic Relief, to raise awareness of the hidden wounds of conflict and to address the issue of stigma that surrounds Veterans’ mental health.

To help spread the word, we’ve been working hard to highlight the Appeal in national and regional press, online (through our own website as well as others), social media, advertising and special events.

81% of Veterans tell us* that they feel ashamed or embarrassed about their mental health problems. *Combat Stress online survey, September 2011 18

Combat Stress

CASE STUDY

James’ story g note

James was pleased when he was sent out to the Gulf War. After five years serving with the Royal Artillery, he was ready to put his training into practice.

Briefin Name:

James

ar : Gulf W no Served es had ed: Jam n e ly p d p n a ie What h owing fr t a harr ersonal p idea tha a d n ent a r fire incid edy would late g a tr t y s il o fam ger P e to trig isorder. combin sD s e tr S tic Trauma

“I’ve got back to the point now in my life where I was before it all [trauma] happened to me. I’m eternally grateful to Combat Stress.”

James

Sometime later, after being refused leave to attend the birth of his first child, James went AWOL. Tragically his son died at birth – an event which triggered James’ Post Traumatic Stress Disorder (PTSD).

“Everything just spiralled out of control after that,” James said. “I was very selfdestructive. I cut myself off from family and friends. I had sleep deprivation, I had bad dreams and night sweats.

In my dreams I saw the friendly fire incident, black smoke pouring from

Annual Review 2012

oil wells and body parts. I was depressed and I had violent outbursts. It cost me everything, my career, my girlfriend.”

James eventually “crashed and burned.”

When he finally decided to get help it was 14 years since he had returned from the Gulf War. He was referred to Combat Stress.

“Since I contacted Combat Stress I’ve almost done a 360,” he said. “They told me I had PTSD and they’ve put a lot of things into perspective.”

James receives counselling and gets vital support from his key worker. He now has a girlfriend, a good relationship with his teenage son and has started his own photography business. (James’ photography features in this Review.)

“I’ve got back to the point now in my life where I was before it all [trauma] happened to me. I’m eternally grateful to Combat Stress.“

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FINANCE

Financial Summary – where your money goes Resources expended and services The charity’s fundraising costs are amongst the lowest in the sector, with only 16% of fundraised income being spent on generating further funds. Combat Stress’s focus is on delivering its clinical and community outreach services in the most cost-efficient manner.

We are also investing for the future by enabling better inpatient care through our build programme and increasing community and partnership working.

Where our money comes from …

Community Outreach Fees 1% Individual giving 9%

Statutory grants 2%

Volunteers & community 7% Events 1% Legacies 10%

Income £15.8 million

Clinical services fees 38.5%

Major donors 4% Corporate 2%

Trading 0.3% Trusts and foundations 9%

Investment income 2%

Service charity grants 13%

Other income 0.2% Special capital projects 1%

… and how we spend it.

Investments & Governance 1.4% Generating voluntary income 12%

Six-Week Veterans’ PTSD Treatment Programme 9%

Treatment Centre Improvements 1.6% TA & Reserve Forces Liaison 1% Helpline 2%

Expenditure £12.3 million Short Stay inpatients 47% Community Outreach Service 26%

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Combat Stress

FINANCE

Statement of Financial Activities (incorporating an Income and Expenditure Account) for the year ended 31 March 2012

Incoming resources from generated funds

Unrestricted Funds Restricted Funds Totals 2012 Total 2011 £’000s £’000s £’000s £’000s

Voluntary income Donations Legacies Service Charities Capital appeals

2,932 1,667 1,223 - 5,822

Activities for generating funds Fundraising events and trading Investment income

2,161 5,093 5,516 - 1,667 2,169 795 2,018 1,588 164 164 2,044 3,120 8,942 11,317

202 374 576

Incoming Resources from charitable activities Clinical services Community Outreach services

2 204 212 - 374 219 2 578 431

5,983 212 6,195

- - -

5,983 212 6,195

4,399 12 4,411

Other incoming resources Other income 39 - 39

Total Incoming Resources

12,632

3,122

15,754

6

16,165

Resources expended Activities for generating funds Cost of generating voluntary income Fundraising events and trading Investment management fees

