When Kim Sissons was discharged from the military after an injury in 2011, her doctors told her she would never be able to walk again. She was 29 years old and a teenage driver had hit her while she was on weekend leave, shattering her neck, left clavicle, scapula, ulna, and destroying her anterior cruciate ligament. Sissons was partially paralyzed on her left side and no longer fit for service, but she was determined to get back on her feet.
Against all odds, she did, and she began to build a new life in Essex, a county with a major military garrison and home to thousands of veterans. But a few years later, the order in her life began to flounder. She stopped pulling herself out of bed in the morning to clean her house. She lost her job, and though she found new work, she couldn't stay hired for more than two weeks. As a former combat medical technician, Sissons could self-diagnose: She was developing post-traumatic stress disorder (PTSD). But for the first time in three years, her doctors couldn't seem to help her.
Since the national roll-out of a new therapy service in 2011, veterans with PTSD in some parts of the country have faced new obstacles in accessing publicly provided care. Many providers of the primary care therapy, known as Improving Access to Psychological Therapies (IAPT), choose mainly to see patients with low levels of depression and anxiety, and they refuse patients with severe PTSD. Providers of secondary care services for more acute mental illnesses, though, can also rule that PTSD doesn't fit neatly into their categories of severe illness, like bipolar disorder, psychosis, and schizophrenia. As a result, veterans like Sissons fall through the gaps.
Over the past year, Sissons has tried to find therapy through her general practitioner, IAPT, and secondary care doctors in the NHS, but none of these routes has led her to treatment. She gets the feeling her doctors don't believe she needs their care.
"I don't open up that much, and when I talk to hospitals, they don't understand," Sissons said.
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Without easy access to clinical care, Sissons sought more immediate support through local veterans charities. She connected with five different organizations in her area and began taking group courses on topics ranging from leadership to poetry writing.
Diane Palmer, a nurse and therapist who works with veterans in Colchester, Essex, says that Sissons's tough hunt for traditional NHS care is common. Because IAPT providers in England's 200 or so localities set their own barriers to entry, patients with complicated conditions don't always make the cut. The NHS Trust that runs the primary care therapy program in North Essex, for instance, won't see many of Palmer's patients.
"The Trust narrowed the criteria so tight that if you had a suicidal thought or had been in crisis in the previous three months, then you wouldn't qualify. If you had significant alcohol issues, or anger, or more than one trauma, you wouldn't qualify," Palmer said. "Then you look at a typical young military veteran and say: 'Well, on the whole, they're angry, they have had more than one trauma, and they've probably been in a bit of a crisis,' so it's not hard to see why they don't get the IAPT service."
Sissons, for one, has more traumatic memories than she can count. She was in and out of the foster system as a child, homeless by 14 and was deployed to Bosnia in 2005. It wasn't until she was sexually assaulted last year, though, that her PTSD began to emerge and she tried to find help. But given the scope of her distress, she could not gain entry into IAPT.
"An emotional thing like that can trigger it off," Sissons tells me, pulling back her red hair to reveal the scars on her neck. "Being a medic, you don't see army work as trauma, you see it as saving lives—but it is trauma. And then [the assault] brought it all home."
Earlier this year, Combat Stress, a major veterans organization, reported a 26 percent increase in the number of veterans seeking treatment for PTSD and other psychological conditions. The organization now sees 5,900 clients, the highest number in its 96-year history.
Though much of the Ministry of Defense's support for veterans targets the period of immediate transition, PTSD often creeps up on patients years after they experience trauma, as it did for Sissons.
"When I first left, I was rather numb," said Sissons. "It's now that I'm struggling, and now that I'm trying to find some counseling help."
To help veterans with mental health issues get the care that they need, the Armed Forces Team of NHS England funded ten pilot programs in 2012 that offer mental health care for veterans in pockets of the country where demand is highest.
"As a veteran, I would prefer to be able to know that everywhere I went had a veterans service that I could go to," said Andy Bacon, NHS England's Lead for Armed Forces. "But given the nature of local decision making, some areas prioritize young vets with PTSD, some no vets at all."
NHS England now spends £1.5 million [$2.2 million] each year on these pilot programs, which provide care tailored for veterans. Diane Palmer leads the pilot in North Essex, known as Veterans First. Her tiny team sees 120 patients a year, and it operates on a shoestring annual budget of £150,000 pounds [$227,000].
Despite its budget, Veterans First provides both counseling and all-around patient support. Their nurses and staffers help patients apply for counseling through traditional NHS routes, fill out forms to claim benefits, and link up with local charities—connecting the dots for veterans navigating the nebulous world of care. Indeed, when Sissons filed a sexual assault charge last summer, it was her clinician at Veterans First, David Powell, who guided her through the legal process and accompanied her to the trial.
After Sissons's assault, Powell also referred her on to secondary mental health treatment through the NHS. But she has been waiting for an appointment for nearly a year. Very recently, she instead began psychological treatment through the local branch of Walking with the Wounded, a privately-funded veterans charity.
"There are big pockets where there aren't veterans services, and where people fall through the net," explained Palmer. "And the damage that does—they just don't come back to look for help, and they lose faith."
The contract for Veterans First and its sister pilot sites runs out in March 2016. Before next spring, NHS England will try to determine how best to continue spending their veterans budget on mental health care, which now exceeds £5 million [$7.6 million] a year.
Sissons, for one, is hoping that the veteran-focused NHS care doesn't fall away. As she limps to her boyfriend's back porch for a cigarette, she recalls her car accident and remembers how easy it was to find care. No one denied that she had a series of severe physical injuries that called for immediate treatment. But clinicians haven't met the urgency of her PTSD with the same reaction.
"Veterans First is a grounding for me," Sissons said. "There are people there that understand a side of me that no one else can."