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Wednesday, November 16, 2022

British army veterans denied treatment for brain injuries | Mental health

The Taliban forces around Ouellette, a British patrol base in a remote sector of Afghanistan’s Helmand province, were slowly finding their range. “One day their rockets hit all our vehicles,” recalls army veteran Neil Edwards. “They were getting really good.”

Edwards had already survived many such attacks. The British forces were having to sleep in unprotected tents, and every day brought peril. At the end of April 2013, Edwards, then a corporal, was in the operations room when he had to organise assistance for the victims of a roadside bomb that had killed three soldiers and injured a further six.

But that was not the event that changed his life. That came two months later, on 30 June. “The first rocket came in mid-morning,” Edwards says. “I grabbed my helmet and body armour and started running for cover – towards the HAB [hardened accommodation block] in the hope it would protect me.”

He didn’t make it. The blast from a second rocket caught him in the open. “The force was overwhelming – like a scene from Saving Private Ryan. The world seemed to stop, I had ringing in my ears.” Right away, Edwards feared the blast had caused permanent damage. But “though I was told I’d be taken to Camp Bastion [the British army Helmand headquarters] for a full assessment, it didn’t happen”.

Neil and Becky Edwards in Braunton, Devon.
Neil and Becky Edwards in Braunton, Devon. Photograph: Karen Robinson/The Observer

For years, the NHS and the Ministry of Defence have insisted this and other blasts to which Edwards was exposed in a long army career did him no lasting physical harm. They have made the same assertion to many other veterans, claiming their debilitating symptom are psychological, not physical, in origin.

Now an advanced diagnostic technology, magnetoencephalography (MEG), is enabling patients’ brains to be scanned, providing maps and locations of brain injuries with precision. It is set to shake the MoD view to its foundations.

Edwards’s MEG scan suggests he is suffering from irreversible brain damage caused by a traumatic brain injury (TBI), with the parts of his brain that have been affected exactly matching his symptoms. The diagnosis has been confirmed by a consultant neurologist who has examined him and other veterans and seen their scans. He says they have “appalling damage”. Potentially, thousands of British veterans may be in a similar position: their lives ruined, but the reasons for their plight misdiagnosed.

The Tory MP and Royal Green Jackets veteran Tobias Ellwood, chair of the Commons select committee on defence, told the Observer he would be writing to the defence secretary, Ben Wallace, to ask for MEG scans to be made freely and widely available.

“This technology may be pivotal in establishing something of which we’ve been becoming increasingly aware – how brains can be damaged on the battlefield by shockwaves whose impacts are often misdiagnosed as post-traumatic stress disorder [PTSD],” he said. “We have a duty of care to these veterans for the rest of their lives, and I’d hate to think that we are holding back for financial reasons when we should be forging ahead with diagnosis and treatment.”

Neil Edwards on deployment.
Neil Edwards on deployment. Photograph: Karen Robinson/The Observer

Nine years after the rocket in Ouellette, Edwards, now 41, is struggling. Having joined the army at 16, and also served in Northern Ireland and Iraq, he has been diagnosed with PTSD. This includes flashbacks that can be triggered by something as minor as a party popper. He also has permanent tinnitus, as well as difficulty reading social clues, and his moods can be volatile.

Worst, however, are his frequent seizures, which began in 2016. At home in Braunton, north Devon, his wife, Becky, shows a video of one of the most recent. It depicts him convulsing, unable to move or communicate for 40 minutes. “When he’s having a seizure, he’s a dead weight,” she says. “I’ll pinch his ear, cuddle him to let him know I’m here. But there’s nothing I can do to bring him round.”

“I’m aware when they start, and when they’re over,” he says, “but I have no memories of when they’re happening. Afterwards, I have no strength and it’s hard to walk.”

The impact on the couple and their daughters, aged 11 and 13, is immense. It’s too risky to leave him at home alone, and if Becky is out their daughter Molly has to watch him. “Our normal life is like a lockdown,” says Edwards. “Theme parks, outings, the things that normal dads do – for us, they’re impossible.” He is a skilled IT expert, and is fortunate to work from home for an employer who accepts that on days when he has a seizure, he will be unavailable. But Becky fears for the future: “What if he gets worse? I’ll be his full-time carer.”

