I’m sitting here at 1 am, two days after my husband’s inquest has concluded and it’s like I am thrown back into my grief for his death all over again. It’s a sad fact that my situation will not be changed by sharing the truth, no matter how hard I scream, my situation will not change.
I listened to 4 days of evidence in his inquest. Some said not to go everyday, but if I hadn’t have gone I would never know the whole truth. #Inquest #PTSD #CPTSD
His truth is important to tell, not least because he is owed that by everyone who ever treated him or had contact with him. More importantly, I need to tell the whole story in order for people to be aware of the amount of cracks there were in a system that was supposed to treat his service related PTSD as a priority to make sure he was not disadvantaged by his service. I would argue that the very system that was set up to address this, ended up disadvantaging him because of the sheer amount of agencies involved in his care.
Dave was first diagnosed with PTSD in 1997, he was detained under the Mental Health Act in 2006 because he took a life threatening overdose. He took further attempts on his life over the years and also self-harmed.
When he returned from Afghanistan, in 2012, he had changed. His once under control symptoms, now became glaringly obvious. He had nightmares, was hyper vigilant, irritable and anxiety ridden. Anyone who has ever known and loved someone with Combat PTSD will know what a strain it can take on a marriage. He was difficult to manage, and mostly difficult for other people to understand and deal with. People will ask you why you are still with them, they will add pressure to an already pressurised situation by trying to turn you against them, but this is in fact the opposite of what the Veteran needs. If there was more support for the families this would enable the Veteran to remain in the solid family unit that they so desperately need. In our case there were no support systems in place.
As I already said, Dave’s symptoms returned after he returned from Afghanistan in 2012. Over the next couple of years, his symptoms became more pronounced and harder for him to manage. He took a job in London, with like minded people, in order to return to some sort of military and therefore safe environment. He returned home every other weekend from 2016-2019.
Due to his symptoms becoming more pronounced and the concerns of his friends in London, which also included a time when he would carry a noose around with him and talk to it every day. One time he placed it over his neck, saw a picture of me, and changed his mind. He would drink too much and self-medicate, he says because he wanted to kill himself and he could never understand why it didn’t work.
I referred him to Combat Stress in 2017, he had an initial assessment and was accepted for a 2 week assessment at Twyritt House. There was, of course a waiting list for this, so because his symptoms were getting worse, I also referred him to PTSD Resolution. When he attended Combat Stress he was given a psychiatric assessment. Just going there was a massive step in itself. He was reluctant to face his demons because they scared him, so he chose to bury them. When he was sectioned in 2006, he was also told to go to Combat Stress. He was told they were the ideal people to help him because they would understand his military trauma. At the time, he could not afford to take time off work as he had a mortgage to pay and a job to keep.
The Combat Stress report stated that Dave was exposed to a number of highly traumatic situations with consequent traumatic memories and survivor guilt. His psychometric tests indicated he had possible severe depression, moderately severe degree of anxiety, daily functioning was affected and high levels of anger. His Impact of Event Scale score was 67- a very high score indicating severe Post Traumatic Stress Disorder. PTSD Checklist for 4 DSMV scored 69 indicating a high intensity of symptoms ( a score of 33 shows that a diagnosis of PTSD may be indicated).
After a two week stay, and some difficulties with his high levels of anxiety and other symptoms listed above, it was decided that Dave was not suitable for the 6 week intensive therapy offered by Combat Stress. His discharge plan said they were to refer him onto TILS, however they say they tried to phone him to ask which TILS he would like to be sent to and that usually this would be followed up with a letter, but in Dave’s instance it never was. This absolutely crushed Dave. He had taken a lot of convincing to attend and his friends commented that he had his spark back in the lead up to his assessment. This rejection dampened that spark. He had always been under the impression that Combat Stress were the only ones who could treat you, he’d been told this since 2006, therefore to be rejected due to his complexity was the trigger for his mental health to start to decline.
