This article first appeared in the Nottingham Post in September 2021

The Taliban takeover of Afghanistan has stirred harrowing memories of a conflict that claimed hundreds of British Army lives and left thousands suffering with severe trauma. With so many ex-soldiers still fighting their own personal battles long after leaving the armed forces, Ben Cooper asks, are we doing enough in Nottinghamshire to care for our veterans?

Richard Fotheringham knew that he was harbouring terrible memories from five bloody tours of Iraq and Afghanistan.

Memories of seeing one of the soldiers in his command killed by a bullet through the neck, and losing two of his closest friends in combat.

But it wasn’t until leaving the forces that the Royal Artillery veteran’s personal battle with trauma began.

Now 37 and a father of two back living in Brinsley, Richard was only 16 when he joined the army in 2000. Three years later, he was sent on his first combat deployment, to Iraq. By the time he came out in 2012 he had completed five deployments, each with its own horrors.

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Having suppressed the harrowing experiences of those tours for years, suddenly without the structure, or the comradery of military life, the memories started to take hold.

“When I got out that’s when I really really struggled,” he says. “I didn’t have that routine or other people around me who knew what I’d been through. That’s when it really hit me.

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“After three to four months I was completely withdrawn and anxious. I was a raging maniac at the slightest thing.”

It was then that the “raw explosions of emotion” as he describes them began.

In the brutal throes of what he now knows was post-traumatic stress disorder (PTSD), Richard lurched between bouts of severe anxiety and anger to phases where he would withdraw from people altogether.

He sought medical help, only to be given advice that didn’t match what he was going through, and eventually resorted to self-medicating with illegal drugs. As the phrase goes, Richard was headed for rock bottom.

“After a load of fails and going back round in circles, I had a complete meltdown. I gave up and thought ‘I’m never going to be able to look after myself and thought, I’m never going to be able to be a father’.”

At this lowest of points, Richard found help.

After years of struggling to get the right care, he came across a specialist facility in Nottingham, the Centre for Trauma, Resilience and Growth, part of the NHS-led Nottinghamshire Veterans Service, and its clinical lead Professor Stephen Regel.

It wasn’t a total, overnight transformation – mental health is never that simple. But it was the hand-hold he needed to stabilise himself enough to get real help.

And it wasn’t just a turning point for Richard. When he was in a dark place, his partner Michaela Walker tried to offer some reassuring light. But as she found out, partners, who are often the first people to spot the signs, are under immense pressure when things are bleak.

Recognising this, the Veterans Centre offers therapy and guidance to partners as well.

Michaela says: “It’s helped me find ways to get actively involved with it. When he’s been through the real bad times I got my own help.

“It’s about stepping back and seeing things from their point of view, but also focusing on yourself and being honest that you are struggling. It’s a lot to deal with.”

Richard and Michaela’s experience has been a long and painful one. But they were lucky to find help when they did – the average time it takes veterans suffering with PTSD to get to that position is a staggering 14 years.

It’s a very long time to be managing a serious trauma. And by the time someone suffering in that way does finally get help, the problem has usually become deeper-rooted, and harder to treat.

Who that difficult task then falls to is something of a grey area. The landscape of veteran support networks, charities, volunteer groups, homelessness aid groups, and mental health providers is complex, fragmented, and often rife with controversy.

It’s an uncomfortable status quo that many argue calls for major reform, at a national level, involving the NHS, Ministry of Defence, charities, the Armed Forces themselves, and, ultimately, the Treasury.

Because as Richard found, going to a GP isn’t always the solution that many hope it will be.

“We were told we can’t help you with military problems,” he says. “I got handed a bit of paper by my GP with the number of the Samaritans and other charities.”

Arguably GPs practices aren’t geared up to handle the complex needs of someone struggling with PTSD, especially in the case of army veterans, whose service record might not even be known to the doctor when they sit down for their appointment.

Jeff Harrison is the chief executive of veterans charity Combat Stress, a volunteer-led organisation that offers clinical therapy, manages veterans’ peer networks around the country, and operates a helpline – to which calls have doubled since Afghanistan came back into the news.

