2010 Annual Review

“Bravery is seeking help for PTSD...”Hugh, former Explosive Ordnance Disposal Engineer

Year ending 31st March 2010

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2010Combat Stress: The story so far

The world is changing, and

so must weCombat Stress was founded in 1919, shortly after WW1, and has a 90-year history of caring for the mental health of Veterans across the UK, and of providing support to their families. Just as our Armed Forces continue to engage in conflicts across the globe, so we retain our commitment to continuing and developing this crucial work.

Over the years nearly 100,000 Veterans have benefited from our support, and with the Armed Forces so committed this number will only rise. While our Service men and women strive to bring resolution and stability to the troubled areas of the world, we similarly work to provide the right mental health treatment to all those Veterans and Reservists who require it.

The past year has been a vital one for Combat Stress, as we have set about reshaping our organisation to enable it to cope with a changing military and political landscape. The biggest challenge we have had to face, of course, is that increasing levels of demand for our services continue unabated. Total referrals to Combat Stress last year were over 1,300, meaning they are now up 72% over the last five years – and with no sign of decline. The problem for the charity is clear: how do

we meet current and projected levels of demand while avoiding lengthy waiting lists? To achieve this we have had to rethink our offering.

Thus 2010 sees Combat Stress undertake one of the biggest periods of growth and reorganisation in its history. Central to this is that we are transforming how we deliver clinical services. Instead of relying on one model alone – treating troubled Veterans through admission to one of our well-established, highly effective short-stay residential treatment centres – we are now gearing up to deliver clinical services in the community, too. It is with our new Community Outreach teams in mind that we launched The Enemy Within Appeal this year, the biggest fundraising drive in our history. You can find out more about both these initiatives in the pages ahead. These are testing times, both for the Veterans we serve and Combat Stress as a whole, but we have never been better placed to confront them.

Chief Executive: Wing Commander David Hill

Wing Commander David Hill, Chief Executive of Combat

Stress, outlines the challenges ahead, and the innovative ways in which the charity

is repositioning itself to face them…

Going ForwardWho we are

At Combat Stress we believe it is the responsibility of all societies to look after their wounded – and the families of their wounded, too. Government certainly has a central role to play in this, but we think it should not be the duty of Government alone. Rather, care for our Veterans is the obligation of every citizen whose freedom and success depends upon the peace and security of their country. The guiding vision of Combat Stress is that all Veterans suffering from psychological wounds deserve access to prompt, specialised and appropriate treatment, care and support, delivered by qualified and understanding professionals.

Combat Stress is already recognised nationally and internationally as a Centre of Excellence in the diagnosis, treatment and management of Service-related mental ill-health, and is currently consolidating its position as the leading provider of such treatment to Veterans in the United Kingdom. We believe that by working in tandem with the Ministry of Defence, the National Health Service and the Armed Forces, we can develop and sustain a regime of care that is well placed to prepare personnel for the impact of trauma, identify symptoms as early as possible, and initiate suitable treatment where needed.

What we believeAt Combat Stress our primary aim is to provide prompt and suitable clinical care and support to Veterans with psychological injuries. To achieve this we offer courses of residential treatment at our short-stay centres in Ayrshire, Shropshire and Surrey, alongside a programme of long-term care through our new Community Outreach teams that are currently being established. Through this two-pronged approach we hope to offer the best and most flexible range of treatments possible, and in doing so improve both early diagnosis rates and treatment quality, as well as reduce the stigma of such ailments. In addition, we strive to increase awareness of military-related psychological injury, including Post Traumatic Stress Disorder, in both the public at large and affected members of the Armed Forces.

What we do

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’09The year in review

During 2009 Combat Stress has grown from being a respected and well-established – but essentially rather small and specialist – charity into an organisation with far-reaching impact. This has been driven by a combination of

increased demand for our services and our desire to both improve our offering and raise the profi le of these problems. Campaigns such as The Enemy Within Appeal have helped fund this vital increase in service provision, while a changed political agenda and increased media coverage have highlighted our work yet further. Politically, we now have a strategic partnership with the Ministry of Defence and the Department of Health that allows us to help shape future services for Veterans. This is an important step, as it creates an equal partnership between two Government departments and Combat Stress, giving us a voice within Central Government.

