combat stress annual review 2012

Annual Review 2012

“With Combat Stress’s support I have been able to get my life back on track. It’s an amazing organisation, doing incredible work.”

FRANCO

Combat Stress2

C A S E S T U D Y

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

But the ordeal left his life in tatters. Missing his Army buddies and suffering severe depression, his marriage fell apart and his wife and two children left.

“Some people turn to alcohol but I had become isolated, introverted and was eating myself to death,” explains Franco. He ballooned to 27 stone with a body fat

mass of 68% (three times what it should be) and a 72 inch waist. “I didn’t know I had PTSD.”

Franco says: “With Combat Stress’s support I have been able to get my life back on track. It’s an amazing organisation, doing incredible work.”

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

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

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

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

FRANCO

Briefing noteName: FrancoServed: Northern Ireland What happened: Franco was beaten so badly by a mob while on patrol in Northern Ireland that he didn’t think he’d live.

How I used to look

Franco’s story

Annual Review 2012 3

S U P P O R T i N g V E T E R A N S A N D T h E i R FA m i l i E S

Introduction from our Chief Executive

Combat Stress is undergoing a once in a lifetime upgrade.

The fundamental change programme we have embarked upon is being funded by our successful The Enemy Within Appeal,

grants from major military charities, companies, trusts, private individuals and the Government. The programme is trying, for the first time, to create a fully integrated mental health and welfare service for ex-Service personnel. This connects Combat Stress, other charities, the NHS and the MoD as never before.

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

We are currently treating over 5,000 Veterans. Recently, we have seen a rapid rise in young men and women who have served in Iraq and Afghanistan seeking our help. This makes up part of the 12% increase in new referrals we receive year-on-year. As a result, waiting times for treatment have increased.

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

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

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

Thank you.

Andrew Cameron Chief Executive


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

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

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

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

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

Why Veterans need our support

* King’s Centre for Military Health Research 2010

Combat Stress4

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

Six-Week PTSD Treatment Programme

(Page 16)

Community Outreach

(Page 12)

24-hour helpline

(Page 10)

Short-Stay Treatment

Programme

TA and Reserve Forces liaison Team

(Page 15)

Well-being and Rehabilitation Programme

how we help



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

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

Combat Stress6

O U R S E R V i C E S

What we set out to achieve

• To establish 14 regional multi-disciplinary Community Outreach Teams to provide local support for Veterans.

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

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

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

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

In our 2011 Annual Review we laid out our aims for the next year that would enable us to increase the quality of our service to ex-Service men and women. These were:



What we achieved

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

• In September 2011 we launched the Six-Week Veterans’ PTSD Programme at our Surrey treatment centre, Tyrwhitt House. To find out how this is progressing, turn to page 16.

• 2011 saw the implementation of a dedicated TA and Reserve Forces liaison Team, see page 15 for more details.

• By working in partnership with the Ministry of Defence, the NHS and the Department of Health, Combat Stress has improved the way Veterans’ mental healthcare needs are addressed and dealt with. Turn to page 10–11 to read about our helpline, funded by the Department of Health. In addition, our Six-Week Veterans’

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

• On 10 October 2011, World Mental Health Day, we launched the second phase of The Enemy Within Appeal. This phase is a UK-wide campaign, largely funded by Comic Relief, to raise awareness of the hidden wounds of conflict and to address the issue of stigma that surrounds Veterans’ mental health. Turn to page 18 to read more. Improving access to our services remains a key aim of the campaign, and we are pleased to report that the Combat Stress 24-hour Helpline has also established a text and email support service.

2011–2012The year in numbers

Number of treatment centres

3

Days of treatment delivered through our three Treatment Centres

24,042

Number of beds in our short -stay Treatment Centres

75

Veterans supported by Combat Stress

4,929

Number of admissions for treatment

2,427

Number of volunteer fundraisers

1,056

Veterans attending our community support groups

3,532

Calls to the Combat Stress 24-hour helpline

6,650

Combat Stress8


Over the next year we will:• Develop both Audley Court and Hollybush House (inpatient

Treatment Centres) in order to be able to deliver the Six-Week Veterans’ PTSD Programme for the whole Veteran population in the UK who are registered with Combat Stress. This will:

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

– Reduce travel times.

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

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

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

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

The introduction of the new services will:

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

• Reduce waiting times for Veterans.

