By Catherine O’Brien
Many soldiers suffering from post-traumatic stress disorder feel unable to acknowledge their plight because of the stigma. Catherine O’Brien meets families who found themselves on the front line struggling to care for their loved ones.
Marion Lee had just popped upstairs when she heard the click of a car door closing. It was a midweek morning and she wasn’t expecting anyone, but now the dog was barking and as she looked out of the window, her stomach lurched. Walking up her driveway was a man in army uniform, carrying a briefcase.
‘You can’t believe what goes through your mind in those few seconds,’ says Marion, as she recalls leaping over the bed, flying down to the hallway and flinging open the front door. She imagines her visitor must have introduced himself but, as she stood rooted to her threshold, his words didn’t register. ‘All I kept saying was, “Please tell me he’s alive.”’
Moments later, Marion was on her sofa, with a kindly neighbour at her side and a cup of strong sweet tea in her hands, learning that her son Alex Harrison, then just 19, had survived but was critically ill after being injured in Afghanistan.
A month into his first tour of Helmand Province during the height of the conflict in May 2007, Alex, a Grenadier Guardsman, had been shot at point blank range by a Taliban fighter.
The bullet had gone under his helmet, through his temple and into his eye socket, causing horrific head trauma. Twice during the emergency flight back to the UK his heart stopped and he had to be revived by defibrillator. By the time Marion was driven to the intensive care unit of the Queen Elizabeth Hospital in Birmingham, he was in a coma. ‘He was black and blue with tubes everywhere and still covered in the dirt he had fallen in. But as I held his hand I felt his fingers move and I knew we had hope,’ she says.
Alex did not become one of the 456 casualties who paid the ultimate sacrifice in Afghanistan, and for that Marion is eternally grateful. But her son’s return from a war zone meant she was about to be put on a front line – one for which she had neither adequate training nor support.
Alex was discharged from hospital a month later, but needed ongoing treatment for his head injuries and ultimately lost the sight in his right eye. However, it was the ‘hidden wounds’ of his post-traumatic stress disorder (PTSD) that took both him and Marion to the brink of despair.
This year, Prince Harry (who served two tours of duty in Afghanistan) has been spearheading an awareness campaign for PTSD, anxiety and depression among servicemen and women as part of Heads Together – the joint initiative he has launched with the Duke and Duchess of Cambridge. ‘Mental health is a sensitive subject among a lot of people, but it doesn’t need to be,’ he said in a recent TV interview. ‘We need to talk about it more, get rid of the stigma.’
For Marion, Alex and countless other veterans’ families, his efforts to get everybody in the traditionally stiff-upper-lip milieu of our military forces listening and talking openly about mental health could not be more imperative. Ministry of Defence figures show that more than 220,000 British personnel served in the Iraq and Afghan campaigns and Help for Heroes has estimated that almost 60,000 of them could develop a mental health problem.
Combat Stress, the leading mental health charity for veterans, says it has experienced a 71 per cent rise in referrals in five years, and it anticipates an ongoing increase because, on average, traumatised ex-soldiers wait 13 years before seeking help. ‘When they do finally reach out, they often say it is their families that have made them come forward,’ says CEO Sue Freeth. ‘Behind every veteran suffering in silence, there are loved ones having to do the same.’
Alex, now 29, is the third of Marion’s four children and they are particularly close because for a large part of Alex’s upbringing she was a single mother. For as long as she can remember, her son wanted to be a soldier. ‘As a toddler, he would march around the garden with a plastic rifle and, at 13, he was first through the door to join the cadets. He struggled at school because he was dyslexic, but once he started his military training, he became a star pupil,’ she explains.
Alex signed up to the Army immediately on leaving school at 16, and undertook ceremonial duties, including Trooping the Colour, before being deployed to Iraq, where he completed a six-month tour, and then to Afghanistan. Wherever he was, he was good at keeping in touch with home. ‘He’d called just a couple of days before he was injured to say things weren’t so bad and I wasn’t to worry,’ says Marion. But the day he was shot I woke up at 4.30am with a sixth sense telling me that something was wrong.’
The Queen Elizabeth Hospital in Birmingham is the specialist centre for UK military personnel injured in conflict zones and a welfare officer was on hand for Marion when she arrived there to see Alex. But once she brought her son back to the family home in Lincoln, they were on their own. ‘There was no back-up and I was thrown in at the deep end,’ she says. She and Alex talked, ‘but he didn’t want to tell me everything that had happened – I think he was trying to spare my feelings’. Soon afterwards, what Marion describes as ‘the hell’ kicked in. While still recovering,
Alex learned that three of his best friends had been killed in Afghanistan. ‘He kept saying, “Why should I live if they’ve died?”’ Marion recalls. Then, on top of his survivor’s guilt, came the hammer blow of being told that surgeons were not going to be able to save the sight in his right eye. ‘That meant his Army career was over – and as far as he was concerned, he had nothing left to live for.’
