#soldiers

Tommy trouble

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It seems the UK Armed Forces are finding it difficult to recruit their own. So much so that they have lifted a 5-yr waiting period for Commonwealth citizens to join up. The National Audit Office states the armed forces are suffering the worst shortage of new recruits since 2010, being short 8,200 from desired levels. Therefore Aussies, Canadians, Indians and other Commonwealth citizens can sign up.

According to official Ministry of Defence (MOD) in the year leading to November 2017 1,759 of the 15,325 regular troops quit  because their time was up. Nearly half (7,439 ) quit early because of worsening conditions and falling morale. 3,325 were kicked out on disciplinary grounds and another 2,337 were medically discharged.

The MOD’s UK Regular Armed Forces Continuous Attitude Survey 2015 revealed,

-The number of personnel stating that they are dissatisfied with Service life has risen to 32%, up from 27% in 2014. Not a good start.

-There has been a fall in the number of personnel reporting that they are proud to be in their Service, from 81% in 2014 to 77% in 2015.

-25% “state that they plan to leave as soon as they can, or have put in notice to leave” (+9% on 2011).

-Satisfaction with pension benefits has dropped 18% since 2011

– Less than a third (27%) of Service personnel agree that the level of compensation is enough

-In 2015, job security was the top retention factor, followed by dental and healthcare provision, pension and opportunities for sport.

  • Individual morale 40% (-6% on 2011)
  • Unit morale 21% (-6% on 2011)
  • Service morale 14% (-4% on 2011)
  • Service life satisfaction 47% (-10% on 2011)
  • Job satisfaction 56% (-8% on 2011)

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Apart from the appalling trajectory of morale, it is clear that care once out of the military doesn’t fare much better.

While the MoD total budget will increase from GBP23bn to GBP50bn by 2020, data about how it is spent is highly opaque. More is learnt by some of the history surrounding the treatment of Tommies.

Support of  veterans has been so lacking that charities such as Help for Heroes has been active picking up the shortfall. It raises over GBP30 million per annum to support the 2,500 British veterans discharged for medical reasons every year to cope with civilian life.

Despite the American Psychiatric Association acknowledging PTSD in 1980, it took the UK another five years to officially recognize PTSD after the sharp increase in veterans suffering from mental health issues post the Falklands War of 1982. Of the 30,000 troops that were sent to fight, the UK armed forces allocated only one psychiatrist to the far away battlefield.

The problem was compounded in the 1990s with widespread closures of UK military hospitals as a cost cutting measure. Seven of the eight military hospitals had been shut or transferred to the NHS by 1999.

The UK Ministry of Defence (MOD) wrote in its recent report on those deployed in Iraq and Afghanistan about how low suicide rates were. It stated, “While rates of mental disorder are lower in the military (3.1%) than the general population (4.5%), the MOD routinely carries out research into those who have served on large scale combat operations, in order to more accurately assess the effects of deployment.” Note there is no data on veteran suicide in the UK.

The UK MOD’s ‘Defence People Mental Health and Wellbeing Strategy’ is supposedly in place to challenge the stigma surrounding mental health issues, to ensure that all who serve, and have served, can enjoy a state of positive physical and mental health. The MOD has committed £22 million a year on mental health with the establishment of two 24/7 helplines for serving personnel and veterans. How is it a charity funds 1.5x what the government does?

To put that in context, Australia spends 20x this amount every year just on veterans counseling services. America, albeit a larger veteran base, spends $9bn on mental health for its soldiers.

One wonders why the MOD doesn’t listen to the surveys and act. Then it wouldn’t have to go down the mercenary route.

It costs HOW MUCH?

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The mind boggles. War is expensive to conduct. Once wars finish, the cost of looking after veterans is massive. In 2000, the Department of Veteran Affairs (VA) in America spent $43.6bn to look after returned servicemen and women. In 2020 it is expected to exceed $212bn (c. 5x), the equivalent of what the Chinese currently spends on its military.  Digging deeper into the data reveals that the cost of the aftermath of Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF) and Operation New Dawn (OND) on veteran treatment keeps growing in a straight line.

