BMJ  2007;335:364-365 (25 August), doi:10.1136/bmj.39314.514734.DB

News

Charities say UK government must do more to help soldiers returning from battle

London

The Royal British Legion will launch a campaign next month to urge the UK government to take better care of soldiers and their families, who are feeling the strains of repeated deployments to Iraq and Afghanistan.

Several military charities and associations say that inadequate housing, a shortfall in compensation for injury, and delays in inquests into soldiers' deaths are a breach of the "military covenant," which guarantees fair treatment to soldiers in exchange for the sacrifice of their civilian rights.

Robert Lee, a spokesman for the charity, said that the campaign will focus on inquests into soldiers' deaths; medical surveillance of troops and their dependants; access to NHS care for discharged personnel; and care of wounded soldiers.

"Battlefield care hasn't been flagged as a major issue for us," he said, "but the returning wounded need help with many daily activities, and right now a lot of that—too much in our opinion—is being done by service charities."

The campaign comes as questions are being raised about the effects of unexpectedly long deployments. A study sponsored by the Ministry of Defence and published in the BMJ last month found that personnel who were deployed abroad for 13 months or more in the previous three years were at significantly higher risk of post-traumatic stress disorder, multiple physical symptoms, and severe alcohol problems (2007 Jul 30 doi: 10.1136/bmj.39274.585752.BE).

Under army guidelines, units should not be deployed for more than 12 months in 36, but this limit has sometimes been breached in recent years, the Ministry of Defence concedes.

British deployments rarely last more than six months, but the US army schedule is far more demanding, with 15 month deployments now the norm. A Pentagon report leaked to the Associated Press this week shows that suicide rates in the US army are at their highest in 26 years. The rate of 17.3 per 100 000 compares with a 2001 low of 9.1 per 100 000. Iraq was the most common location for suicides and attempted suicides. The rate of suicide in the US army is more than twice that in the British army, which was 8.0 per 100 000 in 2004-6.

Suicides in the British armed forces have been falling with civilian rates since the mid-1990s and have continued to fall through recent wars. Suicide rates among soldiers are lower than among civilians in all age groups except under 20 year olds. The number of cases of British soldiers absent without leave has also remained fairly steady since 2000.

A report on psychiatric morbidity in service personnel seen at Ministry of Defence facilities in the first three months of 2007 found that diagnoses of mental illness were most common in the army followed by the air force. Women were significantly more at risk than men, and other ranks were more at risk than officers. No significant excess burden of overall mental illness was found in service staff who were recently deployed to Iraq or Afghanistan, but they did have a significantly higher risk of post-traumatic stress disorder.

After publication of the British Legion report, the defence secretary, Des Browne, told the Sunday Mirror newspaper last weekend, "I agree with the British Legion that we have a responsibility to support our troops and support their families, particularly when we are asking people to do very difficult and dangerous things for our security."

Mr Browne added that he was reviewing some compensation payments and said that the ministry was working to keep deployments within military guidelines. "I think we are improving. I'm not saying that there aren't things we need to do. I accept that we have to continue to get better in the areas that they have identified."

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The Pentagon's Army Suicide Event Report is at https://aser.amedd.army.mil/aser. UK Armed Forces Psychiatric Morbidity is at www.dasa.mod.uk/publications/pdfs/mentalHealth/report_JanMar07.pdf.

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