2009 was a huge year for Combat Stress. Not only did we launch The Enemy Within Appeal, our biggest campaign ever, but we also started to rearrange the way we do things…

Launched by HRH The Prince of Wales at St. James’s Palace on 11 March 2010, The Enemy Within Appeal is the biggest in the charity’s history, with a massive £30m target. This money is vital for the establishment of our 14 multi-disciplinary Community Outreach teams. The appeal has benefi ted from increased media exposure through an important ongoing partnership with The Daily Telegraph, allied to our fi rst TV and poster advertising campaign.

The average age of a Veteran being treated by Combat Stress

43.3

So, what is Post Traumatic Stress Disorder (PTSD)?PTSD is a severe anxiety disorder, capable of overwhelming an individual’s ability to cope. It can develop after exposure to any potentially psychologically traumatic event, often but not always involving risk to life, either that of the individual or of colleagues. Whilst relatively rare, it is however most strongly associated in the public mind with the mental issues facing many ex-Service personnel. A complex and debilitating disorder, PTSD has been referred to in the past by many names, including ‘shell shock’. But with its current title has come increased understanding, and a more sophisticated range of treatments.

Hard-hitting advertising campaign: Raises awareness of the psychological burden of combat

81.5%Army

7.7%Royal

Air Force

7.4%RoyalNavy

2.8%Royal

Marines

0.6%MerchantNavy

Where They ServedHere is how the Veterans we treat served our country

Generation gap

103Our oldest Veteran currently being treated

20Our youngest

Veterancurrently

being treated

The Enemy Within:Our biggest ever appeal

4 5

’10

Hours per day that a new Department of Health-sponsored Veterans helpline will be open for business

The year in review

With increased fi nancial support from The Enemy Within Appeal we have been able to deploy six of the 14 Community Outreach teams we intend to establish. These teams are fully recruited, functional

and operating. “It’s a great start, but we now need to secure funding for the remaining eight, to enable us to develop this important community service further,” says Paula Smyth, Director of Operations.

“With an increasingly young Veteran pool the importance of a community model is that it enables early identifi cation of problems, prompt access to assessment and treatment closer to home. This early intervention and stepped-care model will also ensure that admission to one of our short-stay treatment centres remains available to those who need it most without delay.”

The early part of 2010 has been an incredibly exciting period for Combat Stress, with many of our new Community Outreach teams already active in different parts of the country.

The average length of service (in years) of a Combat Stress Veteran (they tend to be career Service personnel)

10.9

£2.8mBig numbers

Cost of running Tyrwhitt House treatment centre for a year

The percentage of female Veterans being treated by Combat Stress

£240kCost of running the Scotland East Community Outreach team for a year

Hours per day that a new Department

24

The new Community Outreach teams will integrate with our three short-stay residential treatment centres to bring increased levels of care to those Veterans who have previously been a challenge to reach, either through pressure on beds, geographical remoteness, occupational or domestic circumstances or because their needs are better met on an out-patient basis. Each team will consist of a regional welfare offi cer, a welfare support team member, a clinical psychiatric nurse and a therapist, with access to a regional psychiatrist or psychologist as required.

Meet our Community Outreach teams

Warrior women

Hugh joined the Royal Engineers at 16 as a Combat Engineer, and after the Gulf War was posted to a highly specialised bomb disposal unit in the Explosive Ordnance Disposal regiment. But it was in Bosnia in 1996 that Hugh fi rst started to fi nd that experiences like walking up to dead bodies, or being dropped out of a helicopter into a minefi eld, were really playing on his mind.

One day in Bosnia he witnessed a car crash and went to help the driver. While he was patching up the man’s arm, “the guy put a pistol to my head and said in broken English, ‘Eff off back to England. We don’t want you here.’” Then Hugh saw that the car was full of guns. He walked back to his vehicle, all the time expecting the back of his head and face to explode. That night Hugh had a quiet breakdown and was never the same again.

Medically discharged from the Army, Hugh attempted suicide at work and saw his marriage fail; after smashing up his workplace and breaking his boss’s fi ngers over a wage dispute he was diagnosed with Minor Adjustment Disorder, then, years later, with PTSD. “Combat Stress has saved me from killing myself,” Hugh now says. “Life is not perfect, but the therapy has taught me how to minimise the fl ashbacks. When things get too much, I’m now very good at saying to myself, ‘You’re in a house in Essex,you are not in Bosnia’.”