1,356 137 29 1,522

- - - -

1,356 137 29 1,522

1,260 203 6 1,469

Charitable activities Clinical services Community Outreach Services Treatment centre maintenance and improvements

Governance costs

6,708 609 7 7,324

201 6,909 6,853 2,890 3,499 2,170 207 214 1,427 3,298 10,622 10,450

149

Total Resources Expended

8,995

- 149 143

3,298

12,293

12,062

Net incoming / (outgoing) resources before transfers Transfers between funds

3,637 [217]

[176] 217

3,461 -

4,103 -

Net incoming resources / (resources expended) Increase/(decrease) in value of investments Actuarial losses on defined benefit pension scheme

3,420 [237] [1,206]

41

3,461 [237] [1,206]

4,103 164 288

Net movement in funds Fund balances brought forward at 1 April

1,977 20,131

41 329

2,018 20,460

4,555 15,905

Fund balances carried forward at 31 March

22,108

370 22,478 20,460

All of the above results are derived from continuing activities. All gains and losses recognised in the year are included above.

The net of £2.0m added to reserves in 2011/12 was mostly due to timing differences, including a delay to the start up of the specially commissioned Six-Week PTSD Treatment Programme for the NHS, due to recruitment issues. The full year impact would add £1.2m to costs.

We also underspent on some promotional and PR activity.

£11.8m is a general reserve, although it also absorbs losses on the pension scheme and other revaluations, leaving a net £10.8m, well within the reserves policy of 9 – 12 months of operating costs. For example, last year’s operating expenditure was £12.3m showing reserves at 31/03/12 to be 88% of the target ceiling in the reserves policy.

£11.7m (52%) of the £22.5m reserves in the balance sheet, are allocated as capital assets, restricted funds or designated to specific projects.

Efforts to diversify funding sources have continued to be successful with £6.2m or 39% of income, versus £4.4m (or 27% in 2011).

Key Statistics Veterans supported by Combat Stress 4,929 Days of treatment delivered 24,042 Number of admissions for treatment 2,427 Number of beds 75 Number of Treatment Centres 3 Visits made by Regional Welfare Officers 5,192 Number of community support groups held 445

Annual Review 2012

This financial summary has been prepared to illustrate the key areas of ongoing expenditure by Combat Stress (Ex-Services Mental Welfare Society), the principal sources of its income and the funds available. The full Report and Accounts has been filed with the Charities Commission and is available to download from www.combatstress.org.uk Independent auditors’ report to the Members of Ex-Service Mental Welfare Society

In our opinion the information given in the Trustees’ Annual Report for the financial year for which the financial statements are prepared is consistent with the financial statements.

Neil Finlayson (Senior Statutory Auditor) for and on behalf of Kingston Smith LLP, Statutory Auditor Chartered Accountants and Registered Auditors, Devonshire House, 60 Goswell Road, London EC1M 7AD The Board of Trustees approved this report on 18 June 2012

21

THANK YOU

ou Y k n Tha

l nancia om fi e h t r fr teful fo ess receives a r g y t Str usts, e ver We ar that Comba t-making Tr om fr rt an suppo harities, Gr nment and t we er ha ec Servic ies, The Gov . None of w K an t you.

Comp round the U u o h t i w a ossible or people p e b Help f s ld u g o n i w d do (inclu oldier s S e i e t i h r T ) ABF e cha Legion h Servic the RAFBF, s i t i r lB s, e Roya income.

Heroe h T d f y an urce o o s Charit y e ll a k are sti

Combat Stress is very grateful to our Patron, HRH The Prince of Wales, for his practical support and advice during the year.

