The Veterans’ Mental Health Charity
A future worth fighting for Annual Review 2013
‘Combat Stress comes along and gives you the map and the torch to help you find your way out.’ Neil Blower, Kosovo and Iraq Veteran
Combat Stress Annual Review 2013 01
contents A changing organisation
02
with new challenges Who we are and what we do
04
A Veteran’s story: Donald McLeod
06
A focus on the PTSD Intensive Treatment
09
Programme – an overview Aims from 2012 and achievement to report
10
Future facing – a new identity
12
Partnerships
14
Focus on Veterans
18
Delivering a service
20
Raising awareness and improving access
22
Aiming high for 2014
24
Financial summary – where your money goes
26
Statement of financial activities
27
Thank you
28
Honorary structure and contact details
29
02 Combat Stress Annual Review 2013
“The Board of Trustees and Executive Team have worked tirelessly to deliver a step change in capacity and quality of care�
Supporting Veterans and their families 03
A Changing organisation with new challenges Andrew Cameron
Last year saw an increase of 12%
treatment pathways now running at
With support from Help for Heroes
in Veterans contacting us – 1,700
all three of our treatment centres.
we have completed the upgrade
directly sought our help. The steadily increasing need for our expertise is driving a very rapid expansion of services and improvements in therapy available.
Alcohol and substance misuse case management pilot programmes are also being developed to provide support alongside our Community and Outreach Teams. This is an
of our clinical facilities at Tyrwhitt House and Hollybush House Treatment Centres, and we are in the midst of an expansion at our Audley Court Treatment Centre. We are also refreshing and modernising the
It is clear that in future years
important new development for
Combat Stress is going to shoulder
the charity as we have been unable
much of the burden of specialist
to effectively treat some Veterans
treatment. Thankfully, with the
who approach us for help because
commitment of our staff, we are now
of their dependence on alcohol
We cannot be complacent when it
able to provide faster treatment and
and / or other substances. The
comes to fundraising. Our successful
with better results. This year Combat
programmes will work within a new
The Enemy Within Appeal ended
Stress has admitted 1,294 Veterans
joint recovery pathway using the
in March. It has allowed us to
for residential treatment and been
skills of the NHS and Combat Stress.
create better services for Veterans
able to discharge 780 Veterans after completing treatment.
None of these pilot programmes can succeed without investment in the
look of the Charity, to make us as approachable as possible. (See the article, “Future Facing” on page 12.)
which we must now sustain. Our fundraising team has been given the task of finding new interesting
We are increasingly working in
people who deliver them. We are
partnership with the Ministry
recruiting more professionals and
of Defence, the National Health
increasing our training to develop
Service, and the numerous charities
more mental health therapists, more
that provide the services that
occupational therapists, and more
In closing, I would like to pay tribute
support our cause. We are heavily
recovery workers.
to Major General Peter Currie CB.
engaged with the government and our charity partners to influence the development of Veterans’ mental health services at a national level. This partnership has required effort in a number of areas.
To support these three areas and to work smarter we need to measure the effectiveness of our services. Much work is underway in this area. For the sake of our Veterans we need to know where we are doing
New short, intensive treatment
well and where we could do better.
programmes were approved by
We also need to demonstrate to
our Board of Trustees on 27 March
our financial supporters that we are
2013 and will be introduced in the
providing a responsive and effective
coming year. These programmes
service that sees Veterans and their
complement the NHS commissioned
families able to live fulfilling lives.
Post Traumatic Stress Disorder
ways to maintain and if possible increase contributions to support our important work.
Over the past six years, as our Chairman, he has been steering Combat Stress as we respond to the increasing need of a growing Veteran population. He and his Board of Trustees have worked tirelessly with the Executive Team to deliver a step change in capacity and quality of care. We would not be where we are without his enlightened leadership and their commitment to the organisation. He has our heartfelt thanks.
04 Combat Stress Annual Review 2013
Who we are and What we do Our Vision is that Veterans will be able to live free from the harmful effects of psychological wounds.
in the Second World War. Today
Our Mission is to provide timely, effective clinical treatment and welfare support to Veterans who suffer from psychological wounds.
the Royal Navy, Royal Air Force and
In order to realise this we must
Services to support those
• 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
who need our help the most
Our Values are to:
military community, including
• always put Veterans at the centre of our work • aspire to excellence in everything we do • foster a culture of respect and integrity
serving personnel, Reservists,
it’s 42 years old and falling. Of our Veterans, 84% are ex-Army, the remainder equally shared between a very small number of ex-Merchant Navy seamen. Female Veterans account for around 3% of the total.
Combat Stress has a range of services available for Veterans and members of the Reserve Forces. National 24-hour Helpline Every minute of every day, our helpline is available to the whole
Veterans and their families. The helpline is delivered by Rethink Mental Illness. Professional, trained staff listen and give support. These advisors will direct callers to our support workers or refer them
Combat Stress is the leading national charity specialising in Veterans’ mental health. Combat Stress: The charity and service provider There has been a steady increase in Veterans contacting Combat Stress for help, up 12% in the past year alone. Eight years ago our average Veteran was 60 years old, many of the Veterans having served
on to another organisation for specialist help. Community and Outreach Services There are 14 Community and Outreach teams across the United Kingdom. Teams include welfare staff with military experience who understand specific mental health and welfare needs of Veterans. They know how to handle the stigma attached to mental health issues in
Supporting Veterans and their families 05
New referrals 1708
1800 1600
1443
1400 1160
1000 800
1303
1257
1200
1500
948
996
759
600 400 200 0 2005
2006
2007
2008
2009
2010
2011
2012
2013
the military. Our clinical teams work
interventions of tailored individual
Reserve Forces Liaison Team
closely with our welfare officers
and group treatments.
