After the army, I had post-traumatic stress disorder. Now I run a cafe

I loved the army. It gave me a structure and a sense of camaraderie I will never forget. I could just about deal with the racial abuse I experienced at the beginning of my army career and I came to see it as family. But I wasn’t prepared for the impact those years of service would have on the rest of my life.

I served in Northern Ireland and Cyprus. Army life gave me a structure that I think I took for granted at the time and when I left the army I struggled. I don’t know why, but I know what it felt like – I was like a boat without a sail or a rudder. People talk about the transition from the armed forces to civvy street as if it is always a really smooth process but that’s not true for everyone. It wasn’t for me.

I spent some time in Germany. When I returned to England I felt completely lost, like I had no future. I tried a few different jobs but I struggled to adapt. I now know that I was trying to live a “normal” life while dealing with post-traumatic stress disorder.

The memories and flashbacks kept coming. My behaviour became erratic. Keeping work going was a struggle. I fell out with my wife. Then everything collapsed. I was homeless, camping down in the bin areas of blocks of flats. Getting by on people’s leftovers. Hanging round market stalls for the throwaways at the end of the day. My behaviour was getting more and more out of control and I ended up being sectioned.

I look at myself now, serving customers at the Veterans’ Kitchen, running a social enterprise – and I have to pinch myself. When I was homeless I didn’t trust anyone, let alone be able to serve them jerk chicken.

Initially, it was the charity Combat Stress that helped me out and put me in touch with Stoll, a charity with a few hundred homes for veterans. Stoll provided me with a flat in west London and made sure I had the support I needed at the time to get back on my feet. I now have a place I can call home; I have my sail and rudder back and a life to look forward to.

I am one of the lucky ones. I trained up as a chef at the Veterans’ Kitchen and when Bob, the previous owner, retired he passed the business on to me. I now run the Veterans’ Kitchen, next door to Chelsea Football Club. Having a stable home and being able to run our little cafe for veterans and the local community has helped me get back on track.

One of the hardest things for us military people to do is to ask for help. We are trained to be tough and independent. But my advice to anyone coming out of the armed forces is always ask for help.

This year’s theme for World Mental Health Day on 10 October 2016 is psychological first aid and the support people can provide to those in distress.

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After the army, I had post-traumatic stress disorder. Now I run a cafe

"I crashed my car after a night shift and now have post-traumatic stress disorder"

Last month, the Guardian Healthcare Professionals Network published an article about the dangers of doctors driving home after working nights. Two in five UK doctors (41%) have fallen asleep at the wheel after a night shift, according to an online survey of 1,135 doctors from Doctors.net.uk.

Within hours of publication, the network was flooded with emails, tweets and comments below the line and on Facebook from various healthcare professionals who wanted to share their thoughts and experiences. Here are some of them:

I crashed my car after a night shift and now have post-traumatic stress disorder

Back in 2005, I was an FY2 doctor in orthopaedics. Like most junior doctors even today, we would do seven night shifts in a row. Sleeping during nights (even if you had a chance) was frowned upon. When I started foundation training, there was a doctors’ office which had a bed but it was removed by the management in front of us. They insisted that junior doctors should never sleep during their night shifts and if they did have a free moment they should be doing discharge summaries etc.

One Wednesday morning after I had worked five, 12-hour night shifts and had two more to go, I managed to get home and caught a few hours’ sleep. I woke up at around 12pm and decided to drive to the shops. Once on the main road, I quickly began to feel very tired and disorientated. I turned around to head home, but at a major roundabout suddenly crashed into a car. I am convinced that more than 60 hours of night work were behind the accident that day and still feel incredibly lucky that I did not kill anyone that day or get killed myself.

The NHS is destroying its staff, sometimes literally by the accidents from driving home so tired.

As a result, I have post-traumatic stress disorder related to driving. I am so terrified of driving post-nights that I only live within walking distance of hospitals and walk home after every shift. I dare not apply for jobs that involve a commute of any kind and hence I am stuck in non-training jobs.

I fully understand that night shifts and night work is an integral part of my job but it does not have to be so hard or so difficult to provide us with on-call rooms or a reduced number of shifts. I will be 37 soon and I am still doing blocks of three or four very intense nights shifts. My body, my spirit and my life are feeling the pain.

