Episode 4 – Walter Busuttil

Michael: My name is Michael Coates. I am a former fire fighter but I am also a former soldier. It is the
stories from the individuals within this military community that I am desperate to document. Our next
guest is a world leading psychiatrist who specialises in psychological trauma. He spent 16 years in the
Royal Air Force. He was part of the team who rehabilitated the Beirut hostages. He has worked with
adult survivors of sexual abuse and now treats military veterans who have serious and complex cases
of PTSD. Episode 4, Walter Busuttil, this is Declassified.

Michael: It is a real privilege having you here Walter. I know your time is super precious and you are an
extremely important individual, but how has your day been so far?

Walter: Not too bad. I have just come from a meeting with the MOD. The strategy meeting for
charities sitting in for our Chief Exec who is away on leave. It is a privilege to work with so many
people charities, NHS. We all try to help veterans and their families not only for mental health, but
everything and even servicing personnel and their families.

Michael: The work you do is so important and whenever we have engaged before sat on a few panels
the work you do is really inspirational but before all of that I want to take you right the way back to a
young Walter who grew up in Malta. What was life like growing up in Malta?

Walter: Well it was interesting. I was born in 1959, that’s quite a long time ago, 58 years ago. Many of
my family either been children or young adults or old enough to have fought in the second World War.
There was a lot of devastation in Malta. They had the Coventry raid equivalent every day for 2 years in
terms of bombing. I certainly heard a lot of stories of bravery and people who had faced big adversity
and quite a lot of my uncles had been in the military as well and my grandfather had fought in the first
world war he had just got to the front when war it ended. And then the second world war he was very
involved in the war in Malta.

Michael: Was there a lot of devastation when you were growing up? Did you experience it or was it all
rebuilt?

Walter: It was all rebuilt, ration books had gone. But Malta still had them. I still remember them in the
60s and we still had the odd person clearly an amputee and clearly had been ex-military and a lot of
ex-servicemen had settled in Malta. It was kind of our history there had been a great siege St John
and second Great Air Siege in 2nd World War. A lot of hospitals were built especially for taking
casualties from Gallipoli. The tradition in Malta was all about military service and people who had
actually been involved in getting people better as well.

Michael: You mentioned your grandad there? Was your grandad a role model to you growing up?

Walter: I was very young maybe, 5/ 6 or ten, as I was sent to spend time with my grandad because I
was a naughty boy he told me a lot about what happened during the War, of his role and role of his
friends. And then I heard stories from my mum for example next door was bombed out so I was quite
influenced and I was quite interested from a very young age to see how people coped with huge
adversity. Most of them were not ill most of them had a bit of anxiety but most of them were very
resilient and made them better people from all their suffering.

Michael: We are jumping here. You were not thinking like that as a little one. Was the culture in Malta,
the war especially the second world war and the siege being such an influential history part of Malta
and especially your family. But you could not have been thinking like that as a little one?

Walter: No but I was always fascinated by war films and how people ticked, worked as a team and
found it kind of fascinating and I knew with Malta never join the military I first wanted to be a vet and
maybe a doctor but I never thought I would join the military. It came as a shock when I did.

Michael: So we ended up in 1978 in Manchester but before that happened how did you get to the UK?

Walter: What happened was I passed my A Levels I was hoping to get a medical place in Malta but the
government, had a difficult prime minister at the time and had a fight with the doctors and the doctors

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were all sacked and the medical school effectively closed. My friend was going to England I said there
is no way I am ever going so I filled it in and we applied together. I got in but he didn’t. He got in a
year later. So I found myself in a medical place in Manchester but I could not afford it. My dad said I
will send you and do your best.

Michael: 18 years old you turned up in Manchester. Was it a culture shock to arrive here?

Walter. I had never been to Britain before. It was a bit of a shock. It rained a lot. It was quite a bit
different to Malta. It was quite cold but I made a lot of friends and it was good.

Michael: So it didn’t take you long to joined the RAF. You studied general medicine in Manchester it
seems like an odd turn of events to join the RAF? Was it?

