The MoD PTSD decision: A psychiatric perspective

Occupational Health Review

Volumn , Issue 122, 2006, Pages

  Wessely, Simon ^a,b   Hughes, Jamie Hacker ^c   McGeorge, Tristan ^d  

^a Department of Epidemiological and Liaison Psychiatry ^*

^b KING'S COLLEGE LONDON   (United Kingdom)

^c Academic Centre for Defence Mental Health   (United Kingdom)

^d SOUTH LONDON AND MAUDSLEY NHS FOUNDATION TRUST   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 84859286785     PISSN: 09514600     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (38)

1. Multiple Claimants v the Ministry of Defence [2003] EWHC 1134 (QB).
2. Dandeker C (2001). "On the need to be different: military uniqueness and civil-military relations in modern society", RUSI Journal 146: 4-9.
3. [1983] I AC 410.
4. Bolam v Friern Hospital Management Committee [1957] I WLR 582 at 587 quoted by Mr Justice Owen at para 2.D.2; see also Bolitho v City and Hackney Health Authority [1998] AC 232.
5. [2003] EWHC I 134.
6. Moran CE (1945). The Anatomy of Courage, London: Constable.
7. See the National Institute for Clinical Excellence Guidelines for PTSD (full version) 2005, pp. 14-15, available at www.nice.org.uk/pdf/CG026fullguideline.pdf.
8. Young A (1995), The harmony of illusion: inventing post-traumatic stress disorder, Princeton, Princeton University Press:
9. Scott W (1990). "PTSD in DSM-III: A case in the politics of diagnosis and disease". Social Problems 37: 294-310;
10. Wessely S and Jones E (2004). "Psychiatry and the lessons of Vietnam: what were they and are they still relevant?" War and Society 22: 89-103.
11. See the response of the assistant chief of the defence staff operations and systems to the redraft of Principle Personnel Officers 9/93, which examined the nature of PTSD and its management within the military, cited by Mr Justice Owen at para, 15, 16.
12. Jones E, Hyams K, Wessely S (2003). "Screening for vulnerability to psychological disorders in the military: An historical inquiry", Journal of Medical Screening 10, 40-46:
13. Rona R, Hyams K and Wessely S (2005) "Screening For psychological illness in military personnel", Journal of the American Medical Association 293, 1.257-1.260.
14. With the exception of anti-discrimination legislation.
15. NICE guidelines, p.99.
16. Kapfunde v Abbey National plc and another (1998) 45 BMLR 176, cited by Mr Justice Owen at para, 8, 10 as providing "clear authority for the proposition that as a general rule an employer is not under a duty to exercise skill and care in the recruitment of potential employees".
17. Professor Shalev's second report, cited by Mr Justice Owen at para, 9.22.
18. Solomon and Benbenishty (1986). "The role of proximity, immediacy, and expectancy in frontline treatment of combat stress reactions among Israelis in the Lebanon war", American Journal of Psychiatry 143:613-617, referred to by Mr Justice Owen at para, 10.16-10.23.
19. See also Solomon Z, Rami S, and Mikulincer M (2005), "Frontline treatment of combat stress reaction: a 20-year longitudinal evaluation study", American Journal of Psychiatry 162: 2,309-2,314. However this still does not overcome the fundamental problem of selection bias.
20. Jones E and Wessely S (2003), "Forward psychiatry in the military: its origins and effectiveness", Journal of Traumatic Stress 16; 411-419.
21. Shephard B (2000). War of nerves, soldiers and psychiatrists 1914-1994, London, Jonathan Cape.
22. Wessely S, Bisson J, Rose S (2000), "A systematic review of brief psychological interventions ('debriefing') for the treatment of immediate trauma-related symptoms and the prevention of post traumatic stress disorder". In: Oakley-Browne M, Churchill R, Gill D, Trivedi M, Wessely S (eds), Depression, Anxiety and Neurosis Module of the Cochrane Database of Systematic Reviews: issue 3 ed. Oxford; Update Software.
23. Emmerik A, Kamphuls J, Hulsbosch A, Emmelkamp P (2002), "Single session debriefing after psychological trauma: a meta analysis", Lancet 360: 736-741.
24. Operational debriefing, as defined by the claimants, is derived from the SLA Marshall model of historical group debriefing. Marshall SLA (1947). Men against fire. the problem of battle command in future war, New York, William Morrow & Co); Professor Shalev is quoted by Mr Justice Owen at para, 11.3:"... [historical group debriefing] was meant to enable groups of soldiers, at the immediate aftermath of combat, to review and reconstruct a comprehensive picture of the event - combining the views of all the participants... to restore a group narrative of the event - yet in a way that would not discard any individual experience. Psychological healing was expected to result from this powerful group process."
25. See [2003] EWHC 1134 at para, 11.7; Solomon Z and Neria Y (1999), Post-traumatic stress disorder, para, 11.8;
26. Foa, Friedman, Keane (eds) (2000), Effective treatments for PTSD: para. 11.9,
27. Foa et al (2001). Guidelines for mental health professionals: response to the recent tragic events in the US; para, 11.1,
28. Rose, Bisson and Wessely (2002). Psychological debriefing for preventing post-traumatic stress disorder (PTSD).
29. Mr Justice Owen, at paras. 11.15-11.21, held that there was a close similarity between psychological and operational debriefing in that the evidence as to the effectiveness of the former applied to the latter. Both shared the critical elements of group participation, a review of the traumatic event, ventilation of emotions and cognitive processing.
30. Army Training Directive 5; in 1985 the army's annual training directive for health was revised to include training in battle-shock for all officers and NCOs down to the rank of corporal. In 1990 it was extended to all ranks (see [2003] EWHC 1134 at paras, 12.1, 12.14 and 12.18).
31. For example, at para, 12.68 he quoted Professor Solomon: "the connection between many (if not most) PTSD symptoms and the trauma that gave them birth is indirect and remote... even where the wartime origin of the symptoms is apparent, some symptoms, such as recurrent nightmares, are suffered by nearly all soldiers to one degree or another...": see also paras. 12.69 and 12.70
32. Dr Deahl, quoted at p. 371.
33. Conducted under the guidance of the National Screening Committee.
34. Gilbody S, House A, et al (2001), "Routinely administered questionnaires for depression and anxiety: systematic review", British Medical Journal 322:406-409.
35. NICE guidelines at pp 101-103.
36. With the exception of Professor Foa who claimed that the failure to use CBT during the 1980s amounted to substandard care; see para 13.19.
37. See references to ISTSS, effective treatments for PTSD (2000). edited by Foa, Keane and Fridman, at para, 13.38.
38. See quote of Wells KB at para. 13,37.