He started having angry outbursts and stopped taking care of himself like he once did and he no longer attended the gym.
He continued his sessions with PTSD Resolution, but due to working schedules he found it difficult. He was a very difficult man to be around, at times. The stress that PTSD has on a family will never be fully understood unless you have lived it. Dave lost his job in July 2018.
He returned to Birmingham and started to very quickly go into a mental health crisis. The trigger for his mental health crisis was him loosing his job. This was never quite recognised by the professionals that he was to come into contact with. He needed to be kept busy to keep his thoughts and mind under control. No matter how hard he looked for a job, he gave off an aura that made most people uneasy. He was like a tiger, you never quite knew when the next flare up would come. You could trigger him just by a phrase, a song, a smell and his triggers changed every day so you never quite knew what version of him would greet you at the door. This is where the phrase ‘ walking on egg shells’ comes from: the unpredictability of Combat PTSD catches them and you off guard all the time.
I referred Dave to #TILS. This was after conducting my own research into what help was available for veterans in my area, a search which turned up very little. He had a phone triage and was offered a face-to-face assessment at the #RBL in the city centre. Unknown to us, Dave’s G.P had sent an email to TILS to tell them of an instance at the Doctor’s Surgery where he made the Doctor feel very unsafe. He was therefore to have an assessment with two people, for their safety. I could not attend his assessment, which I usually did as Dave found communicating his thoughts and feelings quite difficult, however instead I sent an email outing all of my concerns.
During the assessment it was decided that Dave would be referred onto the #Complex Mental Health Team ( CTS). However, the West Midlands were the last to construct a CTS department, and unknown to us it wouldn’t be in place until the end of September 2018. Dave and I thought that TILS were a treatment option, that the named person was somehow our support worker, which they said at the inquest was not their job. According to TILS, they were mainly just going to keep Dave updated on his referral to CTS. In their leaflet it says they offer treatment, however they stated that there is a lot of confusion about what they are able to offer and they are merely a onward referring agency. One might question what the whole purpose of TILS is under these circumstances.
In between his referral and waiting for CTS to pick up his case, Dave sent an email to TILS stating that he was scared and thought he might need to be put away for a bit to give his family a bit of a break. I followed this up with an email to state that Dave was no longer in control. I had an email back telling me to contact the Crisis Team, however after being given the wrong number and then having to find it for myself, I was told by Birmingham Crisis that Dave was not registered under them and therefore they couldn’t see him. I was advised to phone 111. I kept TILS updated about the situation. On talking to 111 Dave said he had a noose and had a plan, this then led to a Mental Health Nurse assessing him, to which he said exactly the same. Dave was in bed for 36 hours, with a blanket over his head and just shouting abuse whenever anyone tried to disturb him. He was then assessed by a psychiatrist over the phone, by which time he had started to refuse to engage. He stated that he was sick of being assessed by everyone and re-telling his story time and time again. The psychiatrist decided to phone an ambulance as he said that Dave needed to go to hospital for assessment. The ambulance was sitting at the top of our road for 3 hours, awaiting Police escort. the Police didn’t have enough manpower to attend, so the ambulance crew phoned and stated that they would come, but if Dave made any threats that they would retreat, to which I agreed. They could not get Dave to engage, but they carried out a risk assessment based on his presentation and his previous mental health history. He was coded as red for high risk. TILS knew about the situation, but did not refer Dave into primary care, instead getting me to do this and also did not do an updated risk assessment on him, in fact there wasn’t a formal risk assessment from TILS at all. They also did not perform a STORM assessment.