Walter: My dad had a heart attack in my second year in medical school so I thought what can I do to
be self-supporting. I knew that parts of my family had been in the Navy and the Army so I thought well
I would be first in the Air Force. So I applied and then much to my surprise I got in the Air Force.
Which was fantastic. So I was a medical student in the Air Force and when I graduated I had to serve
for 5 years after my house jobs. So I finished my house jobs in Manchester. I then spent 5 years in the
Air Force and I was told that for those 5 years I had to be a general duties medical officer train as a GP
if I wanted to. I could not specialise. So I did. For the first year I was at RAF Waddington and then
sent to Ethiopia just after (during) the famine in 1985 and before that to the Falklands for four months
so well after the war in 1984 but still an interesting place and then I got sent to Germany where I then
spent the rest 4 half years training as a GP at RAF Laarbruck Station so I had a great time.

Michael: I am going to try and push and pull you as there is so much to talk about. I don’t want to
miss some vital things we want to cover. So you ended up in psychiatry in 1989 as a psychiatrist?

Walter: Yes I did. I qualified as a GP and I was about to leave the Air Force and I told the Head of
General Practice I am going to leave. I like talking to people I need to give them time to talk so if you
don’t put me down for retraining in psychiatry I am leaving. So he let me go and so I joined the
psychiatry division so I got to Germany RAF Warton and the first thing my boss talked to me about.
Gordon Turnball here are the plans for the Beirut hostages. I said what are these plans surely they are
dead? No, we will probably get them out if they are alive. This is what I want you to do. My first job
was to see what mental health they had suffered and we were going to help them to get back to
normal.

Michael: So you qualified as a psychiatrist and the plans were put in front of you.

Walter: I joined as a trainee psychiatrist and then the plans were put in front of me. The hostages
were released in 1991.

Michael: I remember as a kid (I was 7 or 8) we are referring to Terry Waite he is the most famous of the
three that you helped and it really sparked the imagination in the UK. I remember being really intrigued
and watching it on the tv. For those who don’t know he spent nearly 5 years held as a hostage in
Beirut and 4 of those years were in solitary confinement. So if we jump to ’91, So you are part of the
team that were sent in to help these guys and their rehabilitation. Where do you start, as that is quite
something?

Walter: It is quite difficult what I learned when I read all the background and the papers and spoke to
other people you should look out for physical and then mental health problems and then you need to
look out for personality change. The physical health would be linked to heavy metal in the water,
contamination, lack of vitamins, been beaten maybe a brain injury those were real physical issues that
you had to help with and all the hostages were properly examined. From a mental health point of view
looking out for depression, anxiety, obsessional, having to do things in a special way. And also
post-traumatic stress disorder and we looked at people’s personality changing for the worse. Where
they had become more insular or post traumatic growth where they had learned from their experience
think about their family and friends in a different way, especially if they were held in solitary
confinement for a very long time.

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My role was first of all to see what the literature said write a paper or two in relation to what we might
find and then Gordons role and the rest of the team set up a plan not just for retrieval but how were
going to deal with the hostage and then their families as well. As we need the family to reintegrate that
person properly. It’s not just about return but reintegration. And of course the problem with family’s
people missing in action in combat as well as being kidnapped and taken hostage the issues that the
family might have is to go into a grieving process believing that person may never return and if the
grieving process completes then it is very difficult if that person does turn up alive to integrate that
person into the family. That is called anticipatory grief. It is a second world war concept. It is really
important to have done all that reading as it makes it so much easier to not reinvent the wheel.

So what that exercise taught me, with the hostages, was most things that need to be done have
actually be done before and it’s really important to be familiar with what has been done before. If you
discover something or do something out of the ordinary, then you document it and write a paper and
publish it if possible so other people can learn.

Michael: Are you testing things then to see if this is best practice?
Walter: Yes you do an assessment of the situation try to employ best practice.
Michael: So it is very important to listen to what someone is saying? rather than pre-empt.
Walter: Absolutely. A lot of psychiatry, counselling is about listening and being listened to and I think
that it a very relevant point.

Michael: And how difficult was it then as you had been a doctor for quite a long time but as you were
the real first and very public case with the Beirut hostages how difficult was it to actually achieve?