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Total obligations for OIF/OEF/OND patients has grown 19-fold in the last 14 years to over $7bn. Total veterans from those campaigns now totals 965,000 and is expected to hit 1.1mn by 2020. Cost per veteran patient over the 2006-2020 period will virtually treble.

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Expenditure on prosthetic devices (e.g. limbs, hearing aids) has near as makes no difference quadrupled in that period.

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Spending on pharmaceutical products is up 1.9x since 2006.

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Drugs such as Oxycontin which contain opioids have found their way to creating problems in the US armed forces. 15% of Army troops admitted to taking illicit drugs (cocaine, heroin, marijuana) and opioids back in 2008.

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Spending on programs to prevent substance abuse is up 1.8x since 2006.

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The VA notes key clinical metric trends from Quarter Four of 2012 to Quarter Four of 2017 show:

• 67% reduction in Veterans receiving opioid and benzodiazepine together;
• 44% reduction in Veterans on long-term opioid therapy (> to 90 days);
• 38% reduction in Veterans receiving opioids;• 56% reduction in Veterans receiving > 100 Morphine Equivalent Daily Dose;
• 51% increase in Veterans on long-term opioid therapy with a Urine Drug Screen
(UDS) completed within last year to help guide treatment decisions.

Spending on mental health programs is up almost 4x since 2006. The VA plans to promote the development of skills in VA providers to diagnose and assess PTSD
by developing a computer-based training using simulated virtual patient
technology that will allow clinicians to practice and receive customizable feedback
on giving CAPS-5 to a lifelike virtual patient.

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The 2019 VA Budget requests $8.6 billion for Veterans’ mental health services, an increase of 5.8% above the 2018 current estimate. It also includes $190 million for suicide
prevention outreach. VA recognizes that Veterans are at an increased risk for suicide and
implemented a national suicide prevention strategy to address this crisis. Veteran suicide in the US is at a 22/day clip.

The price of freedom. All said and told the US over the last 20 years will have spent the equivalent of $2.476 trillion with a “T” on veterans. That is the equivalent of one entire year of UK GDP.

Smart technologies are an absolute must for the VA. The cost of veteran health is the equivalent of 29% of what the US spends on defence, up from 14.8% two decades ago. Asking for yearly increases is a band aid solution.

Banned documentary – Let There Be Light, 1946

In compiling the book of letters from the battlefields of WWII by Lt. Norman Peterson, researching PTSD in that era has unearthed some interesting facts. A documentary made by John Huston in 1946, which chronicled the treatment of troops suffering from neuro-psychiatric conditions, was banned by the Army from release to the public until 1981. The excuse made was that it was necessary to protect the identity of the patients, despite Huston having received signed waivers. It would seem the top brass did not want to have the extent of the problem acknowledged by the broader public.

The first published book related to what we now know as PTSD was the Diagnostic and Statistical Manual of Mental Disorders of 1952. It listed the condition as “gross stress reaction.” It wasn’t until 1980 that PTSD was properly recognized as a psychological issue. After WWII, veterans were told to just tough it out.

WWII British Army veteran, Victor Gregg, wrote the following in The Telegraph newspaper article on 9th November 2015 with respect to PTSD like conditions.

“I remember one day during the Battle of Alamein when my friend Frankie Batt, a man I had enlisted with in 1937, was blown to pieces. I recall trying in vain to put the bits together, to somehow bring Frankie back to life. As I picked up what was left of him I could feel the hate burning inside me. For the next three or four weeks our section never brought in a single prisoner, in spite of the fact that the battle was nearly over and the enemy were surrendering in droves. So long as no officer was there to witness, we shot as many as we could until our anger died its own death…by the time I got home I had witnessed things that I had not thought possible, and my brain was filled with images of suffering that were to haunt me for the next forty years…When I was demobbed, people didn’t talk about what was going on in their minds. It just was not the done thing; you straightened your shoulders and got on with life. The men who did try to raise the subject were treated with scorn…It was only after many years that I realised how much heartache and misery my anger caused to those I loved. 