To block out flashbacks and nightmares, Alex began drinking heavily. He admits: ‘I was drunk most of the time. I’d go out till the early hours, collapse, wake up, and open another bottle of beer.’ He picked fights because ‘everyone was the enemy’, and Marion recalls countless times being called by strangers who had grabbed his phone and looked up ‘Mum’ in his contacts. ‘I’d turn up in pubs and nightclubs in my dressing gown and drag him out screaming. At home I’d lock him in his room, only for him to climb out of the window.’
One morning she went upstairs to find him, still drunk from the night before, tying his bedsheets together in order to hang himself from the loft hatch. On another occasion, after insisting he walked with her to the local shops ‘to get some fresh air’, she became aware that he was veering off the pavement directly into the path of an oncoming bus. ‘He had this blank look on his face and I had two seconds to stop him so I hit him, knocking him to the ground – it was either that or watch him die.’
Six months after Alex’s homecoming, something inside Marion snapped. She had pleaded with their GP to intervene, but had been told that Alex would have to seek help for himself, and Alex had refused. ‘And there had not been a word from the Army – it was as if they had forgotten he existed,’ she says. She resolved that she was going to have to force him to help himself.
Alex recalls what happened next. ‘She came into my room at 7am, pulled off the duvet and said it was time for me to get up, get myself together or to get out.’ Alex didn’t get up straight away – ‘I had to sober up first’ – but by 9am, he had made it into the kitchen. To his protestations that he had no future outside the Army, she told him he was going to have to adapt. ‘That is when I turned the corner,’ Alex says. ‘I realised I wasn’t just giving up on myself – I was giving up on all that Mum had done for me.’
That same day Alex allowed Marion to contact his sergeant, who set the wheels in motion for him to have treatment at Headley Court, the specialist Ministry of Defence rehabilitation centre in Surrey for wounded soldiers. Through his GP, he was also referred to a counsellor, who told him: ‘I’m not going to be able to take away what happened to you, but I will teach you how to cope with it.’ Nine years on, Alex has rebuilt his life. He lives with
his partner Sarah, 28, and their two daughters Isabella, eight, and Eliza, five, in Lincoln, and runs Guardsman Landscaping – his own gardening and property maintenance service – with the help of a business mentor from the charity Supporting Wounded Veterans. ‘I could not be more proud of Alex,’ says Marion. ‘But he deserved better care when he was at his lowest ebb and I wouldn’t wish what we went through on any other family.’
If mental health remains a largely taboo subject on civvy street, a deeply embedded macho culture makes it even more difficult to talk about within military circles. According to the MoD website: ‘In many ways, the stigma associated with mental health problems is more disabling than the condition itself.’ Sue Freeth of Combat Stress says: ‘Younger soldiers experiencing problems, particularly those who served in Iraq and Afghanistan, are coming forward for treatment sooner – within four years – which is encouraging. But we are dealing with a massive embarrassment factor – the expectation that you should be able to cope, and fear that if you speak up, you will be putting your career, and the respect of those you value, on the line.’
Patrick Rea, of PTSD Resolution, a charity that provides counselling for veterans and families, adds: ‘Soldiers soldier on. They are immensely proud, which means we often become involved only when matters have reached crisis point. The end-of-tether moment frequently involves wives or girlfriends who may have felt helpless for years before finally being able to persuade their partners to make the call.’
For Lynn Hawkins, that end-of-tether moment came one Saturday morning five years ago when her husband Dean had a full-blown panic attack – the consequence of PTSD that he had been suppressing for decades. The couple had popped into their local building society to sort out their children’s savings accounts. The trouble was they didn’t have the right documentation and when the cashier politely explained they would have to come back, the red mist descended for Dean, 55.
‘He just exploded,’ says Lynn. ‘He was being verbally aggressive and thank heavens for Perspex screens because otherwise, he later admitted, he would have pulled the guy over the counter. Instead, he started raging at a woman behind us in the queue before I managed to get him outside. He was shaking uncontrollably and it took hours for him to calm down.’
Lynn, 44, had been in the Army herself when she and Dean first met in 1992 (she gave up her military career to have their children Shannon, 18, and Kieran, 15, and has since retrained as a special-needs teacher) and she recalls the man she married being an ebullient, charismatic extrovert.