Walter: It was easy as we were protected at RAF Lyneham. We had the world press there. There must
have been over a thousand photographers when the hostages came out of the airplane when we got
there but it was okay because the hostages were whisked away for either for a quick media interview
other just went straight to the officer’s mess in where we had a dedicated wing, the family met the
hostages in private which was positive, without the cameras and us there. So we kind of embarked on
a model where we tried to reintegrated the family so that lasted about ten days.

Michael: So it is quite short space of time. Was it intense?
Walter: Yes it was intense if people needed support later we did give them not necessary as a Group.
It was intense but it really worked and I think it helped people to learn both the family members and the
hostage how each other had coped and if you like it reassured everybody as people always feared the
worse.

Michael: This is self-indulgent now, were you aware the hostages were still alive? Was there regular
contact?

Walter: I don’t know about that. I was too junior to know this. I was told this is your role as almost
your secondary duty and yes you can study and pass your exams and see xxxx but this is your
research role this is what we want you to do. I was fairly incredulities to start with and I didn’t think we
would get anyone out alive but other people knew better than me.

Michael: From start to finish you said that it was 10 days. We are talking about Terry Waite. It is very
well documented, there is just cause to talk about this. Did it carry on after ten days?

Walter: Yes, each person on the team had a key person to work with. I did not have a key …. that
relationship just carried on over the years. So you know people have remained in contact if they
needed it. Most didn’t and that is good. But most if not all of the hostages they grew as individuals.
they were not particular ill from a mental health point of view. They saw life in a very different way.
They appreciated their family and their beliefs and the meaning of life in a very meaningful way. Now
days we call this post traumatic growth which is …. people need to appreciate that terrible things will
happen in life especially if we are put in harm’s way. But equally, a small proportion of people become
mentally unwell but they as well as people who don’t become mentally unwell so you could have a
paradox … have a mental illness like PTSD but the meaning of things around you has improved but you

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are not well. You are not mentally ill but people around you, God, the meaning of life has changed.

Michael: You might not know this but you as an individual have had such a big impact on this podcast,
post traumatic and I asked you a question about it and we really delve into it now. The first two
episodes with Brian and Terry.… you can see their growth and Terry only the other day fought for
another world title and won. You can’t take this person any place … mental and physical sense. It is
such a narrative of it designates with people. It absolutely resonates with people and for me it should
not end with the PTS or the anxiety or … it should end with the growth.

Michael: So we ended with Beirut hostages so then the Gulf war followed.

Walter: Gulf War, it was good. It was interesting for me as I actually had a war role trained as Medical
officer and I expected to be …. I was still junior psychiatrist and I was told you are not a qualified
psychiatrist and cannot be deployed and I was very upset about that. But we want you to work with
one of our senior consultants to help set up a rehab service for people coming back from Gulf War I so
in the end it was myself and John Rawlings and we set up a brief intervention for people coming back.
Three kinds of areas to deal with. The first was group education on mental health symptoms. The
second was group trailing of people of any symptoms they might have. The last one was for people to
describe what they had been through so that is what happened. Their emotions, how they felt about it
and how they feel about it now. Their sensations would be…… the aim was to deal with any early
post-traumatic stress. It was quite a brief program and as the Gulf War came to an end we were
getting quite a lot of phone calls from GPs, civilian GPS, who heard about us and they wanted us to
look after veterans to. The navy had a 4-week program but we had a 2-week program. The outcome
was quite good. This brief program went on for 2 to 3 years.

Michael: Was it ahead of its time in terms of treatment?

Walter: Yes, to talk technical for a minute. The Israel’s had set up a program and they publish their
outcomes their project was to rehabilitate soldiers who had post traumatic symptoms. But they only
used two ingredients: Education and Symptom helping people to cope with symptoms they left out
telling the story. The Americans did exactly the same as the Israel’s. Their outcomes were terrible.
That was in 1994. We knew what the Israelis were doing. We knew what the Americans were doing
but we went our own way as it were. The interesting thing was the Australians had a big problem with
their veterans from Vietnam they sent 60,000 men to Vietnam they had a big backlash. They did not
treat as real veterans. They were excluded they were pelted with rotten eggs and tomatoes. The
Australian wanted to set up a cutting edge service for veterans and we were visited by Mark Creamer
he borrowed the three ingredients and set up a 6-week program in Australia and it ran from the mid 90s
right up to 2000 and it is still running today. His outcomes were superb. So the three ingredients were
skill and trauma focused therapy. So when I eventually came to join Combat Stress which was 11
years ago. The only reason the employed me was a track record of setting up services for people with
PSTD. They said you need to set up cutting edge services here at Combat Stress. There are 3 respite
rest homes.