We have a dedicated team that
and with other NHS mental health experts to assess a Veteran’s needs. This will ensure the Veteran gets the right treatment in the community close to their home.
• PTSD Intensive Treatment Programme – a residential programme that provides treatment for the effects of long term PTSD and other issues
Outpatients
including depression and alcohol
Assessment by psychiatrists and
dependence.
psychologists enables us to diagnose,
• Well-being and Rehabilitation
define and deliver the treatment the
Programme – occupational
Veterans require. This service is now
therapy-led well-being
available at all three Combat Stress
programmes that complement
treatment centres.
our PTSD programme.
Residential Services
BreakAway Rehabilitation Centres
We have three residential
After a successful pilot scheme
treatment centres:
we have launched the Well-being,
Top Left: Hollybush House
Recovery and Social Integration
in Ayrshire, Scotland
Programme. The programme has
Middle Left: Audley Court in Newport, Shropshire and
been developed in partnership with The Royal British Legion. Veterans will spend time at one of four
Lower Left: Tyrwhitt House
centres in the UK to help rebuild
in Leatherhead, Surrey
their lives and move towards a full
These treatment centres provide: • overnight assessment for
recovery. This will be done through a range of activities and therapies. Veterans learn essential living skills,
those who cannot attend as an
develop better social skills, learn to
outpatient due to clinical need or
cope with everyday stresses and
because they live far away; brief
strains and gain self-confidence.
understands the specific mental health needs of the UK Reserve Forces. The team works directly with Reservists and in partnership with military staff and clinical professionals. They also work to raise awareness of mental health issues in the Reserve Forces so that more of them who need our help come forward.
06 Combat Stress Annual Review 2013
a veteran’s story
Donald Mcleod After a dare with his younger brother Donald, from Gilmerton near Edinburgh, followed in his father’s footsteps and joined the Army. Attracted by the uniform he passed the recruitment process with no problems whatsoever.
Stress. The first step I took was to go to my GP, who also knew about Combat Stress. “It was thereafter I visited Hollybush House. With the trust I have built up
Donald enlisted with the Scots
the Falklands. Aeroplanes came out
with staff at Combat Stress my life
Guards at the age of 20. He served
of nowhere, colleagues were blown
has changed for the better. I’ve tried
in Kenya, followed by two tours of
to bits in front of me and the bodies
to kill myself and had it not been
Northern Ireland. However, it was his
of your friends and Argentinians
for the support that Combat Stress
involvement in the Falklands War that
lay around. It was really hard. The
has delivered through its services at
would have a devastating impact on
nightmares haunted me.”
Hollybush House, I wouldn’t be here
his life for the next 30 years.
After returning to public duty, Donald
It was in 1982, as Donald and his
became increasingly bored with
colleagues were preparing for
Army life and began drinking heavily
Trooping the Colour in Chelsea, that
every night and getting into fights.
they were called to the gymnasium,
today. I’ve taken relaxation classes to help overcome my paranoia and I’ve also found the EMDR really useful. We call it the Star Trek machine. It’s a one-to-one session and it feels like
Donald continues: “When I returned
you are on a train. The train stops
to duty following my time in the
and it would take me back to my
Falklands I soon realised that there
time in the Falklands, allowing me to
Looking back at the news that
was no support. I was becoming
relive everything that has haunted
he would soon be going to war,
increasingly aggressive, drink was
me from the war. I can see, smell and
Donald recalls: “We gathered in the
a big issue and my family wouldn’t
taste everything. The memories then
gymnasium and were told that we
speak to me. Back then there was
gradually disappear and I can’t see
were going to the Falklands. My first
no such thing as PTSD. You were
the bodies any longer.”
reaction was ‘Where on earth were
seen very much as a coward if you
the Falklands’? This was the first time
admitted to having a mental health
I had actually been called to go to
problem. There was, and still is, a
war and I remember thinking ‘Could I
stigma attached to PTSD, preventing
actually shoot’? We spent two and a
many, especially men, from stepping
half weeks on board the QE2. During
forward and seeking help.
a moment that would change his life forever.
this time we were prepared physically
With the help and support that Donald has received from Combat Stress and the staff at Hollybush House he is gradually getting his life back on track. He has stopped drinking, has received help to
“Everyone around me realised I had
overcome his violent behaviour and,
a problem, except me, but I couldn’t
by eating healthier food and taking
do anything to address the issue until
up gardening, he has lost four stone.
I admitted there was a problem. It
He also has a new dog, Biggles,
wasn’t until I met Colonel Bannatyne
that he rescued from a dogs’ home.
while working at Whiteford House in
Biggles is by his side constantly and
“However, nothing could prepare me
Edinburgh that I learned about the
the pair take five walks a day.
for what I was to witness whilst out in
help I could receive from Combat
for what we were going to face on arrival by shooting sand bags. The Army training just kicked in and we realised we had a job to do and this was our purpose.
Supporting Veterans and their families 07
‘Had it not been for the support that Combat Stress has delivered through its services at Hollybush House I wouldn’t be here today.’
08 Combat Stress Annual Review 2013
‘The first step to overcome it is admitting that you need help and overcoming the stigma attached.’ Donald believes that both he and Biggles have been given a new start in life. The severe impact of PTSD as a consequence of his time spent in the Falkland Islands means that Donald does lock himself away and feels that when he is out he is still on patrol, constantly scanning for danger. Nevertheless, Tricia continues to work with Donald to build his confidence. Thirty years on from the Falkland Donald said: “Although the Army provides more support for Veterans now, back then there was no debrief, no support, no nothing. I was living a nightmare. However, Combat Stress have given me hope. I stay away from my military friends as it means I don’t have to think about things. I want to keep my life separate. I want to migrate from being a soldier and become a civvy. It is a difficult adjustment to make but the first step is admitting that you need help and overcoming the stigma attached.”
