Combat Stress Annual Review 2015

Together on the Journey Annual Review 2015 Ex-Services Mental Welfare Society Company registered in England and Wales No 256353, Charity No 206002, Charity Scotland No SC038828

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About us

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ombat Stress is the UK’s leading mental health charity for Veterans. We provide specialist treatment and welfare support to former members (Veterans) of the Armed Forces, Merchant Navy and Reserves who are suffering from psychological injury. After assessment, each Veteran receives a bespoke treatment plan to meet his or her individual needs; an integrated and tailored pathway to maximise their potential for recovery.

Our free 24-hour Helpline and unique network of multidisciplinary Community and Outreach Teams provide nationwide support.

From October 2015 we will be working in partnership with The Royal British Legion offering community services from many of their high street Pop-in Centres. We also offer a Pilot Substance Misuse Case Management Programme that will roll out in more areas later in the year.

Our three residential treatment centres deliver world-class clinical programmes including a Post Traumatic Stress Disorder (PTSD) Intensive Treatment Programme commissioned by the NHS, together with comprehensive rehabilitation and wellbeing services.

Today, the charity is helping more than 6,000 Veterans and last year new referrals increased by 26%, the largest rise in recent years.

ReSIDenTIAl TReATmenT cenTReS, ouTPATIenT SeRVIceS AnD oFFIceS

communITy AnD ouTReAch TeAmS wIThIn TRBl PoP-In huBS

A.TYRWHITT HOUSE (Treatment Centre and Head Office) Leatherhead, Surrey

01.Belfast 02.Birmingham 03.Cardiff 04.Colchester 05.Derby 06.Leeds 07.Manchester 08.Plymouth 09.Southampton

B. HOLLYBUSH HOUSE Ayr, Ayrshire c. AUDLEY COURT Newport, Shropshire D.BELFAST OFFICE

Annual Review 2015 Combat Stress

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6 7

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5 2

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3 A 9

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oTheR communITy AnD ouTReAch TeAmS Northern Ireland East of Scotland West of Scotland North of England PIloT SuBSTAnce mISuSe cASe mAnAgemenT PRogRAmme Northumberland, Newcastle and North Tyneside

Glasgow Wiltshire Forth Valley Portsmouth Manchester PIloT ARmeD FoRceS ReFeRRAl Scheme Leicestershire Police

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contents 02

About Us

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Introduction

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Our Vision

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The Road to Restoration

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The Journey to Recovery

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Ahead of its Time

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95th Anniversary

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First Steps to Getting Help

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Making Effective Progress with PTSD

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Obstacles on the Road to Recovery

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Moving On

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Reaching Out

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The Journey Ahead

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Financial Information

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Your Support for Veterans

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Thank You

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Governance

Seeds of hope gardening is just one of the occupational therapy activities that we offer Veterans. It encourages relaxation, problem solving and it helps build resilience.

“It’s three days in now and I think I’m starting to feel the benefits. I know it’s me being conscious of what I’m doing but the techniques they teach here are quite easy to follow. Being here makes it easy to learn different things as the surroundings are calm and relaxed and nobody is judging you.”

Steve, a Veteran who has attended the two-week Stabilisation Programme

Combat Stress Annual Review 2015

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Introduction Welcome from Chief Executive Peter Poole

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ur 95th anniversary provided an opportunity to celebrate our considerable number of achievements but there were many moments for poignant reflection too. The poppies at the Tower of London helped the whole nation remember those who gave their lives 100 years ago in the First World War. In 2104 we saw the last UK troops leave Afghanistan, many of whom have been affected by loss and injury during the conflict. Perhaps it is not surprising therefore, that we experienced an increase in the number of Veterans seeking our help, up by 26%, the highest ever annual increase.

With this expected to rise even further, we are strengthening our efforts to increase accessibility to our services and to ensure Veterans will be able to receive help sooner. We have also improved our systems and processes to ensure we support the Veteran along the whole care pathway on their journey to recovery.

Improving outcomes for our Veterans relies on the Right: Our Patron HRH The Prince commitment of our staff as well of Wales, pictured here with Ambassador Sir Patrick Stewart, as the continuing generosity of our marked our 95th anniversary many donors and volunteers. Our by hosting a garden party at St collaboration with partners such as James’s Palace in June 2014. the MoD and the NHS is also vital to FAR Right: In March 2015, The ensuring we can achieve our vision Veterans and staff at Tyrwhitt of giving Veterans a real chance to House welcomed HRH Prince Harry who made a private visit to the live free from the harmful effects of treatment centre. psychological injuries.

This year we thank our previous Below, right: Chief Executive Peter Poole and a Veteran in the Chief Executive, Andrew Cameron, Occupational Therapy department. for his leadership over the last four years. We will build upon firm foundations as the leading experts in Veterans’ mental health to create even greater impact, relevance and effectiveness in the future.

Annual Review 2015 Combat Stress

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26%

New Veteran referrals up 26% on previous year

Combat Stress Annual Review 2015

o u r visi o n

The Veteran is at the heart of all we do.

As we accompany them on their journey to recovery we are mindful of our vision, our mission and our values...