Michael: I want to pull you back you are going ahead. … You refer to it already actually the lessons
learned can help the future generations. Tt seems what you are talking from the Gulf War and rehab
services you set up. Maybe I am talking rubbish here but it seems we have devolved a little bit from
the MOD even recently the care military personnel talking. The language is not where it should be.

Walter: It has changed. We had hospitals in my day it is changed trained by psychiatrists, military
psychiatrist. Nowadays, if you are trained you are trained in the NHS. Serve for 5 years as a
physiatrist. When you are fairly senior too are not going to learn any new tricks. You don’t have a
hospital. You only have community services. So what happened, if you like after the Gulf War I, rehab
service was that eventually Gordon left the Air Force and I left in 1997 and we went to a hospital in East
Sussex where we set up a derisory service in the private sector because there were no jobs in the NHS
for us as they had not cottoned on how important this was. Most of our patients were uniformed or ex
uniform services lots of veterans but I ran a unit for adult survivors of sexual abuse I set up a 90-day
program for these people been detained unwell survivors of sexual abuse and I set up a 90-day
program for these people who were really not well. They had been detained under the mental health

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act. Someone decided to question the diagnoses because someone had realised they had had trauma
in sexual abuse in childhood so my service at Tyhurst aimed to take people off their detention section
and really deliver the three ingredient: education in relation to the systems; coping with the symptoms;
and then trauma focused therapy. The vast majority got off the mental health section. The aim was for
rehabilitate and long term psychotherapy service in the community. which really worked extremely well.
That was a big learning for me not only was I involved with veterans and other civilians who had been
involved in quite a number of traumas in war setting, or in an ambulance, or fire setting and now it was
childhood as well which is quite difficult to treat. Eventually I went to …

Michael: To me adult’s survivors of sexual abuse these cases are often complex post-traumatic stress
from the outside in that to me is like hell. It’s like hell. But as someone like you who is in the
profession and has the tools to actually help people. It’s a real, I have been too-in and fro-ing about
this question. I think people like you, is a positive that you are there, but the negative can have subject
and topic around it and is really quite uncomfortable. Did you feel proud to make that kind of impact?

Walter: it is so difficult to know as no one else was really doing this work with an aim to rehabilitate
people off the mental health section and get them out of hospital and safe and well. There were
techniques damp there is a cognitive behaviour therapy people are trained to not to self -harm not to
think in a destructive ay to try and learn to try and get better to interact with others so they don’t feel
suspicious all the time and that people are getting at them.

That was really important that fact that I had been in the Air Force and had been given the role early on
in what the hostages might have. That work was also used with the POWs but I did not get involved in
the POWs personally but my work helped the team to have a strategy for the POW from Gulf War 1. I
ended up as quite an expert in torture incardination solitary confinement association.

Michael: There are not many people can say that, blimey!

Walter: I just happened to be there so I made best use of it for adult survivors. I then worked for three
years for quite a damaged population. Women who fell afoul of the criminal system so I was medical
director for a medium secure hospital and when I got there I found there was a lot of self-harming but
we set up a therapeutic community which means everything was behavioural there was a reward
system. There was no punishment. We brought in dialect therapy where people did that for a year. We
had classes. Really it was just reintegrating people getting them in touch with their emotions and
feelings. We had a series of lectures for PTSD Symptoms and then they had individual sessions and
we discharged some people out of hospital that was a really very good experience. I did not publish
that work. I presented that work at conference it was at that point, three years in that job, that I got the
call from Combat Stress as it were.

Michael: Before we go onto your work with Combat Stress. Essentially, we have ten years there where
you are dealing with complex PTSD, and survivors of sexual abuse, and physiological trauma and
what not. We often talk about post-traumatic stress disorder now but we sometimes forget that it
affects a greater population. It is not just the veteran population it affects. it is very broad. What is it?