Dr Hunniya Waseem, senior clinical fellow, emergency medicine, Bury St Edmunds

Nurses are not allowed to sleep on their breaks – it is a sackable offence

I have fallen asleep at the wheel after working a night shift. I have been a nurse for 10 years and this has happened to me on quite a few occasions.

Nurses are not allowed to sleep on their breaks – it is a sackable offence if they are caught. I spent almost five years working in emergency medicine and the shifts are tough. We often go without food and drink for the entire shift.

I once worked a shift where I had three patients suffer a cardiac arrest in one night. The first was an elderly gentleman; I hadn’t even been told his name before he arrested. He survived. The second was a man in his late 70s who we expected to pass away. The third was the toughest; it was a man in his 30s who had alcoholic liver disease. He arrested at 6.55am, just before the day staff came on. I was working with an agency nurse because we were short staffed. We worked on him for 90 minutes. I left the hospital at 9am after starting at 7pm the evening before.

That morning there had been two major accidents on the roads. It took me two hours to do a 20-minute journey. The traffic was going at a snail’s pace and I fell asleep multiple times that morning in the car. It was midday by the time I got home, showered, reflected on my horrific shift in order to rest properly and crawled into bed. My alarm went off five hours later to do it all again.

Anonymous

Sometimes I wonder how I’m still alive – who looks after NHS employees?

I am a mental health nurse who has worked within the NHS since 2003. Sometimes I wonder how I’m still alive.

In the morning, at about 5am when I’m about to finish my shift, I find it very difficult to keep my eyes open or concentrate enough to even have a conversation with my colleagues.

My concern is when you finish at 5pm, and then get a call immediately from A&E. We cover a big area and I have to go out and assess the patient within four hours. Then you get another call from another A&E, and then another. Sometimes I’m almost home by midnight and get another call.

Something really needs to be done about this. It’s dangerous for anyone to drive while tired, and I know some people would say, park and rest. At that time of the night/morning, where does one park and rest?

The NHS is destroying its staff, sometimes literally by the accidents from driving home so tired. Who looks after NHS employees, because the NHS certainly doesn’t?

Mental health nurse, West Yorkshire

Related: ‘Don’t be a smart arse’ – a junior doctor’s survival guide

I fell asleep at the wheel and was woken up by the car running out of petrol

I fell asleep at the wheel once as a student nurse coming home from a particularly difficult night shift at my placement hospital 30 miles from home. I was lucky as it could only have been for a minute before I got shaken awake by the car running out of petrol as I’d not been able to afford to fill it up on my way in. I sat on the hard shoulder and cried for a good hour until the police came along and knocked on my window. Luckily for me one of the kindest policemen I’ve ever met went and bought me a fiver’s worth of petrol and then followed me home to make sure I got there safely.

Anonymous nurse

It’s not fair for the doctors or their patients

Some hospitals still let you rest but some are militant against any sleeping (often the nurses get it worse than us). As a more experienced junior doctor now, I know my decisions around clinical care and my safety on the journey home require me to have some sleep. Even if that’s just 20 minutes, the difference is vital.

I have been a qualified doctor for three years. Last year my commute was 10 miles down winding country lanes and after a series of seven consecutive night shifts (totalling a 90-hour week) I crashed my car into a brick wall outside my house. Fortunately the damage was only material.

My hospital didn’t provide rest facilities after a night shift so when I finished my medical shifts at 10-11 am I would have to decide whether to risk driving home or sleep in our communal staff room where my day-time colleagues would be taking their breaks. There is no dignity in this. It is not safe and it is not fair to the doctors forced to make these decisions or to the patients they are treating half an hour earlier.

We are doctors, we are humans and our first priority is all too often our patients. Sometimes we need an advocate to protect our interests and safety and this is sadly lacking.

Jenny Worrall, doctor

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"I crashed my car after a night shift and now have post-traumatic stress disorder"

Post-traumatic stress disorder: the bomb waiting to explode

Heywood, a circuit judge given that 2008, is well positioned to make his feedback, not least as it is he and his colleagues who come face-to-encounter with these damaged warriors in court. His god-daughter is a Royal Horse Artillery officer who has just returned from a tour of Afghanistan. Her brother, also, has served 6 excursions of the nation as an Apache pilot with the Army Air Corps, the regiment to which Prince Harry was attached in Helmand. Heywood also counts as a friend a “senior British Army officer out there, presently a standard, in charge of the withdrawal… So I know what is going on and I know how numerous individuals come back scarred from the knowledge.”