“Life is not perfect, but

the therapy has taught me how

to minimise the fl ashbacks”

Veteran experience:Hugh, Gulf War and Bosnia

6 7

3%

97%

“

Simon joined the Royal Regiment of Fusiliers at 15, and was posted to Bosnia twice, in 1995 and 1997. Things he saw there have never left him. He’d often be asked to dig up mass graves so the bodies could be examined by uN teams; other times he’d go on patrol and come across bodies that had been tortured and killed, and just left there.

Then, in 2003, he was posted to Iraq. Caught up in a ‘blue on blue’ situation on entering Basra – “one of our tanks shot at another by mistake; I saw the explosion 50 metres away, but we had to carry on and couldn’t assist” – Simon had to listen to the screams and calls for medics over the radio as he advanced. Other incidents from this time have also stayed with him, many that he’s reluctant to talk about even today.

Leaving the Army the following year he found himself short tempered, snappy and drinking far too much. He had fl ashbacks and recurrent nightmares, mostly about the Bosnian war graves. Referred to Combat Stress by his GP, Simon was diagnosed with PTSD in 2009, and his treatment sessions have now begun; fi nally he’s getting some normality back into this life. “I know for a fact that if I hadn’t found [Combat Stress] I wouldn’t be here today,” he says.

“I know for a fact that if I hadn’t found Combat Stress I wouldn’t be here today”

Recent Success Stories: how Combat Stress makes a differenceIt is not just Combat Stress and the services it offers that are changing, it is also Government’s approach to the whole issue of Veterans’ health and well-being, whether physical or psychological.

The future will see us all working much more closely in order to collectively ensure we meet the mental health

needs of Veterans,” says Combat Stress Chief Executive David Hill.

“This means that closer relationships will need to be developed between Combat Stress and other service providers, most notably the NHS, with whom we are already working closely in Scotland.

In order for this partnership to be extended, the Department of Health awarded Combat Stress £140,000 to embed one of its mental health nurses in each of seven NHS Trusts throughout England. More recently, the Department of Health has pledged a further £2m to enable Combat Stress to establish a 24-hour telephone hotline, improve GP training and education in terms of military-related mental ill-health, and further extend the number of Combat Stress mental health nurses within NHS Trusts.”

All at Combat Stress see this as a real turning point – particularly in the current economic climate, where funding for anything new is so hard to secure.

Amazing upgrades to the three Combat Stress treatment centres in 2010During the last year or so, all three of the Combat Stress regional treatment centres, at Hollybush House in Ayrshire, Audley Court in Shropshire and Tyrwhitt House in Surrey, have had signifi cant upgrades – with all the work at Audley Court taking place in the past 12 months. The Shropshire centre now has a new reception area and gymnasium/fi tness suite.

Meanwhile, at Tyrwhitt House, an extremely generous £3.5m donation from the Help for Heroes charity has allowed us to make substantial upgrades, all of them designed to signifi cantly improve the help we can give to Veterans in need, particularly those from the most recent confl icts. The offi cial opening is likely to be in October.

The average delay between a Veteran leaving the Armed Forces and seeking help from Combat Stress (long enough for any underlying psychological injuriesto be exacerbated)

14yearsVeteran experience:Simon, Bosnia and Iraq

Royal British Legion will fund three Community Outreach teams for three years

RAF Benevolent Fund will fund one Community Outreach team for three years

ABF The Soldier’s Charity will fund one Community Outreach team for three years

Help for Heroes donated £3.5m to allow for a new building and facility upgrades at Tyrwhitt House

8 9

Service Charities: Major Partners

l Managing rising demand – we have had a 72% increase in new referrals since 2005. Recent academic evidence suggests this demand will continue.

l Reducing time gap – it takes 14 years, on average, for a Veteran to come to us for help (see page 8 for details).

l Promoting greater awareness – we need to ensure that Combat Stress is fully integrated into cross-agency partnerships, allowing us to provide the best care for Veterans.

l Securing funding – we need to maximise our possible income from both statutory and voluntary sources.