• Identify suitable patients for the six-week programme.

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

Looking ahead



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

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

low intensity Residential Therapies (focused on maintenance and social integration)Community Outreach

Services (welfare and clinical)

TA and Reserve Forces liaison Team

Welfare support and advice in the community

Short-Stay medium intensity Treatment Programme (focused CBT** therapies inc. EmDR***)

Outpatients (assessment, stabilisation, and preparation for treatment)

24-hour helpline

high intensity Treatment (Six-Week Comorbid* PTSD Programme)

NhS services

Service charities

Charitable Sector Welfare and Social Services partnerships

Other qualified service providers

High intensity treatment Low intensity support

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

**Cognitive Behaviour Therapy (CBT) combines two effective kinds of psychotherapy: cognitive therapy and behaviour therapy. Trauma-focused CBT specifically helps the individual to confront his or her traumatic experiences.

***Eye movement Desensitisation & Reprocessing (EMDR) involves prompting rapid eye movement with outside stimuli, while the patient reflects on the event that is causing distress. The procedure can eliminate or lessen the negative associations of the traumatic event and it has a calming, self-affirming effect.

Combat Stress10

W O R K i N g i N PA R T N E R S h i P

Combat Stress 24-hour Helpline

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

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

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

Big White WallCombat Stress is proud to have joined forces with this award-winning online service, which complements the Helpline. Big White Wall offers a space to anonymously discuss any mental health concerns – and is free to serving personnel, Veterans and their families. It is monitored by trained ‘Wall Guides’ and offers peer support and clinical counselling. Visit www.bigwhitewall.com

Findings from an independent review of Big White Wall found that:

• 75% of members talked about an issue for the first time on Big White Wall

• 80% self-managed their psychological distress

• Two thirds of Big White Wall members said they used the site mostly to relieve stress and loneliness

• Half said they used the site to relieve anxiety and a third cited depression as their main reason for using Big White Wall

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

Big WhiTE WAll mEmBER



5 Things I’ve learnt about the HelplineTalking helps!it’s easy to forget just how helpful talking can actually be. From my experience of talking with Veterans, the Armed Forces often instills a culture of silence that leaves many people feeling they cannot talk about their issues to family and friends. The helpline is helping people to realise the beneficial power of talking. The Helpline is often the first step in seeking help. The feedback we’ve received has been overwhelmingly positive. We provide an opportunity to talk.

Service-related issues don’t just affect the VeteranThe friends and families of Veterans form the second biggest group of people who contact us with their calls and emails (Army Veterans being the first). Often they are trying to hold things together for a loved one who is struggling with mental health issues. This can be a very stressful and upsetting situation for them. The helpline gives friends and family the chance to offload, gain reassurance and find out how and where they can access the appropriate help. For many this makes a huge difference, helping them to carry on supporting their loved one and to find the right support.

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

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

Feeling understood is so importantVeterans often tell me that their gP and other people involved in their care just don’t really understand. Sometimes just by listening properly, you can help someone to feel better because they have had a chance to explain their point of view without being judged or dismissed. The helpline supports people through particularly difficult periods. Those who use the helpline often tell us they find it helpful because they feel understood. The helpline has made a huge difference, providing hope, empowerment, information and support to those who need our help.

2

4 5

1

3

Jason Parker is one of our helpline advisors

NUmBER OF CONTACTS BETWEEN 1ST APRil 2011

– 31ST mARCh 2012

6,650 667NUmBER OF CAllERS

FROm A FRiEND OR FAmilY mEmBER OF A VETERAN

504NUmBER OF CAllERS WhO

WERE FROm A PROFESSiONAl BACKgROUND

Combat Stress12


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

The Veteran will receive a registration form to complete

A Regional Welfare Officer will then visit to assess and provide assistance based on the Veteran’s specific needs

The Welfare Officer will then ask the Community Outreach Team to assess the clinical needs of the Veteran and may make a referral to one or any of the following:

how the Community Outreach Teams work

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

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

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

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

A Combat Stress Treatment Centre for

further assessment and treatment

An appropriate NhS serviceThe Veteran’s gP

The Combat Stress Community Outreach

Team

Support groupsOne-to-one home visits Carer Support groups

Welfare support

Six-Week PTSD Treatment Programme

Short-Stay Treatment Programme (stabilisation,

preparation and rehabilitation)

how do Veterans access our services?