A NEW CAREER Being treated for PTSD has helped Paul develop a new creative focus

Our Vision Our Vision is that Veterans will be able to live free from the harmful effects of psychological wounds.

Our Mission Our Mission is to provide timely, effective clinical treatment and welfare support to Veterans who suffer from psychological wounds.

To realise this we must: • Be accessible to those who need help • Be expert at what we do and be recognised as such • Work in partnership with others • Raise awareness of Veterans’ needs

Our Values Our Values are: • Putting Veterans at the centre of our work • Aspiring to achieve excellence in everything we do • Fostering a culture of respect and integrity

Annual Review 2015 Combat Stress

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The Road to Restoration Paul Schubert left the Army in 1990 after nine years’ service. But it was only in 2013 that he sought the help of Combat Stress

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round four years ago, it occurred to Paul Schubert that something wasn’t right. “I was experiencing panic attacks and I couldn’t fathom why,” he says. “I suddenly felt vulnerable in ordinary situations. Even before this I had dark moods, but again I couldn’t put a finger on it. Then, two years ago, something went wrong at work and I toppled over, so to speak…”

An Occupational Health Advisor gave Paul a leaflet on Combat Stress.

He self-referred and was subsequently diagnosed by one of the charity’s psychiatrists with late-onset PTSD. It wasn’t caused by a single event but by layer upon layer of events experienced over his years in the Army, and compounded by his civilian work beyond that.

Paul had served in the Royal Military Police in the 1980s. In June 1986 he was deployed to Beirut as part of the close protection team for the British Ambassador. He arrived just two months after former hostage John McCarthy had been kidnapped.

Paul explains, “It was a high-stress environment, with a high threat of kidnap against us too. By the end, it felt like a decade compressed into a sixmonth tour.”

Since first contacting Combat Stress in 2013, Paul has attended a twoweek residential treatment programme at Audley Court, the charity’s treatment centre in Shropshire and has benefited enormously. “We were given a toolkit offering ways to cope with what we were feeling. Compared to two years ago, I’m a million times better. My symptoms are alleviated following the programme. I’ve a different outlook and am positive, fit and healthy. Two years ago, I had very little interest in anything.”

Paul has embarked on a new career too, restoring vintage furniture. What began as a creative distraction – something to focus on while he awaited treatment for PTSD – has become a successful Black Country business: Schubey Chic. His work can be found at the Red House Glass Cone in Wordsley, Stourbridge, and online at schubeychic.co.uk

Combat Stress Annual Review 2015

c l i n i c a l pat h way s

The Journey to Recovery The journey to recovery from depression, anxiety or Post Traumatic Stress Disorder is different for each Veteran. After assessment, we work with him or her to develop a treatment plan to address individual need. Treatment may involve Community and Outreach Team visits, outpatient visits, a residential stay or referral to a partner service. However it is delivered, our aim is to provide the right treatment, in the right place and at the right time to give the Veteran the best chance of recovery.

Engagement

Reintegration

We work with the Veteran to stimulate their self-belief and develop their commitment to recovery

Consolidation of the skills acquired through treatment enables the Veteran to improve social integration into families and their communities

Implementing Change This stage increases the capability of the Veteran to change – to strengthen their skills and to improve psychological resilience through active and intensive treatment

Resource Building The Veteran builds resilience to effectively engage in more intensive inpatient or outpatient treatment options

Annual Review 2015 Combat Stress

Self-Maintained Recovery Empowers the Veteran to live their LIFE independently

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Picture perfect one of many striking images produced by the Belfast community and outreach Team Veteran photography project: a project that is helping Veterans build resilience, reduce anxiety and learn new skills

RelAPSe mAnAgemenT Acknowledges the potential for relapse and focuses on the obstacles that are still preventing recovery

TReATmenT oPTIonS Diagnosis and assessment Bespoke individual therapy Stabilisation Programme Recovery and Resilience Programme PTSD Intensive Treatment Programme Transdiagnostic Programme Pilot Substance misuse case management Programme Anger Management Programme Recovery breaks Art Therapy

DelIVeReD VIA 3 Residential treatment centres Outpatient services 15 community and outreach Teams TRBL Break Centres TRBl hubs and other community facilities

Combat Stress Annual Review 2015

Hist o r y

Veterans create basketwoven furniture at Eden Manor

Ahead of its Time Combat Stress was founded in May 1919, after the First World War, to care for soldiers returning home with shell shock. We take a brief look at how it started

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uring the First World War mass conscription of a civilian army, exposed to the horrors of trench warfare and large-scale mechanised destruction, resulted in an epidemic of so-called ‘shell shock’. Thousands of men were returning home from the Front and from sea suffering from trauma. Yet the attitude to mental health was primitive, even barbaric by today’s standards. Many Veterans were confined to mental war hospitals under martial law – with the risk of being sent on, without appeal, to asylums.

The founders of Combat Stress, however, believed rehabilitation could help these men to cope. The organisation opened a recuperative home on Putney Hill in south west London in 1920. Work was seen as essential to masculine identity, providing financial security. Also, many doctors believed work to be an excellent form of therapy so for a number of years, Combat Stress ran schemes that created real work opportunities for Veterans.

