What Shall We Do With The Broken Sailor? – Mental Health and Me.

I am a serving Royal Navy officer. Ten months ago, tears streaming down my face and thinking of my young children, I attempted to commit suicide.

Luckily, my knot tying skills remained as dreadful in 2018 as they had been down on the river at Dartmouth.

Sitting there afterwards contemplating a new level of “rock bottom” that I had never imagined reaching, I made the choice to finally confront the Demons that had plagued my life for many, many years. I sought professional help and over the next five painful, mentally exhausting months I emerged from the deepest of holes.

I mention this not to elicit sympathy, but merely to add context to what follows. This article is not in any way an attempt to undermine, belittle or attack those who are vigorously campaigning for better mental health provision for members of the Armed Forces. Neither is it a call to stop discussing mental health and veteran suicide – far from it!

However, it does articulate my concern that we may be focusing too much on volume of output without necessarily considering the second order effects on those we are trying to help. The message is finally out in the open; this is a rallying call to refine it.

Mental Health provision campaigners

Once one of the ultimate taboo topics, mental health has become one of the most broadly supported and active campaign issues of our time. Outside of the interminable celebrity media tit-for-tat over Brexit, mental health is probably the number one issue pushed actively by those with “Star Factor”. This renaissance was perhaps sparked back in 2016 when their Royal Highnesses the Duke and Duchess of Cambridge, along with Prince Harry, launched the Heads Together campaign. It reached a political peak just a few  weeks ago when the Chancellor of the Exchequer laid out Budget plans to pump an additional £2Billion per year into mental health services by 2023. These services will include specialist units in all A&Es, new teams for schools, more mental health ambulances, etc. This is, undeniably, ‘Good News’.

Articulate and passionate veterans have harnessed the power of social media to pursue an agenda for better mental health awareness and provision for both serving and ex-military. Some, such as the redoubtable Philip Ingram (@PhilipIngMBE) have laid bare their struggles and achieved real traction within the corridors of power at Westminster. They have been largely successful – for example the Government has recently introduced metrics and data gathering that will, for the very first time, accurately assess the numbers of veterans accessing mental health provision and, where possible, attempt to identify any service background for those who have committed suicide.

The Myths

 Modern society, backed by the advance of ‘clickbait’-esque media, has killed nuance. Military personnel are either heroes or broken. This is helped neither by politicians (see President Trump blaming the recent mass shooting in Thousand Oaks, California, on a ‘broken’ USMC veteran’s mental health) nor popular culture and media. Look no further than ‘The Bodyguard’; it was the BBC’S smash hit of the Summer but the ‘hero’ was again a broken, mentally damaged individual, irreparably scarred (physically and mentally) from time in Afghanistan. It was as clichéd as it was predictable. Not for TV drama the mundane reality of a squaddie who, after a career spent bulling boots for Regimental or ceremonial duties, a few crunchy tours and far too many nights living in sub-standard Married Quarter accommodation, decided to use his Enhanced Learning Credits to take some close protection courses and go and work for the Government.

The sheer pervasiveness of this image of the modern service person was laid bare in evidence provided to the House of Commons Defence Committee¹when 82% of poll respondents believed that mental health problems were one of the three most common issues faced by people leaving the Armed Forces. A scarcely less worrying 78% believed that mental health problems were either somewhat or much more likely to happen to someone one who had served. This is hardly surprising and is reinforced when Twitter and newspapers almost seem to scrabble over themselves in a rather ghoulish rush to push out the name and service details of the latest suicide victim.

The facts – Serving Personnel

Since the 1990s the trend within the serving community has been relentless in one direction. That direction is, however,²down. In fact, the suicide rate among serving males is significantly lower than comparable age ranges in the wider UK population; there is a spike in Army males under 20 years old (caused by 3 taking place in quick succession on the year in question) however that age group is still at a lower overall risk that their old school friends in civvy street.

In very general terms, the camaraderie of service life, the improved appreciation, recognition and support for mental health provision over recent years and, most importantly, a sense of worth (yes, really – stop your tittering at the back of the room!) all contribute to this decrease³in risk.

Interestingly – and perhaps providing the trigger for fears of a similar bow-wave of incidents here in the UK – is the experience of the United States.

For the first time the suicide risk of a serving member of the US Armed Forces now exceeds that of the general population. What started as a very minor divergence back in 2008 is now stark. The US and many other foreign militaries are also way ahead of the UK in terms of reporting higher rates of PTSD. Expert assessment suggests that there are many reasons why this is the case – ranging from longer, more combat-intensive tours (up to, and often over, 12 months duration) and a much broader employment of reservists, through to nuances in US healthcare provision (for example, US veterans have to show a service-related diagnosis to receive any enhanced post-service ⁴ healthcare benefits.