Just what is going on, however, remains a point of contention. It is 99 years since Charles S Myers, a captain in the Royal Army Healthcare Corps, published “A contribution to the research of shell shock”, bringing the term to prominence by studying the signs of three traumatised soldiers on the Western Front. Rather than the continual boom of Initial Planet War bombs, it is the hidden risk of IEDs (improvised explosive devices) that leaves the deepest mental scar on today’s troops. But the symptoms remain the identical: what Myers identified as shell shock is now acknowledged as PTSD (albeit a problem that is not limited to war zones), classed as a delayed response to trauma that provokes recurring distressing memories and flashbacks and, in some circumstances, triggers a harmful modify in behaviour.

The present day Army is keen to demonstrate that, not like a century in the past, it has grasped the concern. A leaked memo noticed last week by the Telegraph, written by Maj Gen Robert Nitsch in January, shortly right after he was appointed CBE in the 2014 New Yr Honours checklist, attempts to tackle what he calls a “general drip of unfavorable publicity about the mental state of Armed Forces’ veterans”.

The memo, distributed to the Army’s most senior officers beneath the instruction that they should “feel cost-free to publicise” its message, stresses that “there is, so far, no evidence to help the assertion that we are sitting on a time-bomb of PTSD among regulars who have served in Iraq or Afghanistan”. It says that “a job in the Armed Forces is not related with an all round enhance in risk of building a psychiatric or psychological-overall health disorder”, and that even though the number of male Armed Forces veterans account for 9.1 per cent of the population, veterans make up only three.five per cent of the prison population.

Dan Jarvis, a former Paratrooper who served in Afghanistan and is now the shadow justice secretary, criticises the language employed in the briefing as “complacent” but says that it points to a wider ­problem.

“The Ministry of Defence has created some enhancements in current many years, but I think, ­culturally, there are nonetheless these folks who seem not to want to tackle the total scale of this,” he says.

Maj Gen Nitsch’s stance is backed up by official and – the MoD stresses – independent figures that it says are the most trustworthy and up-to-date obtainable. But critics warn that they may possibly not give the total image.

Writing in the Telegraph this month, Stuart Tootal, a former commander of three Para and chairman of the Afghanistan Trust, cast doubt on the official MoD numbers for PTSD, which claim, he says, four per cent of soldiers will suffer from the problem, rising to five per cent among infantry units and 6 per cent among reservists.

“This calculation is based mostly on a review completed in 2009,” he says. “Since then, the Uk has been at war for one more 5 years, and thousands more have served. Additionally, the study did not track veterans, so it are not able to consider account of the delayed onset of PTSD – which can often manifest itself when veterans depart the familiar atmosphere of the military and enter civilian life.”

Certainly, considering that the figures have been compiled the quantity of troops who have served in Afghanistan in search of aid from Combat Stress, the UK’s top psychological-health charity for veterans, has improved by an average of 50 per cent every 12 months. The charity’s most current figures, published earlier this month, display that it obtained 358 new referrals representing Afghanistan veterans in 2013, in contrast with 228 in 2012 – a rise of 57 per cent. Not all, of program, are for PTSD. War leaves myriad hidden scars.

“The point at the moment is, we just really do not know the place it is going to go,” says Dr Walter Busuttil, director of healthcare providers. “This has been going on for years. I joined Combat Stress in 2007, and from 2011 there has been this huge leap every single yr. They [the returning soldiers] are coming to us greater educated about the symptoms. It is normally their wife or girlfriend who has created them come to see us.”

Tragically, a lot of partners do so only after they have been the victim of an assault themselves. An MoD-funded research published by the King’s Centre for Military Overall health Research last 12 months discovered that Iraq and Afghanistan veterans are far more very likely to commit a violent offence throughout their lifetime than their civilian counterparts, with a “stark” big difference witnessed in males aged beneath thirty. A lot more than 20 per cent of the 2,728 younger soldiers followed in the review had committed a violent offence, compared with 6.seven per cent of younger men outdoors the military. Men with direct fight publicity had been 53 per cent much more very likely to commit a violent offence than individuals serving in a non-fight position. Several much more flip to drink.