Supporting Veterans and their families 09
A focus on the PTSD Intensive Treatment Programme – An Overview
Combat Stress was awarded
Early results are excellent with
National Specialised Commissioning
good attendance on the course
from the Department of Health in
and a low drop-out rate of 15%.
2011 to provide a PTSD Intensive
Objective and subjective measures
Treatment Programme. Our clinical
demonstrate a clear improvement
audits demonstrated that 75% of our
in PTSD symptoms, as well as
patients had a primary diagnosis of
less depression, anxiety, anger
PTSD, of which 62% also suffered
and alcohol abuse. Veterans leave
from depression and alcohol or
better able to take part in everyday
drug dependency. The PTSD
activities – a big step forward.
Intensive Treatment Programme is aimed mainly at these patients suffering severe symptoms of trauma. The essential components of the programme are group psycho-education and group skills training, and individual traumafocused therapy. Our programme is based on an Australian Veterans’ programme, which successfully treated 4,000 Vietnam War Veterans. The programme has been running since September 2011 at Tyrwhitt House,
The Australian outcomes by–andlarge demonstrated a pattern: one third were doing well at one year follow-up and needing little further help; one third were getting better and needing some help; and one third not doing so well and needing more help but still showing improvement. In the past year, some 152 Veterans have completed Combat Stress’s PTSD Intensive Treatment Programme.
Surrey. A year later, we rolled it out to our other two treatment centres.
PTSD INTENSIVE TREATMENT PROGRAMME • Courses commenced in September 2011 at Tyrwhitt House and September 2012 at Hollybush House and Audley Court. A total of 24 courses were run at our treatment centres.
• 152 veterans completed the programme. • The course is now attracting referrals direct from the NHS and an amendment to the Combat Stress referral pathway is under consideration to improve access to the treatment programme.
10 Combat Stress Annual Review 2013
Aims from 2012 and Achievement to Report During the year we set ourselves some key targets to ensure that access and delivery of our services met the needs of all our Veterans and improved overall satisfaction of the “Combat Stress experience�.
AIMS
achievements
Assessment by psychiatrists and psychologists enable
Outpatient Services
us to diagnose, define and access the treatment Veterans require. This service is now available at all three treatment centres.
The PTSD Intensive Treatment Programme is now
To develop Audley Court and Hollybush House
available throughout the UK. The programme was
to enable UK-wide service delivery for the
in September 2012 and Hollybush House in October
PTSD Intensive Treatment Programme.
launched at Tyrwhitt House in 2011, Audley Court 2012. This vital service has supported an additional 42 Veterans at Audley Court and 23 Veterans at Hollybush House during the year.
Our Well-being Programme was initially aimed only at Veterans on the PTSD Intensive Treatment Programme. However, it proved to be so popular and effective that it
Well-being and Rehabilitation
was enhanced and expanded. Patients who may have been attending the treatment centres for some years, but have not seen much improvement, have participated in the well-being programme to great effect. They are now more able to benefit from the other therapies on offer.
Supporting Veterans and their families 11
Specific Achievements During 2013
The Enemy Within Appeal In March 2010, our Patron HRH The Prince of
The Appeal has also focused on the mental
Wales launched The Enemy Within Appeal.
well-being of our Reserve Forces. We have
The appeal objectives were to:
engaged directly with over 3,200 Reservists,
• transform mental health services for Veterans • raise awareness of the plight of Veterans suffering from psychological injury • encourage Veterans and their families to seek help earlier
Reserve Forces living with psychological trauma to access help. “It was an epiphany for me. I had just thought I was on my own, that I was a freak, that I was weak, and then I met other people who got it and that was absolutely fantastic. You think
As a result of our three year Appeal, we have
that no one else can understand. You don’t
successfully re-shaped the way we deliver our
know what to do. It’s like being stuck in pitch
services and made serious inroads into waiting
black darkness, walking around this maze with
lists and removing the stigma that surrounds
dead ends. You get lost. And then Combat
Veterans’ mental health. Now Veterans seek
Stress comes along and gives you the map
help sooner – Armed Services personnel who
and the torch to help you find your way out.”
have served in Iraq are seeking help some
Neil Blower, Kosovo and Iraq Veteran
2 Neil Blower and family
military staff and professionals helping those
years after discharge and those from
Afghanistan just 2 years.
New Combat Stress website launched In 2012 we took on a task to re-design the
was brighter and more engaging for everyone,
first port of call for many people interested
whether they were looking for a contact
in Combat Stress – our website.
number to refer themselves to Combat Stress
It was last updated in 2009 but, as the
or wanting to make a donation.
sophistication of websites increased massively
After a great deal of design and technical
over the last few years, its visual impact began
work, we arrived at a site with three clear
to diminish.
pathways on the home page and clear options
We consulted Veterans and staff at our three
for contacting and supporting us.
treatment centres about their views and also
While the number of visits fluctuated after the
surveyed members of the public.
re-launch, the quality of visits has increased
It became clear that we have three distinct audiences: Veterans and their loved ones;
with the average visitor staying on the site for 30% longer than before.
volunteers and supporters; and medical and
Any website needs to be ready to change and
other professionals working with Veterans.
adapt – technology and styles rarely stay still
Our old website served up lots of information but was visually quite dark and lacked personality. It was important that a new site
– but now, Combat Stress is better placed to talk to those who need to talk to us, be they a Veteran, supporter or concerned GP.