In America, TBI has been recognised as common among veterans of conflicts since 2008. A 2020 study by Harvard University’s Belfer Center for Science and International Affairs, entitled Modern warfare destroys brains, says frequent exposure to blast waves in Iraq and Afghanistan has left 20% of veterans with TBIs, the total running into six figures.

Neil and Becky Edwards and their two daughters.
Neil and Becky Edwards and their two daughters. Photograph: Karen Robinson/The Observer

It calls TBI “the signature injury of the war on terror”, adding that many thousands of veterans suffer from PTSD and TBI. The impact of TBI is a key reason why so many Iraq and Afghan veterans are driven to suicide. British soldiers fought alongside Americans in Iraq and Afghanistan, but according to the MoD, the rate of TBI among British veterans is much lower – 4% or less.

Neil and Becky Edwards say the refusal of the NHS and MoD to accept that his symptoms have a physical origin makes his condition much harder to deal with. Officially, his fits are termed “psychogenic non-epileptic seizures”, a product of his PTSD. “That means psychological therapies are pushed on to Neil that we know don’t work,” says Becky. “He’s constantly asked to relive the experiences that made him a different person. It’s hard to get him to go to an appointment, because to Neil, there’s no point.”

Other families feel similarly aggrieved. James England is a veteran of Bosnia and three deployments to Iraq. He was in a traffic accident that caused a bleed on his brain while stationed in Germany in 2003. But although this required a stay in intensive care, he was sent to Basra, Iraq, immediately afterwards instead of being allowed to convalesce, and took part in heavy fighting.

“You wouldn’t send a soldier into battle with a broken arm,” says his wife, Kate. “Yet they sent my husband after he’d had a brain haemorrhage.”

After leaving the army in 2007, England couldn’t hold down a job, suffered mood swings that he treated with alcohol, and has twice tried to take his life. With balance problems, he often falls and “shakes as if he’s got Parkinson’s: and still the MoD won’t recognise this is TBI. They won’t engage because they know how many guys are affected. Through the networks we have built, I know of thousands whose suffering is probably caused by TBI,” she says.

MEG scans have been available for years, and are used to aid diagnosis in dozens of epilepsy treatment centres. Research shows they will detect the abnormal “slow wave” signals caused by injury, and the new neural pathways that the brain tries to grow when old ones are severed.

Until recently, the problem was that analysing the MEG scan data had to be done manually, a process that took many days. The recent breakthrough, made by British medical software company Innovision IP, is the development of a computerised method that cuts the time to produce a report, so greatly reducing cost – a scan plus analysis starts at £5,000 per patient.

This works by comparing patients’ scans with those drawn from a huge database of ordinary people unaffected by TBI. “The slow waves caused by injuries show up, allowing us to identify whether and where activity is abnormal,” says the firm’s chief scientific officer, Professor Gary Green. “A conventional MRI scan may well not reveal this. The MEG scan will.”

Innovision’s chief executive, Peter Schwabach, reveals the firm is also analysing the brains of athletes and victims of accidents. But though some of these cases are serious, neurologist Steve Allder says the evidence of TBI among veterans is the most severe. He interviewed Neil Edwards and James England. “I’ve now seen five or six vets and I’ve never come across anything like this before. Their MEG scans are almost unbelievably abnormal, catastrophic. These are men who went off to serve their country and came back different, with conditions that are getting steadily worse.”

For Edwards, Allder’s report came as a huge relief. “No one wants a brain injury, so it’s bittersweet. But if I were American, I’d already be getting support. To be told my symptoms have a physical origin takes me closer to getting more effective treatment here.”

Kate England agrees. “The MoD says very few people have this problem, but a lot of guys are being overlooked. They need to scan the vets who wind up homeless, or in prison, or in mental health units. It’s horrendous and distressing, but now they may get help.”

MEG scans have been used to help diagnose TBI in veterans by the US government for more than 10 years. Yet in Britain, an MoD spokesman told the Observer they are seen merely as a “promising technique” that needs further research. He added: “The health and wellbeing of our armed forces is critical. We provide a treatment programme for traumatic brain injuries at the Defence Medical Rehabilitation Centre in Nottinghamshire and are working on a national research programme to advance diagnosis, management and rehabilitation in the area of brain injuries and PTSD.”

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