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Acute military psychiatric casualties from the war in Iraq
- Christopher T Barker (15 July 2005)
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Christopher T Barker, consultant military psychiatrist employed by MOD
Send letter to journal:
ctp{at}doctors.org.uk Christopher T Barker
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Turner et al (2005) highlight potential risk factors for admission to Role 4 (the receiving UK military hospital). Previous contact with mental health professionals was present in 37%, marriage (40%), reserve troops (21%) and non-combatant (Combat Service Support, CSS) (72%). The increased referral of CSS troops was also the experience of the forward Field Mental Health Teams (FMHT). It is possible that the cohesiveness of combat units is greater, particularly when performing their operational role, whilst CSS units are often augmented with troops from elsewhere. FMHTs are often based with CSS units and there may be an issue of proximity. Turner et al found only 11% of admissions had seen a CPN in the field (psychiatrists are also part of the FMHTs) the rest presented directly to Role 3 (the field hospital) or at sea. This is not as surprising as one might suspect. Of the two forward FMHTs one did not “open for business” until the war phase. Both forward teams often found themselves ahead of certain combatant elements and patient referrals would often go rearwards. These teams were also mobile as they supported their brigades within Close Support Medical Regiments (CSMR) and therefore would not have been accessible at all times. In addition, one of the field hospitals moved to a forward position and received direct referrals. Most of the forward FMHT time was spent on psycho-education and other military/medical roles. I agree that very few referrals were directly related to combat, but as Turner et al suggest, what the individual put down to difficulty coping with the physical environment and separation from family and/or partners will have been driven by combat related anxieties. Unlike Turner et al our FMHT referral rate peaked just prior to the war phase with a subsequent peak 2 weeks later, at a time when the majority of the movement and fighting had finished. Until well into the war phase there remained the threat of biological and chemical weapons. In total 17 of the cases seen by the FMHTs were referred for casualty evacuation. Some of these will have been discharged at on arrival in the UK so the figure of 13 patients who had seen a CPN in the field reflects the caseload seen in the forward areas. The FMHT rate of recommendations for casualty evacuation was 18%, administrative repatriation 15% and the rest returned to work. They also report no psychiatric diagnosis in 35 of their sample. Many of the psychological reactions will have settled as before arrival at Role 4 many days later. Their finding of a significant reduction at the end of the war phase can be explained not only by formal cessation of hostilities, but also by the departure from theatre of a significant number of troops. Turner, M., Kiernan, M., McKechanie, A., et al (2005) Acute military psychiatric casualties from the war in Iraq. British Journal of Psychiatry, 186, 476-479 |
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