12 Combat Stress Annual Review 2013
‘We know Combat Stress and our Veterans have achieved a great deal and that we are capable of more. Collectively, that is our greatest strength.’
Supporting Veterans and their families 13
Future Facing – A New Identity We know that mental health has been a taboo subject for many years but things are starting to change. The public at large is beginning to understand that mental health, like physical health, is changeable and that illness does not mean weakness.
Veterans suffered. This helped us to
means to them and they kindly
show Veterans that we understood
guided us as we developed a new
their situation, and it encouraged
logo for the charity.
donors to help us keep this vital work going.
We need a memorable persona, relevant and recognisable to
In 2012, however, it became clear
Veterans, donors, medical
that focusing on recovery would
professionals – anyone who
serve us better. We needed to show
might support or need us –
the solutions we offer and illustrate
before opportunities to hear
It is therefore crucial that Combat
how we help Veterans rediscover the
about us start to decrease.
Stress presents itself in a way
pride and self-belief that they found
that looks beyond the flashbacks,
in themselves when they were in
nightmares and anxiety, and sees
uniform.
the potential within the individual.
The timing is crucial. There has been
of more. Collectively, that is our
Veterans are coming to us with
a great deal of media coverage in
greatest strength.
a desire to reclaim their lives and
recent years so the general public
protect their relationships. It is
is more aware of Veterans’ mental
up to us to make sure that when
health issues and the work of
someone encounters Combat
Combat Stress.
Stress, they recognise a professional
We know our Veterans and Combat Stress have achieved a great deal and that we are capable
Our logo, imagery, language and tone of voice need to reflect our strengths. In the coming year we will align the Combat Stress brand
organisation with heritage, expertise,
However, we’re concerned that
to clearly define us as the leading
pride and proven ability to help
after the troops withdraw from
Veterans’ mental health charity
Veterans change their lives for
Afghanistan, the amazing work and
and a catalyst for better lives and
the better.
commitment of the Armed Forces
stronger families. We will instil
will start to slip from the public’s
a culture of pride, respect and
We have been looking at how
mind. Before that happens, we
personal recovery in everything
Combat Stress presents itself to
need to make sure that the public
that we do.
the outside world. In the past we
image of Combat Stress accurately
struggled to explain simply and
represents the charity and what we
clearly the issues that our Veterans
really do achieve. That’s why we
face and how we help them. We
spoke to Veterans, supporters and
often relied on striking images and
staff about what Combat Stress
language focused on the difficulties
The document in your hand is an embodiment of this culture, as is all our work from back office to front line service delivery.
14 Combat Stress Annual Review 2013
Partnerships Whilst Combat Stress is the recognised charity delivering mental health services for Veterans, the issue is so acute that it is essential we use our capabilities and those of other organisations as efficiently as possible.
We must continue to identify
Our collaboration with the NHS
and develop partnerships and
has not gone unrecognised. The
relationships which support our
Veterans’ Wellbeing Assessment
cause and create an environment
and Liaison Service, delivered by
for better mental health provision
Northumberland, Tyne and Wear
for Veterans.
NHS Foundation Trust and Tees,
Our partnerships and collaborations are broad and include the government, the National Health Service and a wide range of exService charities and other not for profit organisations. We enjoy a close relationship with the Department of Health and the
Esk and Wear NHS Foundation Trust in partnership with Combat Stress, recently won the “Making a Difference award” in the north east. The service was also shortlisted for the Military and Civilian Health Partnership Awards in the category “Care of Veterans”.
Ministry of Defence, and this year
This category was won by The
renewed a strategic partnership
North Essex Veterans’ Mental
agreement with the Departments
Health Network, which is a three-
of Health (including the devolved
way alliance between the NHS,
Departments in Scotland, Wales and
MoD and Combat Stress. The
Northern Ireland) and the Ministry
service promotes recovery by
of Defence.
assisting Veterans and those in
The National Veterans’ Mental Health Network Inspired by the Andrew Murrison paper “Fighting Fit” and promoted by the Department of Health, this exciting strategic partnership with the NHS will deliver mental health care to Veterans through eight regional Armed Forces NHS Health Networks. In time this partnership will provide a unique framework where we share resources, expertise and provide integrated services. We share a common goal – to strive for better mental health provision.
transition to access local services including health and well-being but also resettlement, housing and employment. Other collaborative ventures to reach the final were the London Veterans’ Assessment and Treatment Service under the “Health Improvement and Promotion Award”, and Johanne Tomlinson, a nurse at Stafford Prison who was a finalist for the “Healthcare Civilian of the Year”. Johanne uses the Combat Stress 24-hour Helpline as an intrinsic part of a programme
Supporting Veterans and their families 15
“The mental health of our Service personnel and Veterans is a top priority – that is why this Government has committed £7.2 million to improving services. This is in addition to the invaluable support offered to the ex-Service Community by Combat Stress, which augments the dedicated assistance provided by the National Health Service and the Ministry of
©Crown copyright 2011
Defence. I welcome any initiative that improves the mental health care of our Veterans and I fully support the new Surrey Veterans Mental Health Partnership service.” Secretary of State for Defence, and Surrey MP, The Rt Hon Phillip Hammond
designed to identify ex-Service
Together with The Royal British
prisoners with a high level of anxiety.
Legion, we have enjoyed a
She has persuaded the prison
strategic partnership with the
authorities to authorise the Combat
Department of Health since 2010.
Stress freephone number for use
This arrangement has enabled
in prisoner pay phones and refers
us to organise conferences to
prisoners to Combat Stress six
address healthcare issues, such as
months prior to their release.
the specific needs of the Reserve
The Surrey Veterans Mental Health Partnership, a joint venture between Surrey County Council, NHS Surrey and Combat Stress, provides access to specialist treatment for more than 100,000 Veterans in the county. Combat Stress works with the NHS and local government to provide doctors and social services in Surrey with the tools and understanding to seek out Veterans in need of care.
