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Edited by
Richard Williams, University of South Wales,Verity Kemp, Independent Health Emergency Planning Consultant,Keith Porter, University of Birmingham,Tim Healing, Worshipful Society of Apothecaries of London,John Drury, University of Sussex
The London Nightingale was designed to be the largest field hospital in UK peacetime history. It was built in a matter of weeks on the site of an existing exhibition centre, with a final capacity planned for 4,000 intubated patients who had COVID-19, and 16,000 clinical staff. Supporting the mental health of its staff was a key element from its inception, with a specialist team engaged to create and implement an evidence-based, tiered, occupational health model. The emphasis was on minimising distress and moral injury, and maximising post-traumatic growth through a rapid, de-medicalised, forward psychiatry model that encouraged return to work where possible. The London Nightingale was fortunately never required at anything near its capacity, but the mental health team was operational throughout its life, and openly disseminated its standard operating policy and learning to other UK hospitals, many of which used it as a template to design their own.
This observational study examined return to duty (RTD) rates following receipt of early mental health interventions delivered by deployed mental health practitioners.
Method
In-depth clinical interviews were conducted among 975 UK military personnel referred for mental health assessment whilst deployed in Afghanistan. Socio-demographic, military, operational, clinical and therapy outcomes were recorded in an electronic health record database. Rates and predictors of EVAC were the main outcomes examined using adjusted binary logistic regression analyses.
Results
Overall 74.8% (n = 729) of personnel RTD on completion of care. Of those that underwent evacuation home (n = 246), 69.1% (n = 170) returned by aeromedical evacuation; the remainder returned home using routine air transport. Predictors of evacuation included; inability to adjust to the operational environment, family psychiatric history, previously experiencing trauma and thinking about or carrying out acts of deliberate self-harm.
Conclusion
Deployed mental health practitioners helped to facilitate RTD for three quarters of mental health casualties who consulted with them during deployment; psychological rather than combat-related factors predicted evacuation home.
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