[2024] UKUT 191 (AAC)

[Mr H] has not received any formal psychological treatment to date. He has had a number of assessments, and at one point was offered group therapy or Eye-Movement Desensitisation and Reprocessing (EMDR), but these never reached fruition.

He has tried pharmacological treatment in the form of two SSRIs (Selective Serotonin Reuptake Inhibitors Antidepressants), with some reduction of symptoms.

The treatment requirement for PTSD is trauma-focussed therapy in the form of either Trauma Focussed Cognitive Behavioural Therapy or Eye-Movement Desensitisation and Reprocessing (EMDR).

However, in my opinion, [Mr H] needs a lot of ‘psychological preparation’ before embarking on a structured form of therapy. He needs to build up a therapeutic, trusting relationship with a professional to work on some low-grade coping strategies, and anxiety management in the form of relaxation, mindfulness and graded exposure, prior to discrete work on the trauma.

If [Mr H] can embark on some form of therapy, for example the EMDR which is in the pipeline, I envisage this will take a lot longer than the standard 18-24 sessions normally prescribed.

Evidence suggests that 2 in 3 people with PTSD eventually get better without treatment. 1 in 3 may have more lasting effects, which can last for years and can be very severe. Outcome will depend on length and severity of trauma but the majority of those with severe cases respond well to highly specific trauma focused therapies. The trauma aspect of the illness is relatively uncomplicated to treat but associated factors such as alcohol, illicit drug use, relationship breakdown, financial difficulties, poor self-esteem and social withdrawal are harder to tackle.

Positive factors include, but not limited to, a robust premorbid personality, above average cognitive ability, good social skills, optimism, social and environmental stability and strong social support, less severe trauma, early intervention, minimal duration of trauma, trauma not experienced up close, and absence of alcohol and illicit drug use. Males have better overall prognosis.

Taking these factors into account, in my opinion, [Mr H]'s prognosis is poor. There is a predisposition to anxiety and evidence of poor coping mechanisms. He joined the Army at a young age, when his personality was still forming, and there is evidence that he struggled to cope, as well as forming solid relationships and it is likely there were elements of his personality which were not robust.

There is evidence of poor self-esteem, pessimism and social withdrawal. However, he has a strong family support network.

He has suffered for many years without being able to engage in the support or treatment he has required. There appears to be a barrier to accessing treatment which he first must overcome.