• Paul Fjelrad

Living With PTSD - So, what now Mr Johnson?

When I started writing, I didn't imagine embarking on some sort of mental health crusade for PTSD awareness. I just wanted to tell a story that I thought might help. But as all the talk is now about the roadmap for lifting lockdown, I can't ignore what's happening and what’s on the horizon as this shit is personal for me.

Coronavirus public ad campaign on a bus shelter
Bending the rules costs lives - Photo by Getty Images

So let me start by introducing you to something that those who have worked with me over the years will recognise as the "5 minutes with a calculator conversation". This is where I use a simple technique combining common sense, some simple assumptions, and a calculator, to estimate the scale of a challenge. I’ve used this technique through 20+ years of technology consultancy, on everything from national-scale government IT systems, to the online business models of multi-national blue-chip corporations. It’s always amazed me how something as simple as this, and the insight it gives, is so often missing in the board rooms of big business and the offices of Whitehall.

A recent BBC article had a PTSD survivor describe it as “your own version of hell”, a description I recognise all too well, while another reported 40% of frontline NHS staff showing signs of PTSD.

A nurse under stress, holding her face in her hands
Nurses on the frontline - Photo by iStock

I want to try and put that in context with some numbers.

2018 studies found 3-5% of the UK population will experience PTSD symptoms at some point during their lifetime.

Based on the latest UK population figures, that’s 2 - 3.5 million people who will experience some symptoms of PTSD at some point during their life.

Two-thirds will recover within a few months, maybe without treatment. For 0.6 - 1.1 million it will take extensive treatment over months or years to recover. For some of those it’s a chronic condition they will struggle with for the rest of their lives.

That was based on studies from 2018. There are an estimated 506,000 frontline NHS Staff. 40% of that is over 200,000 people potentially facing their own personal "version of hell".

PTSD is often only discussed in the context of soldiers. There are 145,000 full-time personnel, currently serving in the military and studies put the prevalence of PTSD at 4% for the UK Armed Forces as a whole, rising to 6% for combat veterans. I won’t ever minimise what any PTSD survivor has endure, particularly not when we’re talking about those who have chosen to serve their country, and I understand why PTSD in veterans has received focus in the past, but there is another reality I want to recognise here.

If these studies monitoring the mental health impact on NHS frontline staff are even close to accurate, that means from this last year alone there could be over 200,000 NHS staff, who have put their health on the line in the battle against COVID-19, and are at risk of being left with the scars of trauma and PTSD after this war is finally won.

Many heads of healthcare workers around a patient
Many hands caring for us all - Photo from iStock

Yet our mental health services weren’t equipped or funded to deal with the scale of need before the pandemic, yet alone to face this new mental health epidemic looming ominously on the horizon.

This "analysis" took me 5 minutes with a calculator and internet access.

So, now what Mr Johnson, Mr Hancock? Where is your exit strategy? Where is even a simple acknowledgement of the problem?

Person in trauma therapy with face in their hands
Trauma Therapy - Prevention is better than cure - Photo by iStock

I've been keeping an eye on the COVID Trauma Response Working Group for a while now. There was a brief flurry of publications back in May and June of last year, and not a lot since. I'm also hearing first hand what's been put in place to support nurses who are reporting symptoms of stress, anxiety and depression, and to call it pathetic would be to do that word a disservice. I'd call it a joke, but this is in no way funny.

My best friend is a nurse. He like thousands like him are the troops being sent over the top with no plan in sight of how their wounds are going to be healed when their duty is done.

Even before the pandemic, we had a mental health and suicide crisis in this country. The Health and Social Care Act of 2012 created a legal responsibility for the NHS to deliver "parity of esteem" between mental and physical health, and this was to have been achieved by 2020. All I can say to that lofty goal and whether they got anywhere near achieving it, is if only.

The challenge was acknowledge in 2011, with the government's "No Health Without Mental Health" strategy.

Based on the government's own numbers, mental health problems account for 23% of the burden of disease in the United Kingdom, but spending on mental health services consumes only 11% of the NHS budget. The link between physical and mental health, and how long-term mental illness then increases the risk of a number of serious physical maladies has been long understood, and so this spending shortfall is massively amplified. It doesn't take a genius, health professional or any serious data analysis skills to understand the maxim, "prevention is better than cure". To bring this back to PTSD again, a study published by NICE has shown that prolonged serious mental illness, such as PTSD most definitely is, reduces expected life-span by 10 - 15 years.