The Cambridge History of the First World War contains an article by Jay Winter, Professor of History at Yale University, where he suggested that shell shock in WWI comprised around 20% of all troops, not the 5% often reported. His contention was that the truth was deliberately suppressed otherwise sufferers would not have received a disability pension if not accompanied by physical wounds.

In 1993, MA Kidson, JC & BJ Holwill wrote in the Medical Journal of Australia a piece titled, ‘Post-traumatic stress disorder in Australian World War II veterans attending a psychiatric outpatient clinic’. Out of 108 veterans who participated in the study 45% were shown to carry symptoms of PTSD – as defined by DSM-III – 48 years after it had ended. The study claimed, The presence of PTSD was significantly associated with the taking of casualties (an indicator of severity of war stress as reported by the veterans themselves) and with combat stress as rated by their treating doctors.”

A 2007-08 study at the University Michigan looked at 78 WWII veterans being treated for depression and discovered that 38% of them had significant PTSD symptoms.

Dr. Helen Kales, principal investigator of the geriatric psychiatry section at the University of Michigan wrote,

World War II veterans come from a generation in which expressing psychological symptoms or distress was pretty stigmatized. So these cases may have gone untreated as the vets did not seek treatment and were able to somehow suppress their symptoms and function.

Reading into Traumatic Brain Injury (TBI) reveals even more concerns about the problems we face dealing with returning soldiers.

While PTSD does not necessarily require physical damage to occur, TBI, in the military, tends to occur when exposed to blast-related injuries such as artillery, improvised explosive devices (IED), land mines and rock-propelled grenades (RPG).

TBI can be the result of occurrences where an object (bullet, bomb fragments) causes the scalp/skull to break or fracture. Sometimes it is a closed injury where the outside force impacts the head but no objects manage to penetrate. Even in the case of closed injuries, the brain can experience such considerable force that it can result in torn tissues, bleeding and other physical damage which can be irreversible in severe cases.

TBI was better recognized in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) where 1.64 million served. 60% of blast injuries in those conflicts resulted in TBI. According to the US Veteran Affairs (VA), 59,000 (c.10%) Iraq and Afghanistan veterans who used the Veterans Health Administration (VHA) from 2009 to 2011 were diagnosed with TBI.

VA now records that 4.3mn receive disability benefits, up 2mn from 2000. The total budget for the VA in 2019 will total $198.6bn, up from $97.7bn in 2009. It was $43.6bn in 2000. The VA is asking for $212bn for 2020. The VA budget relative to the defense spending budget was 14% in 2000. It is now 30%. The cost of war is obscene. The cost of looking after veterans is hot on defence spending heels.

Sniping a VC winner with ambush journalism

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How ridiculous could Fairfax Media be to attack and smear Benjamin Roberts-Smith VC – a decorated Victoria Cross winner – as a war criminal, a “callous, inhumane” murderer and a bully? Winning a VC is nigh on impossible without heroics which change the course of a battle with complete disregard of self preservation.

Since 1861, 3,502 Congressional Medals of Honor have been granted to US military personnel. The VC has seen 1,358 winners since 1856 to soldiers of Her Majesty. That isn’t to say a VC is twice as hard to get. It’s to say it takes someone doing pretty special deeds to win either.

Here is what Roberts-Smith won his VC for:

“For the most conspicuous gallantry in action in circumstances of extreme peril as a Patrol Second-in-Command with the Special Operations Task Group on Operation SLIPPER.

Corporal Benjamin Roberts-Smith enlisted in the Australian Regular Army in 1996. After completing the requisite courses, he was posted to the 3rd Battalion, Royal Australian Regiment, where he saw active service in East Timor. In January 2003, he successfully completed the Australian Special Air Service Regiment selection course.