Setting the agenda, identifying the challenges

1 Create step change – establishing a modern, fully-integrated mental health service for Veterans.

2 Achieve excellence – providing effective evidence-based treatments to produce positive, lasting outcomes.

3 Secure funding – creating the right balance between State and charitable funding.

Our primary objectives are to...

1 Roll out the fi rst phase of Community Outreach, which is to have 50% of the planned teams fully operational.

2 Build a lasting partnership with the NHS – aiming to establish formal partnership arrangements with at least one NHS commissioning authority in each functioning Community Outreach region.

3 Develop a sound evidence base by capturing assessment, treatment and outcome data electronically on all Veterans in receipt of our care during the relevant reporting period.

4 Raise £8.93m towards The Enemy Within Appeal target.

5 Submit National Specialist Commissioning bid with the aim of funding short-stay treatment for Veterans with the most complex needs.

Over the next year we will…

Funding: The ongoing challengeA constant challenge, of course, is to ensure that Combat Stress can continue to fund the increasing levels of provision that are now being demanded of us.

One highly positive development, for instance, is that the charity has now completed a year under contract with Government in Scotland. This arrangement has seen a portion of the Hollybush House, Ayrshire treatment centre’s in-patient provision being funded by the Scottish parliament, as is one of our Community Outreach teams in Scotland. At the end of this fi rst 12 months, quarterly monitoring has shown how effective the use of these public funds has been, and we’re hopeful that a similar model may become common practice in other partsof the UK.

Paul [not his real name] had what looked like a perfect life: he’d worked his way up to the role of senior manager at a global electronics company, he had a nice house, and a lovely wife and son. He was also a qualifi ed combat medic in the TA. Called to serve in Iraq in 2003, he found himself on-call 24 hours a day, working 12-hour shifts, trying his best to save every casualty – soldiers, civilians, even Iraqi prisoners. Every day there were more bodies, more injuries, more attacks: his memories from that time will

“I can honestly say that I owe my life

to that man”

Veteran experience: ‘Paul’, Iraqnever leave him. Once his vehicle was ambushed by sustained gunfi re and three rocket-propelled grenades. Paul was convinced he would die that day.

Returning to the uk, Paul wouldn’t talk about his Iraq experiences, and by 2005 had turned into, as he says, ‘a walking monster’: moody, irrational, exploding at the littlest thing. Images from Iraq would replay like a video in his head. Eventually he hit a colleague and was signed off.

On Christmas Eve 2005 he had his fi rst visit from a Welfare Offi cer from Combat

Stress, and “I can honestly say that I owe my life to that man,” he says. Diagnosed with severe PTSD and co-morbid depression, Paul went on to attempt suicide twice, lost his job, and was medically discharged from the TA. But his three Combat Stress treatment sessions a year provide light at the end of the tunnel. Now working part-time as a caretaker at the local community centre, he was recently asked, “When are you going to get a proper job?” Hearing that, he thought to himself, “I’m barely able to do this one.”

10 11

After joining the Army at 20, Steve went to Iraq in 2003. One night, in a ‘safe area’ protected by Challenger II battle tanks, he heard an explosion on one of the tanks. Trained as a medic, Steve raced to the burning Challenger and treated two wounded survivors. But two crewmen were still missing. His boots melting, he mounted the burning vehicle and continued to search. But all he found were body parts, which he bundled up in his poncho and took to the field morgue.

Later, in Basra, he was again in the wrong place at the wrong time, on this occasion chasing an armed robber. “He stopped and shot at me with his pistol,” says Steve, “but unfortunately for him he wasn’t a particularly good shot, and I was. I hit him four times. The thing that stays in my head is his puppy-dog eyes as I watched him bleeding out.”

At first Steve didn’t think these incidents had affected him, but later, on holiday in Greece with the lads, he was suddenly beset by emotions. “It was like waves crashing over me,” he says. “I didn’t know if I wanted to cry, curl up in a ball, or lash out. So I went back to the hotel room and put my fist through the door.”

Steve left the Services, but in civilian life things didn’t get much better until, after a fight at work and feeling suicidal, he was offered private counselling with a woman who’d worked with the emergency services. Feeling out of her depth, she put him in touch with Combat Stress.

