The wound that could not speak its name
April 2022: Post-traumatic stress disorder (PTSD) can be caused by a wide variety of situations, says Matt Minshall, who describes how a UK-based charity is providing much needed care and treatment for sufferers
The terrifying memories of a tsunami may not evaporate when the waters subside. A terrorist attack may never end for the survivors. War is not over for everyone when peace is declared. The aftermath of crises of all forms can be extensive. With lives lost, physical injury, the destruction of buildings and property, displaced people and economic strife, the overt signs are apparent. But the unseen wounds of resultant mental stress are often hidden from immediate view and may prove to be the most destructive outcome of all. PTSD can be caused by a wide variety of situations across all human interaction, including car crashes, rape and bullying, as well as war. For example, in December, 2021 a report by the UK’s National Health Service (NHS) forecast that there would be 230,000 new cases of PTSD in England alone as a result of Covid-19.
The duty of care for mental health support is a national responsibility and there should be adequate provision for all affected. As awareness grows and the understanding both at a scientific and social level grows, the burden of care will grow. Police forces are now known to be particularly vulnerable; a study by Cambridge University identified that almost one in five suffer with some form of PTSD.
A past lack of caring for those who have served their country in war has been shameful. Prior to World War I, what is now known as PTSD was considered by some to be a weakness and was sometimes punishable by death. This lack of understanding and empathy caused a concept of shame among sufferers, which was promoted by a rigid system of blinkered thought. It was during World War I that the effects were first given deep analysis. The term ‘shell shock’ was coined in 1917 by a Medical Officer called Charles Myers. It was also known as ‘war neurosis’, then combat stress and then PTSD.
Recent conflicts have highlighted the profound effects, created awareness and better understanding and accelerated the study. The key factor is that PTSD is treatable. Sadly, as a nation, the priorities for provision of such care in the UK are not all they should be. The burden of giving effective help has partly fallen to charities. These are effective at different levels, though many struggle with funding and barriers from a government system rigid with bureaucracy.
PTSD Resolution is an example of a caring organisation that promotes a pioneering attitude to helping, and which focuses solely on providing help for the sufferer at no cost.
There are four features of PTSD Resolution’s service delivery that particularly distinguish the mental health treatment it delivers to the UK armed forces veterans’ community. The trauma therapy service includes:
Veterans who are suffering from alcohol or substance addiction;
Those who are in the criminal justice system;
Family members, where their mental health has been affected; and
The rigorous collection of clinical outcome measurement data.
PTSD Resolution was founded in 2009 by Colonel Tony Gauvain, (ret), who is charity chairman and Piers Bishop; both are therapists trained in Human Givens Therapy. The charity has had more than 3,000 referrals to date, delivering each therapy programme free of charge through a network of 200 therapists throughout the UK, in person and increasingly online since the coronavirus pandemic.
The four pillars of service provision by PTSD Resolution enable treatment to be delivered and monitored carefully across the country, addressing cases that are often complex and distinguish the veterans’ community, and that can result in addiction, imprisonment and family breakdown.
Practice-based evidence is at the heart of the work of PTSD Resolution, comprehensively and accurately reporting on the therapeutic journey of every veteran or family member treated.
This is important in the management of the programme because it enables precise monitoring of results to ensure a consistent standard of care across the network of therapists. It also provides evidence of the effectiveness of treatment, which is essential when promoting the service to veterans, who are often highly sceptical about mental health support and are reluctant to access it.
A strong indicator of the level of satisfaction with the service is the very low drop-out rate, with 78 per cent of cases arriving at a planned treatment conclusion where both the client and therapist agree that no further treatment is required. Treatment is efficient and cost-effective, costing the charity £750 for a completed programme, with clients in front of therapists for their first appointment typically within a week of contact and including an average of six outpatient treatment sessions in total, but further sessions are provided where necessary.
Measurement is considered invaluable in the service to veterans, bringing the client's voice into the process. It provides the opportunity to observe progress in treatment through each client’s self-reporting and they can express dissatisfaction with any aspect of support.
The client journey is mapped from the point of referral right through to after care, sometimes years after the end of active treatment. In the first contact with clients, the screening process is conducted by the charity’s administration team over the telephone to gather essential information including the client’s mental health experience to date.
When clients first see a therapist, they are invited to fill in three different measures before treatment starts:
The CORE-10 scale, a highly respected and widely used measure of general distress;
The IES, a 15-item measure of the impact of psychological trauma that has been used internationally for 50 years; and the
PRN-14, which is focused on an audit of emotional needs and functioning, developed by Human Givens therapists.
This provides the client with the ability to offer multiple perspectives on their current experience and presents the therapist with a comprehensive overview of the client’s current situation.
Metrics are used throughout the therapy, with feedback measures employed after each session to ensure that the client and therapist are on the same page. This process provides a map and compass for the therapist to assist and the client to understand on their shared journey.
Yet the value of practice-based evidence goes well beyond the individual client-therapist interaction. The most recent analysis of PTSD Resolution data on closed cases where treatment has been completed, taken in October 2021, demonstrates that 87 per cent of cases had at least two measurement points with CORE-10 and 74 per cent of these cases improved reliably in treatment, with 46 per cent of cases demonstrating final scores below the cut-off scoring in the normal healthy range.
These comprehensive results reflect accurately what is taking place in the service, building confidence for clients, for therapists and for the organisation.
Since the very beginning, PTSD Resolution has committed to working with practice-based evidence. The charity encourages all veterans’ mental health service providers to join this journey, so they can all learn from and support each other in an open and transparent manner. This would benefit everyone, especially the clients they seek to help.
The article, Measuring Outcomes for Delivery of Therapy to Veterans, was first published by the Royal College of Psychiatrists Quality Network for Veterans Mental Health Services (QNVMHS).
For further information on PTSD Resolution, visit here
The explosion of Covid PTSD cases is a mental health crisis in the making, Rhiannon Lucy Cosslett, The Guardian
Police workforce: almost one in five suffer with a form of PTSD, University of Cambridge
Shell Shock during World War One, Professor Joanna Bourke, BBC History
Quality Network for Veterans Mental Health Services, Royal College of Psychiatrists