Walter: Look reducing it down to its bare minimum it is a failure to lay down a proper cohesive
memory. It’s a memory problem. I don’t really look at it as a mental illness in the real sense. When we
are kind of doing anything in our life, our mind is always trying to lay down a memory and putting it in a
file. So at the moment I am sitting down with you. It will lay down the facts that I am sitting down
talking to you. I am a bit anxious so that will go in the same bundle as the fact that I feel my skin and
the pressure on my bum as I am sitting down. All of that will go to one bundle and a fuse box in the
brain and that puts it all into my hard drive. And that’s how I lay down a memory. I have been to a
radio station to produce a blog with Michael today. That’s a safe memory. When something terrible is
happening to me the mind does something very different. The mind protects me from the horror or I
will fight and run away or I will freeze and someone will kill me. The brain will not lay down a memory.
The rule is the mind must lay down a memory no matter what. It will lay down the memory in
flashbacks, memory, they are out of the blue they are horrible they are the things that makes me really
frightened and I haven’t been in touch with my emotions at the time so I have become very anxious at
the time looking out for signs of danger and I feel emotionally numb and blank inside and then I realise

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the best way to cope with anything is to avoid anything to do with my origin trauma the more I isolate
myself and get myself out of stress situations the more likely it is I will cope but the more I avoid things.
The more I don’t confront what has happened the more likely it is my mind will say please file me away
and I will go round and round in circles. And then what tends to happen is I adapt to avoid in things so
much that I ignore relationships and I became very isolated and then I become depressed. very
common with PTSD. And in Britain the way to avoid things is to drink a lot of alcohol and that helps us
avoid to think what happens. So alcohol is another issue. And of course we could use cannabis, so
people use cannabis. emotional numbing is very unpleasant: good news – big deal; bad news – big
deal. Caffeine from chocolate, coca cola, and other soft drinks and coffee and tea. And we will also
use amphetamines and cocaine. PTSD comes in a package to me. It comes with a …. Experience of
the trauma hyper arousal and emotional numbing and avoidance and it always comes with depression,
alcohol, depression cocaine, … psychotic with …. In guys who have had post-traumatic stress. But
there is a biological kind of reason for this. I talked about the xxxx before it is the first kind of junction
that fuse box, it blows if you get a brain scan it shows the volume of that part of the brain is less, and
the volume of xxx where I am supposed to store things is less. But with therapy and some medicine
these two areas of the brain can recuperate and they can recover. It is very important people don’t feel
that there is no treatment that will work. They may have had a bad experience with someone who has
not let them … but actually these is treatable.

Michael: You spoke there about … like nicotine and drugs and alcohol and not what there
self-medicating because people have not initially gone for treatment or gone for treatment but it has
not worked and tried to go away to self-medicate, to dumb it all down. Is that correct?

Walter: Absolutely yes. It is a real problem. Many people do try to get help early on. Please keep
trying. But they don’t find the right service or their expectations are too high or too low or they meet
the wrong therapist or are put on the waiting list for a long time. Combat Stress 80% of our veterans
have tried to get help before coming to us. Many of them. There is huge time delay between leaving
the military and coming to us on average especially the older veterans Falkland War, Gulf War I,
Northern Ireland veterans it can take an average of 12 to 14 years. The younger veteran now because
we think the MOD have done a lot more education and people know and are much more savvy or your
wife or good women or your girlfriend or your mum know a bit more about PTSD and they are coming
much earlier. The average for Afghanistan and Iraq respectively is about 2 and 4 years after they leave
the military to come to us for help.

Michael: Social media has … negative on social media but we share things as a small individual awe
push thing out quite a lot and since we have started this and you are episode 4 and I am shocked with
how many people have got in touch with me since. People who have been suicidal or the first time
they have contacted someone and said they are feeling suicidal I then have to go I am not a
professional I am literally just bring into this to attention but there is some professional help there. I
could listen to you. I sometimes lose my thoughts because it is so informative what you are talking
about. I have this big list of questions and I am not quite sure what is the best thing to ask but I want
to break it down again. What is the brain actually doing during treatment? Because we talked about
filing away. Is that what the brain is actually doing?

