Ex-service personnel are entitled to Priority Treatment for service related physical and psychological disorders within the NHS. For more information please click here. Once referred to the Veterans' NHS Wales and following an assessment. Your main problems will be discussed with you and various therapy options discussed or where required a referral to specialist treatment centre or veterans charities or organisations will be made with your permission.
Below is a summary of information that we feel maybe of use to veterans with mental health problems:
What are anxiety disorders?
Anxiety disorders are neither minor nor trivial. They cause considerable distress and are often chronic in nature. Both panic disorder and generalised anxiety disorder, are one subtype of several anxiety disorders, including:
- generalised anxiety disorder (GAD)
- panic disorder (with or without agoraphobia)
- post-traumatic stress disorder (being exposed to armed combat)
- obsessive compulsive disorder
- specific phobia (e.g. of spiders)
- social phobia (social anxiety disorder)
- acute stress disorder
In some instances it is difficult to distinguish the different disorders, and co-morbidity is very common, with other anxiety disorders, depression and other mood disorders. Many of our current veterans referred so far have one or more of the above disorders which requires treatment, e.g. medication and or psychological therapy.
Important messages to share with people with generalised anxiety disorder or panic disorder
Anxiety disorders are common, chronic, the cause of considerable distress and disability often unrecognised and untreated. If left untreated they are costly to both the individual and society.
A range of effective interventions is available to treat anxiety disorders, and depressive disorders including medication, psychological therapies and self-help. Individuals do get better and remain better. Involving individuals in an effective partnership with health care professionals, with all decision-making being shared, improves outcomes. Access to information, including support groups, is a valuable part of any package of care.
What is Depression?
Depression refers to a wide range of mental health problems characterised by the absence of a positive affect (a loss of interest and enjoyment in ordinary things and experiences), low mood and a range of associated emotional, cognitive, physical and behavioural symptoms. Distinguishing the mood changes between major depression and those occurring ‘normally’ remains problematic: persistence, severity, the presence of other symptoms and the degree of functional and social impairment form the basis of that distinction. Many of our current veterans are describing symptoms consistent with depression. Particularly if they also have PTSD.
Commonly, mood and affect in a major depressive illness are unreactive to circumstance, remaining low throughout the course of each day, although for some people mood varies diurnally, with gradual improvement throughout the day only to return to a low mood on waking. Arguably as common, a person’s mood may be reactive to positive experiences and events, although these elevations in mood are not sustained, with depressive feelings re-emerging, often quickly.
Behavioural and physical symptoms typically include tearfulness, irritability, social withdrawal, reduced sleep, an exacerbation of pre-existing pains, and pains secondary to increased muscle tension and other pains, lowered appetite (sometimes leading to significant weight loss), a lack of libido, fatigue and diminished activity, although agitation is common and marked anxiety frequent. Along with a loss of interest and enjoyment in everyday life, feelings of guilt, worthlessness and deserved punishment are common, as are lowered self-esteem, loss of confidence, feelings of helplessness, suicidal ideation and attempts at self-harm or suicide.
Cognitive changes include poor concentration and reduced attention, pessimistic and recurrently negative thoughts about oneself, one’s past and the future, mental slowing and rumination.
Depression is often accompanied by anxiety, and in these circumstances one of three diagnoses can be made: (1) depression, (2) anxiety, or (3) mixed depression and anxiety, dependent upon which constellation of symptoms dominates the clinical picture. In addition, the presentation of depression varies with age, the young showing more behavioural symptoms and older adults more somatic symptoms and fewer complaints of low mood.
In addition, those with a more severe and typical presentation, including marked physical slowness (or marked agitation) and a range of somatic symptoms, are often referred to as melancholic depressions, or depression with melancholia. People with severe depressions may also develop psychotic symptoms (hallucinations and/or delusions), most commonly thematically consistent with the negative, self-blaming cognitions and low mood typically encountered in major depression, although others may develop psychotic symptoms unrelated to the patient’s mood.
Many of our veterans are or have been used to drinking large amounts of alcohol to get through the day, cope with unpleasant symptoms as described above. Drinking patterns have often been established as part of routine life within the Armed Forces which continue when the individual leaves.
There is now a large body of evidence in the health literature that drinking alcohol can have a negative impact on our health, relationships, work and wellbeing. During the assessment at the Veterans' NHS Wales we ask about how much alcohol the individual is consuming and any related symptoms.
Part of a management plan might need to address alcohol issues if they are deemed important. This might entail being referred onto a specialist drug and alcohol agency in the individual area to assist with expert treatment, support and counselling.
What is Post-traumatic Stress Disorder (PTSD)?
Post-traumatic stress disorder (PTSD) can develop in people of any age following a stressful event or situation of an exceptionally threatening or catastrophic nature e.g. serving as a member of the armed forces in a combat zone, witnessing deaths, serious injury and or causing death or serious injury.
Effective treatment of PTSD can only take place if the disorder is recognised. In some cases, for example following a major disaster, or military operation specific arrangements to screen people at risk may be considered (see links page to the Medical Assessment Programme for Veterans).
For the vast majority of people with PTSD in civilian life, opportunities for recognition and identification come as part of routine healthcare interventions, such as treatment following an assault or accident, or when domestic violence or childhood sexual abuse is disclosed.
Research in PTSD demonstrates that approximately, 30% of people experiencing a traumatic event may develop PTSD. Symptoms often develop immediately after the traumatic event but the onset of symptoms may be delayed in some people (less than 15%). PTSD is treatable even when problems present many years after the traumatic event. We are currently assisting veterans from tours in Northern Ireland and from the Falklands War and beyond.
Assessment can present significant challenges as many people, including veterans avoid talking about their problems to mates, colleagues and family. People with PTSD may not present for treatment for months or years after onset of symptoms.