Themselves 51%

Through a family member 9%

Through their GP 4%

Through another charity 14%

Through another welfare organisation 22%



“I served for over 20 years in the Army so I understand the pressures that soldiers are put under. This helps when I need to build rapport with a client.The Veterans we support are usually very anxious. I reassure them it’s ‘okay’ if they get emotional during our session. I go through their childhood history, what their background was like and then through their Service life. We will then go back to the key traumatic incidents that happened and work through them. We also discuss what’s happened to them since leaving the Forces. Gaining trust is one of the most important parts of my role. When I visit Veterans and they talk about a particular place, I understand: the

geography, the terms a soldier uses to explain his job, the equipment he’s been carrying, the tension, and the training. I can look someone in the eye and know what they are talking about without looking puzzled. Because of that shorthand, Veterans are more willing to talk about their Service experiences and what has happened to their lives since leaving the Forces. Most ex-Service personnel have never had PTSD explained to them or what they are actually going through. Many are very angry and emotional. Yes, my job can be draining but it’s also very rewarding because I know that someone is in a far better place when I leave than when I first walked in.”

Robert lappin Regional Welfare Officer, Scotland West

Robert Lappin

‘inside Right’ Inside Right has been set up to help young ex-Service men and women with mental health problems. The initiative uses the hook of football and provides access to ongoing support and services.The programme is a unique partnership between the military and mental health charities including Combat Stress, the Football Foundation and The Ministry of Defence.The feedback received so far has been very encouraging. A Veteran who has been involved in the project said:

“I can now see some light at the end of the tunnel instead of a train careering towards me. The light might only be a small candle flickering, but it’s something and it’s giving me hope.”

Visits

First time contact visits 817

Visits made by Regional Welfare Officers

5,192

Support groups

Carer support groups held

Number held

Veterans attending

98445 3,532

Phot

o co

urte

sy o

f Her

ald

and

Tim

es G

roup

Combat Stress14

C A S E S T U D Y

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

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

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

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

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

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

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

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

“Combat Stress basically saved our lives. Their practical and medical help took the pressure off us so I could get myself together. I can’t thank them enough.”

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

“Combat Stress basically saved our lives …”

PETER DOOlAN, mC

Briefing note

Name: Peter Doolan, MC

Served: Kosovo, Sierra Leone, Iraq

and Northern Ireland.

What happened: As a teenager Peter

had experienced ferocious fighting

in Kosovo. By 21 he had operated

behind enemy lines in Iraq before

engaging in battle.

Photograph by Sam Spurgeon



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

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

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

Shoulder to Shoulder

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

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

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

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

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

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

Working in Partnership

have been sent overseas on their own and can find it difficult to integrate into ‘tight knit’ Regular units. After coming home they often won’t see these people again. Some feel that they have ‘done their bit’ and leave the Reserve Forces for good, whilst others resume civilian life and do not return to Service for many months. This means Reservists are often isolated from those within the military, who they might be willing to confide in when their memories begin troubling them.

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

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

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

Armed Forces health Partnership

health treatment – along with other voluntary sector organisations and the NHS – we can create integrated

‘whole-person’ services which produce outcomes for Veterans and their families that are far and above the sum of our parts.”

Since the launch of the partnership, we have achieved a great deal including: the Shoulder to Shoulder project (see left); a number of conferences with health professionals; as well as the production of the GP guide

‘Meeting the healthcare needs of Veterans’. This is available to download from our website www.combatstress.org.uk

Combat Stress16


Six-Week Veterans’ PTSD Programme

Our newly established Six- Week PTSD rehabilitation programme is designed to treat Veterans suffering from severe forms of PTSD and another condition or conditions, such as depression, alcohol and illicit drug misuse.

Veterans will need initial stabilisation by clinicians before they can be admitted to the programme, ensuring that their depression and substance misuse are under control.

The programme is run by two full-time equivalent psychologists/Cognitive Behavioural Therapy-trained mental nurse therapists; supported by Consultant psychiatrists, registered mental health nurses, occupational therapists, psychotherapists and other multidisciplinary Treatment Centre staff – ensuring that the Veterans on the programme are appropriately supervised.