Dave was referred to the Crisis Team, who then referred him to #HomeTreatment. I contacted the Home Treatment Team the next day to ask if anyone was going to come and see him, but I was told that his name was not on the board therefore he had not been allocated anyone and wouldn’t be getting a visit that day. At about 4pm Dave got up and decided to take the dog for a walk. I thought this was very strange considering he had been in bed for the past 4 days without moving. When he came back, he could hardly stand or speak. I asked him what he had taken and he could not put two words together. I phoned the Home Treatment for advice and they told me to phone 999. The ambulance arrived and they decided to take him to hospital as he lacked mental capacity. The Doctor’s at the hospital automatically put his presentation down to alcohol, even though he hadn’t got out of bed for 4 days therefore his slurred speech was a presentation of PTSD not alcohol consumption.
He was seen and again assessed by the RAID Team while in the hospital, the RAID Team referred him back to the Home Treatment Team(HTT). The next day, I phoned the Home Treatment Team to confirm that they had had the hospital’s notes and assessment and was told they had and that they were offering Dave an appointment with one of the their psychiatrists and that a worker from the HTT would be visiting him at home. The first home visit happened while Chloe was at home where she raised concerns about Dave’s declining mental health. The first psychiatrist appointment happened to be on a day that Dave had been triggered while attending the job centre, he was highly agitated and hyper vigilant. He didn’t feel safe. He explained that the last time he saw someone talking in a different language on a walkie talkie, dressed all in black, he was blown up. The only thing the consultant seemed to take from this meeting was not Dave’s mental health but his aggressive manner. I feel he was judged from the start due to a condition that came about from serving his country. The Consultant cut the meeting short and said he would re-arrange it for a few days time as Dave made it too difficult to complete the assessment. I didn’t actually know what they were assessing him for if I’m honest, there seems to be a lot of assessments and not a lot of support.
Home visits were arranged for every other day, however in actual fact only 2 home visits took place in the whole length of his care. The second appointment was calmer, with Dave apologising for the previous appointment and his presentation. He needed to feel you cared and understood his condition and he was still sussing them out. However, he was engaging and was attending their appointments. The Consultant at this point made a note that he would be discharging Dave in the next appointment- I’m not sure how you plan to discharge someone that you haven’t even finished assessing?
The next appointment didn’t go very well to say the least. When Dave shared some of his symptoms, including the fact that he ‘blacked out’ the psychiatrist said that Dave was fully aware of the things he was saying and doing and was using it as an excuse to justify his behaviour. Dave also stated that he had started using Ethidrine to calm his mind down and he begged the Doctor for anti-psychotic drugs. The Consultant told us that he could not give Dave any medication, and that he was to start to reduce his use of Ethidrine. I told them that this was impossible, that it was unmanageable from a financial and emotional point of view. This resulted in frustration on my part. I was trying to fit Dave’s appointments in around working full time, being the only wage earner and also caring for and managing his care. I was also being led to believe that Dave’s symptoms were made up, that he used them as an excuse. I ended up walking out of the meeting. I had gone back to work and didn’t realise that Dave’s MP3 player was in my car. He used music to help calm his mind and blot the world out when he was feeling anxious or when his mind was too noisy. I had some messages left on my phone from him, so I returned and left his MP3 player in the porch. In the meantime, Kayleigh had had some missed calls from him so she phoned him back and she said he was shouting at people in the street and threatening them. She was really worried and the call upset her so I told her to meet me at work and I would take her home so that she didn’t have to worry about what she would walk into. Kayleigh has Asperger’s and had already been referred by 111 to Social Services as she was classed as a vulnerable adult. Dave’s PTSD made her highly anxious as he was so unpredictable.
