'˜Veteran suicide rates in our allies are rising ... we need to find out if it is the same here'
Concerns among veterans about suicide rates are mounting '“ but figures are not formally collected. Philip Bradfield and the Johnston Press Investigations Unit reports.
A psychologist at a leading veterans charity says it is important that more research is carried out in order to find out if a spike in military veteran suicides among the UK’s allies is also reflected among British ex-service personnel.
Dr Dominic Murphy, a senior clinical lecturer at Combat Stress, says that the lack of data on the issue is a “red light” for those concerned about veterans’ welfare.
His research of the charity’s mushrooming client base has reflected what is already known - that young men from unstable backgrounds who leave the services after a short period are most at risk from suicide.
What he does not know is whether the rapid increase in demand for the charity’s mental health services might also suggest a rise in suicides among the UK’s veterans.
“We don’t actually know those rates. From the mid-noughties onwards there has been a higher rate of suicide among American and Canadian and Australian veterans and some of our European allies and we just don’t know [the situation] in the UK because the last study was in 2009.”
Although suicide is “not very common” the rises among UK allies have been “significant”.
The rises among UK allies have been over a similar time frame.
“One could argue it might coincide with the end of the wars, the active war fighting phase in Iraq and Afghanistan. These are still low prevalence rates but any increase is very worrying, it is a very negative outcome.”
He adds: “For me it is a red light that we need to actually fill this gap with data.”
His understanding is that UK coroners don’t routinely ask if the deceased was a veteran when they do kill themselves.
The Johnston Press Investigations Team wrote to coroners across the UK and those who replied confirmed that they had no means to record that someone was a veteran after an inquest.
“The fact that you wrote to all the coroners and could not collect any data just shows that we don’t really know what is going on.”
By contrast the health care systems of Canada, American, Australia have a veterans affairs agency which tracks them on a national database and allows access to different health provision, he says.
He has just completed a study of 400 of the 3,185 clients currently being treated by Combat Stress, looking at how often they have suicidal thoughts or ‘suicidal ideation’.
The results have been accepted for publication in the Journal of the Royal Army Medical Corp.
“Our data suggests that 19% of our [client] population currently experience moderate to severe suicidal ideation”.
Some of the risk factors for suicidal thoughts he found among his client base are being a young single male, an early service leaver ( less than four years of continuous service), unemployed and having had more difficult childhood experiences.
Such veterans often grow up without adult role models who can regulate their emotions well.
“It just means people get really stressed and can’t calm down.”
This finding confirms research by other academics.
It is a “red flag” if his clients have made any actual plans or attempted to take their life or self harmed in the past.
“Protective factors” that mitigate against suicide are whether they have loved ones and whether they have more positive thoughts to balance out the negative ones.
“Often this is friends, family, children, pets - if people don’t have those again that is very concerning. So you can see why people who aren’t in employment or relationships is kind of worrying.”
He adds: “For such people they cannot see a future where they are not suffering from mental health problems.”
“When you are in the military you have quite a high status, you have a job you are quite respected, you have got peers around you. You then leave the armed forces and you may not be working, you may not have any friends, social support around you. That loss of status can be very difficult for people, as it would be for anyone; loss of meaning and loss of direction.”
Some of the main symptoms of PTSD are reliving symptoms, eg flashbacks and intrusive thoughts, smells, feelings on the bodies, nightmares, and hyper arousal – being very vigilant.
“For a veteran in Northern Ireland they might be walking down the street talking to you, but there attention is not really on you. They might be looking around to see if there are snipers or if there is someone following us.”
“That is a common issue. I work with veterans in a therapy room and they will really struggle if they have their backs to a window. They will struggle to concentrate on me. These conditions are common to veterans from England and Northern Ireland who served in Northern Ireland, for example.
“These are people in the British armed forces that may have served in Northern Ireland and live in England or served in Northern Ireland and live in Northern Ireland.
“Or they may have served in other deployments and live in Northern Ireland.”
Their military service may have been 20-30 years ago and yet this is still their mind-set, he says.
But an even bigger threat than PTSD is the depression which usually accompanies it; “dark thoughts” about the future and feelings of worthlessness.
“It is the depression unfortunately that is the big risk factor. In general a lot more people have depression than PTSD.”
The latest study from King’s College London has done a representative study of serving and former military personnel, he says. It found around 20% of them had depression and around 4% PTSD. “But the point is that depression is more prevalent.”
So while suicide itself is proportionately very rare, he says, the main goal of his organisation is to reduce the symptoms of PTSD or depression.
But for all the struggles and heartache he sees, for those who come forward and ask for help, there is good news.
Among such veterans the support offered by Combat Stress means they have “quite good outcomes”.
And while the absence of key factors can increase the risk of suicidal thoughts, adding them into the life of veterans can also provide protection; these include acquiring a partner, getting a job, taking up hobbies, and getting a pet.
He builds self respect among clients by highlighting the courage they have taken to open up their innermost feelings to a complete stranger.
“When I work with clients with PTSD I think it takes so much bravery, they are meeting me, a stranger, and then trusting me to talk about the most awful mental health difficulties.”
“Helping people re-engage with meaningful activity is really important. This can be better self care, cooking healthy food, getting back into education or employment, or just doing arts and crafts or trying to rebuild relationships with their loved ones.”
Combat Stress has three treatment centres in Great Britain. Veterans in Northern Ireland may receive community based treatment or attend a centre in Great Britain.
Dr Walter Busuttil, director of medical services at Combat Stress, said the current approach to veteran suicide in the UK is based on a study that is now 10 years old.
“In the meantime international literature, particularly in America, but also in Australia and other Nato countries, has shown that the rates of suicide have increased in their veterans over the last 10 years or so.
“And we are still, if you like, still in the dark and there is a real need to conduct a further suicide study.”
So the answer to all JP Investigations’ questions about whether veteran suicide rates have risen is “we don’t know”, he said.
“It would be great to know. If we are going to speculate what is going on there is certainly much more publicity when veterans commit suicide than there was say 10 years ago.
“But the true answer is we just don’t know.”
In Australia the suicide rate from 2002–2015 was 14% higher among male veterans than all Australian men. In the US, 20 veterans died by suicide daily in 2014 and veterans were 2.1 times more likely to die by suicide than civilians in 2015.
Canadian figures from 1976 to 2012 found male veterans were 1.4 times more at risk of suicide than civilians.
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