 The appalling plight of children used as soldiers in countries divided by civil war has been brought to our attention in recent years by focusing on the immediate trauma, abuse, physical injury, and subsequent disability and psychological damage caused. However, less attention has been paid to the British Armed Forces’ attitude to using its under-18 year olds in armed conflict and their vulnerability to developing serious mental health problems. The UK recruits 16-year old children to all three branches of the military and is the only European country to deploy under-18 year olds in war fighting situations. As Prince Harry takes up his place at the elite army officer academy at Sandhurst and with the war in Iraq featuring significantly in the recent general election, managers, staff and others in child and adolescent mental health services (CAMHS) need to be aware of the full implications of their attitudes to the continuing conflict and the complex needs of military families. For example, there are clear contradictions in the British government’s use of minors in battle zones with its obligations under the UN Convention on the Rights of the Child and the Children Act 1989 to protect and safeguard children. It is important that staff employed by the Ministry of Defence or working for NHS trusts or other employers in towns with garrisons and naval and air bases, in particular, are fully aware of the psychological impact and serious consequences for young people and young families likely to present with disturbed behaviour, abuse, relationship difficulties and mental health problems. A report by the children and armed conflict unit, Essex University, details the specific ways that the Ministry of Defence has ensured that the needs of military power and political control override the best interests of these young service personnel. Article 38 of the Convention on the Rights of the Child emphasises the particular vulnerability of children as civilians and soldiers in armed hostilities and recommends signatories refrain from sending children into battle. It recognises that children’s rights are particularly vulnerable to violation during armed conflict and lays down specific obligations on the State to protect children caught up in situations of war. If the non-deployment of personnel under the convention’s recommended minimum ages would destabilise the unit of which they are part, then the MOD reserves the right to deploy younger recruits. Arguing against non-deployment of under-18s, the government claims that once children are trained in the Armed Forces, they are considered to be professionals and are treated as such. They play an important role in their unit, and their removal would undermine the effectiveness and cohesiveness of the unit, be demoralising and unpopular, and add to the training burden. The demographic profile indicates that the majority of military recruits are from poorer socio-economic groups where a higher proportion of children and young people are at greater risk of developing mental health problems. The British army, for example, specifically targets recruitment at low income, high unemployment, disadvantaged areas where children with few academic or career prospects are able to sign up to six year minimum service contracts at 16 years of age, seduced by glamorous images of travel, machismo, and attaining employable skills. The recent adverse publicity over the culture of bullying and suicides at military training establishments revealed a tiny, previously hidden, glimpse of what many vulnerable young people may also be subjected to on a routine basis. Young offenders institutions are another favourite recruitment target where it has long been established that around 70 per cent of inmates have undiagnosed mental health problems. CD and DVD computer games and literature that emphasise war as fun, exciting and a professional activity are widely distributed in schools, youth clubs, websites and military recruitment offices. What is less publicised is that since 1971, 24 children have died and 10 were seriously physically injured while on active service. Nurses and social workers working in the military - themselves possibly quite young - may find trying to help another young person suffering mental health problems a difficult challenge if their training and working environment negates the emotional cost of military activity. Uniforms, regiments and all the paraphernalia of the forces make these young people look a lot older than they are but the evidence suggests that, paradoxically, they may be developmentally and emotionally immature due to earlier childhood neglect and deprivation and thus more at risk of developing mental health difficulties under the strain of combat. The British army specifically targets recruitment at low income, high unemployment, disadvantaged areas where children with few academic or career prospects are able to sign up to six year minimum service contracts at 16 years of age, seduced by glamorous images of travel, machismo, and attaining employable skills Until very recently the yearly rate of suicides among young men between the ages of 16 and 25 had been rising steeply since the 1980s. Research has not offered a definitive reason for this worrying trend but among the causes suggested by experts are a confusion about roles in a post-feminist culture; prolonged adolescence; individualistic culture emphasising competitiveness; and exposure to extreme violent imagery in digital media and games. It is likely that with predicted declining recruitment the military will enlist previously unsuitable candidates and therefore a greater proportion of children at risk of suicide as a result of post-traumatic stress disorder. Under-18s make up a third of those joining the forces each year. When vulnerable 16 year olds sign their service contracts it is doubtful that it is with the informed consent of themselves or their parents or guardians or that they fully understand the implications that they will be unable to discharge themselves after a short minimum period. For many the prospect of a secure future, with a paternalistic employer and a sense of importance will offer some hope in an otherwise bleak and impoverished life with few prospects. With Iraq likely to be a regular destination for all army regiments, the consequences for a generation of young recruits are considerably worrying. Most can expect to be quickly sent abroad into highly insecure environments where it is not easy to distinguish friend from foe. The stress and anxiety levels will be high for prolonged periods of time. The less psychologically robust under-18’s, who may already have several predisposing elements for developing mental health problems, are, therefore, a high-risk group. The evidence suggests that post-traumatic stress disorder is increasingly being recognised by the military with symptoms that include depression; self-harm; nightmares; anxiety; and aggression. The World Health Organisation recognises that young soldiers exposed to conflict situations can more easily develop the disorder leading to persisting patterns of problematic behaviour and functioning. These problems may not emerge until years later or after the symptoms are revealed by, for example, alcohol or substance abuse. Many children may be withdrawn, depressed and display difficulties in social relationships. Children deployed in Northern Ireland, the Gulf, Bosnia, Afghanistan and Iraq have had to undergo very traumatic experiences such as removing the bodies of dead soldiers they had just shot at, some of whom were not older than 12 years, or dealing with women and young girls who had been raped. Military families may well show a variety of parenting, relationship, child protection and mental health problems that originate from severely traumatic experiences which have been ignored, unrecognised or misdiagnosed. Taking this into account during holistic assessment work could be the start of acknowledging and unlocking painful feelings which need expression and containment in order to help families recover. Because military life is peripatetic, with the rotation of regiments and training requirements, mental health staff will find it hard to build up long-term secure therapeutic relationships before families move on to their next base. This emphasises the need for managers to develop consistent, collaborative inter-agency work to ensure that families where mental health problems are developing can be comprehensively assessed, engaged and signposted to the appropriate sources of support. The Children’s National Service Framework provides a focus for primary care and mental health partnership trusts and other employers to include CAMHS among their priorities for service improvement and capacity building within the workforce. New training opportunities are being developed along with new capabilities and competencies to provide a standard framework across the UK which aims to ensure that new innovative teams with multi-disciplinary backgrounds can offer holistic care and treatment. Early intervention for vulnerable groups such as child soldiers is essential if problems are to be detected early and subjected to preventive treatment designed to build resilience and self-awareness. But, most important, staff needs to recognise that along with the unmet need in the wider community there is a specific and elevated risk for developing mental health problems among Britain’s own child soldiers. |