Forces. The conference in January 2013, entitled “Future Reserves Healthcare: Developing a 2020 Vision”, took place in Nottingham and considered healthcare issues that may emanate from the plans to expand and restructure the Reserve Forces. Research from King’s College London shows a higher percentage of Reserve Forces suffer from mental ill-health than those in Regular Forces. The conference
Military Charities
helped to inform government
Maintaining a close relationship with
consultation on the subject.
the other ex-Service charities is essential to eliminate duplication and ensure shared resources are used effectively to provide the highest service standards to Veterans. Combat Stress is at the forefront of these relationships and is a board member of both The Confederation of Service Charities (COBSEO) and Veterans Scotland. In addition to this, we work particularly closely with other service providers such as SSAFA, Help for Heroes, ABF The Soldier’s Charity, Royal Navy and Royal Marines Charity and RAFBF.
Some 130 representatives of the MoD, Armed Forces, voluntary, health and local authority sectors attended to raise awareness of the proposals and to discuss the healthcare implications. Delegates were addressed by the Minister of State for Defence, Personnel, Welfare and Veterans, Rt Hon Mark Francois MP, and Dr Dan Poulter MP, Parliamentary Under Secretary of State at the Department of Health.
16 Combat Stress Annual Review 2013
The PTSD Intensive Treatment Programme is funded by National Specialised Commissioning through the NHS Our Helpline is delivered by Rethink Mental Illness
‘It is important to remember that many of our services are possible only in partnership with other organisations.’
Both Ministers also addressed other
mental health equivalent to First
not-for-profit organisations at the
Aid training for those working in the
Conference, designed to provide
Veteran community. The company
follow-up to the Murrison initiatives
provides participants with the skills
on Veterans’ mental health.
and confidence to give crisis first
Our close relationship with The Royal British Legion has provided other benefits. The use of their Break Centres has enabled us to provide care for Veterans and their families at special week long programmes for those who need
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.
less intensive care. In the near
We also work with other not
future we hope to be able to offer
for profit organisations such as
community services for Veterans
Timebank, Big White Wall, Warrior
alongside The Royal British Legion
Programme and many others. New
in their town centre sites.
this year was a memorandum of
Together with fellow ex-Service
understanding with Remploy.
charities SSAFA and The Royal
Remploy Poppy Factory and RBLI
British Legion, we are working with
offer Veterans tailored services
Mental Health First Aid England to
to identify skills, build confidence,
raise awareness of a new Veteran
assist with writing CV’s and provide
focused service. Mental Health First
access to a wide range of vacancies
Aid England has been funded by the
with an employer partner network.
government and is a Community
They work with employers to help
Interest Company delivering the
Veterans with psychological injuries
Supporting Veterans and their families 17
Some Key Partnerships
remain in their role. For Veterans with more complex needs, Remploy offers tailored programmes for each individual based on the use of psychometric tests that assist with identifying career goals. Workplace Mental Health Support is an additional service that supports Veterans with mental ill-health. It is available to Veterans who are suffering and face difficulties in the workplace. Many of our services are possible only in partnership with other organisations.
18 Combat Stress Annual Review 2013
focus on veterans
‘I took in every bit of information, guidance and coping technique Combat Stress taught me.’ paul welton Just before Christmas 2008 I had an altercation with a staff member at work.
consecutive operational tours by the
In desperation my wife phoned
time I was 22.
another military charity and
I just picked this guy up and pinned
1996 aged 19. We were the first
him against the wall in my office.
troops out there after they signed
Something just snapped in my mind,
the peace agreement. I was working
like a flick of a switch. I walked out of
16 hour days, 7 days-a-week in
work and went home feeling down. I
temperatures of -22 degrees Celsius.
went to bed that night, woke up and
On a daily basis we were fishing
During that first assessment week
I didn’t want to live any more. From
corpses out of the river near
at Combat Stress I turned into
that point on I didn’t leave my house
a dam because they were
a sponge. I took in every bit of
for 9 months.
causing disruption to the local
information, guidance and coping
electricity supply.
technique the staff taught me. I
I was just 16 when I joined the Army
I first went out to Bosnia in January
explained what was happening to me. Within half an hour of that call someone rang from Combat Stress. I went for an assessment at Combat Stress and was diagnosed with severe complex PTSD.
chipped away and I managed to turn
Catering Corps: a soldier first and
After two tours of Bosnia I was then
a chef second. I was very good on
deployed to Northern Ireland; that
the military side and just seemed to
was the final straw. I left the Army
I would’ve killed myself if it wasn’t
excel at field catering.
and got a job as a chef in the local
for Combat Stress. I now do loads of
hospital but I would have severe
fundraising for them; it’s my way of
anger outbursts which I thought
giving something back.
The Army was always what I imagined and hoped it would be until Bosnia. I did two operational tours there in 1996 and 1997, and then served in Northern Ireland a year later. So I went on three
were ‘normal’. I got married in 2002 and life continued until that fateful day at work when the switch flicked in my mind.
my life around in just two years.
Supporting Veterans and their families 19
‘It’s not just changed my life, it’s also changed the lives of my little daughter, my wife, family and friends.’ neil gray Neil began serving in the Royal Navy in 1979, tracking submarines, and later joined the Intelligence Services.
to do something quite dangerous to
“Once I sent a chap of 25 into a
interested in where you’ve been
building and he got blown up.
or what you’ve done. What we are
Unbeknown to me the building was
interested in is how we can help’. It
rigged. I carried guilt and shame
was music to my ears.
from that for more than 20 years.