However, much has changed over the decades, particularly since 1980 when ‘Post-Vietnam Syndrome’ or ‘delayed-stress syndrome’ was first codified by the psychiatric community. Now we describe the condition of shell shock as Post Traumatic Stress Disorder or PTSD. At Combat Stress, a significant milestone was passed in 2007 when the charity appointed its first full-time medical director, consultant psychiatrist Dr Walter Busuttil. Our clinical services have developed rapidly since then,

Annual Review 2015 Combat Stress

and in 2011 we were awarded NHS funding to deliver an Intensive Treatment Programme for PTSD. Combat Stress is now a charity with a far-reaching impact. This has been driven by two factors: an ever-increasing demand for our services (up 26% in this last year alone) and our desire to offer a ‘gold standard’ in care. Today we support around 6,000 men and women suffering from a range of conditions, including anxiety and depression, as well as PTSD. We can also show our clinical model for PTSD works, following a two-year study into our Intensive Treatment Programme, the results of which were published this year in the British Medical Journal Open.

Much remains to be done as Combat Stress heads towards its centenary in 2019. However, we have much to be proud of too.

It is 95 years since the founders opened their first recuperative home on Putney Hill. Could they ever have imagined just how far their pioneering work would come?

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95th Anniversary Combat Stress commemorated 95 years of lifechanging work with special events, planting poppies at the Tower of London, and even a stint on Bake Off!

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pring 2015 marked the end of our 95th anniversary year. Since the First World War we have helped rebuild the lives of more than 100,000 ex-Service men and women with psychological injuries.

Our commemorations began on the charity’s 95th birthday itself – 12 May 2014 – with events held at our treatment centres. Staff and Veterans gathered at Tyrwhitt House, Audley Court and Hollybush House to enjoy barbecues, games and cake, before releasing balloons.

Our Patron His Royal Highness The Prince of Wales commemorated the anniversary by hosting a reception at St James’s Palace in June 2014, where he met Veterans, staff and supporters of Combat Stress. The Prince highlighted the charity’s achievements since it was founded in 1919, as well as the need for Combat Stress to continue providing specialist mental health care to ex-Service men and women.

Raising awareness of Combat Stress and the Veterans who need our help is an important part of the charity’s work. To coincide with our anniversary, we revealed to the media that between 2012 and 2013 there had been a 57% increase in the number of Afghanistan Veterans seeking our help for their mental health conditions. This received substantial media coverage – more than 970 news pieces – and our social media campaign message was seen by two million people.

Last year was significant for another reason – the centenary of the start of the First World War. The Tower of London chose to commemorate the occasion with an art installation, Blood Swept Lands and Seas of Red, in the famous moat; 888,246 ceramic poppies were planted to represent every British and Colonial fatality in the war. Combat Stress was chosen as one of six charities to benefit from proceeds of the sale of the poppies, and our staff were invited to help plant poppies to create the moving display.

Our 95th anniversary finished on a high note, with Combat Stress featuring on BBC One’s The Great Comic Relief Bake Off in March. Celebrity baker Paul Hollywood visited Tyrwhitt House to find out about the lifechanging work we do across the UK. He met some of the Veterans before rolling up his sleeves and helping them bake cakes in the kitchen.

The film about his visit was broadcast during a Bake Off episode, which helped bring awareness of our work to a whole new audience.

Above: placing poppies as a reminder of lives lost during the First World War Below: Paul Hollywood and Veterans bake up a treat at Tyrwhitt House

Combat Stress Annual Review 2015

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First Steps to Getting Help For today’s Veteran with psychological difficulties there are a number of routes to treatment and support at Combat Stress. Crucially, individuals are able to self-refer and 52% of initial enquiries received last year came directly from Veterans themselves

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ur free 24-hour Helpline is a vital point of access for many, and it is delivered on our behalf by the charity Rethink Mental Illness. In 2014/15, 19% of Veterans were referred to us this way. Other paths to Combat Stress are via NHS community mental health teams, GPs and consultants (representing 10% of referrals last year) and other Service charities and welfare organisations (13% of new referrals).

Once contact has been made, the first person that a Veteran will meet is often one of our Regional Welfare Officers who typically has a Service background themselves. The Welfare Officer will carry out an initial welfare assessment, after which the clinical members of the Community and Outreach Team will work with the Veteran to begin the process of accessing appropriate treatment. For some, this may mean attending a residential programme at one of our three specialist treatment centres: Tyrwhitt House in Surrey, Audley Court in Shropshire or Hollybush House in Ayrshire. For others, perhaps with less complex psychological needs, community-based interventions may be the best route to recovery. We have 15 Community and Outreach Teams (COTs) covering the UK. Over the past two years, Combat Stress has carried out a Community Review to improve accessibility and introduce a new way of working in the community. Our COTs often spend hours on the road, visiting Veterans in their homes or local area. While critical in a number of cases, how many more ex-Service men and women will we reach when we have presence on the high street?