Steve underwent Eye Movement Desensitisation & Reprocessing (EMDR) therapy, one of the most effective trauma-focussed approaches Combat Stress uses to treat PTSD. Developed in the last 20 years, EMDR often works well with Veterans who have disturbing thoughts, feelings or flashbacks. By inducing rapid eye movement while the patient reflects on the distressing event, its negative associations can be reduced.

“It sounds bizarre,” Steve admits. “You think ‘how can that work?’ But it does. I did a 40-minute session for the tank incident and another one a week later for the chap dying at my feet. In under an hour you go from crying, and feeling tight in the chest, to being able to talk about it calmly.”

Steve no longer has to visit Combat Stress regularly, and life is good, with a job, a steady relationship and plenty of interests. “You can never be cured,” he says, “because the things you’ve seen and done are there in your head. I like to think of memories as being like books in a library; if I feel the wrong book is falling open I can pick it up, close it and put it back on the shelf.”

Veteran experience: Steve, Iraq

“I like to think of memories as being like books in a library; if I feel the wrong book is falling open I can pick it up, close it and put it back”

Buys a week of diagnosis and assessment at one of our short-stay treatment centres

£2.1k

Funds 12 ‘Just for Us’ support group meetings for partners, carers and loved ones

£5.4k

Funds a Veteran’s annual treatment and care at one of our short-staytreatment centres

£12.6k

Delivers our Community Outreach service nationwide for one week

£52.5k

How your support can make a difference…

Covers the annual cost of a bed in one of our short-stay treatment centres

£109.5k

Successes this financial year

1 Strategic partnership established with Ministry of Defence and the Department of Health.

2 Joint partnership with the Royal British Legion in the Department of Health’s ‘Third Sector Strategic Partner Programme’.

3 Successful launch of The Enemy Within Appeal.

4 Secured media partnership agreement with The Daily Telegraph.

5 Contract started (1 April 2009) between Scottish Government and Hollybush House.

6 Scottish Government agrees to fund one Community Outreach team in Scotland.

7 Six Community Outreach teams funded and now fully functioning.

8 Increased media coverage (print only) equivalent to £3.5m of advertising.

9 Tyrwhitt House and Audley Court score ‘Excellent’ with The Care Quality Commission. Hollybush House awarded similar rating by The Care Commission for Scotland.

A Sustainable Future

Due to increasing demand for our services from;l the growing number of potential Veteransl a desire to intervene earlierl the need to reduce the 14-year time gap,Combat Stress has had to transform its services to make them more responsive, efficient and effective. We are working hard to effect the right balance between State and charitable funding to best meet these needs.

Our position in the UK as the focal point for, and leading provider of, Veterans’ mental health services is recognised by the Governments of the UK and Scotland. We are working in partnership with them to shape and deliver the best possible mental health care for Veterans.

We also seek to maintain longstanding working partnerships with many Service charities. In particular, the RAF Benevolent Fund, ABF The Soldiers’ Charity and The Royal British Legion who have all made commitments to The Enemy Within Appeal, and Help For Heroes who have funded a £3.5m upgrade of Tyrwhitt House, our short-stay treatment centre in Surrey.

In a wider sense we continue to be sincerely thankful and extremely grateful to all of our donors, be they institutional or individuals, but the funding requirement is not diminishing, and without your help we could not be where we are today. It is certain that we will need to continue to ask for your contributions for us to help the Veterans of tomorrow.

During 2009/10 the following success milestones were achieved…

We are constantly thrilled and impressed by the efforts of our supporters to raise money for Combat Stress.

12 13

INCOMING RESOURCESIn pursuing the key objective of delivering mental health care to Veterans, the Society raised funds in six major areas.

2010 2009 £000s £000sClinical & Community Outreach services 4,454 4,318Donations & events 5,443 4,489Legacies 1,170 862Service charities 1,276 716Investment income 195 362Other 7 10 12,545 10,757

Income from the Veterans Agency to fund the cost of treatment and travel for qualifying war pensioners is vital to the Society and amounted to £3.1 million (2009: £4.2 million). The Scottish Government contributed £1.2 million (2009: Nil) to the cost of Veterans resident in Scotland attending Hollybush House.