But tours to Sierra Leone and Iraq with the Corps of Royal Electrical and Mechanical Engineers (REME) had led to him suffering mood swings, flashes of temper and periods in which he would withdraw into himself. ‘He went through some horrendous experiences, which he wouldn’t talk to me about back then and that built a barrier between us,’ says Lynn. ‘I started to find myself tiptoeing on eggshells and the children learned to do the same.’
In 2006, having been commissioned into the Royal Artillery as a captain, Dean took on the highly sensitive role of Notification Officer, tasked with delivering devastating news to the families of those lost or severely injured in action. As a father of four (he has two children from a first marriage as well as his daughter and son with Lynn) with operational experience, he was eminently qualified for the job, but it took its toll.
‘Every time you knock on another door, your heart is in your mouth because you know something of the emotional hand grenade that is about to go off,’ he says. ‘For those poor families, it is a moment they will never forget.’ With hindsight, Dean can see that he was struggling with the burden of grief among the relatives he encountered. ‘We are told not to build emotional bridges, but when you are doing the job, it’s hard to be detached. I would come home and sit in a darkened room talking to a bottle of wine rather than my wife. It is amazing she stuck by me. Lynn is one of the hidden wounded.’
Lynn was the only one who knew the true cost to Dean’s mental health at the time because innate professionalism prevented Dean from appearing anything other than strong and capable. ‘As far as his colleagues were concerned, there was nothing he couldn’t handle,’ she says. ‘It was at home that the stress would come out – he would break things, slam doors. We never knew how he was going to be.’
Lynn admits she did contemplate leaving Dean. ‘I told myself we shouldn’t be living like this and worried about the effect on the children. But I feared that if we did walk out, Dean would kill himself.’
She told no one what they were going through, ‘because who could I turn to? My husband was part of the welfare system, but there was no one there to care for the carers.’ There are, she explains, other complications. ‘If you tell someone you husband isn’t coping, first you feel as if you are being incredibly disloyal to him and, second, you worry that you might be jeopardising his career, and with that, the wage that he is bringing in and the roof over your head. There is a massive need for a confidential support network that protects military families so that they can feel safe in talking openly about mental health issues.’
After what Dean calls his ‘tsunami moment’ in the building society, he was diagnosed with PTSD and also chronic adjustment disorder and depression. The Army arranged for him to have counselling, which was of some help, but being signed off work meant he festered at home. ‘I felt angry and bitter at being dropped after all my years of service and that made me even more withdrawn and hard to live with,’ he says. It was almost two years before his regiment sent someone to check on his welfare, at which point Lynn told them furiously that they were too late.
The Hawkins’ experience comes as no surprise to the charities supporting veterans. Sue Freeth at Combat Stress says: ‘To be candid, the Army has always had difficulties in managing people on sick leave, and mental health is something that is only just becoming OK to talk about.’ She praises veterans and their families who are prepared to speak out, ‘because getting individuals to tell their stories helps reduce stigma and enables others to feel they can come forward’.
She also welcomes extra government funding – three years ago, £7.4 million was set aside to improve mental health services for veterans and service personnel, and this February NHS England announced plans to invest a further £1 billion a year in mental health services generally for the next five years. But NHS care remains patchy. Combat Stress surveyed GPs last year and found too many are unfamiliar with guidelines for treatment of military psychological traumas.
‘This lack of knowledge can lead to veterans experiencing delays in accessing specialist help or being placed on less effective treatment programmes,’ says Freeth. Combat Stress runs a 24-hour helpline which is available to veterans, serving personnel and their families. The charity also incorporates family sessions into its recovery programmes. ‘We would like to do more for families but we need more funding to make it happen.’
As far as Dean and Lynn are concerned, the credit for his recovery goes to the small charity Supporting Wounded Veterans, which every year takes around 25 veterans skiing in Klosters, Switzerland, to boost their confidence and act as a game-changer. Many have physical injuries, including loss of sight and limbs. But many also are, like Dean, crippled by mental health problems.
Dean had never skied before, but went on the 2015 trip and says he returned ‘not as a changed man, but as a man ready for change’. Through the charity, he was then paired with a business mentor who acted as an adviser and navigator of the jobs market and last autumn Dean embarked on his new full-time job as a facilities manager with Tesco.
‘Thanks to Supporting Wounded Veterans, I have the man I married back once more,’ says Lynn. ‘And now, at last, we can be the family we were always meant to be.’
Mothers, wives and girlfriends are often frontline carers for veterans suffering from PTSD. But in the case of Paul Twaites, it was his younger sister Nina Brierley to whom he turned for support after a catastrophic breakdown.
