Numbers matter in mental health. Politicians demand them. Service planners need them. And statistics, no matter how flawed, can shape perceptions of a particular problem.
That’s why a new report from the King’s Centre for Military Health Research is a must-read for anybody campaigning for better support for serving and ex-forces suffering from post-traumatic stress disorder.
King’s latest study, published last week, found that 17 per cent of ex-forces whose last deployment was a combat role in Iraq or Afghanistan would probably qualify for a PTSD diagnosis. That’s big.
Now, I don’t take King’s figures as Gospel for a number of reasons. I think many personnel may be downplaying their symptoms when they fill in the self-report questionnaires that King’s uses to generate its results, so its findings are probably under-estimates. There’s more to say on this. But let’s leave methodology aside, and consider politics.
Ever since King’s began its studies on the eve of the Iraq war, it has been talking about PTSD prevalence rates in the British military in single digits. The new study – with its 17 per cent figure – changes that. It suggests that roughly one in six veterans who left the military after a combat deployment in Iraq or Afghanistan probably qualify for the diagnosis. For the first time, there’s now an ‘official’ figure that makes PTSD sound more like a big deal, and less like a problem at the margins.
I need to hit a pause button here to thank the King’s team for being so generous with their time in explaining their research (which is funded by the Ministry of Defence) to spare me jumping to the wrong conclusions. The 17-percent finding needs to be treated with particular care. This figure applies to a sub-group of ex-forces whose last deployment was a combat role (a minority of veterans). Since King’s has never been able to study this sub-group in so much detail before, it advises that you ‘absolutely cannot’ conclude that PTSD is rising significantly by comparing the result with other studies of different groups. That would be to fall into the “floating denominator” error – otherwise known as apples and oranges.
It’s also tempting to chuck the 17-percent number into some back-of-the-envelope calculations to try to figure out a rough total for the number of ex-forces who probably have PTSD. This is another no-no: It turns out to be a lot harder to calculate this total than it looks, and King’s hasn’t yet done the maths.
But in politics, perception matters more than statistical subtleties. I may be naive, but I suspect that it will be a lot easier to get decision-makers to listen by quoting a PTSD prevalence figure closer to 20 per cent (albeit for a particularsub-group) than the single-digit rates for the wider military that King’s was finding while I was writing Aftershock.
Here’s an example of what I mean: Professor Sir Simon Wessely and Professor Nicola Fear, the co-directors of King’s, gave evidence to the Commons Defence Select Committee on March 27. They explained that PTSD prevalence rates for the military population as a whole had increased from about 4 per cent in 2003-4 to about 6 per cent in 2014-15. Simon also pointed out that PTSD prevalence could be as high as 9 per cent in some combat units. But in general, Simon said, the rates of the disorder are about the same in the military and civilian population. He added that 50 per cent of the PTSD that arises in the forces is caused by non-operational traumatic incidents such as car accidents or assaults, rather than things that happened on tour. I urge anyone interested in this topic to read or watch the whole thing.
Summing up, Mark Francois MP thanked the panel for giving ‘very conclusive evidence’ that had reassured the committee that a ‘lazy’ media narrative that ‘our people come out mad, bad and sad is nonsense.’ I share Mark Francois’ disdain for sensationalism. Nevertheless, I suspect that the 17-percent figure may make it harder to conclude that the life-or-death struggles being fought by ex-forces with PTSD across the UK take place primarily in the imagination of journalists.
As I saw first-hand while writing Aftershock, even those veterans and their families struggling with the most severe presentations of PTSD can experience remarkable transformations when they find the right support. Lives are lost or ruined when they don’t. This latest study from King’s will make the voices of those calling for change harder to ignore.