Up to eight Veterans participate in each group. The work day is full and we expect the Veterans to participate in the whole of the programme which runs between 9am and

5pm during week days; with ‘homework’ tasks and some therapy in the form of practical work being done at weekends. Two half days for family/ carer involvement are also scheduled. The Veterans on the programme have a workbook which they work through during the programme.

Veterans can use all facilities in the Treatment Centre including the activity centre and gym. We also have an Occupational Therapy-led Well-being Programme to help Veterans with the ‘homework’ tasks set by the main six-week programme, as well as to keep them engaged in activities and situations that they need to confront.

Our programme has three main therapeutic mechanisms: group psycho-education, group skills training and individual trauma-focussed therapy. It is based on the Australian Veterans’ rehabilitation programmes, which have been in place for many years. There is a large evidence base of over 4,000 Australian Veterans who were suffering from chronic PTSD and other conditions including substance misuse, depression with social and relationship complications, benefiting from such programmes. The Australian treatment outcomes are: one third of Veterans on the programmes will do well and need little help at one year follow-up; one third get better but need some help, one third don’t do so well but need less help than they did at the outset.

Treatment outcomes so far are promising for Veterans treated at Combat Stress.

Dr Walter Busuttil

A review of the programme by Combat Stress Director of Medical Services, Dr Walter Busuttil



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

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

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

Our therapists helped him to cope with his guilt and the mental images that still paralysed him. His partner for the last six years, Melanie Williams, says that while it has been “hard,” things could have been worse. The treatment has transformed their lives. “Brian hasn’t hit the bottle and he hasn’t hit me,” she says. “He used to snap at me for no reason and I did find that very upsetting.”

The intensive six-week course of therapy at Combat Stress proved a turning point. At Tyrwhitt House in Surrey, Brian was surrounded by tranquil gardens and fellow ex-Service men and women who understood what he was going through. “Brian was completely different,” smiles Melanie, describing his “amazing”

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

Melanie no longer worries when Brian “draws into himself,” knowing “everything will be fine.” For Brian, seeking help has made all the difference, giving him the strength and tools “to break the cycle of depression and the black thoughts.”

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

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

mElANiE

Briefing noteName: BrianServed: Falkland Islands What happened: At just 21 Brian

was onboard HMS Sheffield when it was hit. Twenty of Brian’s comrades died that day. After desperate efforts to fight the fires, the ship was

abandoned and eventually sank.

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

Combat Stress18


Raising funds and awareness

in march 2010 our Patron hRh The Prince of Wales launched The Enemy Within Appeal on behalf of Combat Stress. This three-year fundraising

campaign will help us to treat the escalating number of Veterans with mental health problems who are turning to us.

The Enemy Within Appeal is being used to:• Enhance clinical treatment at our three short-stay residential

centres and provide access to specialist clinical support in the community

• Raise awareness of the plight of Veterans with mental health issues

• Reduce the stigma that surrounds Veterans’ mental health, encouraging both Veterans and their families to seek help early

We need Veterans to come to us sooner for the help that they so desperately need. To achieve this, we must address three key issues:

• The lack of education and understanding about mental health issues.

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

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

On 10 October 2011, World Mental Health Day, we launched the second phase of The Enemy Within Appeal. This phase is a UK-wide campaign, largely funded by Comic Relief, to raise awareness of the hidden wounds of conflict and to address the issue of stigma that surrounds Veterans’ mental health.

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

81% of Veterans tell us* that they feel ashamed or embarrassed about their mental health problems.

launch of the Anti-Stigma Campaignlast year, Combat Stress saw yet another rise in the number of ex-Service men and women turning to it for help. Despite this, it is a sad fact that Veterans still wait an average of just over 14 years after leaving the Services before seeking our help. This is far too long. During this time Veterans and their families suffer and the delay often leads to additional mental health and social problems. Relationships falter, marriages break down and, in a few cases, Veterans succumb to suicidal thoughts. many suffer in silence and don’t know where to turn for help.

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

COmBAT STRESS SUPPORTER

The Enemy Within Appeal

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

*Combat Stress online survey, September 2011


C A S E S T U D Y

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

“Everything just spiralled out of control after that,” James said. “I was very self-destructive. I cut myself off from family and friends. I had sleep deprivation, I had bad dreams and night sweats. In my dreams I saw the friendly fire incident, black smoke pouring from

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

James eventually “crashed and burned.” When he finally decided to get help it was 14 years since he had returned from the Gulf War. He was referred to Combat Stress.