Resources expendedNo. of active Veterans registered 4,381No. of new contacts 1,303Net increase in active Veterans registered 398

Residential treatmentNo. of treatment centres 3No. of admissions for treatment 2,581Days of treatment delivered 24,087Percentage occupancy 80.5%Cost of treatment £7,353,000

40% of the cost of treatment was met from charitable sources after taking account of funding received from the Veterans Agency, the Scottish Government, local authorities and other fees.

Community Outreach servicesCost of Community Outreach Services £1,719,000No. of regions 14No. of visits made to all Veterans 5,900

Statement of Financial Activities for the year ended 31 March 2010 Unrestricted Restricted Totals Totals funds funds 2010 2009 £’000s £’000s £’000s £’000sIncoming resources from generated funds:Voluntary incomeDonations 3,386 - 3,386 3,631Legacies 1,170 - 1,170 862Service charities 1,276 - 1,276 716Capital appeals - 1,281 1,281 313 5,832 1,281 7,113 5,522Activities for generating fundsFundraising events and trading 776 - 776 545Investment income 195 - 195 362 971 - 971 907Incoming resources from charitable activitiesClinical services 4,442 - 4,442 4,306Community Outreach services 12 - 12 12 4,454 - 4,454 4,318Other incoming resourcesOther income 7 - 7 10 7 - 7 10Total incoming resources 11,264 1,281 12,545 10,757

Resources expended:Activities for generating fundsCost of generating voluntary income 923 - 923 620Fundraising trading 249 - 249 131Investment management fees 29 - 29 27 1,201 - 1,201 778Charitable activitiesClinical services 6,235 - 6,235 5,855Community Outreach services 1,719 - 1,719 1,240Treatment centre maintenance & improvements 789 329 1,118 1,267 8,743 329 9,072 8,362Governance costs 133 - 133 216Total resources expended 10,077 329 10,406 9,356Net incoming/(outgoing) resources before transfers 1,187 952 2,139 1,401Transfers between funds - - - -Net incoming resources/(resources expended) 1,187 952 2,139 1,401Net gains/(losses) on investment assets 1,338 - 1,338 (930)Actuarial (losses) on defi ned benefi t pension scheme (1,567) - (1,567) (929)Net movement in funds 958 952 1,910 (458)Fund balances brought forward at 1 April 13,995 - 13,995 14,453Fund balances carried forward at 31 March 14,953 952 15,905 13,995

Balance Sheet at 31 March 2010 2010 2009 £’000s £’000sFixed assetsTangible assets 6,931 5,718Investments 6,122 4,593 13,053 10,311Current assets 5,337 4,252Less current liabilities (1,397) (746)Defi ned Benefi t Pension Scheme Asset/(Liability) (1,088) 178Net assets 15,905 13,995Funds:Unrestricted fundsGeneral fund 7,509 6,556Investment revaluation reserve 948 -Defi ned benefi t pension scheme surplus/(defi cit) (1,088) 178Designated funds 7,584 7,261Restricted funds 952 -Total funds 15,905 13,995

These summarised accounts are not the Society’s statutory accounts and may not contain suffi cient information to allow for a full understanding of the fi nancial affairs of the charity. For further information the full annual accounts, the Auditor’s report on these accounts and the Trustees’ annual report should be consulted. Copies of these can be obtained from the Ex-Services Mental Welfare Society, Tyrwhitt House, Oaklawn Road, Leatherhead, Surrey KT22 0BX.

RAH Nunneley, Honorary TreasurerRegistered Company No 256353 Registered Charity No: England & Wales 206002, Scotland SC038828

Summarised Financial Statement

RESERVESThe Society operates on the basis of a long-term commitment to Veterans. The general reserve at 31 March 2010 was £7,509,000 – equal to 8.4 months expenditure. The trustees are aware that the general reserve is not at the desired level of 18 months, but continue to address this and the operating needs of the Society through prudent fi nancial management.

Designated reserves represent the funds invested in the fi xed assets of the Society, and also include funds set aside for specifi c purposes.

Independent Auditors’ statement to the Trustees of the Ex-Services Mental Welfare SocietyWe have examined the summarised fi nancial statements of the Ex-Services Mental Welfare Society.

This statement is made solely to the Trustees of the Society, as a body in accordance with the terms of our engagement. Our work has been undertaken so that we might state to the Trustees those matters we have agreed to state to them in this statement, and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Trustees of the Society for our work, for this statement, or for the opinions we have formed.

