New trauma after PTSD claim is blocked

Mental Health Nursing,  Jul 2003  

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Military personnel claiming that they were not properly treated for post traumatic stress disorder have lost their legal campaign for compensation.

The High Court has concluded that the Ministry of Defence did not systematically fail to protect servicemen and women from the psychological effects of participation in war.

Two thousand claimants who saw action before 1987 were blocked from taking action under the previously existing crown immunity.

But combat immunity means that the Ministry of Defence does not face the normal employer's duty to ensure a 'safe system of work' where combatants are engaged with an enemy in the course of combat. Nor do soldiers in battle owe each other aduty of care.

Mr Justice Owen ruled that 'combat immunity' covered active operations against the enemy in which personnel were exposed to attack or the threat of attack, including planning and preparation and peacekeeping.

Counsel for the claimants alleged a 'macho culture1 which saw psychological problems as a sign of weakness, discouraging personnel from reporting them. They argued that the armed forces missed vulnerable recruits, did not prepare personnel for battle trauma or identify and treat symptoms of PTSD.

But the judge said the MoD had not breached its duty of care. He acknowledged there were individual cases, however, which the MoD had recognised, where there had been a negligent failure to detect, diagnose and treat a psychiatric disorder.

The MoD said it acknowledged that some members of the armed forces would be subjected to traumatic experiences and suffer stress. 'But this does not mean that the MoD has been negligent, or that the individual is entitled to receive common-law compensation.'

Aberfan

Research published recently in the British Journal of Psychiatry says childhood survivors of the Aberfan disaster in 1966 still experience post-traumatic stress disorder.

Earlier research suggested that children are more adaptable to adversity.

Researchers from the University of Wales college of medicine, Cardiff, say their findings challenge this. Of 41 survivors questioned in 1999, 12 continued to meet diagnostic tests for the disorder. Twenty five men and women, now in their late 30s and early 40s, had at least one symptom in the previous two weeks.

Many found that any small reminder brought back feelings of the horror. Some had bad dreams and many tried to avoid talking about the disaster. About half the survivors appeared to have suffered PTSD at some point,

One hundred and forty five children survived Aberfan while 116 were killed when an unstable slag heap engulfed a primary school. In the aftermath of the tragedy many experienced sleeping problems, nervousness, friendlessness, and bedwetting.

However, full remission for adults was attainable, and there was no reason to think it different for children.

Childbirth

But wars and disaters are not the only source of PTSD. Up to five per cent of mothers suffer PTSD after giving birth, with many others experiencing symptoms such as nightmares, Stephen Joseph, a psychologist at Warwick University claims.

Dr Joseph says PTSD in mothers is often misdiagnosed as postnatal depression by health professionals. An emergency caesarean was one possible trigger. A research review suggested that 2%-5% of women might develop the disorder following a difficult childbirth, but many more might display some symptoms.

Patients retained painful images of the experience, including recurrent dreams. They avoided anything that would remind them of the birth, and maintained an emotional detachment from people and an inability to relax.

Dr Joseph, co-author of an article on the subject in the medical journal Psychology, Health and Medicine, linked avoidance of sex, birth flashbacks, and parenting problems with the disorder.

'It's long been recognised that women can go on to develop psychological problems following childbirth, and this study clearly suggests that some suffer from post-traumatic stress.'

Copyright Community Psychiatric Nurses Association Jul 2003
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