One of the first significant developments following our Community Review is a new service to be launched in partnership with The Royal British Legion. From 1 October 2015 we will be moving some of our clinical work into their centrally located Pop-in Centres. It means Veterans will be

Annual Review 2015 Combat Stress

able to access multiple services in a single visit.

A further joint initiative is underway: introducing Occupational Therapy to our Pop-in services to support Veterans’ as they learn new skills and engage in meaningful activity in their local community.

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Call for help

24-hour Helpline for Veterans, serving military personnel and their families.

0800 138 1619 To view a video about the Helpline visit http://bit.ly/24HelpCS The second largest group to call the Helpline is friends and family

The Helpline is available to Veterans, serving personnel and their families. An Operator tells us more about the service: I work in a small team of seven people providing helpline support 24-hours a day, seven days a week, every day of the year.

A large number of the calls we receive are from Veterans reaching out for help for the first time.

Many feel isolated and have deep anxieties, as well as confusing and frightening manifestations of, for example, PTSD. It can take a lot of courage for them to make that initial call, so when they do we focus on making sure they are listened to, as well as letting them know it is One-to-one a safe place to talk.

Our Community Many Veterans feel enormous and Outreach Team members will work relief because acknowledging with Veterans in and facing their issues is a big their local area thing. It’s the beginning of taking control and making a difference for themselves. We can then provide them with information and contact details for agencies that can help and we can pave the way for access to specialised treatment at Combat Stress.

A Veteran recently told me that if he hadn’t had the opportunity to talk to someone at 3am he would have been in a far worse state than he was.

Confidential support is out there: we’re just a phone call away.

Combat Stress 24-hour Helpline Worker

Combat Stress Annual Review 2015

S P EC I A L I S T T R E AT MEN T

Making Effective Progress with PTSD When Veterans come to Combat Stress with anxiety, depression or PTSD they are often unable to see a way out but our effective treatments have shown positive results

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any Veterans who come to us for treatment have Post Traumatic Stress Disorder (PTSD). Many will have lived with the condition for years before seeking help. In the meantime, depression, anxiety – or problems with alcohol and drugs – may have taken hold as they’ve struggled to cope on their own.

Typically, the Veterans we see have complex psychological and social needs. We work with each one individually to develop a tailored care plan.

This may include one-to-one and group therapy sessions in the community, short-stay clinical treatment, occupational therapy or welfare signposting.

It may also mean referral to NHS and other specialist services – or working with a partner organisation such as The Royal British Legion to deliver our Wellbeing, Recovery and Social Reintegration Programme at their UK Break Centres. Our clinical and welfare services are always evolving to offer Veterans the best chance of long-term recovery. For those suffering most profoundly, our six-week PTSD Intensive Treatment Programme is showing highly positive outcomes.

Put simply, PTSD is a normal reaction to an abnormal experience. It may develop if we are exposed to an extraordinary situation, far outside the norm, which our mind may struggle to make sense of. PTSD can occur after someone goes through a traumatic event. If you repeat the traumatic events day after day, it’s not hard to understand how the impact on the mind can be devastating. Symptoms include vivid flashbacks of the experience, a sense of emotional detachment as traumatic memories are repressed, sudden anger, disturbed sleep and panic.

In the first study of its kind in the UK, published in March 2015 in the British Medical Journal Open, Combat Stress demonstrated that a unique combination of individual and group therapies can achieve significant improvements in Veterans’ mental health. We surveyed 231 Veterans at the end of, and six months after, PTSD Intensive Treatment Programme across our residential centres. The Programme included at least 15 individual traumafocused cognitive behavioural therapy sessions – as well as 55 group sessions

Annual Review 2015 Combat Stress

designed to work alongside trauma therapy to rebuild the skills Veterans need to thrive and feel confident.

Drop-out rates were very low and, most importantly, 87% of participants had a reduction in their PTSD symptoms. We also saw significant improvements in relation to depression, anxiety and anger problems – as well as in the ability to work and fit into the community.

94%

completed the Intensive Treatment Programme during the study

231

Veterans were asked how they felt at the end of the course

87%

were able to report a significant reduction in symptoms Results were maintained at the six-month follow-up.

15 An image from the Belfast Community and Outreach Team Veteran photography project

The findings of this study demonstrate that treatment specifically designed for Veterans – taking place in dedicated, rather than general, clinics – is effective for ex-military personnel with PTSD. Our Intensive Treatment Programme is currently funded by the NHS. However, there has been a marked rise in referrals to Combat Stress in recent times, particularly from Veterans who served in Iraq and Afghanistan. In the financial year to April 2015, new enquiries for help increased by 26%. We will need to expand our clinical services accordingly – which will mean securing additional funding and resources. The good news, though, is that we can offer treatments that work.

Find out more If you want to find out more about available treatments for PTSD, we have made a short film. In it, Professor Mark Creamer from the University of Melbourne and Dr Walter Busuttil, Medical Director at Combat Stress, talk about our PTSD Intensive Treatment Programme.