We are extremely grateful to all our supporters, including: Help for Heroes

BAE Systems plc

The Royal British Legion

Seafarers UK

Poppy Scotland

The Wolfson Foundation

ABF The Soldiers’ Charity

The Corporation of Trinity House

The Ministry of Defence

Newman’s Own Foundation

Comic Relief

Telegraph Media Group

Westminster Foundation

D. D. McPhail Charitable Settlement

The Sir Jules Thorn Charitable Trust /Ann Rylands Special Project

Royal Navy and Royal Marines Charity

Oak Foundation The Scottish Government Royal Air Force Benevolent Fund Northern Ireland Community Relations Council

22

Balhousie Care Group The Royal Foundation of The Duke and Duchess of Cambridge and Prince Harry Department of Health

Combat Stress

Honorary S tructure

Patron

Board of Trustees

His Royal Highness The Prince of Wales

CB (Chairman)

KG KT GCB OM AK QSO PC ADC

President General Sir Redmond Watt KCB KCVO CBE

Vice Presidents

Major General Peter Currie

MBE MA (Deputy Chairman)

Mr Richard Nunneley Colonel Philip Baxter Air Commodore Oliver Delany Mrs Jenny Green

CB CBE

Major General Euan Loudon

General Sir Edward Burgess

CBE

KCB OBE

Ms Helen Pernelet

Lieutenant General Sir Roderick Cordy-Simpson

Lic en Droit; Dip Law OBE MA

Air Chief Marshal Sir David Cousins

Mr Trevor Royle

Colonel Robert Ward

General Sir Charles Huxtable

Director of Medical Services Wing Commander Walter Busuttil

Dr Suzy Walton

Dr. Charles Goodson-Wickes Brigadier Charles Grant

MA MInstF

Mrs Christine Sterba BSc MSc PhD CPsychol CSci AFBPsS MRI CDir FRSA

OBE

Director of Fundraising & Communications Ms Uta Hope

MA FRSE

RN DL

BSc (Hons), ACA

Mr Adrian Pollitt

KBE CB

Commander The Lord Effingham

Director of Finance & Administration (Interim) Mr Stephen Chaytow

OBE MBA BA FCIPD FCMI FBIFM OBE MA

KCB

MA FCMI RN

(Honorary Treasurer)

Air Vice-Marshal Nigel Baldwin

KCB AFC

Chief Executive Commodore Andrew Cameron

Mr Robert Bieber

Mr Dennis Bailey

Vice Admiral Sir Geoffrey Dalton

Executive Management

MB ChB MPhil MRCGP FRCPsych

RM

Professor Simon Wessely MA BM BCh MSc MD FRCP FKC FRCPsych FMedSci

Director of Operations & Governance Mr Garrett Taylor

KCB CBE

The Hon Bernard Jenkin MP

Lieutenant General Sir John Kiszely KCB MC

Air Marshal Ian Macfadyen CB OBE FRAeS RAF

The Lord Moonie Surgeon Captain Morgan O’Connell RN FRCPsych

The Rt Hon Sir Malcolm Rifkind KCMG QC

Dr Chai Patel

MBE

Director of Strategic Planning and Partnerships Lieutenant Colonel Peter Poole

Mr Benedict Brogan

MBE MILT

CBE FRCP (Chairman)

Mr Tony Banks Mr Simon Blagden

Brigadier Ed Butler Major General Peter Currie

CB

Major General Sir Evelyn Webb-Carter

General the Lord Richard Dannatt

KCVO OBE 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 RN

Commodore Toby Elliott OBE DL RN

Director of Human Resources Miss Natalie Styles

DSO CBE

Derek Twigg MP

His Grace The Duke of Westminster

RGN DPSN BSc (Hons) LLM

The Enemy Within Appeal Board

MSc MCIPD

GCB CBE MC DL

Sir Roy Gardner The Duke of Hamilton The Rt Hon The Lord Hutton PC

The Hon Bernard Jenkin MP

Miss Nicola Jones Mr Josh Lewsey MBE

Ms Helen Pernelet Lic en Droit; Dip Law

Constitution The Ex-Services Mental Welfare Society is a company limited by guarantee and a registered charity governed by its memorandum and articles of association.

Company number 256353 Charity numbers England & Wales 206002 Scotland SC038828

Mr Ashok Rabheru

CVO DL

Mr Julian Sainty Ms Carole Stone Annual Review 2012

23

Combat Stress Tyrwhitt House Oaklawn Road Leatherhead Surrey KT22 0BX 01372 587000 www.combatstress.org.uk

“Combat Stress basically saved our lives.

Their practical and medical help took the pressure off us so I could get myself together. I can’t thank them enough.”

PETER

Registered Charity no. 206002 Charity no. Scotland: SC 038828 Company limited by guarantee: Registration no. 256353