ForcesWatch published ‘The Last Ambush? Aspects of mental health in the armed forces’ on 28 October 2013 – the first report since the Iraq and Afghanistan wars began on the roles that youth and poverty play in mental health problems among veterans. The report is based on 150 sources, including 40 British academic studies of military personnel. This is the report’s conclusion.
[Download the fully referenced report at http://www.forceswatch.net/content/last-ambush]
Given the myriad subtleties of well-being and ill-being, all claims about mental health in any group, perhaps especially a military one, must be provisional. If meaningful conclusions are possible at all, academic research ought to shape them, but a fuller understanding depends on more than what studies can tell us about prevalence and risk factors for narrowly defined mental health effects. If an Infantryman with a troubled family background develops a stress reaction in Afghanistan, or if alcohol misuse has contributed to a veteran’s homelessness, then the questions of why and how this has happened are not only – or even mainly – psychological; they have their roots in society at large. What, then, do mental health problems in the armed forces tell us about our society and the place of the armed forces within it? Is there a wider narrative in which the mental health research becomes socially and politically meaningful?
The research reviewed for this report points strongly to: a) socio-economic disadvantage as a major factor in pre-traumatic vulnerability; b) the preponderance of the most vulnerable individuals in the most dangerous military roles; and c) prolonged exposure to the traumatic stressors of warfare as the primary triggers for stress reactions in combatants. In general terms, war is a marriage of poverty and violence, in which people from poor backgrounds are recruited into violence on behalf of the state. Whether or not war is a necessary evil, the research shows that it attacks the minds of those who enact it. For the poorest recruits, this is likely to be the latest assault in a long line, beginning with the material poverty of their childhood. Whilst the psychological impact of military training and war is manageable for some or even negligible, for others, particularly the youngest from the poorest backgrounds, this last ambush may be a tenacious one.
Against this, the prevailing, official narrative characterises armed forces careers as formative opportunities for young people who would struggle in civilian life. The Ministry of Defence states: ‘We take pride in the fact that our armed forces provide challenging and constructive education and training opportunities for young people, equipping them with valuable and transferable skills. The services are amongst the largest training providers in the UK, with excellent completion and achievement rates, and the quality of our training and education is highly respected.
Whether Infantry recruits do gain meaningful training that will transfer to the civilian jobs market later on is far from clear. Even so, whilst some veterans, having seen war for what it is, say that they would never encourage a young person to join up, others look back on their time in the forces with appreciation. For example, in a Radio Tees phone-in about the minimum age for recruitment, a veteran who joined the Army at 16 said that if he had not done so he would have ended up in prison. There are as many veterans’ views about their time in the forces as there are veterans.
How we interpret the mental health research depends on which narrative we choose to situate it in: one of exploitation or one of opportunity. Does the state put young people’s minds in harm’s way by recruiting them into what two veterans have called a ‘killing machine’? Or are young people well served by the armed forces despite a minority unfortunate enough to suffer problems as a result, as others have suggested? Both these narratives rest on claims about the best interests of young people and, less obviously, moral views about warfare. The findings of mental health research appear to both support and challenge each of these positions. On the one hand, the armed forces can be formative for young people; far from all personnel have mental health problems as a result of their work. At the same time, the armed forces are not a glorified version of the social services; they achieve their purposes by violence and it is for the performance of this violence that some of society’s poorest young people are recruited. If military recruitment supports and exploits young people, it demands a narrative incorporating shades of both realities. It is this third perspective, perhaps, that can best situate the findings of mental health research in their social and political context.
Whatever perspective we may choose to take, there are certain views that the research shows clearly to be false. One such assumption, historically stubborn but perhaps now losing traction, is that mental health problems are due to the constitutional weakness of certain individuals. The research shows that this is wrong. Whilst factors connected with an individual and their background shape responses to trauma, these are not responsible for traumatisation itself. There is no virtue of character that can bestow immunity to trauma; veterans are traumatised not because they are defective, but because they have been immersed in the dehumanising abnormality of extreme violence, which eventually takes a toll on even the most hardened of veterans. The research collected in The Last Ambush shows that immersion in traumatic events makes personnel more likely to commit violence, suffer from PTSD, and/or misuse alcohol whether or not these problems were already part of their history (but particularly if they were). The evidence points to the grim, unavoidable conclusion that, in the wake of war, a substantial proportion of its participants become more violent and suffer from debilitating mental health problems, although neither outcome will affect most individuals fortunate enough to avoid the worst that war can be.