Watch it at: http://bit.ly/CS_ITP The full BMJ Open paper about the ITP may be downloaded from here: http://bit.ly/ITPResults

Combat Stress Annual Review 2015

M A K I NG P R OG R E S S

Obstacles on the Road to Recovery An important part of overcoming mental health difficulties is admitting a problem exists – Combat Stress is working hard to help Veterans break the stigma barrier

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ot everyone who needs intensive treatment for PTSD is ready for it. For some Veterans, there are other problems to be confronted first, such as depression or drink and drug misuse. And then, of course, there is the issue of stigma.

Many Veterans find it difficult to ask for help – or even admit they have a problem. After all, they have been trained to be self-sufficient: effective at all times, especially in emergencies. Many will confess to us they knew they had a mental health problem even when they were serving, but they were afraid to seek help for fear of appearing weak to their peers, family and friends. They also feared for their careers.

Others weren’t aware they had a mental health problem but maybe knew they were drinking too much, losing their temper more easily or they were becoming socially withdrawn. Often it was only a family member who realised something was actually wrong.

To help address these barriers Combat Stress ran a public anti-stigma campaign in 2013, which led to many Veterans accessing care. Then in December 2014 we published an academic paper in the Journal of the Royal Army Medical Corps (‘PTSD, Stigma and Barriers to Help-Seeking within the UK Armed Forces’). The primary aim was to educate military doctors and medics. The Forces themselves have been playing their part in breaking down stigma too with Trauma Risk Management (TRiM) which promotes mental health awareness throughout the ranks.

Our collective efforts seem to be having effective results. A decade or so ago, the average age of Veterans receiving help from Combat Stress was 60.

Today, it is 42. Younger Veterans of the Afghanistan and Iraq conflicts are approaching us more quickly too: on average 2.1 years and 4.4 years from discharge, respectively.

But having finally reached out for help, what still stops a Veteran engaging in treatment? It is important to acknowledge there may be other, sometimes multiple, obstacles to accessing treatment but often the barrier is a problem with alcohol or drug misuse.

Annual Review 2015 Combat Stress

We are continuing to roll out our Pilot Substance Misuse Case Management Programme. Working closely with partner substancemisuse services, we have specialist nurses and practitioners who work closely with the Veteran to manage their treatment and ensure onward referral to appropriate services.

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is the average number of years it takes a Veteran to ask for help after leaving Service across all conflicts. Younger Veterans of Afghanistan and Iraq are coming to us sooner; 2.1 years and 4.4 years respectively.

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When drink or drugs are an issue…

Dave Marsden Pilot Substance Misuse Case Management Programme Nurse explains: Dave Marsden, one of our specialist Substance Misuse Nurses, is based at the Northumberland Recovery Partnership. Veterans who access the NHS for alcohol and drug issues are flagged up to receive Dave’s specialist help. He describes his mission as “to help Veterans get the best treatment using all available options, and to support them as they progress.” When their addiction is under control, Dave refers many to Combat Stress for what he calls ‘gold-standard treatment’. As a qualified psychiatric nurse, he understands the necessity of tackling substance misuse which prevents Veterans being able to move onto effective treatment for traumarelated injuries.

Dave works with our Regional

Welfare Officers and Community and Outreach Teams with regular referrals and follow-up visits, but no two days are the same. The new case management service allows him to check progress wherever the Veterans are on the treatment pathway. He can then offer support, whether that’s accompanying a Veteran to an appointment if they feel anxious, to helping them into a new home or college course.

Dave is keen to raise awareness of this integrated support service to other Veterans with mental health and dependency issues when he’s out and about – the posters, leaflets and cards he distributes across Northumberland get snapped up.

He also loves the rewards his job brings. “The new case management

service is the way forward. It eliminates accessibility issues for Veterans needing multiple services.

Communication is key to helping each Veteran achieve their goal of a better future and this service allows all of us supporting Veterans to work together to help them get there.”

Pilot Substance Misuse Case Management Programme: Running: Wiltshire, Glasgow, Northumberland, Newcastle and North Tyneside Planned: Forth Valley, Portsmouth, Manchester

Combat Stress Annual Review 2015

m ovi n g o n

Reconnecting Rebuilding relationships is an important part of recovery, whether at home, socially or at work

84%

84% of businesses agreed that Veterans have important skills that would benefit UK businesses.

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Moving On A large part of recovery is rebuilding and renewing relationships with friends, family and colleagues.

Combat Stress offers support to help Veterans reconnect

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o what are the goals of treatment? Essentially, we are aiming to achieve two things together. The first is a reduction in symptoms of PTSD and, typically, depression and/or alcohol misuse. The second is an improvement in ‘function’ in close relationships, whether at home, socially or at work.

We have already demonstrated positive outcomes from our PTSD Intensive Treatment Programme at six months after completion, and we will continue to assess participants and report again on their progress after two years.

However, Veterans face numerous challenges, particularly in rebuilding their relationships and rejoining the workforce after treatment. A broad network of support is needed to ensure long-term success.

Veterans have to regain the trust of their loved ones. They have to show them they are no longer irritable and angry, prone to isolating themselves, hyper-vigilant of attack, feeling suicidal even, or drinking to excess. They have to be dependable once more. While supporting the Veteran on their journey to recovery, Combat Stress also provides information for families in relation to the Veteran’s symptoms and will signpost to the most appropriate support agencies.