If we're to continue to count the cost of the COVID-19 pandemic in "lost years" of life, then these figures will need to be added to the already grim total.

Perhaps I can give you a possible reason for this state of affairs, and why I believe a national campaign is required to change the fundamental assumptions upon which mental healthcare is planned, structured, and funded. The core of the NHS, when it comes to physical care, is predominantly built on the fundamental assumption that if you require treatment, particularly in an emergency, then it must be there for you. There may be waiting lists, difficulty getting appointments and queues in A&E, but fundamentally it is sized to meet the need. It may seem an absurd example, but we would not ever find it acceptable as a nation if an ambulance only attended 25% of car accidents, or 50% of people who attended hospital with a broken leg, were sent home to fend for themselves.

Yet, this isn't the way we think about everything.

According to the most recently published statistics there are nearly 4,500 people sleeping rough on any given night. There aren't shelter places for all of those 4,500. We as a nation, are apparently ok with some people sleeping rough, and the state not providing for them. The average age at death of someone sleeping rough is 43, which is roughly half the usual life expectancy. So that means, as a people, that we're apparently ok with a certain number of people dying from being homeless, even if we almost certainly don't say this out-loud. There are services provided by the state for homeless people, yet it is not sized to meet the need. Therefore the fundamental principle upon which these services are based must be, "we can't help everyone" and therefore there must be a certain acceptable number of deaths. Yet this isn't, and shouldn't, just be accepted as a given. In Denmark, by law, there must be a place in a shelter for every homeless person.

So what about the NHS and mental health? What are the fundamental principles upon which those services are based?

You are 4 times more likely to die from suicide than a car accident, yet 70-75% of people who complete suicide have had no contact with mental health services in the year before their death. If you do manage to get your GP to refer you, then you face a waiting time of 9 to 18 months to get to see a counsellor and even then, the sessions are doled out in meagre groups of 6 to 8, before you are sent back to your GP again. Meanwhile GPs will continue to hand out anti-depressants like sweets, something has surged during the pandemic, despite the fact that there is a well-documented increased risk of suicide in the first 4-6 weeks of taking anti-depressant medication.

This is the mental healthcare system that a frontline nurse faces should they be one of the 40% who may be experiencing anxiety, depression, and all the early signs of PTSD. Does that sound like a service that is planned, structured and funded to meet the need?

I was fortunate enough to be able to access therapy through the amazing people at Brighton Therapy Centre, who are a private organisation and charity. I got an assessment within a week of my initial call, and was assigned a trauma specialist 3 weeks later. I saw him twice a week for a year, before reducing it to once a week. All-in-all, I received treatment for 3.5 years, and that is considered to be a fairly rapid recovery process for Complex PTSD. At no point was there any discussion about reassessing my need, and I was never at any risk of being reassigned another therapist.

That level of care is currently impossible through the NHS.

It would therefore seem to me that the state of mental healthcare in the NHS follows a similar principle to that of services for the homeless. That it is based on the principle that "we can't help everyone" and therefore we as a society must believe there is an acceptable level of suffering and deaths from mental illness. Not because we tried to help and couldn't, but because of a basic lack of availability of the needed services.

You know what, if this was just about my PTSD then I would be a little annoyed, but I wouldn't expect anyone other than me, my friends and family, to give a damn about this. After all, I could afford to pay for my own care. If we're talking about the 3-5% of the population, who are likely to experience symptoms of PTSD during their life, then I'll get angry but honestly, I'm not expecting our society to change. I even don't expect any of you to care that much when it's my friend who is suffering, no matter how much I might rant and rave about it. I'll be supporting him and get him the care he needs, even if I'm paying for it myself.

But given everything our NHS frontline heroes have done for us in the last year, do we not have to do better than this for them? Does our compassion and gratitude only extend to well-meant, but relatively hollow, gestures such as the Clap For Carers?

We are being told that part of learning to live with COVID in the years to come, means we will have to accept a level of deaths, just as we do from the yearly flu outbreaks. Does that include accepting a level of suffering of NHS doctors and nurses from the impact and aftermath of this pandemic that has left them traumatised? Does that include accepting a number of deaths from suicide because those who cared for us, don't get the psychological care they need?

So, now what Mr Johnson? What are your acceptable numbers?

Do you and your advisors perhaps need to borrow my calculator?

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