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On May 22, 2002, at the European Conference on Traumatic Stress in Berlin, a plenary session was held to discuss a major class action suit brought by 2,000 British service personnel against The UK Ministry of Defense. The plaintiffs (service personnel) claimed that the British armed forces were negligent in not providing education, briefing, debriefing, and detection and treatment of a wide range of psychological reactions relating to military experience from the late 1970s through the mid-1990s. The areas involved in conflict included the Falklands War, Northern Ireland, the Gulf War and the Bosnian War. The defendants (Ministry of Defense) refuted all of the charges.

The case, which was about more than posttraumatic stress disorder or Gulf War syndrome, was tried before a judge sitting alone in The Royal Courts of Justice in London. The claims of the plaintiffs were tested against three major areas:

  1. What was the evidence for intervention at the relevant time periods from the 1970s onward?
  2. What were other armies providing at the relevant times--e.g., U.S. and Israeli forces?
  3. What was National Health Service (NHS) practice in terms of diagnosis and treatment at the relevant times?

Judgment on the case was delivered May 21, 2002, the day before the plenary session. ISTSS member Chris Freeman, MD, introduced the case and set out the issues being tested before the court. The case involved the generic issues described above and individual issues from the 2,000 British service personnel (mostly army, but some navy personnel). Each side chose lead cases, and a final group of 30 lead cases was agreed upon by both sides. These cases were designed to illustrate the main points of the generic case.

Edna Foa, PhD, served as an expert witness for the claimants and argued that during the critical period there was sufficient knowledge about effective treatments for combat-related anxiety and, as a result, the Ministry of Defense had a duty to make better provisions for the service personnel than they did. Oscar Daly, MD, also served as an expert witness for the claimants. To examine the generic issues, Daly used his experience of treating people who have suffered from posttraumatic psychological problems as a result of civil disturbances in Northern Ireland. In particular, he concentrated on the issues of culture and stigma, service in Northern Ireland and treatment in "the real world." He also concluded that more should have been available for the service personnel.

Professor Simon Wessely was instructed by the defendants. He addressed the issue of the prevention of war-related psychiatric injury, arguing that the only proven way to do this is not to send people to war. He also discussed matters of military culture, suggesting that the military have different aims, objectives, backgrounds and values than civilians.

At the end of the session the audience was advised that judgment had been found in favor of the Ministry of Defense on the majority of charges. The judge said that he "was satisfied that the defense ministry was in breach of its duty of care to four of the claimants, but such cases turned on their own facts and did not demonstrate a systemic failure." Despite the ruling, this case is likely to have a significant impact on the provisions of psychological care to military personnel exposed to traumatic events both during their time in the military and after they leave it. It is hoped that the case has highlighted their needs and will result in better services being made available to them in the future.

Jonathan Bisson, Cardiff & Vale NHS Trust, is consultant liaison psychiatrist and honorary senior lecturer.