Along with family and social relationships, getting back into work can be hugely beneficial. The corporate sector has a powerful role to play in helping Veterans reintegrate and ex-Service personnel have a wealth of skills they can bring to the business environment. New research commissioned by Combat Stress this year revealed that Veterans would have better employment prospects if businesses understood their mental health needs and how to access specialist support.

In March 2015 we held The Military Mind – a ground-breaking symposium at the Wellcome Collection in London, which brought together expert speakers from the Department of Health, the Ministry of Defence, Combat Stress and Barclays, to explain the opportunities and challenges for companies with employees who have served in the Armed Forces.

The event highlighted the specialist treatment options which are available, and the continued need for strong communication between Human Resources and occupational health departments, as well as the Veteran’s GP and Combat Stress.

The event, which was sponsored

by Thales, was well attended and live-streamed on the Combat Stress website to reach a wider audience.

We look forward to building on its success. In the meantime, we will do more to inform GPs, psychiatrists and other professionals as well as families and the public – about Veterans who suffer from mental ill health.

Survey results In March, as part of The Military Mind symposium, we carried out a survey to find out what UK businesses thought about employing ex-Service men and women. We interviewed 500 decisionmakers from UK companies in a range of sectors.

The results were very positive with 84% of respondents agreeing Veterans have important skills that could benefit businesses, while 75% of the respondents said they would hire more Veterans if they had expert advice on how to support them in the workplace.

Combat Stress Annual Review 2015

R A I S I n g AwA R e n e S S

Reaching out Raising awareness is a key part of combat Stress’s success. The more the public understands, the greater the support for Veterans

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uring 2014 and 2015 Combat Stress received a record 5,186 pieces of media coverage. This not only helped to raise awareness of our work but highlighted the issue of Veterans’ mental health and the need for the public’s continued support of our charity.

On our 95th anniversary in May 2014 we revealed we’d seen a 57% increase in referrals from Afghanistan Veterans between 2012 and 2013.

The media response was incredible, with more than 970 pieces of coverage over two days including the front page of The Guardian and interviews on Sky News, ITN and BBC News. Our campaign message on social media was seen by more than two million people – our largest audience ever.

We also received extensive media coverage as we were one of the charities that benefited from the Tower of London’s spectacular poppy installation commemorating the centenary of the First World War. At Christmas we were honoured to be chosen as the charity for the Sunday Express Christmas Appeal, which raised thousands of pounds and increased awareness of our work.

In March we had another successful media campaign when we revealed a 26% increase in Veteran referrals Media campaign in the previous year. At the same ‘Luke’s War’ ran time the outcomes of our PTSD in November to Intensive Treatment Programme raise awareness were published in the British Medical of how Veteran Journal Open. The two stories mental ill-health received 234 pieces of media impacts families. coverage on one day.

Annual Review 2015 Combat Stress

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The power of art Blood Swept Sands and Seas of Red was a poignant reminder of the losses suffered during the First World War

47,000 ‘likes’ on Facebook

our social media Website: combatstress. org.uk Facebook: facebook.com/ CombatStress Twitter: @CombatStress You Tube: Search for Combat Stress Charity LinkedIn: Search for Combat Stress

T HE F U T U R E

The Journey Ahead The future: With new referrals rising by 26% we expect the next year to be challenging

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ver the last year we reviewed how our Community and Outreach Services could be improved to increase accessibility, reduce waiting times and focus on delivering services closer to where Veterans live. With the review complete, we are implementing the recommendations and a newly-shaped community service, that brings in fresh ideas while retaining the best of the old model, will launch on 1 October 2015.

We also look forward to the continued development of the Pilot Substance Misuse Case Management Programme for Veterans experiencing difficulties with alcohol and drugs.

Annual Review 2015 Combat Stress

Currently, the service works closely with local voluntary and statutory substance misuse services in England and Scotland, offering screening and brief interventions. The programme is running in Wiltshire, Glasgow and Northumberland, Newcastle and North Tyneside and we plan to offer the service more widely across the UK. We are particularly looking forward to introducing structured peer support and are working with Mindspace in Perth where four of our Veterans completed a 26-week training course resulting in an accredited mental health peer mentoring qualification. We hope to introduce a wider network of peer support in the coming year.

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Art Therapy ‘chilling’ by Shaun is an intricate acrylic painting that has featured in several exhibitions of Veteran artwork this year

Our research, and the outcomes from our treatments, contribute to the body of global clinical evidence which improves understanding of both Veterans’ mental health problems and effective treatment options.

We will continue to collect data for all our treatment programmes, both in the community and treatment centres, and these will form the basis of future research. A new Patient Administration System will be implemented during 2015 helping clinical staff to store and retrieve Veteran records more efficiently and allow us to better evaluate our effectiveness.

As a charity, we are always looking at ways in which we can do more with less. During 2015/16 we will explore further activities with our existing partners to share resources, increase our reach and improve efficiency.

We will be recruiting regional fundraisers to provide local contacts and co-ordination for our supporters while also raising awareness of our services for Veterans.