When we returned home, Dave was not in. He later returned and he had a look in his eyes where he wasn’t actually present. He couldn’t find his MP3 player and he couldn’t calm his mind down. It was like he was there in body, but not spirit. He started to throw pictures and ornaments while demanding that we find his MP3 player. We all started searching frantically for it in order to make him stop, but he would just threaten to smash something else if we didn’t find it soon. He went to punch Kayleigh when she said something that triggered him, and I stood in front of her. He then started punching the light fittings, which ended up in bare wires dangling from the ceiling. He literally smashed up every single thing he could, he upended furniture, he emptied bins. The Police were called, but this had to be done in silence as if he knew they were on their way, this would only trigger him more. For 45 minutes he continued,with more 999 calls to find out where the Police were. By the time they arrived, he had retreated to the attic and barricaded himself in. When the Police started talking to him, he made threats and told them to leave. He told them he had a noose in the attic. This promoted more response cars and in the end two negotiators were called to try and get him down from the loft. He would not move and the Police would not go up and get him so they told us we had to leave in order for us to be safe. Kayleigh and I slept in the car overnight and Chloe went to her boyfriends. During this time, the Liaison and Diversion Team had been notified and when they didn’t hear an update from the Police by 2 am, they passed the notes to the bed manager. The Police did not contact them again.
The Police came in to arrest him the next day because he had accidentally, in his ‘ blackout’ thrown a table that had hit me and caused bruising. I phoned the HTT team, while he was in custody telling them what happened the night before and asked for him to be assessed. I was told that they would need to be informed by the Police that he was in custody and that either way Dave’s biggest problem was that he couldn’t accept responsibility for his actions! During his time in custody, he was meant to have a mental health assessment. Mountain Health Care deemed him fit to interview, even though no mental health assessment had been carried out- they said it wasn’t their responsibility, but it was the Liaison and Diversion Team who had this responsibility.
Dave had told the Police that he had Service attributed PTSD, suicidal thoughts everyday and had self- harmed in the past. The Liaison and Diversion Team member, stated that Dave would not engage in her 5 minute assessment. She said he was not known to local mental health teams therefore there was no further action needed. She stated that she only had Dave’s word for his diagnosis. In the Inquest it transpired that his Doctor’s name and address were on the paperwork as was mine, but no checks were made. However, as the HTT had not notified his G.P of any involvement or sent them any details of their interactions with him, the G.P would not have been able to direct her to HTT anyway. No further checks were made and no further action. In hindsight she said if she had known the full events of the night before and his involvement with the Crisis Team, she would have asked for a mental health assessment to be carried out. She stated that the Police did not share the details of the stand off and negotiators having to be called.
HTT did not make contact with the #Police, even though I had told them he was in custody. They noted that it was my responsibility to keep them updated. The Consultant did say that in the situation Dave was in, an assessment should have been sought within 24 hours, but ideally while he was in custody. This should have been carried out by the HTT.
Dave was released and told to get a taxi home. I sent the girls to other places, lying to them that he was not coming home as I wanted them out of danger. Dave would not be very pleased with being in custody and after the night before events, I was worried primarily for their safety. Dave was very aggressive when he returned, asking me if I know what he had been through and how he had been treated. He took some food and locked himself in the attic again. Of course I was worried for his and my safety, but I couldn’t leave the house because I didn’t know what he would do to it if I left.
The next morning he got up, and I asked him why he hadn’t had an assessment in custody. He said he was sick to death of being assessed and nothing happening that it was a waste of time.
He asked me if I wanted him to leave and I had to say yes. He had always told me that the girls and I were the safest in the world. We were now longer safe, he knew that things had turned in a direction that there was no going back from. He said he needed money to make sure he could eat and have somewhere to stay and I gave him £1300. He left of his own accord and asked me to wait for him while he got treatment. I had actually lost all hope that he would actually ever return to the man I married after all these years, there seemed to be no treatment available. I was stuck between a rock and a hard place, I had to protect my girls first, then Dave and then myself. I thought if the HTT team knew he was no longer at home, that someone would offer him an inpatient treatment in order to keep him safe: I was so very wrong in this.
Dave left and text me the next day to say he was standing outside his Dad’s house. He hadn’t seen his Dad in 20 years and I found this very strange. However, I had been told that Dave manipulated me and that I had to remain strong in order to make him take accountability. Even the Police officers on the night he smashed up my house asked me what I was doing with him and Women’s Aid had become involved, as well as Social Services with a #MARAC Team.
