As the fog of morning clears ...
The NHS wants quick results, as do the MoD and therein lies the problem: the veterans that slip the net. The longer a veteran is floating around on the periphery of main stream society on his/her own, the less effective their treatment is going to be. If they've suffered any additional traumas in civilian life, the chances are that it'll compound the effect of their service related PTSD.
In my own case, I wasn't diagnosed for 12 years. In that time I adjusted to civillian life and learned to see to my own needs in general functions (work, accommodation etc). I faced hardships with regard to benefits etc as I didn't know I was entitled to claim certain things because of my disability. There were times when I couldn't afford to eat properly because of paying for my bedsit and bills. I became more flexible and open towards other points of view and ended up walking a path half way between the rigourous discipline of the armed forces and the some times chaotic lack of order of civvy street. I learned to look at things for myself and make my own assessments ... so an inflexible model of care from the NHS was never going to work.
I feel that those models MIGHT work very well for people with PTSD that are still serving, providing something's done about the stigma related to mental health issues in society as a whole, they may also work for people recently back into civvy street ... but for those thousands of unsupported veterans in society that struggle from day-to-day, it's of little use.
The thing that I need the most is someone to sit and talk to in a secure environment that understands the issues and won't press my triggers when we're discussing life arond PTSD. It takes a long time to build up that trust to be able to open up sufficiently to make the sessions of support useful. I recently came to the end of a 2 year counsellling arrangement with Nottingham Counselling Services. I'd been floating around Nottingham, looking for support since leaving Cornwall, only to find that I wasn't being listened to and that I seemed to know more about PTSD than the mental health practitioners I was initially being referred to. I also became aware of the fact that service related PTSD needs to be dealt with in a slightly different manner - simply because there's a different language and attitude involved. Very different ... and the implications of a practitioner saying something that could trigger a reaction leading to physical harm of the practitioner are very real. I eventually ended up in NCS after my GP told me of their existence. I called them up, went through a flexible assessment and was treated with care and dignity. It took a long time for me to open up on some issues to my counsellor, probably over a year. He gave me the listening ear that I needed and helped me to reflect on some of the issues that I was working through in my mind and I helped him learn about PTSD in veterans. NHS models of treatment don't allow for that time scale n the main. Most practitioners will have signed the patient off and moved on to the new list. The ones that allow you flexibility are very few. It takes time to establish trust when you've been conditioned to ignore all problems and function in the role assigned to you ... until you drop. You're conditioned to be part of a collective and you have your role to play. You don't put yourself first ... and you're ready to sacrifice yourself to save your mates.
This opens up another difficulty for the NHS. How do their practitioners get that experience and awareness? I can only think of one way - they carry out detatchments of 6 months or so working with currently enlisted troops on bases. They live the barrack life, they learn the barrack talk and they see what goes on for themselves. This just might make them a more effective practitioner, whether they're a psychologist, psychiatrist or CPN/Behavioural Therapist. The key to any successful therapy lies in the practitioner's ability to make an effective bridge between him/herself and the patient. If that can't be done, any treatment will be a waste of time ... and it will be met with the cold wall of defence ... and you won't penetrate it.
The other difficulty that the NHS has, as mentioned above, is that all treatment is time limited. Time became more of an issue with the NHS when hospital appraisals were first introduced on every aspect of operations - from assessments on the way they carried out treatment to the inner functions such as personnel and equal opportunities. Every function has a tick box and one of the criteria for assessment will be how many patients a hospital treats a year. Bascially, thanks to central government, our hospitals are having to play the numbers game in order to ensure their funding is secured. While, initially, this process may have helped some of the slacker hospitals and treatment centres to improve their operations ... I feel it can also be to the detriment of patients when administrators get caught up in the numbers game and forget that they're dealing with people ... and in the function of care to ailing people, time, kindness and dignity are very important factors.
As in all things led by a political society, we go from one extreme to the other, because people are too lazy, as a whole to put the effort into some sort of constant, acceptable, balanced perfomance. Our failing political system underlines this. Each new government blames the last for its current situation. It's about time we had a more representative form of government: If the people vote 28% tory, 25% labour, 19% liberal, 5% green - that is exactly what the make up of the government should be. It may take longer to reach an agreement on some issues ... but at least it would be a decision that more of us might be able to cope or be happier with.
If we could get that level of representational flexibilty in government, think of what benefits could be achieved in society as a whole if people were forced to consider more than their own agenda ... and were having to compromise for the sake of progress for the good of all?
If we had a good system of government with a high level of awareness ... coupled with a good system of flexible medical care .... would 15% of the prison population and 25% of homeless people in this country be veterans? For those of you that think only of Afghanistan and Iraq ... think further back because there are thousands of veterans that still need care and support. The government started talking about awarding the wounded the equivalent of a 'Purple Heart' to those wounded in service of their country. It'll take more than that to honour the Military Covenant ... but recognising the sacrifice would be a step in the right direction.