Paul, 47, is a former Navy medic whose service while attached to the Royal Marines included tours of Iraq and Afghanistan. In 2007 he was involved in the rescue of countless severely wounded soldiers. Paul subsequently joined the police force in his home county of Gloucestershire and in 2013 was the victim of a serious assault while on duty, which triggered delayed-onset PTSD.
‘Paul and I were not particularly close growing up. We tolerated each other, but we were different. At school, I was a natural student while I think he’d admit that he didn’t always apply himself. Like many siblings, we’d stand up for each other one minute and slap each other down the next,’ says Nina, 45, a dietitian and mother-of-four who lives in west London with her husband Joe, a paediatric consultant at Great Ormond Street Hospital.
‘During our 20s, we lived our own lives. I moved to London and spent several years as a model; Paul worked in engineering. He had a son, Alex, who is now 19, with his long-term girlfriend, but the relationship subsequently broke down and that was when he decided to sign up with the Royal Navy. He was almost 30, which is late to embark on a military career, but it was great for him – it gave him the sense of identity and purpose he’d been missing. After his first tour to Iraq in 2002, I could see that he had changed for the better. He was less selfish, more considerate – he phoned home more and I no longer had to remind him when it was mum or dad’s birthday.
‘The change for the worse came after his second tour of Afghanistan in 2007. We all piled down to his flat to welcome him home, but he was monosyllabic, withdrawn and very twitchy. He spoke a little to my husband, who as a doctor is used to handling people who have been through trauma, but he didn’t open up to me. I had my hands full at the time caring for my daughter Teejan, now 19, who is disabled (she has a brain development disorder) and also our three sons, Lukas, Fred and Rufus, who were then all under five (they’re now aged 14, 12 and ten). Paul seemed to get his life together after that – he decided to leave the Navy and joined the police force. He was also settled with a long-term girlfriend, so although I was aware when I saw him that he was sometimes on a short fuse, I thought he was coping.
‘In 2013, two things happened to Paul. He ended with spinal and neck injuries after being called to deal with a pub fight and his girlfriend left him. He rang me out of the blue and said he was having flashbacks and nightmares and couldn’t sleep. He hadn’t wanted to call our parents because he didn’t want to worry them. I think he felt that as his sister, I was someone he could trust and that I could give him the combination of practical and emotional support he needed. And I could listen, but I didn’t know the right thing to say and I was desperately worried.
‘Fortunately I have a friend who is a nurse at Headley Court, the rehabilitation centre for wounded soldiers, who confirmed Paul needed specialist help. I spoke to Combat Stress, the mental health charity for veterans, which explained that I needed to get Paul referred for counselling through his GP, which we did. Staff at Combat Stress have been brilliant and Paul has been supported by other military charities, including Skiing with Heroes, but there isn’t always the backup within the NHS. I feel strongly that men and women who have served their country shouldn’t have to rely on charities for the care they need.
‘Paul has never spoken to me about what he experienced in Afghanistan and Iraq. I can only imagine it was awful, but I don’t ask because I guess he is not telling me for a reason – probably to protect me, and also himself. Our conversations are often about the small things – his physiotherapist might have rung to change the time of his appointment and that can seem like the end of the world to him on a bad day.
‘When he phones, I stop doing whatever I am in the middle of and give him my 100 per cent attention. And I’ve learnt to gauge when I need to just listen, and when I need to give him a verbal kick up the backside. He’s doing brilliantly now. He’s back at work and in a new relationship and, although we both know he’ll never be quite the same again, a huge positive is that he and I have become incredibly close.’
Paul says: ‘I am immensely grateful to my family and my work colleagues for supporting me through what we call my “rage days”. But I’m not keen on anybody knowing how bad things really were. For a long time, I bottled things up – the flashbacks, the hyper vigilance and the anger. No matter what people say, you are not going to reach out for help until you are ready. Nina kept checking up on me and when I went downhill, I knew she would be the person I could talk to best. My parents have always been there for me, too, and I talk to them, but I don’t have to worry about worrying Nina. She can soak up whatever I say and thanks to her pragmatic approach, I got the professional help I needed.’
Where to find further help
Combat Stress runs proven treatment programmes that are funded by the NHS. Its 24-hour helpline is open to veterans and families. 0800 138 1619, combatstress.org.uk.
PTSD Resolution offers treatment through a network of 200 accredited therapists nationwide. Unlike many charities, it will treat those who have alcohol-related problems or who have ended up in prison. Its helpline takes calls from veterans and families during office hours. 0300 302 0551, ptsdresolution.org.
Supporting Wounded Veterans helps wounded ex-Iraq and Afghanistan campaign soldiers, including those with PTSD, back into employment through a ski-based induction and mentoring programme. It has also recently set up a family support network. supportingwoundedveterans.com.