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July 22, 2019

Access to Help – Illness with PTSD UK


In theory, there is a huge focus on access to mental health support in the UK. I imagine this is a driver worldwide, at least in the so-called civilized parts. How well is this working when it comes to the now ageing, frailing veterans of the Bush wars that were conscripted to fight for long, repeated stints that would be unthinkable today?

I was chatting to someone ex BSAP, now living in the UK. Like many fortunate enough to live past 60, his body is showing signs of wear and tear. Behind the cancers, glaucoma, Parkinsons and diabetes, this section of the population commonly (if not universally) have underlying, undiagnosed problems that today, clearly fall under the mental health heading.

Their background of boarding schools, years of war – combat alternating with civilian life in financially and socially broken countries – would challenge anyone’s sanity.

Factor in their conditioned stiff upper lip (complaining was social suicide), their unfulfilled dreams (the country had no use for chefs or jewellers) then add the stress of late-life (penniless) immigration to other countries and it should not take a mental health professional to realise that these alpha males (and some females) are not going to seek help.

These men are unaccustomed to talking about their mood swings, fatigue, confusion, disturbed sleep, flashbacks and anxiety fluctuating with depression. It shouldn’t be necessary. My grandmother could diagnose it – And she is dead.

The medical system will only notice them when their body starts breaking down. It’s at this point that the support services are expected to be diligent. But are they?

You’d expect an opportunity to assess them would include lots of carefully probing questions by any assessor made aware of their background. Is this happening? The evidence says no.

The findings of my report (part of a much larger one) are going to take another 6 weeks to complete. This is because I write, but I am not a medical professional and there is a tiny chance that a recent interview that I was party too did give full weighting and acknowledgement to the fact that a person from this background undeserstates problems – Easily measurable by a lack of medical records in a country where healthcare is free of charge, (No barriers)

This issue affects ex-combatants regardless of the side and theatre they fought in.

Let’s check.

Assignment

My part in this assignment was tight. If you want to add your evidence it must adhere to the same principles.

Purpose

Check for discrimination against people with untreated PTSD, Battle Fatigue, Late On-Set PTSD in Accessing Support UK

Requirements

A person from this background needs an assessment for medical or benefits checks.

They must have:

A scant medical history. (Evidence shows the vast majority cannot ask for medical help)

A 3rd person must accompany them – The affected person will typically understate their problems and struggle to detect unfairness.

NO preconceived ideas, so NO discussion or browsing online forums. Any research is limited to that offered by the official relevant service – Eg: DWP, PIP, ESA, any medical needs assessment. Interaction with the specialist in place to support the physical side is allowed as any disease is likely to be advanced.

Mental health, battle fatigue, PTSD type symptoms must be flagged (by a 3rd person) We cannot hold people to account for neglect or failings if they haven’t been made aware they exist. Ensure this is admitted by the assessor, Eg: I have read the claim/form/am familiar with the background.

An additional proven physical health issue that increases care or reduces mobility must co-exist. This demographic is highly unlikely to seek therapy for any unseen condition.

Assessment Guidelines

You might have been told that you may not record assessments. As a rule, this is the case. In matters of public interest though, this rule doesn’t apply.

You are assisting in an investigation and possibly expose whether sectors of a population are being dealt with in a way that prevents them from accessing services. The public interest outweighs the rule because the intention is to ensure that information is accurately collected, not to win an appeal – (It might be used to make notes for any appeal, but that is not the intention.)

The pre-advising of recording disqualifies participation because it could influence the interview. Recordings will be fact-checked and reduced to script to replace notetaking. Audio is needed in cases where a consensus of opinion is sought. (Leading questions, shaming vulnerable people to make verbal nods, missing probing opportunities, etc) Recordings also accurately measure the amount of time the Assessor spends speaking vs listening to the interviewed person)

In short, you may record interviews for your own use, and when you are investigating an issue in the public interest. You may not covertly record audio specifically for later use at a tribunal without disclosing your intent.

Findings

I have completed an assignment but cannot provide an accurate report until notified of the outcome which will take around 6 weeks. It could be that although I found the interview to be clearly prejudicial, that the interviewer was using specialised tactics to ensure a fair outcome.

Initial impression? A huge concern that a person with a scant medical record due to avoiding medical help coupled with poor face to face communication skills still presents a serious barrier to accessing the right levels of support.

