Long road to recoveryBMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c647 (Published 18 February 2010) Cite this as: BMJ 2010;340:c647
All rapid responses
Re “The Defence and National Rehabilitation Centre, (DNRC). Whom will it rehabilitate?
The Defence and National Rehabilitation Centre (DNRC) near Leicester has just been opened (1). It has 200 beds for rehabilitation of which 80 are reserved for “seriously wounded soldiers”. As things presently stand, it seems destined to supply a non-existent need and it is difficult to see how these beds will be filled as currently specified.
The main reason is that, according to the UK Government’s figures (2), in the last four years, 2014 to 2017 inclusive, only one member of the armed forces has been killed by “hostile action”. Even allowing for a ratio of ten injured for every fatality (as experienced by the US army this century (3) this leaves very few potential physically injured soldiers to become patients and so fill the 80 beds allotted for their physical rehabilitation.
However, in the same four years (2014 to 2017) there were a total of 121 accidental deaths (road and other accidents) to members of the UK regular armed forces. Applying the same ratio of dead to seriously injured this suggests that there might be a total be upwards of a thousand injured military personnel from accidents, in the last four years. A number will probably be dealt with locally by the NHS services near the site of the accident and some of them (? A minority) might subsequently occupy some of the 80 beds allotted for rehabilitation of the physically injured at the new DNRC. However calculated, there will be very limited numbers of armed service personnel requiring physical rehabilitation to fill the allotted 80 beds
In contrast to the pleasingly few fatal and physically injured service personnel, there are significant numbers of service personnel who have acquired occupationally-associated medical conditions during their military service. These include the “relatively uncommon” prevalence of PTSD at 4.8% and the rather more worrying prevalence of 18% suffering from alcohol misuse recorded in service personnel (4). Both these conditions are eminently treatable by modern methods (viz. The management of PTSD, NICE, CG26. 2005 and Alcohol Use Disorder, NICE, CG115. 2011).
Perhaps the military authorities might make use of the new DNRC to provide effective treatment to affected military personnel, with non-physical conditions, before they return to civilian life
J Wilson Carswell, OBE FRCS
1 Injured soldiers’ centre opens doors to return troops to fighting fitness. Financial Times, 19 June 2018, page 3
2 UK armed forces deaths in service 2017, 2016, 2015, 2014. National Statistics. Gov.UK
3 Official figures for US casualties in the Afghan and Iraq wars. 5,669 killed and 52,272 wounded
4 The prevalence of common mental disorders and PTSD in the UK military, using data from a clinical interview-based study. Iversen AC et al. 2009, BMC Psychiatry, 2009, 9, 68
Competing interests: I wish to declare my following interests in this subject; the possible use in future of the DNRC for the treatment of service personnel with psychological conditions. I am employed by Moving Minds PM and R ltd, being a director and a shareholder in the company. Moving Minds is a limited company, registered with Companies House and is a psychological services provider Moving Minds arranges for the psychological assessment of referrals and if required subsequent treatment. Our referrals are predominantly persons who develop definable psychological conditions (Anxiety, travel anxiety, depression or PTSD) typically after road accidents. We are referred patients directly or indirectly from motor insurers or case management companies or personal injury lawyers. We also receive referrals directly or indirectly from employers whose employees are thought to have anxiety or depression or other psychological conditions. Assessments are supported using standard psychometric measurements. Treatment closely follows NICE guidelines of the relevant psychological condition. We have had no contracts or referrals of service personnel either via the NHS, The Ministry of Defence or Combat Stress. We have not been involved in the management of patients presenting primarily with Alcohol Use Disorder.