Encouraging soldiers to talk through their traumatic experiences is now an accepted part of life in the Armed Forces.
Defence Focus writer Sharon Kean reports for benhealth.
Soldiers are far more likely to experience traumatic events than the average civilian – it’s the nature of the job.
But the recent pace of operations in Afghanistan has meant an increase in the number of casualties, and the images of seriously injured soldiers featured in the BBC’s Wounded documentary are a stark reminder that many return home with life-changing injuries.
Physical injuries are obvious but the psychological and emotional effects of combat are often less apparent. However, it is an issue the Army is taking seriously. Since April last year, Trauma Risk Management, TRiM for short, has been an accepted part of Forces life and any unit deploying on operations is now expected to have trained practitioners among its numbers.
"When someone has a traumatic experience on operations the people they want to talk to are their mates," says Major Richard Dorney, an officer with more than 30 years’ experience in the Grenadier Guards, which oversee the Army’s TRiM programme. "We are building on that, by training people to recognise the symptoms and signs that something's not right."
TRiM practitioners are not psychologists or counsellors, but they are trained to spot when someone might have a problem. "We filter those who are most at risk, signposting them to the field mental health team," says Dorney.
Informal chats are used, usually three days after an incident, and monitoring continues with further interviews after one month then again after three months. It is a voluntary process, relying on soldiers to come forward for a conversation, which they are guided through in a controlled way.
Guard Corporal James Dean says TRiM helped him, after a series of traumatic incidents left him needing help. Before deploying to Afghanistan, he witnessed an accident on a firing range, his first experience of violent death. "At the time I just swallowed it, because of the stigma," he says. "But then out in Garmsir we took a casualty. It threw me and I just ended up freezing."
Despite this he continued and ‘pushed it down and buried it’. However, things came to a head after an incident in southern Afghanistan where he had to deal with a seriously injured child. An explosion in Sangin’s busy bazaar left a three-year-old Afghan boy with a shrapnel wound, which sliced into his head. Corporal Dean was the team medic who treated him.
"Your training kicks in and you do your job, then five seconds later when you sit down with a brew and a cigarette it hits you," he says. "When I'd calmed down all I could think about were my own kids - all I could see were their faces."
Luckily, his company sergeant major took Dean to one side. “He managed to find the only quiet bit of Sangin, sat me down and we went through half a packet of fags and I talked my heart out."
Knowing that he had been through similar experiences meant Dean felt he wasn't being judged and could be honest with him. As a result he was referred to the mental health team at Camp Bastion, and evacuated back to the UK for two weeks, before being allowed to return to Afghanistan.
"The Army's a close knit society so it's taken a while to get onto this, but the stigma is disappearing,” says Dean. “I don’t have any shame in what happened in Sangin and I shouldn't do."
Major Dorney is confident that TRiM has done much to break down the barriers that have traditionally led to many soldiers suffering in silence, afraid to show signs of weakness. He adds: "People's attitudes to stress are changing as a result of TRiM. If a senior commander says this is OK then it removes the stigma - there's a lot more awareness out there."
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Specialist support
Several specialist centres and charities across the country treat and rehabilitate injured servicemen and women.
Headley Court, near Dorking, Surrey, is the armed forces’ dedicated rehabilitation centre where 220 military and civilian staff treat 6,500 patients a year.
For most combat casualties, Headley Court is the final stage of the recovery process, helping people with major trauma after they have been treated at Selly Oak Hospital, Birmingham.
Its facilities include a hydrotherapy pool, four fully-equipped gyms and a state-of-the-art limb-fitting and amputee centre.
The centre has 66 inpatient beds for the most serious cases, including limb loss, brain and spine injury. These patients can spend up to nine months at Headley Court.
There are a further 100 residential places for patients on three-week rehabilitations courses for muscle, bone and joint injuries, which can be either work or sports related.
“We focus on vocational rehabilitation,” says Lieutenant Colonel John Etherington, clinical director at Headley Court. “Everything we do here is about returning people to work. Most patients want to return to active duty and their units want to have them back.”
Major Phil Packer, famous for his fundraising challenges including completing the London Marathon earlier this year, was treated at the centre after being paralysed during a rocket attack in Iraq in 2008. Headley Court helped him to regain some of his mobility and he completed the 26 mile course in 14 days raising thousands of pounds for disabled soldiers in the process.
St Dunstan’s is another provider, a national charity, giving lifelong support and rehabilitation to blind and visually impaired ex-servicemen and women.
Ray Hazan, St Dunstan’s president, was blinded and lost his arm after a parcel bomb exploded in Northern Ireland in 1973. He says: “Sight loss can be devastating. It is a long, challenging journey of rehabilitation. Emotionally, you can feel isolated and frustrated by the situation. You have to re-learn many of the everyday tasks you once took for granted.
“My first realisation that I hadn’t lost everything came around three weeks after the explosion. I was visited by a member of the St Dunstan’s team, who gave me a tactile watch and taught me to tell the time through touch. It was this practical support that made me realise I could regain independence – it was something to live for.” St Dunstan’s has rehabilitation centres in Ovingdean near Brighton and in Sheffield.
The TRiM concept was originally developed by the Royal Marines 10 years ago.
Two Army psychiatric nurses were asked to write a programme to help manage the effects of trauma on troops, building on the support that comes with being part of a military unit.
Major Richard Dorney estimates that now, around two and a half thousand people within the Army are trained, either as TRiM practitioners or in the more senior role of co-ordinator.
Healthcare for the armed forces
Members of the armed forces, their family and friends are eligible to purchase personal healthcare from the Benenden Healthcare Society. Membership costs just £1.50 per person, per week, and you can join online.
This article first appeared in issue 10 of benhealth, the magazine for Benenden Healthcare members.