The facts – Veterans

Veterans face a very different set of issues, one of which is the “not knowing what we don’t know” statistics issue mentioned above. Very little work of academic rigour has been published that explores the last 5-10 years in any great depth; much work on veterans continues to be baselined by the work of Dr Navneet⁵Kapur and his colleagues who observed data for the cohort 1996-2005. Shockingly, it revealed that the risk of suicide in men aged 24 or under who had left the Armed Forces was approximately two to three times higher than the risk for the same age group of civilians.

Risk increased those males who had served in the Army, and yet again for those who left after just a short length of⁶service. Here, it is the lack of training and lower rank that was a major deciding factor. In this case, the rapid transition from military to civilian life (sometimes as little as 2-3 weeks) places these men in a position whereby they are the least well equipped to deal with the changes to their circumstances and, crucially, also the least likely to seek or even be aware of, available⁷help.

The problem

So what is my problem? Why am I blathering on about mental health and suicide, when there are juicy nautical arguments to be had over the exact definition of what now constitutes a ‘Frigate’ or a ‘Sloop’?

My concern is simple. I believe we have reached the point at which we need to recognise and concede that the battle for publicity is over; the battle for a more balanced approach needs to begin. If we are to avoid feeding and perpetuating the myth of the ‘broken soldier’ we need to focus more on the care and health provision available, more than the individuals. That sounds cruel, heartless and contradictory. How can you help those suffering from mental health issues and at risk of suicide by not talking about them? But let me flip the question on its head; every time a news feed pops up on Twitter or Facebook mourning another veteran suicide, what are we doing? Are we truly lamenting their loss, or are we simply feeding the gluttonous media beast that feasts on bad news and personal tragedy? Do those who leap to re-tweet really care about the suffering and anguish of the latest smiling face picture to be filed under “took own life”, or is there a less savoury dollop of morbid opportunism to score political points?

Much like the economy, perception is everything; by stoking the perception of a suicide crisis are we in danger of creating one?

If that sounds like a controversial leap too far, one need only look back at a relatively recent tragic case study of Bridgend. Media hyperbole and the constant sensationalising (and publicising) of each and every victim, whether there was any concrete correlation or not, fuelled a suicide cluster – as outlined succinctly by the Guardian at the time. Suicide clusters are a recognised phenomenon; they are notoriously difficult to identify and combat – primarily because they can occur with no real causation or underlying factors. In whatever circumstance though the advice remains the same: do not make matters worse. And that is what makes me uncomfortable about military suicides. Each and every poor soul who has taken their own life had their own individual reasons for doing so. In my case, it was trauma experienced long before I joined the Royal Navy. Others have been afflicted by their experiences in Iraq and Afghanistan. Many more will be plunged into darkness by ‘traditional’ ailments such as poor health, family breakdown or financial woes – which are only partly, if at all, anything to do with the fact that they serve, or used to.

Yet by lumping all of these people together across the blunt medium of the internet, the one common factor becomes THE factor: they were military, as am I. They had issues, as do I. They saw no way out – what chance do I have?

The danger of dissent

Passion is a wonderful thing. Doing something you believe in with your entire being, is an even better thing. But, does it make you lose subjectivity, particularly when your entire standpoint is based on your own personal experience and individual circumstances?

I earlier lamented the descent of the country to one of extremes. You’re either for or against something. It is this binary attitude that has poisoned discourse and debate. Brextremist or Remoaner? Quasi-Communist Big State NHS centralist, or privatising capitalist scumbag? Military mental health is hurtling in the same unfortunate direction, stoked by a new wave of politicisation amongst veterans and the ability to reach large volumes of people over social media. The ‘left behind’, the poorly treated, the disgruntled, the political fringes: all fighting to be seen as the one true “correct” authority on veteran mental health. The waters of discourse are not only muddied – they are thick as tar. You are either 100% behind “the cause”, or you are against – traitor to your old comrades, ripe for abuse and vilified as heartless or dismissive.

One of the most effective mainstream political advocates for better mental health provision for the military and veterans is ex-Gunner officer Johnny Mercer, Member of Parliament for Plymouth Moor View (@JohnnyMercerUK). However, he strayed away from the binary world and faced the wrath of the Twitterati veterans community for his temerity. What did he say? That some veterans charities were ‘over-playing’ the mental health card (particularly that of PTSD) in order to secure greater funding and donations. Well, having worked in the charitable sector myself prior to joining up, his words struck me as entirely accurate. Charities are not what they once were. They are no longer the retirement comfort blanket for ex-civil servants and community minded individuals. It is an industry as ruthless as any in the private sector – there is a limited (and shrinking) pot of public cash to be had, so of course the new professional class of “Third Sector” CEOs, Grants Officers and Fundraising Executives are going to make the most of their individual USPs.