“I went to Tyrwhitt House for a
Another time I was snatched by the
week’s bespoke treatment and
other side for 24 hours, beaten up
then went on to the PTSD Intensive
and tortured.
Treatment Programme in early 2012.
“As years went by I was very much
I saw psychologists, psychiatrists,
in denial but eventually I started to
trauma therapists, I had everything.
realise something was wrong. It was
“I’d not slept for 20 years and to
very serious and debilitating.
suddenly be able to sleep, well that’s
“One day a car stopped in front
worth more than money. I’m not
of me. I tapped my horn, not in an
intense or angry any longer, just
angry way. The driver jumped out
very laid back and calm.
and started swearing. I could see my
“It’s not just changed my life,
wife was terribly scared so I got out.
it’s also changed the lives of my
The chap tried to throw a punch. My
little daughter, my wife, family
memory went. I came around when
and friends.”
I had him round the neck and about
him. It was a great awakening. “I heard about Combat Stress and called them. They said: ‘We are not
20 Combat Stress Annual Review 2013
Support groups provide Veterans with the opportunity to meet, socialise and establish social networks.
Delivering a Service Our Community and Outreach Teams deliver a front line service, supporting Veterans in their own community. A Community Service Our Community and Outreach Teams provide: • ongoing support, education, advice, counselling, advocacy and liaison; • access to other organisations that can help or alternative services; • carer and family support on a oneto-one and group basis; • help for family and carers to access resources or services within the community;
• pro-active work on anxiety and anger management techniques with Veterans (Stabilisation); • ongoing welfare visits to the Veteran to re-assure, assist, identify welfare needs and provide a direct link to Combat Stress; • support groups provide Veterans with the opportunity to meet, socialise and establish social networks with fellow Combat Stress clients in the community. This year we have continued to work with members of the UK Reserve Forces.
Supporting Veterans and their families 21
Combat Stress embarked on an ambitious project to extend the current building and add facilities so that more Veterans can get the support they need.
Top Left: Community Outreach Support, Jim Lawrence meets Donald McLeod
Redevelopment and Expansion at
embarked on an ambitious project
all treatment centres
to extend the current building and
Top Right: The Therapeutic Garden at Tyrwhitt House treatment centre
Each treatment centre has
add facilities so that more Veterans
undergone some form of
can get the support they need.
redevelopment during the year, particularly as we have now incorporated specific outpatient facilities to support Veterans locally. At each centre, Outpatients is accessed independently so that clinics and assessments can be held separately from that of our residential treatment programmes. The main building work this year has been the redevelopment of our Audley Court Treatment Centre in Shropshire. Combat Stress
The new building, which has doubled clinical capacity at Audley Court, comprises four additional consulting rooms, three group rooms and a large training area. In addition, we are developing a new bedroom annex with eight bedrooms, two of which are specially designed to accommodate physically disabled Veterans.
22 Combat Stress Annual Review 2013
Raising Awareness and improving access
Events
Manager of Psychological Therapies
Lecture Series
Dr Nicola Sorfleet.
Combat Stress Lecture Series events
Corporate
are always very popular with our
Combat Stress was fortunate to
supporters. These events are well
benefit from the 20th annual ICAP
attended and this year was certainly
Charity Day held in December 2012.
no exception.
The high energy, celebrity-filled
Summer Lecture A Scottish focus with BBC Special Correspondent Allan Little
event has enabled us to raise both awareness of and funds for our work. ICAP’s support is funding our Outpatients facility, and will enable
Armistice Lecture
us to continue supporting families
‘Leaving Kabul: How to get out
in the community. On Tuesday
without having to get back in’
5 February, Sir Patrick Stewart
Sir Sherard Cowper-Coles
joined representatives from Combat
KCMG LVO
Stress at an event at 10 Downing
Hanging Up Your Boots
Street for the 20th ICAP Charity
Hanging Up Your Boots brought the military and sporting communities together for a discussion about the challenges of life after a highly intensive career. Led by Combat Stress supporter and former England rugby player Josh Lewsey MBE, the event at
Day Cheque Reception hosted by Samantha Cameron. Also attending the event was ICAP CEO Michael Spencer, other charities and supporters, along with the ICAP Charity Day team. It was a wonderful occasion to mark 20 years of ICAP Charity Day.
The Royal Geographical Society in February was our first joint venture with rugby players charity Restart. Joining Mr Lewsey on the panel was the former Commander of British Forces Brigadier Ed Butler CBE DSO, former England cricketer Michael Vaughan OBE, CEO of
Top: Ross Kemp filming The Invisible Wounded for Sky 1
the Rugby Players’ Association
Middle: Sir Sherard Cowper-Coles, guest speaker at our Armistice Lecture
Damian Hopley, and Combat Stress’s
Lower: A Battle Proms fireworks finale
Supporting Veterans and their families 23
Press Coverage This year Combat Stress secured 3,298 stories in both national and regional media, helping to raise significant awareness of the charity’s work. This amounts to the equivalent advertising spend of £6.7m – we have reached out to 447m people. Combat Stress also featured in several television programmes including Sky 1 documentary ‘The Invisible Wounded’, presented by Ross Kemp, and BBC One’s ‘Who Do You Think You Are?’ with Sir Patrick Stewart. In January Combat Stress welcomed ITV
exceptional Summer events has
Daybreak to Tyrwhitt House to
soared year-on-year and in 2012
film a piece about the charity’s work
over £34,000 was raised thanks to
after a team of Daybreak presenters
Adam’s incredible hard work, our
won £30,000 for us on All Star
enthusiastic volunteer collectors,
Family Fortunes.
and Blades Aerobatic Display Team.