Walter: The brain is processing things it is getting the fused box that has blown to start working again.
Bonding emotions at the time of the trauma with emotions now. It is bonding those emotions with the
facts of what happened and it is also bonding our sensations. If someone assaulted me on a lawn that
had just been cut and the smell of a grass was a trigger. I would avoid all grass and all smells to do
with grass but actually a treatment would be to have to face and confront and the smell is not in itself a
danger to you and you need to detangle the trigger from the fear. Drama focused therapy to a degree
is reliving and it very difficult if someone has been terrified. But if you relive it with a therapist who you
trust then people do get better. Once in a clinic I had a 19-year-old guy who had just left the army and
had been in Afghanistan and then the very next patient was a tail end Charlie his wife had died 6
months early he had the treatment was the same the complications were the same. You could get
someone suffering with PTSD for so many years he has lost his relationships, he has not worked for
many years, he is now an alcoholic. The complications are what makes it difficult and the engagement
and ability to engage and the kind of safety of therapeutic relationships to keen someone in therapy
and make sure they complete treatment in the Airforce we used to say is make sure you get all the gold

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nuggets from your patients. And the gold nuggets would be the last things people wanted to deal with
that they wanted to share that they were ashamed maybe that they were afraid or they felt guilty that
they let someone down.

Michael: How do your form that relationship with?

Walter: It is important not to scare people off. what I have always done the first appointment I say to
people I am really interested in your symptoms and I am interested in your military service and I am
interested in your background so that puts them at ease straight away. They have probably been really
worrying and haven’t slept for two nights and they probably think we are going to get a whole story out
of them. Once you have seen someone two or three times and then you have a plan. And if you have
someone who can’t cope with their trauma straight away so then we give them some skills as …
therapy that involves reliving and also you need to look at and educate them to what the symptoms
are. So look PTSD is a memory issue it is how memories are formed you are not weak in any way this
can happen to anyone the more you are exposed the more horrible the thing is the more at risk you are
the less supported you are by your mates then the more likely you will get this and I have seen every
rank from vey top to the very bottom with PTSD.

Michael: Episode 2 with Terry he won’t mind us talking about this. The stuff you are saying there is the
stuff he is saying from the other end. It is one tour packed in full of trauma full of at risk constant risk
that is something a lot of people forget. I was just speaking to my brother on the way in he has done
Afghan and Iraq. He was telling me on things that have happened. and I see that is really traumatic
and it is condensed and I say is that why strength and bravado and you look at the perception of
someone into The Parachute Regiment or the Marines or the Royal Engineers. Are you finding that
because there is that bravo people are not coming forward and not talking about it and not showing the
weaknesses?

Walter: It is quite interesting in because there are two phases in war where we expect more mental
health casual ties to come for help. The first if you have many deaths in the battle field and that
happened in 2007 in Afghanistan and that’s when we have a lot come forward. The second peak is
when the war finishes when everybody kind of stops problem solving so they are not kind of think if I
go back to Afghan how am I going to survive all of us need to bond and keep strong as a team. When
we kind of know we cannot be deployed again or when we retire from the military when our job
changes when we have time now to focus and thinking about that happened that is when our delayed
post-traumatic stress hits and that’s when people go for help. It is almost predictable.

Michael: So you can now relax and start filing this stuff away?

Walter: For some from the second war everyone came back and knew they had to rebuild the country
everyone knew about the second world wars and every one was on the same page and that casualties
of mental health were not great to begin with. In fact, most casualties started when they retired at the
age of 65. They have to have a family, children a job, a house, carry on with their career. At 65 they
stop no career no responsibility I am retired and then I will remiss and that’s when it hits me. Delayed
for the second world was there is this contestant then meaning purpose…. Retire… nothing. But you
released of any responsibility unless you have or busy like my 93-year-old who was kept very busy by
his wife and then she died

Michael: And generally there are forgotten victims in this. And you have eluded this several times.
Spouses, partners and children are affected by people who have experienced in trauma. Do you get
involved in that?