The research also shows that it makes little sense to describe prevalence of mental health problems in the armed forces as ‘high’ or ‘low’. We can confidently say: that the mental health risks are significant and appreciably higher in general than those found in civilian life, especially for those who have left the forces; that identifiable mental health-related problems are common and that these only describe part of the mental health effect of military life; and that war trauma affects certain groups of personnel, particularly younger individuals from poor backgrounds, appreciably more than others. If potential recruits, who may be as young as 15 when they apply to enlist, are not told of these risks or are not able to consider seriously their real-life implications, then recruiting them is an exploitative practice.
It would also be wrong to assume that all veterans are significantly harmed by military life, or to be fatalistic about the prospect of recovery when many veterans are resourceful in their own healing. One veteran, eight years after leaving the Army, said that he scrutinises his behaviours daily in order to facilitate his gradual recovery. Professional help is important, he said, but he and other veterans still have to work at recovery themselves using their own resources. The research on post-traumatic loss of social support, as well as veterans’ own stories, show that those who are able to describe their situation and draw informal and professional support from those around them may be better able to manage than those who cannot. This depends in turn on others, perhaps especially civilians, being willing to listen non-judgementally to veterans’ stories when they choose to tell them and to respect their silence when they do not.
In recent years, the Ministry of Defence has increased funding for mental health research, supported informal sources of support such as helplines, and improved access to specialist psychiatric help. Genuine progress is being made, although this still fulfils only a small part of the rigorous duty of care that the state owes to the people it sends to war. Mental health in the armed forces must be understood in the context of the complete career process: what happens before joining, during the career itself, and afterwards, are all important factors in the mental health or illness of personnel. An assumption that mental health problems are primarily a post-deployment challenge would be ignoring the effect of pre-military factors on vulnerability; in particular, the evidence shows that who gets recruited for which roles matters. This report has shown that recruits from the most socio-economically disadvantaged backgrounds, who are most vulnerable to the effects of traumatic stress, are being channelled disproportionately into the most trauma-exposed, front-line combat roles.
In this regard, the age at which personnel are recruited is critical: the youngest recruits are typically the most socio-economically disadvantaged and are over-represented in direct combat roles, as discussed earlier. This finding strengthens calls for a review of the policy which allows the armed forces to recruit school-leavers from age 16. The Ministry of Defence has resisted this on grounds that these individuals are not suited to mainstream education and would struggle to find civilian jobs, and that recruitment targets would be unachievable without them. No verifiable evidence has been presented to support either claim.
The UK’s practice of recruiting from age 16 is unique in the European Union and rare worldwide; most states now recruit only adults into their armed forces. The exceptional British position has been challenged by the United Nations Committee on the Rights of the Child, Parliamentary Committees, and a number of human rights organisations. The policy also remains starkly at odds with the bar on young people joining the civil emergency services, buying alcohol or tobacco, watching a violent adult film, signing legally binding contracts and even playing certain computer games that simulate military roles, until they attain the age of adult responsibility at 18. There is a growing global consensus that only after a person reaches this age should society deem them ready to make an informed and responsible choice about whether to enlist. Since those who enlist as minors into the British armed forces bear a disproportionate share of the risks, as shown in The Last Ambush and elsewhere, the justice of the policy is in question and it deserves to be reviewed. The government’s obligations under the United Nations Convention on the Rights of the Child, which include ensuring that the best interests of young people are ‘a primary consideration’ in how policies are crafted,add further justification to the accumulating calls for change.
All that said, the research collected for this report points to one conclusion that is beyond reach of policies on either recruitment or welfare. In the final analysis, veterans’ trauma proceeds from the crucible of war, in which extreme violence leads to substantial numbers of psychologically wounded people. Many will live with this insidious legacy of warfare for the rest of their lives. The scourge is war itself. We as a society must realise that we cannot support wars without also condoning the traumatisation of combatants and civilians alike. We can choose health or war, but not both.