As our courts demonstrate, the casualties extend beyond the soldiers themselves. Earlier this yr, a packed Northampton Crown Court heard how Liam Culverhouse, a 25-12 months-previous lance corporal with the Grenadier Guards, was blinded in one particular eye in an assault in Afghanistan in November 2009, in which 5 of his comrades had been killed. A couple of months soon after he was discharged from the Army with PTSD, his 7-week-previous daughter Khloe was taken to hospital with severe brain harm and fractures to her skull, ribs and limbs. She died, aged 19 months, right after paying far more than a 12 months in hospital.

^{L/Cpl Liam Culverhouse (RRP)}

Culverhouse, who was jailed for 6 many years for leading to or making it possible for the death of his kid, had warned Army medical doctors prior to the assault that he was very likely to harm her. However, they committed a “serious error” by failing to share the data with the Army Welfare Service or civilian safeguarding agencies, a situation evaluation has since found. Philip Hammond, the Defence Secretary, insists that lessons have been learnt from the case.

Any mention of complacency is denied by the MoD, which factors to the £7.four million that has been invested in mental-well being providers. “We are committed to offering everybody who serves in our Armed Forces all the help and assistance they need to have,” a spokesman says. “We want to even more reduce the stigma of mental sickness, encouraging even a lot more men and women to come forward, and we will continue to work closely with Combat Tension to assist veterans accessibility the wide selection of help accessible.”

The extent of the mental strain on soldiers has now been officially noted in an appeal hearing that took location on Thursday for Sgt Alexander Blackman, the Royal Marine convicted of murdering a wounded Taliban captive, which led to him having his sentence decreased from 10 to eight years. The Court Martial Appeal Court located “greater weight” ought to have been given to the fight tension he was below when he shot dead the badly wounded fighter in September 2011.

^{Sentence reduced: Sgt Alexander Blackman (PA)}

Individuals concerned are aware, nevertheless, that the man recognized as Marine A was tried in a military court, supposedly better equipped to understand the special stress of war. In the civilian criminal courts, the fret is that veterans’ trauma may fall on uncomprehending ears.

As a end result, in January Justice Secretary Chris Grayling ordered a overview to appear at veterans in the criminal justice technique, following amendments tabled to the Offender Rehabilitation Act by Dan Jarvis.

“It is not about letting men and women off lightly,” says Jarvis. “But we require to make positive we have a criminal justice system that is mindful of some of the experiences they will have faced.”

For now, there are nonetheless broken veterans slipping via society’s cracks, who are left to stare by means of the reinforced glass of our courtrooms.

Post-traumatic stress disorder: the bomb waiting to explode

Dispelling the nightmares of post-traumatic stress disorder

In post-traumatic stress disorder or PTSD, sufferers repeatedly relive the traumatic occasion. Photograph: Azhar Rahim/EPA

On Tuesday morning we woke to the information that a passenger ferry had sunk off the coast of South Korea, with at least four individuals confirmed dead and 280 unaccounted for. Meanwhile, although the search has continued for the missing Malaysia Airlines plane, relatives’ hopes of a risk-free landing have long considering that been extinguished.

Human tragedies like these are the things of day-to-day news, but we rarely hear about the long-phrase psychological results on survivors and the bereaved, who might encounter the symptoms of submit-traumatic pressure disorder for many years soon after their expertise.

Though most people have heard of PTSD, number of will have a clear concept of what it entails. The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) defines a traumatic occasion as 1 in which a particular person “experienced, witnessed, or was confronted with an event or occasions that involved real or threatened death or serious damage, or a risk to the bodily integrity of self or other folks”. PTSD is marked by 4 types of responses to the trauma. 1st, patients repeatedly relive the event, both in the form of nightmares or flashbacks. 2nd, they seek to avoid any reminder of the traumatic event. Third, they truly feel continually on edge. Fourth, they are plagued with negative thoughts and reduced mood.