While Dave was away, we didn’t hear from him apart from the odd text. In all honesty, I was relieved to have a bit of breathing space from dealing with his mental health. I needed respite, little did I know that this respite was to end his life, but with no family support or any other type of support except to tell me that he was dangerous, manipulative and lacked accountability was available.
HTT phoned by by accident on the Thursday thinking it was Dave’s phone. I phoned them back and for 9 minutes, I told them of my concerns about his mental health and the fact that I didn’t know where he was. A psychologist from the CTS phoned him on the 2nd October, as there had been a delay in him being taken on by this team due to the fact that they were not operational. Within minutes of talking to him, she said she had extreme concerns regarding his mental health. He was erratic, going around in circles and extremely angry at the HTT Team and their lack of knowledge of his blackouts. He told her they had said that it was made up and this had confused me as I didn’t know what to believe. He refused to give his whereabouts and kept making threats against the HTT team. She said that the only time his voice changed was when his family were mentioned, he stopped being so angry and said that I was the only one who had ever been there for him and that he needed to get back home. He stated how much he loved me and the girls and that we were his world. however, then he would go back to his hatred of the HTT Team. In this phone call, he stated that he had Valium and would take it all in one go and that he had left with a noose and some clothes. He stated he had a plan and the intention of taking his life. The CTS psychologist phoned the HTT Team and told them of her extreme concerns for Dave’s safety and that of others. From this phone call they only concentrated on his danger to them and stated that there were to be no more home visits and that he was to be discussed in the team meeting the next day.
Dave was not contacted and was not discussed in the team meeting the next day. The HTT say he was, but there no records of this and no actions following the phone call raising concerns. The psychologist had also phoned his G.P to update them and they made a note of the need to form a safety plan and the noose and Valium. The HTT records did not mention the Valium or the noose, only the danger to them. After further attempts to contact Dave over the next few days by the CTS, the psychologist phoned the local Police. She told them of her concerns for his safety and others. However, the said as they didn’t know where he was it would be difficult to do anything with this information. They recorded it as an enote, which the Police officers attending on the day of his death had never heard of and had no access to. The enote only focused on his danger to others, it did not mention his danger to himself even though the Officer confirmed that the psychologists statement was correct that she did tell him.
Dave returned to the house after 6 days away. I was told by the Police to phone them if I was ever concerned due to their being a safeguarding marker on our house. Over the next two days, I phoned them 5 times stating that I was scared to go out of my house and too scared to turn the lights off or go to bed because I didn’t know what Dave would do. He was sleeping in the alleyway. He had a very distinctive cough and I could hear this at all times of the day and night. I didn’t step out of my house for fear of what he might do. The Police did not attend over the 48 hour period of my phone calls, despite it being a P2 call. They said they did not have the manpower and that this happens regularly. It is important to note that I had not been told of the phone call with the psychologist and didn’t know of Dave’s disclosures about his danger to himself and others. No one from the HTT Team tried to contact him in any way, even though they had not assessed him after the stand off and had a concern voiced about his safety.
On the Monday, I phone the HTT team to talk to someone about Dave as I wanted someone to come out and see the conditions he was living in and to get him help. I was told that they were all out on calls and that someone would phone me back. Due to the desperation of the situation, Women’s Aid told me that due to the Police not attending I was left with no option but to obtain an emergency non molestation Order. I had an appointment at the local court the next morning. Despite trying my hardest to get him help, I also had to think of our safety and it felt that everyone was telling me this was not mental health it was domestic abuse and that he was intimidating me by remaining in the alleyway. No one from the MARAC Team was notified about his disclosure of self harm intentions and harm to others to my knowledge.The next morning, I left in a taxi and out of the house. Kayleigh was due to be picked up by her friend at 10am. She rang me while I was at court telling me that she was scared as Dave was in the garden and kept going into the shed for something. He was knocking on all the windows and shouting her name. The last contact she had with him was where he went to punch her and she was listed as a vulnerable adult. I phoned the Police, asked them to attended and they did. They said that he was sitting in the garden, calm and did not get up. They told him I was at court, although they maintain that they did not tell him what for but he seemed to know. If he was told I was at court, he would know that there would be no other reason for me to be there. I still maintain that by sharing this information, that would have been the catalyst for him totally giving up. As mentioned before, his one protective factor was me and the girls, take that away and there was nothing.