Volunteer Fundraising – Battle Proms For the last 8 years, Adam Slough and his team at JSL Productions have welcomed along Combat
In total, Battle Proms has raised over £100k for Combat Stress and is an exceptional example of loyal, generous and positive support for Veterans that we work with.
For every £1 we spend
Stress to collect and raise awareness
talking to our donors
at their annual Battle Proms Picnic
we make £4
Concerts – a series of musical extravaganzas with military displays and fireworks each held at a major
220 cold contacts
country house venue including
became warm donors by
Highclere and Blenheim. The reputation and popularity of these
Top: 20th ICAP Charity Day Cheque Reception hosted by Samantha Cameron
giving a donation in 2013
24 Combat Stress Annual Review 2013
‘We are helping Veterans recover sufficiently so they can manage their own recovery.’
Supporting Veterans and their families 25
Aiming High for 2014 In this coming year Combat Stress will continue to consolidate its existing services and develop new services and treatment programmes. Combat Stress intends to introduce a new Alcohol and Substance Misuse (Case Management) Service for Veterans who suffer from
We will also work in partnership with
By introducing vital new
The Royal British Legion to create
programmes and refining our
facilities on the high street where
existing clinical services, including
Veterans and their families can
our current well-being programmes,
easily get help with mental health,
we are helping Veterans to manage
social and welfare needs. These sites
their own recovery. The aim is to
will provide the ideal opportunity
give them the skills and confidence
to bring together other relevant
to allow them to get back into
services using a ‘one-stop shop’
employment and improve their
approach .
relationships – as well as improve
addictions and who also have
We are refining our existing
underlying mental health problems.
community services to improve
This service, which is not currently
access to treatment by:
available anywhere in the UK, aims
• understanding the community
at developing better access to
in which the Veteran lives and
trauma-focused services to treat the
the services that are currently
Veteran’s underlying mental health
available to them – both through
condition. The case management
the NHS and through other third
service will work closely with
sector charities.
statutory substance misuse services, ensuring that Veterans
• delivering a comprehensive care
are channelled immediately into an
package in partnership with other
appropriate trauma-focused service
organisations, Service charities
once they have completed their
and the NHS (in particular
treatment for alcohol and
the Veterans’ Mental Health
Substance misuse.
Networks) to meet their needs.
We expect that this service will initially be rolled out at three sites towards the end of 2013, and further sites will follow in due course.
their social interactions and their life within the broader community.
26 Combat Stress Annual Review 2013
Financial summary – where your money goes In recent years, we have substantially increased and improved our services and facilities. Over the last ten years our charitable expenditure has increased from £4.4m in 2003 to £12.1m in 2013, an increase of 175%. Building projects to improve and expand our Treatment
Where our funding came from...
£170k 1% Helpline
£15,567K
£64k 0%
£300k 2%
Statutory Grants
Other Income
£421k 3%
£49k 0%
Investment Income
Trading – Events and sales
£434k 3% Corporates
£6,528k 42%
£815k 5%
Clinical services
Volunteers and Community
£3,616k 23%
Trusts and Service Charity Grants
£523k 3%
Major donors
Centres over the last ten years have cost £7.4m.
£1,329k 9%
A further £1.8m capital
£1,318k 9%
Legacies
Individual Giving
expenditure is planned for 2013/14.
...And how we spent it.
£183k 1%
Governance
£3,154k 23%
Community Outreach Services and Reservists Liaison
£6,447k 46%
Clinical Short Stay Programme
£195k 2% Helpline
£13,933K
£469k 3% Improving access
£1,667k 12%
Cost of generating funds
£1,818k 13%
Clinical Intensive PTSD Programme
Supporting Veterans and their families 27
Statement of Financial Activities (incorporating an Income and Expenditure Account) for the year ended 31 March 2013 Totals
Unrestricted Restricted
Totals Restated
Funds
Funds
2013 2012
£’000
£’000
£’000 £’000
Incoming resources Incoming resources from generated funds
Voluntary income
8,335 8,942
5,369
2,966
Activities for generating funds
49
–
49 204
Investment income
421
–
421 374
6,698
–
6,698 6,196
64
–
64 37
Incoming resources from charitable activities Other incoming resources Total incoming resources
12,601 2,966 15,567 15,753
Resources expended Costs of generating funds
Cost of generating voluntary income
Fundraising events and trading
Investment management fees
1,614 1,141
1,614
–
–
–
– 137
53
–
53 29
1,667
–
1,667
1,307
Charitable activities
Clinical services
Community Outreach Services
Helpline
Raising awareness and improving access
Governance costs Total resources expended
8,098
167
8,265 7,262
887
2,267
3,154 3,031
– 251 9,236 183
195 218
195 258 469 286
2,847 12,083 –
10,837
183 149
11,086 2,847 13,933 12,293
Net incoming / (outgoing) resources before transfers 1,515 119 1,634 3,460 Transfers between funds
232
(232)
– –
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 Net movement in funds Fund balances brought forward at 1 April Fund balances carried forward at 31 March
1,747 (113) 1,634 3,460 564
–
564 (237)
78
–
78 (1,206)
2,389
(113)
2,276 2,017
22,107
370
22,477 20,460
24,496
257
24,753 22,477
All of the above results are derived from continuing activities. 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. Of the fund balances held at 31 March 2013 of £24.7m, £12.3m (50%) are allocated as capital assets, restricted funds or designated to specific projects or revaluation reserves. The remaining £12.4m is a general reserve. The trustees have set a target level for general reserves of between 9 and 12 months of budgeted expenditure. This level is necessary to meet day to day operational requirements essential for the maintenance of its operations, to even out cash flow fluctuations and to provide a prudent financial base from which to continue to develop Combat Stress and its services. The budgeted expenditure for 2013/14 is £16.9m, which projects further expansion of the charity’s services. The level of general reserves is projected to be 8.8 months. This Statement of Financial Activities is only an extract from the annual report and accounts of Combat Stress. For further information the full annual trustees’ report and accounts can be obtained from the Head Office or from our website at www.combatstress.org.uk. The full accounts have been audited and the auditor’s report was unqualified.