The problem is especially prevalent among military charities – huge numbers of which have popped up in the last decade. Many are exceedingly small, local affairs. To stay afloat, they need to get their ‘pointy elbows’ out. That is not necessarily, in itself, a bad thing: more money than ever before is being raised to support ex-servicemen and women in need. But it is disingenuous to suggest that none of these (particularly the amateur-led ones) have ever over-played, or otherwise exploited a growing awareness and appreciation of veteran mental health issues to push their own fundraising agenda. To claim the moral high ground and cast slurs on anyone who dares to raise a legitimate point for debate is blatant dishonesty.

The fact that Mercer was most strongly attacked by those involved in that sector told me two things. Firstly, that he had struck close to the bone; more tellingly it underlined that those most involved in an issue are often too close to it to be subjective. For the “politicised veteran” community every comment or critique becomes a personal attack, both on them as an individual, on their cause, or, in this case, their own suffering and health issues. A potent combination but one which badly skews the serious debate that is needed.

Where do we go from here? 

What then, is the point of this article, other than the random musings of yet another ‘broken’ service person? Well, what I really, really want (other than a gratuitous Segway into being able to post a Spice Girls phot!) is for everyone to just calm the heck down. The poison and politics needs to be taken out of this debate. It is not a Left or Right issue. Governments of all shades have sent British men and women to war, often ill prepared, and often left severely lacking support on their return. Nor should it be a weaponised issue with which the new breed of ‘common touch’ political activists can beat and berate the ‘elite’ within the established political party system.

How do we do that?

Firstly, stop sharing images of those who have taken their own life. The worst offenders in this regard are often other ‘broken’ veterans – often proudly displaying a tag in their profile marking them out as a PTSD survivor/sufferer. To be blunt, they should know better. They are often followed by like-minded individuals and so you end up having triggering images circulating among an already susceptible group – so it is hardly surprising when others fall into the vice-like grip of spiralling depression and the final, tragic end.

Next those campaigning, from celebrity elite through to professional charitable organisations and right down to us, the interested general public, should focus on the cold, hard facts of available help and provision, not the heart-rending stories of individuals. I say again, this sounds callous, but the exploitation of grief (or more likely, anger) of close family and friends to push a political narrative is wrong – even if the ultimate intent is admirable.

Finally, we all know that sex sells in the media . But so does the mentally fractured, dysfunctional, often psychotic and simmeringly dangerous characterisation of veterans that we are routinely subjected to on our screens and in our books. It is yet another example of the exploitation of tragedy to fuel profit and viewing figures. Page 3 girls died a natural death because society had moved on – perhaps it is time to stop milking the mental health issues of a (still fortunately relatively small) cohort of UK Armed Forces and veterans?

Summary

I hope you will excuse the somewhat unpolished romp through the issues presented here; writing is not a forte of mine.

Mental health awareness, particularly where it concerns serving members of the Armed Forces and veterans, is at never before seen levels within public consciousness. This has been achieved not only via celebrity endorsement but by the myriad and tireless efforts of veterans groups and individuals. But now we are in danger of going too far: Initial good intentions of raising awareness and putting pressure on action, ANY action, to finally be taken to address a lack of available support, is now bordering on ghoulish obsession in some quarters.

There are a number of simple ways to stop stoking the fires of misrepresentation but that would rely on individuals taking responsibility for their actions (or, even considering the impact they are having on others). Or, companies and media outlets finding new story lines.

I know that some will read this and find the idea of anyone being ‘triggered’ by a Twitter post laughable. I used to think so too. Until I found myself in a very, very dark place, alone, cut off from family, support networks, reading about a ex-Serviceman who was my age, with children the same age as mine and who had suffered the same vile Demons as myself. At that time, in that place, and with that particularly scrambled brain, it was but a very small step to searching Google for the most efficient and painless ways to end a life.

If I am being honest, when I first started penning this piece a few weeks ago I didn’t really hold out much hope of either happening anytime soon, but things may be shifting, very slowly. Very rarely has my OJAR ever said “thinks at a 4-Star level”, however General Sir Nick Carter made a number of the points raised above in his first Christmas Lecture to RUSI in December. Most of the media decided to pick up on his re-iterated comments about the younger generation and their attitude to service, but for me, one nugget sticks out.

“So while our servicemen and women appreciate public support, they want to be valued and respected – not pitied – in other words it’s about empathy not sympathy.”

CDS, RUSI, 11 Dec 18

That, to me, is what this is all about.

1. House of Commons Defence Committee: Mental Health and the Armed Forces, Part One: The Scale of Mental Health Issues, (HoC, 2018), p.35. Statistics taken from a 2017 Poll by Lord Ashcroft submitted as evidence.
2. Ministry of Defence: ‘Suicide and Open Verdict deaths in the UK regular Armed Forces: Annual Summary and Trends Over Time, 1 January 1984 to 31 December 2017’, (MoD, 2018), p.1.
3. HoC Def. Cttee, p.26.
4. HoC Def. Cttee, p.30.
5. Kapur et al: ‘Suicide after Leaving the UK Armed Forces – A Cohort Study’, PLOS, published 3 Mar 2009.
6. Ibid, p.10.
7. Ibid.