Ex-soldiers in the region, who have mental rather than physical scars, can now be seen by specially-trained NHS staff. Health Editor Barry Nelson investigates.

MOST of us have seen the ancient, flickering film showing First World War victims of shell shock. Even across the gulf of 90 years, the images of wild-eyed, gibbering, trembling soldiers have the power to shock.

It is now accepted that being shelled, shot at and bombed every day takes a terrible mental toll. These days, the term shell shock is no longer used but the problem of mentally damaged exsoldiers is still with us. And with increasing numbers of British soldiers fighting in Iraq and Afghanistan, there are a steady stream of former servicemen and women needing treatment to heal the mental, as well as the physical, scars of war. That’s why consultant psychologist Symon Day has spent the past two years training teams of mental health workers to better understand and treat damaged former soldiers.

Symon was delighted when his employer – the Tees, Esk and Wear Valleys NHS Foundation Trust – became one of only six mental health trusts in the country to pioneer a new way of dealing with veterans nearly two years ago. Funding from the Department of Health and the Ministry of Defence has allowed 105 mental health workers to be specially trained.

Crucially, the extra funding also gave 65 specialist trauma workers the expertise to treat the modern day equivalent of shell shock – Post Traumatic Stress Disorder, or PTSD. So far, since the scheme was formally launched in July, about 40 veterans have been seen by specially-trained staff.

Symon says the staff are trained to deal with everything from depression and other mood problems to anxiety, alcohol and drug misuse, adjustment difficulties caused by the transition from military to civilian life and the most serious problem – PTSD.

SINCE the six schemes got under way, it is becoming clear that the scale of veterans who suffer from PTSD has been under-estimated.

“Studies have shown the prevalance of PTSD in the general population was between five and 15 per cent. We anticipated 15 per cent of the veterans using the pilots would have PTSD, but we are actually seeing more like 30 per cent with PTSD.”

Simon believes the actual figure could be nearer to 50 per cent of veterans.

Apart from being trained in techniques such as trauma-focused cognitive behavioural therapy the “trauma workers” also use a little-known technique known as eye movement desensitisation and reprocessing. Developed in the US in the late Eighties, EMDR has a proven track record in the treatment of PTSD.

The extra training is also designed to make civilian health workers more aware of military culture. “Telling veterans to pull themselves together or not to be wimps is probably not a good idea,” says Symon.

Another no-no is to imply that you – a mere civilian – have any idea of what it is like to be under fire. “It is far better to acknowledge that from the outset,”

he says.

Treating civilians with PTSD, who may have been through a horrific car crash, can typically take about eight treatment sessions. But many veterans have so many problems that it can take more like 20 sessions to get them back to an even keel.

Some veterans get symptoms of PTSD early on but self-medicate through alcohol or drugs. This often leads to vets losing partners, jobs, their homes and finishing up in the gutter.

“The other pathway is that people get on with their lives until some crisis triggers their symptoms,” says Symon.

TYPICALLY, veterans with PTSD suffer repeated flashbacks which make them endlessly relive horrors seen on the battlefield.

“Some patients believe they are actually back in Iraq or Afghanistan.

One chap starts dodging bullets when I start treatment. He can actually feel the bullets whizzing past his head.”

In some cases, loud bangs will cause veterans to take cover behind parked cars. “They are typically very jumpy, they will be in the supermarket car park, scouring the roofs for snipers.”

A typical vet can take a year or more of regular treatment sessions before they can be discharged. The first phase is to try to stabilise them, get them off alcohol or drugs, make sure their home is secure and then concentrate on trying to make them more emotionally stable.

“We have to help them learn to manage high levels of emotion. Then we can start the actual trauma treatment.”

While it is still early days, Symon is hoping that the days when veterans in the North-East and North-East Yorkshire struggled to get the treatment they needed is over.

“We don’t want anyone falling through the net anymore,” he says.

■ Find out more about the service can visit tewv.nhs.uk/veterans or contact your GP or local veterans’ support organisation.