28 Combat Stress Annual Review 2013
thank you The Corporation of Trinity House
The Scottish Government
D D McPhail Charitable Settlement
Seafarers UK
this demand we need to continue to
Department of Health
Sir Jules Thorn Charitable Trust /
seek out support for our vital work.
Dr Chai Patel CBE FRCP
We currently work with so
Freemasons’ Grand Charity
The need for the services of Combat Stress to the Veteran population is steadily rising year-on-year. To meet
many wonderful individuals and organisations who are passionate about our work and this year is no exception. We could not do what we do without your support.
Help for Heroes Horses Help Heroes ICAP plc
Ann Rylands Special Project Telegraph Media Group Victims & Survivors Service Northern Ireland The Westminster Foundation Our supporters include Service
The Irish Ex-Service Trust
charities, grant-making trusts,
advice and support from our Patron,
The Ministry of Defence
companies, the Government and
HRH The Prince of Wales.
The RAF Benevolent Fund
ABF The Soldiers Charity
The Royal British Legion
BAE Systems plc
The Royal Navy and The Royal
for sponsoring this year’s
Comic Relief
Marines Charity
Annual Review.
We continue to gratefully receive
many individuals throughout Britain and beyond. A special thank you to Thales UK
Supporting Veterans and their families 29
Honorary Structure and contact Details Patron His Royal Highness The Prince of Wales KG KT GCB OM AK QSO PC ADC
Board of Trustees Major General Peter Currie CB (Chairman) Mrs Jenny Green OBE MA (Deputy Chair)
President General Sir Redmond Watt KCB KCVO CBE
Colonel Robert Ward RM (Honorary Treasurer)
Vice Presidents Mr Dennis Bailey
Air Commodore Oliver Delany OBE MBA BA FCIPD FCMI FBIFM
Air Vice-Marshal Nigel Baldwin CB CBE
Lieutenant General Andrew Graham CB CBE
Mr Robert Bieber MBE MA
Major General Euan Loudon CBE
General Sir Edward Burgess KCB OBE
Mrs Mary Molesworth-St Aubyn DL
Lieutenant General Sir Roderick Cordy-Simpson KBE CB
Ms Helen Pernelet Lic en Droit; dip Law
Air Chief Marshal Sir David Cousins KCB AFC Vice Admiral Sir Geoffrey Dalton KCB Commodore Toby Elliott OBE DL RN Dr Charles Goodson-Wickes DL Brigadier Charles Grant OBE General Sir Charles Huxtable KCB CBE The Hon Bernard Jenkin MP Lieutenant General Sir John Kiszely KCB MC
Colonel Philip Baxter
Mr Adrian Pollitt OBE MA Mr Trevor Royle MA FRSE Mr Stephen G Smith FInstF Mr Russell Thompson OBE FInstF Dr Suzy Walton BSc MSc PhD CPsychol CSci AFBPsS MRI CDir FRSA Professor Sir Simon Wessely MA BM BCh MSc MD FRCP FKC FRC Psych FMedSci KBE The Enemy Within Appeal Board
Air Marshal Ian Macfadyen CB OBE FRAeS RAF
Executive Management
The Lord Moonie
Mr Simon Blagden MBE
Surgeon Captain Morgan O’Connell RN FRCPsych
Mr Benedict Brogan
The Rt Hon Sir Malcolm Rifkind KCMG QC
Major General Peter Currie CB
Derek Twigg MP Major General Sir Evelyn Webb-Carter KCVO OBE His Grace The Duke of Westminster KG CB CVO OBE TD CD DL
Chief Executive Commodore Andrew Cameron MA FCMI RN
Director of Finance & Information Management and Governance Mrs Victoria Reynolds FCCA Director of Fundraising & Communications Ms Uta Hope MA MInstF
Director of Medical Services Wing Commander Walter Busuttil MB ChB MPhil MRCGP FRCPsych RAF (Retd) Director of Operations Mr Garrett Taylor LLM BSc (Hons) DPSN RGN
Director of Strategic Planning and Partnerships Lieutenant Colonel Peter Poole MBE MILT
Mr Tony Banks
Brigadier Ed Butler DSO CBE
Director of Corporate Management Miss Natalie Styles MSc MCIPD
General the Lord Richard Dannatt GCB CBE MC DL Sir Roy Gardner The Duke of Hamilton The Rt Hon The Lord Hutton PC The Hon Bernard Jenkin MP
Constitution
General Sir Roger Wheeler GCB CBE
Miss Nicola Jones
Ex-Services Mental Welfare Society.
Mr Josh Lewsey MBE
Air Marshal Sir Robert Wright KBE AFC FRAeS FCMI
Ms Helen Pernelet Lic en Droit; Dip Law
Company limited by Guarantee Registered in England and Wales No.256353
Vice Admiral Peter Wilkinson CB CVO RN
Mr Ashok Rabheru CVO DL Mr Julian Sainty Ms Carole Stone
Charity Registration No.206002 Scotland No.SC 038828 Tyrwhitt House, Oaklawn Road, Leatherhead, Surrey KT22 0BX
The Veterans’ Mental Health Charity
‘I’d not slept for 20 years and to suddenly be able to sleep, well that’s worth more than money.’ Neil Gray, Northern Ireland Veteran