He says: “The fact that someone’s a veteran isn’t necessarily on their records. If someone doesn’t want to say he’s a veteran it won’t be on there. And many GPs don’t know to ask that.

“We’re starting to get GPs to be ‘veteran aware’. That number needs to increase. It is a very special form of PTSD that they have and they need to be treated by people who understand that.”

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Someone who understands the harsh realities of combat very well is now part of that support network here in Nottinghamshire. For 18 years Keith Girling served in the Grenadier Guards, during which time he completed combat tours in Northern Ireland and the first Gulf War.

Now he is Nottinghamshire County Council’s first Armed Forces Champion, leading a new council initiative to provide support to veterans in the county, alongside Councillor Johno Lee, an Afghanistan veteran who lost his leg to a landmine.

Keith says: “For veterans to ask for help is very difficult. I’m a veteran, I’ve been through my own black patches, the depression side of it, and I’ve learnt to ask for help.

“Veterans are very proud, they’ve been in circumstances where they’ve lived by their own wits, survived by their own ego to get through.

“There’s always been a culture of ‘man up, get over it, have a drink, don’t worry about it’. A lot of the veterans are from that old culture. It’s a question of getting them to admit that and have the courage to ask for help.

“That’s the biggest challenge we face as an authority.”

Set up to meet the challenge, the council’s Armed Forces Community Strategy, which Keith leads, is only in its early days – on Wednesday September 15 the council’s Communities Committee will meet to give final approval for the scheme.

Keith believes that specialised care and support is best delivered by veteran-led organisations and charities than by the NHS.

He says: “I think the NHS is not particularly well geared-up to deal with veterans with mental health issues, that’s a big problem.

“Often the soldiers have been through the NHS system, they’ve said bluntly, in the language of a veteran, that it’s a load of b*****ks.

“Charities are an example of the standard of the community of where we live. Veterans have protected society and now it’s up to society to protect veterans.”

It’s a view held by many in the veteran community, but not all.

As Jeff Harrison puts it: “Most charities wish that they didn’t exist. We will have achieved absolute success when there is no need for Combat Stress. That would mean all veterans are being looked after properly by government processes.

“But the NHS is so short of funding for so many things. It’s unlikely in the near future that there will be funding for that. In the meantime we are happy to step in and fill the gap.”

As the leader of a small organisation, Stephen Regel, who runs the Centre for Trauma, Resilience and Growth, on Gregory Boulevard in Nottingham, is frank that the service is limited in what it can achieve.

And, he says, until national government puts its money where its mouth is over mental health funding, a “postcode lottery” of localised support is going to continue.

He says: “Funding is an issue. It always has been. In certain areas of the country there is good support, but not in others. It can be a bit of a postcode lottery.

“There are some excellent charities in Nottingham. There’s a network of people that are doing good work. But it’s in pockets rather than consistently everywhere.

“At a national level the government needs to put much more funding into mental health. They often talk about it but nobody sees it.”

Someone who is determined to hold the government to account over its commitments is Nottingham East MP Nadia Whittome, who herself has suffered with PTSD.

She says: “People with severe mental ill-health are sitting on waiting lists for months, even years. We’ve lost a quarter of mental health beds, and Notts Healthcare NHS Trust had 485 urgent new referrals in May alone.

“To provide the support I’ve mentioned, our councils, the NHS – and third sector organisations like Emmanuel House, Framework, and the Royal British Legion, which do fantastic work to support and advocate for veterans in Nottingham – rely on central government funding.

“The money is there, but so far the political will hasn’t been.”

The veterans support community has its disagreements. But there are some things it is unanimous about: that no one should feel ashamed to come and admit help, and nobody who is suffering – whether they are an armed forces veteran, an emergency services first responder, or a civilian who’s been through a trauma – should suffer alone.

“People bottle things up inside of themselves,” says Jeff Harrison. “A veteran once told me, ‘The bravest thing that I ever did in my life was to pick up the phone and ask for help’.”

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