Respective responsibilities of Trustees and AuditorsThe Trustees are responsible for preparing the summarised fi nancial statements in accordance with the recommendations of the charity’s Statement of Recommended Practice.

Our responsibility is to report to you our opinion on the consistency of the summarised fi nancial statements and Trustees’ Annual Report.

We also read the other information contained in the Annual Report and consider the implications for our report if we become aware of any apparent misstatements or material inconsistencies with the summarised fi nancial statements.

Basis of opinionWe conducted our work in accordance with Bulletin 1999/6 “The auditors’ statement on the summary fi nancial statements”, issued by the Auditing Practices Board for use in the United Kingdom.

OpinionIn our opinion the summarised fi nancial statements are consistent with the full fi nancial statements and the Trustees’ Annual Report of the Ex-Services Mental Welfare Society for the year ended 31 March 2010.Kingston Smith LLPChartered AccountantsRegistered AuditorsLondon

Incoming resources

£12,545,00035.4% Clinical &

Community Outreach services43.4% Donations & events

0.1% Other

70.8%

16.1%

11.5%

1.6%

Resources expended

£10,406,000

Clinical services

Fundraisingactivities

CommunityOutreach services

Governance

35.4%

43.4%9.3%

10.2%

9.3% Legacies

10.2% Service charities

1.6% Legacies

14 15

WWW.COMBATSTRESS.ORG.uk

We are extremely grateful to all our supporters, including:

Combat Stress, Tyrwhitt House, Oaklawn Road, Leatherhead, Surrey KT22 0BXRegistered Charity Number: 206002 Charity Number Scotland: SC 038828 Company limited by guarantee: Registration Number 256353

01372 587000

Patron His Royal Highness The Prince of Wales KG KT

GCB OM AK QSO PC ADC

President General Sir Reddy Watt KCB KCVO CBE

Vice Presidents Mr Dennis BaileyAir Vice-Marshal Nigel Baldwin CB CBE

General Sir Edward Burgess KCB OBE

Lieutenant General Sir Roderick Cordy-Simpson KBE CB

Air Chief Marshal Sir David Cousins KCB AFC

Vice Admiral Sir Geoffrey Dalton KCB

Commander The Lord Effingham RN

Dr Charles Goodson-Wickes DL

Brigadier Charles Grant OBE

General Sir Charles Huxtable KCB CBE

Lieutenant General Sir John kiszely KCB MC

Dr Paddy Linehan MD BCh FRCGP MRCS DCH

D(Obst) RCOG

Air Marshal Ian Macfadyen CB OBE FRAeS RAF

The Lord MoonieSurgeon Captain Morgan O’Connell RN

FRCPsych

The Rt. Hon. Sir Malcolm Rifkind KCMG QC

Derek Twigg MP

Major General Sir Evelyn Webb-Carter KCVO

OBE

Air Marshal Sir Robert Wright KBE AFC FRAeS

FCMI

His Grace The Duke of Westminster KG CB

OBE TD DL

Chairman: Major General Peter Currie CB

Honorary Treasurer: Mr Richard Nunneley

Board of Trustees Mr Robert Bieber JP

Air Commodore Oliver Delany OBE MBA FCIPD

FCMI FBIFM

Mrs June DromgooleMrs Jenny Green OBE

Ms Helen Pernelet Mr Adrian Pollitt OBE

Mr Trevor Royle MA FRSE

Mrs Christine SterbaDr Suzy Walton BSc MSc PhD CDir CPsychol CSci

AFBPsP FRSA

Colonel Robert Ward RM

Professor Simon Wessely MA BM BCh MSc MD

FRCP FRPsych F Med Sci

Executive Team Chief Executive: Wing Commander David Hill MSc BSc (Hons)

RMN FInstLM RAF (Retd)

Director Finance & Administration: Mr Ray Salmons MSc FCIS

Director Medical Services: Wing Commander Walter Busuttil MB ChB

MPhil MRCGP MRCPsych

Director Strategy Policy & Performance: Lieutenant Colonel Peter Poole MBE

Director Fundraising & Communications: Mr Robert Marsh BSc MSc

Director of Operations: Mrs Paula SmythDeputy Director Human Resources: Miss Natalie Styles MSc MCIPD