During his tenure with the Regiment, he deployed on Operation VALIANT, SLATE, SLIPPER, CATALYST and SLIPPER II. Corporal Benjamin Roberts-Smith was awarded the Medal for Gallantry for his actions in Afghanistan in 2006.

On the 11th June 2010, a troop of the Special Operations Task Group conducted a helicopter assault into Tizak, Kandahar province, in order to capture or kill a senior Taliban commander.

Immediately upon the helicopter insertion, the troop was engaged by machine gun and rocket propelled grenade fire from multiple, dominating positions. Two soldiers were wounded in action and the troop was pinned down by fire from three machine guns in an elevated fortified position to the south of the village. Under the cover of close air support, suppressive small arms and machine gun fire, Corporal Roberts-Smith and his patrol manoeuvred to within 70 metres of the enemy position in order to neutralise the enemy machine gun positions and regain the initiative.

Upon commencement of the assault, the patrol drew very heavy, intense, effective and sustained fire from the enemy position. Corporal Roberts-Smith and his patrol members fought towards the enemy position until, at a range of 40 metres, the weight of fire prevented further movement forward. At this point, he identified the opportunity to exploit some cover provided by a small structure.

As he approached the structure, Corporal Roberts-Smith identified an insurgent grenadier in the throes of engaging his patrol. Corporal Roberts-Smith instinctively engaged the insurgent at point-blank range resulting in the death of the insurgent. With the members of his patrol still pinned down by the three enemy machine gun positions, he exposed his own position in order to draw fire away from his patrol, which enabled them to bring fire to bear against the enemy. His actions enabled his Patrol Commander to throw a grenade and silence one of the machine guns. Seizing the advantage, and demonstrating extreme devotion to duty and the most conspicuous gallantry, Corporal Roberts-Smith, with a total disregard for his own safety, stormed the enemy position killing the two remaining machine gunners.

His act of valour enabled his patrol to break-in to the enemy position and to lift the weight of fire from the remainder of the troop who had been pinned down by the machine gun fire. On seizing the fortified gun position, Corporal Roberts-Smith then took the initiative again and continued to assault enemy positions in depth during which he and another patrol member engaged and killed further enemy. His acts of selfless valour directly enabled his troop to go on and clear the village of Tizak of Taliban. This decisive engagement subsequently caused the remainder of the Taliban in Shah Wali Kot district to retreat from the area.

Corporal Roberts-Smith’s most conspicuous gallantry in a circumstance of extreme peril was instrumental to the seizure of the initiative and the success of the troop against a numerically superior enemy force. His valour was an inspiration to the soldiers with whom he fought alongside and is in keeping with the finest traditions of the Australian Army and the Australian Defence Force.“

Having spent time with a veteran in recent weeks, it is clear the majority of us have never had to face live fire in war. We aren’t across the mental and physical stresses of being in battle and seeing mates killed or severely wounded. Soldiers and veterans quite rightly don’t take kindly to people they’ve put their lives on the line for  calling into question their dedication and service of country.  Even letters CM has read from WW2 veterans show the pressures they faced. Does the SMH know some 46% of people that serve in the military come out with some variant of PTSD? Why not show some dignity rather than sift through trash to besmirch a hero?

Fairfax Media taking potshots at the bravest of the brave looks daft. Is it any wonder Benjamin Roberts-Smith is fixing his legal bayonet to skewer those who tried to impugn his valor? He made a point of his fighting was to ensure freedom of the press but equally they have to be responsible for reporting accurately.

The Sydney Morning Herald just took a potato peeler to a gun fight. Having said that, the VC special forces veteran could probably force the paper into surrender with an unpainted pinky finger. Roberts-Smith would be the first to admit he killed in battle then again as General Patton once said, “you don’t win wars by dying for your country but making the other son-of-a-bitch die for his!