We plan to improve the digital solutions

currently available for supporters who donate via online giving and who purchase tickets and merchandise from our online shop. We are very aware that our website currently does not work well when accessed from mobile devices and this will be improved in the coming year.

Many individuals are generous enough to leave a legacy to Combat Stress in their Will. This is an important source of income for us and we plan to develop our legacy work to provide better information to those who wish to remember us.

We have begun the process of recruiting a new Chief Executive and are grateful to Peter Poole for stepping in as Interim Chief Executive. Replacing Andrew Cameron will be difficult but we look forward to the new ideas, new focus and new challenges that a fresh perspective will bring.

We have started to plan for our centenary year in 2019 and we will continue to work on our culture change to best meet the needs of our Veterans who are, as ever, at the heart of all that we do.

Combat Stress Annual Review 2015

2014/2015

Financial Information In 2014/15, in accordance with our plans, we increased our charitable expenditure to ÂŁ14.0m [2013/14: ÂŁ13.5m]. However, we had to withdraw funds from our reserves for the first time in many years in order to do so, as our income fell short of planned targets

I

n order to generate the higher income levels needed for the future and to reduce the risk of fundraising shortfalls, we have increased investment in our fundraising activities. We will continue to seek out alternative income streams and innovative ways of raising funds.

outreach project The northern Irish coast photographed by the Belfast community and outreach Team Veteran photography project

Annual Review 2015 Combat Stress

25

2014-15 Expenditure £’000 Generating Voluntary Income 2,660 15.72% Residential Treatment Programmes 9,421 55.69% Community Outreach Services 3,421 20.22% Reserve Forces Liaison 106 0.63% Helpline 269 1.59% Raising Awareness and Improving Access 412 2.44% Substance Misuse Case Management Programme 389 2.30% Governance 240 1.42%

Total

2014-15

Expenditure

16,918

2014-15 Income

2014-15 Income

Events Statutory Grants Corporates Volunteers and Community Major Donors Legacies Individual Giving Trusts and Foundations Royalties Clinical Services Trading Investment Income Other Income

Total

£’000 124 759 334

0.83% 5.07% 2.23 %

1,089 1,018 1,862 1,470

7.28% 6.80% 12.45% 9.83%

2,683 370 4,617 85 547 3

17.93% 2.47% 30.86% 0.57% 3.66% 0.02%

14,961 Combat Stress Annual Review 2015

YOU R S U P P O R T

Your Support for Veterans From Christmas Appeals to corporate benefactors, Combat Stress is grateful for the donations and support that enables our work

L

ike many other UK charities, the income Combat Stress receives has been affected by several years of economic austerity. In addition, the withdrawal of UK troops from Afghanistan in 2014 has led to a general drop in media interest in Veterans’ affairs, making the fundraising climate all the more challenging.

Nonetheless, Combat Stress has had some notable successes in the past year, recruiting 10,286 new individual donors to help us deliver our work – one of our campaigns beating its fundraising target by £30,000. Our spring 2014 appeal focused on the centenary of the First World War and the reasons for Combat Stress being founded. Our autumn Armistice appeal highlighted why the charity is still relevant today - we have seen an increase of 57% in new referrals from Veterans of Afghanistan, with every indication of more to come.

Many individuals have also been generous enough to leave a legacy to Combat Stress in their Will. This is an important source of income for us, amounting to over £1.86 million in the last financial year.

At the same time we are very grateful for a new source of financial support, The Forces Lottery - theforceslottery.com. By the end of 2015 we had accumulated over 4,500 entries each week and raised £29,479.

Over the coming year we will also be developing a Benefactor Programme for individuals who would like to support our core services with an annual gift of £5,000. We are asking these donors to consider making a five-year pledge, so that we can better plan our finances for the future.

Our corporate benefactors have been extremely generous in 2015. Thanks to the sponsorship of Thales UK, for example, we were able to deliver our ground-breaking The Military Mind business symposium in London in March of this year. Virgin Trains has stepped up too, providing free tickets to Veterans in need and with long distances to travel for residential treatment.

Support from trusts and foundations, both locally and nationally, is a significant part of our fundraising programme and helps us to provide our core services. Our supporters include Service charities and grant-making trusts.

Our Volunteer Fundraising Team attended several major events across the country including a series of Battle Proms concerts that raised over £25,000.

Annual Review 2015 Combat Stress

27

For every £1 we spend: Wincanton Racecourse Charity Race Committee organised an Armed Forces Race Day that raised £50,000 and provided a hugely enjoyable family day for the Forces community and general public. The Team also represented the charity at the National Armed Forces Day event in Stirling, the annual Beating Retreat event in London and numerous running events across the UK. We organised and hosted a number of prestigious events including a concert at St John’s Smith Square to commemorate the First World War and an Annual Supporter Dinner held alongside imposing displays of aircraft at the Imperial War Museum. A series of lectures delivered by journalist Kate Adie, archaeologist, historian and broadcaster Neil Oliver, and writer and broadcaster Martin Bell OBE were all sold-out events.

We are grateful to everyone who attended our events, hosted their own or who took part in sponsored challenges to raise money for Combat Stress.