Walter: We (Combat Stress) we don’t in theory get directly involved in treating families but our articles
probably allow us to so we have done 1994 I set up a research department at combat stress and we
have done 3 projects in relation to families in particular spouses and carers so we know of the guys we
treat who are the illest their careers and spouses are ill many very high rates 4 or 5 times the rate for
alcohol problem PTSD from emotional contamination and depression. We also know that the ones
who drink the most are most likely to have young children in the house so we are really concerned. We
have set up a group education program. We are looking at the results now. The study is finished. We

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are about to publish our outcome’s it is a problem we imported from Michigan veteran’s association of
Michigan. Now we are looking to pilot this using skype with groups on skype because it’s very
important that spouses and carers and we hope if we get funding we can do a children study as well, in
relation to need, but most important in relation to intervention. So it is very important to look at the
whole family rather than just the veteran.

Michael: It is fascinating. You have essentially got these big strong characters that look after their
family and then they are really facing difficult times and that fight and battle in their heads can be really
fierce. We sat on a panel once, and I am not saying I was the same level as you, I was there for a
different reason, but someone said “well there is a cure” and you were “I would love to see the cure”.
But is there a cure? Can you see a cure can we breakthrough? You say it three or four times. What’s
next?

Walter: Cures are very strong words for me and that raises a lot of expectations and I am always after
is improvement in function in relation to work, socialisation and relationships at home especially and
meaning and meaning of life. And also reduction in symptoms. Less alcohol, less depression, less pts.
and for some there is a cure that is meaningful and lasts but it all depends on how severe things are to
start with and how intensive the treatment is. To go back to when I was asked to take over Combat
Stress. By the way, I was the first medical officer ever to be employed full time by Combat Stress even
though we are going to celebrate our centenarian next year. The board of trustee said we
are going to have a lot of guys coming back from Iraq and Afghanistan plus a lot of veterans what can
you do to help. You know the Australians came to see . First thing< I did was phone Mark I think we
need to import the 6-week program from Australia. I said look Mark I need to send some staff to
Australia to see how you have upgraded things. I kept an eye on his publications so we import
ted the 6-week program and was eventually funded in the NHS in 2011 and equally we then appointed
community psychiatric nurses and we welfare officers in the community which we have now placed
with occupational therapist in the community and grew our psychologists and now we employ about
40 in the UK n now we are about 5.5 psychiatrists. We have centres in Scotland and leatherhead….
and Hedley Court, unfortunately has become a day centre. Because we need to move into the
community more about, because of financial pressure as well. So combat stress has been running
quite good cutting edge services. Our 6-week program outcomes come out better than Australia and
better than America chairman said. Walter why do you get such good outcomes. It’s because it’s a
course a program it is not stigmatising they then have a wrap around. They are bonded as a team.
They do project work together. Those who cannot start to talk about their therapy, to open up as it
were and we have a very low failure rate in that we have about 6% don’t complete. Which is really
incredible which is incredible as the American have between 46 and maybe 60% non completion rate
so people dropping out. There’s’ is no point investing money in cutting edge clinical services even if
they are properly evidenced base people don’t engage or drop out. So there is a very important that
whatever clinical services you set up they are use friendly and tailor made for veterans.

Michael: I am a big fan of you guys. I wanted to ask you one question actually. You have gone
through a lot. How do you offload?

Walter: I am kind of lucky, firstly I have hobbies. I like painting. I do watercolours and oils now and
then. My father had a hobby of horology fixing clocks and watches which I took up when I was quite
young and I fix clocks and watches which I took up when young, in my spare time. I don’t have much
spare time. I have a very supportive wife who is a psychologist so we can certainly do things but we
don’t talk about work normally, we just do things together. It’s important to have a bit of structure to
your life. I have always woken up early. In Malta as a child I would get up early I’ve always got up
early. You get up at 5 am and go fishing, you feed your cat with little fishes. I am lucky I can drive to
Leatherhead from where I live. I am very lucky we have very nice colleagues who we work with. Not
only within combat stress a very supportive staff but also with colleagues in the military and in other
charities.

Michael: It’s great. Walter we are going to have it leave there. I really hope this helps someone else.
Seek help and have a chat

Walter: It has been a privilege. Thank you very much.