The Police were not aware of the phone call from the psychologist or the fact that he was under the HTT Team, in hindsight they said if they had known this information they would have made contact with the HTT Team. The HTT Consultant said that ideally Dave should have had a mental health assessment at this stage.
The HTT phoned him on the morning of his death, to make an appointment. Bear in mind that they had not tried to make contact or seen him since before the Police negotiators involvement. They said he was calm and polite in this phone call, therefore they arranged to drop him off a bus pass to attend an appointment on the 12th. They said that obviously the risk had gone because of his calm demeanour over the 2 minute conversation. They did not drop off the buss pass that afternoon either. The Police say also that because Dave was calm, they were limited in their abilities to do anything and that all they can go by is how someone appears to them in that instance. My argument to this is, knowing Dave’s past aggression and hatred towards the Police and HTT, if he was all of a sudden calm and polite surely that in itself should have raised alarm bells. Someone who is going to take their life will appear calm ,because they have come to peace with their decision.
Dave hung himself that day. He had no alcohol or illicit drugs in his system, he very calmly gave into his death. This in itself tells you of how mental ill he was, he could have saved himself by meagerly standing up, but he looked like he was asleep when he was found.
Hearing all of this, I hope you see the big picture of how many people were involved in his care, however they all wanted to carry out assessments : 6 in total while he was in crisis. No treatment or support was offered throughout this to either him or our family. Everyone seemed to think he was the responsibility of someone else, no one took ownership except for one Doctor who only had a 20 minute phone call with him. She was limited in what she could do, she notified all of the people who she thought would help and they only took from it that he was a danger to other people. He didn’t seem to matter to anyone.
Veterans with service related conditions are supposed to be treated a s priority and not to be disadvantaged by their service. I would say that Dave was disadvantaged by his service because the teams that dealt him in the community, had no training in PTSD and did not know how to treat him. They all waited for the CTS to kick in, but the CTS wasn’t even operational. All of the services involved had no understanding of the Veterans Covenant and just said that it meant they were given a few more changes that other people due to their aggression and swearing! The very fact that their care pathway involves more specialist services actually makes the likelihood of slipping through the cracks more possible. The fact that no one quite understands them and have no training in this area hinders their support while veterans are in crisis.
Dave wanted help, he wanted to live but he didn’t want to live in the way his mind was making him. He engaged with services, however as time went on and his crisis deepened, with no support he lost faith in the professionals and he gave up hope that anyone would help him. Although Dave’s case encapsulates every single failure that you could do in a complex system, his case, to lesser degrees is not unusual. Veterans are not being given the support and the help they so desperately need and their families are not being supported to enable them to cope on a daily basis with them.#Suicide #Military suicide#Suicide #Militarysuicide
I have started a Change. Org petition to make the Veterans Covenant enshrined in law with repercussions via an Ombudsman to those who are not upholding it. The duty of care lies with the initial employer. If employees of any other business ended up with conditions that not only debilitated their life but ultimately ended it, they would have a duty of care to make sure it was dealt with. The Asbestos cases are a prime example of this, however for some reason it is just accepted that if you served in the armed forces, especially in a front line combat unit, you are more likely to get PTSD and that you may ultimately die from this. I sought help from every available source, I asked repeatedly for Dave to be sectioned for his own safety and that of others, but anything I did fell on deaf ears. How is this allowed to carry on without anyone standing up and saying enough is enough?
Aug 18, 2019 by Jo Jukes