‘I was having nightmares and I couldn’t walk down the street or step on grass,’ says Alexander Kennedy MC (pictured above, left), a military veteran who witnessed his fellow soldiers – close friends – killed by improvised explosive devices in Afghanistan.
It is perhaps no surprise to doctors that Mr Kennedy has been diagnosed with PTSD (post-traumatic stress disorder) since those incidents in Helmand Province, but the stigma around mental illness continues to prevent many veterans seeking support.
That, and Russia’s war in Ukraine re-triggering trauma, is why the RCGP (Royal College of General Practitioners) and NHS England are encouraging more practices to become ‘veteran-friendly accredited’, in an initiative strongly supported by the BMA.
I had lots of space and time but people were there if I needed anythingMr Kennedy
Mr Kennedy is thought to be the youngest person to receive the Military Cross, one of Britain’s highest military decorations, since the Second World War. He received it in recognition of his efforts to aid his injured platoon commander while under fire during a battle in 2009.
For him, knowing the clinician treating him understands his situation is important. He joined the Army’s Mercian Regiment at 16 in 2007 and was deployed to Afghanistan having just turned 18, the youngest age soldiers can be deployed to the front line.
His first tour was ‘a great experience’, he says, ‘but I was unaware how much it had hit me until a couple of years later’.
Promoted to lance corporal, Mr Kennedy was sent on a course that covered bomb combat to prepare for his next tour. ‘At that time there were a lot of amputees, or people killed that way,’ he tells The Doctor.
‘After that, it hit me pretty hard. My mum sensed something wasn’t right. I took myself out of the field and came home.’
Change in behaviour
Mr Kennedy says the Army’s macho nature means seeking help is stigmatised. At first, he remained undiagnosed and turned to alcohol, which he says ‘amplified’ the trauma.
‘Within the military it’s known we drink an awful lot,’ he says.
‘It’s work hard play hard. I know people who have criminal records because they were spiralling.’ Although Mr Kennedy was seen by a military doctor in Afghanistan, it was only when he returned that a senior officer ‘noticed a change’ in his behaviour when he was preparing for his next tour.
‘They told me to stop drinking,’ he recalls. ‘But my parents knew it was more than that.’ His parents knew their local GP, Jonathan Leach (pictured above), was ex-military so urged him to pay him a visit.
They may not have known Dr Leach is also NHS England’s associate medical director for armed forces and veterans’ health and set up the accreditation for GPs along with Brigadier (retd) Robin Simpson, a former Army GP and professor of military primary healthcare and veterans’ health.
Each GP practice is likely to see a military veteran every dayDr Lodge
Mr Kennedy remembers his first appointment with Dr Leach: ‘He just looked at me and said, “You need help”. He understood. He has a lot of experience with trauma and has seen what can happen. Ultimately, Dr Leach saved my life.’
Mr Kennedy was referred to a specialist veterans’ unit for eight weeks. ‘Things happened very quickly,’ he recalls. ‘There were a lot of other specialists, like psychologists, involved.’
Mr Kennedy, who remains on sick leave from the Army, says PTSD is ‘a subject that makes you very vulnerable’.
‘You have PTSD because you survived,’ he says. ‘Your colleagues didn’t. I needed to speak to somebody who understands that [because] you are exposing very personal things. PTSD for someone who has been in a car crash is different. Veterans have seen their friends getting blown up. We’re not special, but it’s different.’
The need for understanding
Mr Kennedy was alongside other veterans with PTSD. ‘A lot of it was a blur,’ he says.
‘But it was reassuring to be in an environment with other people being treated for the same thing. I had lots of space and time but people were there if I needed anything. My mum and dad had an emergency number.
‘I could open up. I spoke to just one individual [clinician], which helped. I didn’t want to constantly relive the trauma. It was fast, but not too quick for me to be able to deal with it. I had gone months not knowing what to do, the next minute I was on track. We like structure in the military.’
Mr Kennedy says he is lucky to have a supportive family but notes ‘not everyone has that’, which is one of the reasons he wants more GP practices to become accredited through the RCGP.
He believes it will give more veterans the reassurance to seek help from someone who understands the unique pressures of serving in the military.
So far, 1,500 GP practices have the accreditation, which has helped refer more than 20,000 veterans.
The more clinicians who have this understanding, the betterDr Leach
For Dr Leach, who spent 25 years in the Army and served in Iraq, Yugoslavia and Northern Ireland, spotting PTSD among veterans is ‘a lot easier, because I get it’.
‘I have a particular advantage because I served,’ he says. But he wants to see an accredited clinician in every hospital and primary care setting to help advise where referrals can go via Op Courage: The Veterans Mental Health and Wellbeing Service and the Veterans Trauma Network.
‘The concept is very straightforward,’ explains Dr Leach. ‘When someone registers, we ask if they have a military background, and code it. There is a clinical lead for the practice. It doesn’t need to be a doctor. It’s a similar concept to a safeguarding lead.’
Accreditation affects the culture of the whole service ‘from the receptionists through to referral’, he adds. ‘Wider understanding is really important. This is a group of individuals with very specific needs.
‘Rather than bouncing in and out of services, you can refer patients to the right place at the right time. It helps in terms of getting people better, but also – given where we are in general practice – identifying trauma earlier helps take some pressure off the service.’
The aim is to refer patients ‘before things escalate’ and a two-week schedule is the target. ‘In the same way as cancer, treating it earlier leads to better outcomes,’ says Dr Leach, who notes: ‘Every individual is going to have slightly different traumas but it’s the same combined reason.’
Having knowledge of PTSD from a military perspective has also helped Dr Leach identify it in civilian cases, including one patient who had been in a car crash a year earlier and a woman who had been sexually assaulted by her father when she was a teenager.
‘These examples have nothing to do with the military but me and colleagues are much more attuned to the signs,’ Dr Leach says.
‘The more clinicians who have this understanding, the better.’
In the same way as cancer, treating it earlier leads to better outcomesDr Leach
Jackie Lodge, a GP at Kirkbymoorside in North Yorkshire, became veteran accredited after seeing an email from the RCGP last August. Her practice already knew of 31 veterans among its 6,000 patients but has since identified more.
‘It can be as easy as a simple question,’ says Dr Lodge, who has learnt some patients are veterans from conversations in consultations.
She also praises her reception and nursing teams for helping to ask or including the option on forms.
‘One veteran saw a poster about the accreditation and told me all about his military service,’ she says.
‘He said if he hadn’t seen it, he wouldn’t have said anything.’
Dr Lodge says she learnt more about Op Courage referral options through the training and how she is able to fast track veterans with injuries sustained in active service.
One of her patients, injured serving in Northern Ireland, had hip pain and was on the waiting list for a musculoskeletal clinic that can take up to a year.
‘I was able to quote the Armed Forces Covenant to expediate him through the NHS system,’ she says. ‘Two weeks later he had been seen, was comfortable and pain free. I couldn’t believe it.’
The scheme is evaluated by the University of Chester, which found 84 per cent of accredited practices now feel they have a better understanding of veterans’ needs.
And it has been ‘wholeheartedly’ welcomed by Colonel Mark Weir, chair of the BMA armed forces committee, who says: ‘Such a service is likely to prove supportive to both service and veteran families, some of whom may face similar challenges.’
Dr Lodge says the accreditation appealed as it is free and not time intensive.
‘Each GP practice is likely to see a military veteran every day,’ she says. ‘It’s so easy and can really help our patients.’