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

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

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

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

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

JAmES

Briefing note

Name: James

Served: Gulf War

What happened: James had no

idea that a harrowing friendly

fire incident and a personal

family tragedy would later

combine to trigger Post

Traumatic Stress Disorder.

Combat Stress20

F i N A N C E

Financial Summary – where your money goesResources expended and servicesThe charity’s fundraising costs are amongst the lowest in the sector, with only 16% of fundraised income being spent on generating further funds. Combat Stress’s focus is on delivering its clinical and community outreach services in the most cost-efficient manner. We are also investing for the future by enabling better inpatient care through our build programme and increasing community and partnership working.

… and how we spend it.

Community Outreach Fees 1%

Statutory grants 2%

Clinical services fees 38.5%

Trading 0.3%

Investment income 2%

income£15.8 million

Other income 0.2%

Special capital projects 1%

Service charity grants 13%

Trusts and foundations 9%

Corporate 2%

Major donors 4%

Legacies 10%

Events 1%

Volunteers & community 7%

Individual giving 9%

Expenditure £12.3 million

Six-Week Veterans’ PTSD Treatment Programme 9%

Short Stay inpatients 47%

Community Outreach Service 26%

Helpline 2%

TA & Reserve Forces Liaison 1%

Treatment Centre Improvements 1.6%

Generating voluntary income 12%

Investments & Governance 1.4%

Where our money comes from …


F i N A N C E

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

Independent auditors’ report to the Members of Ex-Service Mental Welfare Society

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

Neil Finlayson (Senior Statutory Auditor) for and on behalf of Kingston Smith LLP, Statutory Auditor Chartered Accountants and Registered Auditors, Devonshire House, 60 Goswell Road, London EC1M 7AD

The Board of Trustees approved this report on 18 June 2012

Key Statistics

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

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

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

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

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

Statement of Financial Activities (incorporating an income and Expenditure Account) for the year ended 31 march 2012 Unrestricted Funds Restricted Funds Totals 2012 Total 2011 £’000s £’000s £’000s £’000sincoming resources from generated fundsVoluntary incomeDonations 2,932 2,161 5,093 5,516Legacies 1,667 - 1,667 2,169Service Charities 1,223 795 2,018 1,588Capital appeals - 164 164 2,044 5,822 3,120 8,942 11,317

Activities for generating fundsFundraising events and trading 202 2 204 212Investment income 374 - 374 219 576 2 578 431

incoming Resources from charitable activitiesClinical services 5,983 - 5,983 4,399Community Outreach services 212 - 212 12 6,195 - 6,195 4,411

Other incoming resources Other income 39 - 39 6

Total incoming Resources 12,632 3,122 15,754 16,165

Resources expended Activities for generating fundsCost of generating voluntary income 1,356 - 1,356 1,260Fundraising events and trading 137 - 137 203Investment management fees 29 - 29 6 1,522 - 1,522 1,469

Charitable activitiesClinical services 6,708 201 6,909 6,853Community Outreach Services 609 2,890 3,499 2,170Treatment centre maintenance and improvements 7 207 214 1,427 7,324 3,298 10,622 10,450

governance costs 149 - 149 143

Total Resources Expended 8,995 3,298 12,293 12,062

Net incoming / (outgoing) resources before transfers 3,637 [176] 3,461 4,103Transfers between funds [217] 217 - -

Net incoming resources / (resources expended) 3,420 41 3,461 4,103Increase/(decrease) in value of investments [237] [237] 164Actuarial losses on defined benefit pension scheme [1,206] [1,206] 288

Net movement in funds 1,977 41 2,018 4,555Fund balances brought forward at 1 April 20,131 329 20,460 15,905

Fund balances carried forward at 31 March 22,108 370 22,478 20,460

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

Combat Stress22

T h A N K Y O U

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

We are extremely grateful to all our supporters, including:

Thank You

We are very grateful for the financial

support that Combat Stress receives from

Service charities, Grant-making Trusts,

Companies, The Government and from

people around the UK. None of what we

do would be possible without you.

Service charities (including Help for

Heroes, the RAFBF, ABF The Soldiers

Charity and The Royal British Legion)

are still a key source of income.