In accordance to 1 estimate, practically 8% of folks will create PTSD for the duration of their lifetime. Clearly trauma (and PTSD) can strike any person, but the dangers of establishing the issue are not equally distributed. Costs are increased in socially disadvantaged areas, for instance. Ladies might be twice as most likely to develop PTSD as guys. This is partly simply because women are at better chance of the sorts of trauma that generally make PTSD (rape, for example). However – and for unknown factors – when exposed to the very same kind of trauma, women are a lot more vulnerable to PTSD than men.

What triggers it? In a single sense, the answer is clear: a particular trauma. Yet this is only component of the story, since not everyone who is raped or badly beaten up develops PTSD. Of the modern psychological attempts to response that query, the most influential is the one particular formulated by the clinical psychologists Anke Ehlers and David Clark at the University of Oxford.

They argue that PTSD develops when the man or woman believes they are still seriously threatened by the trauma they have seasoned. Why need to someone assume they are even now endangered by an event that took place months or even years previously? Ehlers and Clark recognize two aspects.

Very first is a unfavorable interpretation of the trauma and the normal emotions that follow, for illustration believing that “nowhere is risk-free”, “I appeal to catastrophe”, or “I can not cope with stress”. These interpretations can make the individual truly feel in danger physically (the planet looks unsafe), or psychologically (their self-self-assurance and sense of nicely-getting truly feel irreparably broken).

Second are problems with the memory of the trauma. Partly because of the way the person experiences the event, the memory by some means fails to obtain a appropriately created context and meaning. As a consequence, it consistently intrudes. Ehlers and Clark liken the traumatic memory to “a cupboard in which a lot of factors have been thrown in speedily and in a disorganised vogue, so it is not possible to fully close the door and issues fall out at unpredictable times”.

These variables adjust the way individuals behave. They could stay away from situations that may possibly spark a memory of the trauma, and will occasionally try out to deaden their feelings with drink or drugs. Yet these strategies tend to entrench and exacerbate the problem.

PTSD can be handled with antidepressants or different varieties of psychotherapy, like prolonged publicity treatment and eye motion desensitisation and reprocessing. Even so, a latest meta-analysis of 112 research performed in excess of the past thirty many years identified that cognitive behavioural therapy (CBT) was the single most effective kind of therapy.

CBT generally comprises 3 principal strands. First, it evaluates the individual’s excessively adverse ideas about the trauma and its aftermath – for example by helping them understand that they are not to blame or that their emotions are normal and all-natural. Second, the treatment method functions on the person’s memory of the trauma: the personal may possibly be asked to publish a detailed account of the event relive it in their imagination revisit the web site of the trauma or be proven how to cope with the type of objects or situations that trigger the traumatic memory.

The last strand entails tackling the type of behaviours that have a tendency to fuel PTSD, for example by demonstrating that trying to suppress a thought is futile (if you doubt it, try appropriate now not to feel of a white bear) or that staying away from a situation only strengthens one’s worry.

A course of CBT for PTSD generally requires meeting with a therapist once or twice a week above many months. Offered how debilitating the problem can be, that can seem like a quite extended time to wait to get one’s existence back on track. Nonetheless, pioneering analysis published in final month’s issue of The American Journal of Psychiatry suggests that there might be an substitute. Rather of months, it could be feasible to tackle the symptoms of PTSD in just 7 days.

Anke Ehlers at the University of Oxford and her colleagues randomly assigned 121 individuals with PTSD (about 60% female, forty% male) either to a 7-day program of intensive CBT weekly sessions of CBT for three months a type of psychotherapy acknowledged as emotion-targeted supportive counselling or to a 14-week waiting listing. Participants in the very first 3 groups all obtained the very same sum of treatment (18 hrs).

The results were striking. The intensive CBT proved practically as successful as the standard three-month program, with respective recovery charges from PTSD of 73% and 77%, and the intensive version made its effects more rapidly. For the supportive counselling group, recovery was 43% (an additional finding that undermines the idea that all varieties of psychotherapy are equally efficient). Amid the waiting list group, just seven% had recovered. Each programs of CBT also led to massive reductions in levels of anxiousness and depression.

Most importantly, the advantages lasted: 40 weeks right after getting into the review, about two-thirds of the CBT individuals had been nevertheless totally free from the signs and symptoms of PTSD. The treatment is not easy – it confronts highly distressing occasions and feelings, following all – but it performs.

Dispelling the nightmares of post-traumatic stress disorder