Coping with trauma following military operations
2 Oct 09
A new system that provides peer group support to individuals following traumatic events is helping military personnel cope with trauma as they return from operations in Afghanistan.
Armed Forces trainers and students participate in a Trauma Risk Management (TRiM) course at Amport House in Hampshire
[Picture: Corporal Russ Nolan RLC, Crown Copyright/MOD 2009]
Trauma Risk Management or 'TRiM' is a peer-delivered support system through which members of a Service unit are trained to identify various risk factors in colleagues who have been subjected to traumatic incidents.
Among Service personnel who are routinely placed in potentially traumatic situations, stress is common - it comes with the job. Personnel exposed to the operational environment will inevitably experience stress to a greater or lesser degree.
However, contrary to popular belief, only a small proportion will suffer the type of stress that may lead to mental health issues and, in spite of the current high operational tempo, only a small percentage will encounter Post Traumatic Stress Disorder (PTSD).
Major Richard 'Skid' Dorney MBE, ex-Grenadier Guards, has been a TRiM trainer for over four years:
"Most people will dust themselves off, albeit after a period of re-adjustment, getting on with their lives relatively unaffected by the experience.
"It is true of course that a small number of people do need some additional support after incidents, in some cases when they return home from operations.
"The trick is to identify those most at risk of developing problems and to signpost them to the appropriate support at an early stage," he said.
Major Richard Dorney MBE
[Picture: Corporal Russ Nolan RLC, Crown Copyright/MOD 2009]
In times of stress, a serviceman's 'Esprit de Corps' - the strong bond of trust and loyalty between members of a unit - can be an obstacle when it comes to speaking to 'outsiders', even medical practitioners, about their concerns.
And then there is the stigma commonly, and mistakenly, associated with PTSD.
This is where Trauma Risk Management (TRiM) comes in. The peer-delivered system is designed to identify various risk factors in Service personnel following traumatic incidents:
"TRiM is not therapy or counselling nor is it a medical initiative," explained Maj Dorney. "Service personnel are usually reluctant to talk to strangers when they are in difficulty and invariably it is their mates that they turn to for help.
"For this reason TRiM is delivered by trained personnel already in the unit, known as the 'Buddy Buddy System'."
Three days after an incident, personnel who are identified as being at risk are invited to take part in an informal interview. The aim of the session is to assess how the individual is coping and whether any of the key risk factors are present.
This process is repeated at the one-month point and a comparison of the outcomes is made. This makes it possible to identify those people who may be having problems early on.
A management plan can then be put into place so that anyone who is struggling and needs qualified help can obtain it early on.
"PTSD is simply a wound to the mind. It will heal if treated properly and the earlier we identify those in need, the more effective their treatment is likely to be."
Major Richard 'Skid' Dorney MBE
There are many support services available, ranging from the Unit Padre, Unit Welfare Officer and Regimental Medical Officer to the more specialised community Mental Health Teams and Field Mental Health Teams (when deployed).
Most people will feel much better after four to six weeks. But for the small minority who are not doing well, TRiM practitioners can identify those individuals and allocate them appropriate help.
Major Dorney said:
"For the very small number who have more serious problems it is worth remembering that PTSD is treatable and the Army has its own mental health professionals who can effectively treat those in need."
For the last two years TRiM has been used effectively among deployed Service personnel in Iraq and Afghanistan. A direct benefit of the system is an increase in general awareness of Post Traumatic Stress Disorder along with the corresponding reduction in the stigma that is often associated with mental health problems:
"We do not stigmatise those who are wounded in action and PTSD is simply a wound to the mind," says Major Dorney. "It will heal if treated properly and the earlier we identify those in need, the more effective their treatment is likely to be."
A recent and robust study into the effectiveness, sponsored by the MOD and carried out by a team from King's College London, found TRiM to be 'both acceptable to those who might benefit from it and, most importantly, to do no harm'.
Armed Forces trainers and students during a Trauma Risk Management (TRiM) course at Amport House in Hampshire
[Picture: Corporal Russ Nolan RLC, Crown Copyright/MOD 2009]
The report by the King's Centre for Military Health Research, recently published in the Journal of the Royal Army Medical Corps (see Related Links >>>), also concluded that there was evidence that TRiM 'may be of substantial benefit to those who become TRiM practitioners', and that the 'regular exercising of the TRiM system in units should additionally ensure that all personnel are more cognisant of the effects of traumatic stress and what can be done about it':
"We all have a moral obligation to assist those who need our help," said Major Dorney. "But it is also important that we take every opportunity to make people aware of the facts rather than the myths.
"Service personnel are not alone with their problems and we should all do our best to banish the stigma attached to mental health and encourage people to get help early if they need it."
Major Dorney has lectured to a wide variety of national and international audiences on TRiM-related matters and has trained over 250 TRiM practitioners from a wide variety of military and civilian organisations.
He helped pioneer TRiM in the British Army and has acted as a mentor to many organisations setting up their own trauma management projects and, in 2006, he was chosen as part of a UK team to visit the United States to assist in a US TRiM research programme.