BAE Systems plc

Seafarers UK

The Wolfson Foundation

The Corporation of Trinity House

Newman’s Own Foundation

Telegraph Media Group

D. D. McPhail Charitable Settlement

Royal Navy and Royal Marines Charity

Balhousie Care Group

The Royal Foundation of The Duke and Duchess of Cambridge and Prince Harry

Department of Health

Help for Heroes

The Royal British Legion

Poppy Scotland

ABF The Soldiers’ Charity

The Ministry of Defence

Comic Relief

Westminster Foundation

The Sir Jules Thorn Charitable Trust /Ann Rylands Special Project

Oak Foundation

The Scottish Government

Royal Air Force Benevolent Fund

Northern Ireland Community Relations Council

h O N O R A R Y S T R U C T U R E

Board of Trustees major general Peter Currie CB (Chairman)

mr Robert Bieber MBE MA (Deputy Chairman)

mr Richard Nunneley (Honorary Treasurer)

Colonel Philip Baxter

Air Commodore Oliver Delany OBE MBA BA FCIPD FCMI FBIFM

mrs Jenny green OBE MA

major general Euan loudon CBE

ms helen Pernelet Lic en Droit; Dip Law

mr Adrian Pollitt OBE MA

mr Trevor Royle MA FRSE

mrs Christine Sterba

Dr Suzy Walton BSc MSc PhD CPsychol CSci AFBPsS MRI CDir FRSA

Colonel Robert Ward RM

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

The Enemy Within Appeal BoardDr Chai Patel CBE FRCP (Chairman)

mr Tony Banks

mr Simon Blagden MBE

mr Benedict Brogan

Brigadier Ed Butler DSO CBE

major general Peter Currie CB

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

miss Nicola Jones

mr Josh lewsey MBE

ms helen Pernelet Lic en Droit; Dip Law

mr Ashok Rabheru CVO DL

mr Julian Sainty

ms Carole Stone

Patronhis Royal highness The Prince of Wales KG KT GCB OM AK QSO PC ADC

Presidentgeneral Sir Redmond Watt KCB KCVO CBE

Vice Presidentsmr Dennis Bailey

Air Vice-marshal Nigel Baldwin CB CBE

general Sir Edward Burgess KCB OBE

lieutenant general Sir Roderick Cordy-Simpson KBE CB

Air Chief marshal Sir David Cousins KCB AFC

Vice Admiral Sir Geoffrey Dalton KCB

Commander The Lord Effingham 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

Air marshal ian macfadyen CB OBE FRAeS RAF

The lord moonie

Surgeon Captain morgan O’Connell RN FRCPsych

The Rt hon Sir malcolm Rifkind KCMG QC

Derek Twigg mP

major general Sir Evelyn Webb-Carter KCVO OBE

his grace The Duke of Westminster KG CB CVO OBE TD CD DL

general Sir Roger Wheeler GCB CBE

Air marshal Sir Robert Wright KBE AFC FRAeS FCMI

Vice Admiral Peter Wilkinson CB CVO RN

Commodore Toby Elliott OBE DL RN

Executive management

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

Company number 256353

Charity numbers England & Wales 206002Scotland SC038828

Chief ExecutiveCommodore Andrew Cameron MA FCMI RN

Director of Finance & Administration (Interim) mr Stephen Chaytow BSc (Hons), ACA

Director of Fundraising & Communicationsms Uta hope MA MInstF

Director of Medical ServicesWing Commander Walter Busuttil MB ChB MPhil MRCGP FRCPsych

Director of Operations & Governancemr garrett Taylor RGN DPSN BSc (Hons) LLM

Director of Strategic Planning and Partnerships lieutenant Colonel Peter Poole MBE MILT

Director of Human Resourcesmiss Natalie Styles MSc MCIPD


Combat Stress Tyrwhitt House Oaklawn Road Leatherhead

Surrey KT22 0BX

01372 587000 www.combatstress.org.uk

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

“Combat Stress basically saved our lives. Their practical and medical help took the pressure off us so I could get myself together. I can’t thank them enough.”

PETER

combat stress annual review 2012

Documents

i e sintroduction

n d t h e i r fa

combat stresss

s u p p o r t i n g

s e s t u d yfranco

exservice personnel

new career

new referrals