Highlights & Issues

The interview started off with an open and friendly greeting. The Assessor confirmed she had read the claim form, which I will attach. The 3rd party mistakenly took the wrong glasses and was unable to refer to any notes.

The 3rd party explained (again) that the respondent was uncomfortable being interviewed. This discomfort was minimised by the interviewer. Despite pre-warning that the subject understated his difficulties, questions were put to him, and in a closed-ended way – The intention seemed designed to produce a required outcome or to restrict the quality of information that could be gathered from a vulnerable person.

An examples:

“So you want to cook for yourself?” “And you can …”Open a can all by yourself?” Shamed verbal nod.

Fact: The respondent misses meals due to fatigue and needs prompting. He lost 10KG and suffers rapid weight loss if not prompted to prepare and eat food. He resists eating due to spleen tumour 20+cms in size causing a feeling of fullness.

“So you work fulltime?” (TICKED BOX) This despite the admission that the respondent was able to work with reasonable adjustments that included isolation to prevent exposure to germs and habitually working fewer hours than before. He did work 7 days, now manages between 3 and 5, on lighter duties.

The subject has painful muscle cramps in his legs, as well as neck & shoulder pain from an old army injury. He also has a hernia & a skull crushed on one side. This was stated on the form and highly visible, along with swollen lymph nodes which were not looked at. Instead, the only physical check was to see if the subject could look left, right & touch his knees at that moment. The cramps add to fatigue, weakness and pain which although obvious, are difficult for the subject to admit to.

The assessor suggested he “drink tonic water,” for the cramps. No encouraging to seek medical advice for those or any other issues.

Fact Check shows that quinine in tonic water only had any impact on muscle cramps back in the old colonial days. As such, suggesting this was potentially harmful advice given to a cancer patient requiring a high-quality diet.

Talk Time

The time the interviewer speaks compared to the time the interviewed person is given to fully answer questions is important.

Assessments are designed to gather information. This interview had the Assessor hogging the talk time at a level of 82%!. The balance of the talk time was shared between the 3rd party and the person being interviewed. A percentage of the Assessor talk time was spent giving an opinion that compromised immunity had no bearing on mobility.

FactCheck proves this wrong. From the Handbook ” Safely – in a manner unlikely to cause harm to themselves or to another person, either during or after completion of the activity • To an acceptable standard • Repeatedly – able to repeat the activity as often as is reasonably required • In a reasonable time period – no more than twice as long as the maximum period that a non-disabled person would normally take to complete that activity. “

It is unsafe for an immune compromised person with breathing that is impeded under exertion to safely & repeatedly walk any distance outdoors.

More to follow when I am able to evaluate fully. These notes could change as it’s possible that the Assessor observed more thoroughly than she probed & listened.

Method

In your assessments, please note:

Questioning Technique

The purpose of an interview is to encourage people to speak about difficult subjects.

My report (so far) found closed-ended questions that seemed designed to get a quick verbal nod from people who are flagged as struggling to admit weaknesses – Physical or mental. I am expecting a flawed outcome but time will tell.

Care & Empathy

Potentially triggering interviews might currently be carried out by untrained professionals in this area – They cannot interpret non-verbal signs and should not be put in the position.

Watch out for people claiming to be professionals, using cliches like, “I have a lot of experience interviewing all types.” This could mean that they are not mental health trained and therefore cause major post interview trauma. Many vets are at high risk for suicide, self-harm and loss of control.

My report found this interview to have caused notable tension and mood swings after the interview. At times, the questioning & information gathering felt bullying, but I will seek consensus on this.

Mental Health Support

Saying a 3rd party can be with a person for support implies that they will be encouraged to provide support. It doesn’t. The interviewer was told that the subject is volatile, but reduced this to his personality naturally meaning he has a “short-fuse.” I felt this was insulting to a person trying but struggling to discuss their issues, but will seek consensus from the audio.

How is your assessment modified to allow for extra mental health support? (If at all)

Many local veteran support services are limited to veterans who fought in the home country services. This already brings human rights into question, especially where ex-combatants were conscripted rather than volunteered.

Like anything, it often takes challenges to a system to change things. Large numbers of men and women who lived through wars elsewhere are getting to the age and stage in life when they are more likely to appear on the medical radar for the first time.

They are now a group protected by law, but this is a relatively recent change. We are watching to ensure they do not fall through the cracks.

So far, it’s not going well.

Update to follow. Regard these as rough notes.

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