Your support allows us to deliver lifesaving treatments. Although the last few years have been financially tough, we remain confident we can deliver the services we believe are needed now more than ever.

81p is spent on Veteran treatment and support

16p

is spent on fundraising

2p is spent on raising awareness, improving access and tackling stigma

1p

is spent on governance

YOU R S U P P O R T

Thank You We would be unable to support our Veterans without the help of individuals, partners and organisations

W

e would like to thank the many individuals, corporate partners, Service charities, benevolent funds, trusts and foundations that have supported us this year. We are immensely grateful for their continuing commitment and for the many ways in which they enable and enrich our work.

We appreciate the support of everyone who ran, swam, climbed, baked, sang, danced, walked or took part in one of the countless sponsored challenges that were undertaken for the benefit of Combat Stress. Every penny raised helps our Veterans move forward towards a more positive future.

Annual Review 2015 Combat Stress

29

coRPoRATe PARTneRS we are grateful to the many companies whose staff gave their time to support our work in very practical ways. goldman Sachs were just one of our corporate partners whose staff have volunteered at combat Stress treatment centres

Combat Stress Annual Review 2015

g ov e r n a n c e

Governance Patron

General Sir Roger Wheeler GCB CBE

Interim Chief Executive and

His Royal Highness The Prince of Wales KG KT GCB OM

Vice Admiral Peter Wilkinson CB CVO

Director of Strategic Planning

Air Marshal Sir Robert Wright KBE AFC FRAeS

and Partnerships

President

Lieutenant Colonel Peter Poole MBE MILT Director of Finance, Information

General Sir Peter Wall GCB CBE DL

Board of Trustees

Management and Governance

Vice Presidents

Lieutenant General Andrew Graham CB CBE (Chairman)

Ms Victoria Reynolds FCCA

Mr Dennis Bailey MCSI

Colonel Robert Ward (Hon Treasurer)

Air Vice-Marshal Nigel Baldwin CB CBE

Mrs Jenny Green OBE MA (Deputy Chairman)

Mr Robert Bieber MBE MA Lieutenant General Sir Roderick Cordy-Simpson KBE DL Vice Admiral Sir Geoffrey Dalton KCB Commodore Toby Elliott OBE DL RN Brigadier Charles Grant OBE General Sir Charles Huxtable KCB CBE DL The Hon Bernard Jenkin MP Lieutenant General Sir John Kiszely KCB MC DL

Mr Peter Allen

Director of Medical Services Wing Commander Dr Walter Busuttil MB ChB MPhil MRCGP FRCPsych RAF (Retd)

Air Commodore Dusty Amroliwala OBE MA MBA FCIPD

Director of Operations

Colonel Philip Baxter

Director of Fundraising

Mrs Jessica Hughes

and Communications

Mr Christian K B Melville LLB DIP LP NP TEP WS

Mr Tim Brawn BA

Mrs Mary Molesworth-St Aubyn DL Major Mickey Morrissey FCSI

Ms Julie Shannon MA RMN ADEP

Director of HR and Corporate Management Miss Natalie Styles MSc MCIPD

Mr Stephen G Smith

The Lord Moonie

Mr Jan Sobieraj

Surgeon Captain Morgan O’Connell RN

Mr Russell R Thompson OBE FInstF

Mr Richard Nunneley

Dr Suzy Walton BSc MSc PhD CPsychol CSci CDir FRSA

Company Limited by Guarantee

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

No. 256353

Dr Chai Patel CBE FRCP Sir Malcolm Rifkind KCMG MP Derek Twigg MP Major General Sir Evelyn Webb-Carter KCVO OBE DL His Grace The Duke of Westminster KG CB CVO OBE TD CD DL

Interim Chief Executive and Director of Strategic Planning and Partnerships Peter Poole

Welfare Society Registered in England and Wales Charity Registration No. 206002 Scotland No. SC 038828

Directors Chief Executive Commodore Andrew Cameron MA FCMI RN (outgoing 31/3/15)

Director of Finance, Director of Medical Information Management Services and Governance Dr Walter Busuttil Victoria Reynolds

Constitution Ex-Services Mental

Director of Operations Julie Shannon

Tyrwhitt House, Oaklawn Road, Leatherhead, Surrey KT22 0BX combatstress.org.uk

Director of Fundraising and Communications Tim Brawn

Director of HR and Corporate Management Natalie Styles

Paul Schubert, Veteran

Photo: Alamy

‘I’m a million times better today. My symptoms are massively alleviated following the programme. I’ve a completely different outlook: positive, fit, healthy. Two years ago I had very little interest in anything.

It’s a lot easier now.’

Combat Stress Tyrwhitt House, Oaklawn Road, Leatherhead, Surrey KT22 0BX General enquiries: 01372 587 000 Email: contactus@combatstress.org.uk 24-hour Helpline: 0800 138 1619 Website: combatstress.org.uk Facebook: facebook.com/CombatStress Twitter: @CombatStress You Tube: Search for Combat Stress Charity LinkedIn: Search for Combat Stress Ex-Services Mental Welfare Society.

Company registered in England and Wales No 256353, Charity No 206002, Charity Scotland No SC038828