The Military Mental Health Continuum Model


[Start of video]

[Fade in to Sergeant (Sgt) Shawn Clarke, speaking to the camera]

[Sgt Shawn Clarke: ] The way that I came up through the army … it was, you know, mission before self, you do what it takes, you get the job done and that’s it. No questions. No nothing. Suck it up. Do the job. You know, and the I’ve been thinking that way for so many years and you know doing what needs to be done so, I mean, I come back from this last deployment after doing everything I’ve done, time to get back to work. Let’s get it done. Suck it up, carry on, solider on, whatever you want to say and I can’t.

[Fade in to Lieutenant-Colonel (LCol) Stéphane Grenier, speaking to the camera]

[LCol Stéphane Grenier, Operational Stress Injury (OS) Special Advisor : ] We used to see mental health issues or operational stress injuries as a black and white thing. You were either sick or you were healthy. If you were healthy, the chain in of command employed you and deployed and when you were sick, you were sent to the clinic.

[Switch to slide: Old View of Health]


Old View of Health
Healthy (green)Sick (red)
Chain of Command Responsibility Medical Responsibility


[LCol Stéphane Grenier: ] We used to look at things in shades of green or red according to this particular model.

[Fade in to Sgt Robert Dolson, speaking to the camera]

[Sgt Robert Dolson : ] From my experience before the tour, and mental health, I knew how people got treated, you know, I was an infantry sergeant, you know. I was on that end of how people got treated. I was one of those guys who went “Mmm… whatever”, you know, so…. or “Is he faking it?” You know….that’s always the big worry and I was maybe worried that maybe someone would think I was…you know, just faking it.

[Fade in to Sgt Shawn Clarke, speaking to the camera]

[Sgt Shawn Clarke : ] So, there’s shame, embarrassment, failure, you know and those are the things that for me kept me away from going to see a doctor to get help.

[Fade in to Captain (Capt) Brian MacPherson, speaking to the camera]

[Capt Brian MacPherson : ] I sort of thought there may be something wrong but I was still going to work, I was still doing my job and I thought I was still doing a good job. So because I had nothing to compare it to I didn’t know what someone with PTSD would look like. I’d never met anybody. I had no idea what it looked like so I had a very bad image of what someone with a mental health problem would look like.

[Fade in to Lieutenant-Commander (LCdr) (retired) Owen Parkhouse, speaking to the camera]

[LCdr (ret.) Owen Parkhouse : ] And I never had the time to really sit back and think about all the experiences that I had been through in my career and it kept on piling up and it was like a messy desk in my head and the things were not filed and then finally it just hit.

[Fade in to Sgt Shawn Clarke, speaking to the camera]

[Sgt Shawn Clarke : ] Now I realize it’s real, you know, it happens to all kinds of people.

[Fade in to LCol Stéphane Grenier, speaking to the camera]

[LCol Stéphane Grenier : ] The Canadian Forces developed a new way to look at mental health issues in cooperation with the U.S. Marine Corp.

[Image (US Marine Corps USMC Logo) appears beside LCol Stéphane Grenier]

[Fade in to LCol Stéphane Grenier, speaking to the camera]

[LCol Stéphane Grenier : ] This new model allows for a better, broader understanding of mental health conditions and it’s not all about black or white or green or red.

[LCol Stéphane Grenier : ] We’ve inserted two segments in between there, the yellow part is more of an early detection part where somebody is reacting, the equivalent of having a bad day.

[Display slide beside LCol Stéphane Grenier: Mental Health Continuum Model]




Mental Health Continuum Model
HEALTHY (green)REACTING (yellow)INJURED (orange)ILL (red)
Chain of Command Chain of Command Chain of Command Chain of Command
Health Services Health Services Health Services Health Services

[LCol Stéphane Grenier : ] The orange part, a little more serious, but as you can see the model now offers the movement from left to right, right to left. Doesn’t mean that you’re having issues and you’re having a difficult time that you are not going to go back into that green zone.

[LCol Stéphane Grenier : ] Now along that continuum, the chain of command always plays an important role. No longer do we need to see things in black or white ....meaning that the chain of command needs to stay involved at every step. Keep this model mind and keep referring to it while you watch this video.

[Display slide full screen: Mental Health Contiuum Model]

[Fade to LCol Stéphane Grenier]

[LCol Stéphane Grenier : ] The point here is that mental health conditions are really no different from physical conditions. A light ankle sprain on a morning jog may not need a robust medical intervention and the way the chain of command and your peers support you to recover from that ankle sprain is instrumental. So you’ll go back to the shacks, put some ice on it or you’ll go back home, stay off your leg for a couple of days and then you’ll recover.

[Display slide full screen: Mental Health Contiuum Model, voice over LCol Stéphane Grenier]

[LCol Stéphane Grenier : ] Mental health conditions are a little bit of the same. Early intervention works. The way the chain of command and your peers support you is instrumental in that recovery and shifting back to the left, into the green zone.

[Fade in to Major (Maj) Suzanne Bailey, speaking to the camera]

[Maj Suzanne Bailey, Social Worker : ] The model was developed using behavioral signs that somebody in an individual’s life would readily notice. So we didn’t want to use the clinical symptoms that we would find in a diagnostic manual, because to people like you and I that’s not particularly helpful. So we involved actually CF personnel, family members and a whole bunch of stake holders in developing a model that would use behaviors that are easily observable to anyone.

[Display slide full screen: Mental Health Contiuum Model, voice over Maj Suzanne Bailey]

[Maj Suzanne Bailey : ] The model goes from green which is a health phase [image jump to green block], sort of a person’s normal day to day behaviour to yellow [image jump to yellow block] which is reacting which is mild distress but reversible, to orange [image jump to orange block] which we called injured and it’s more persistent distress and it might require a little more intervention to red [image jump to red block] which is ill which would require professional or clinical intervention.

[End of video]

Recent experiences have taught us that many CAF members have physical and mental health concerns that, if identified and treated early, have the potential to be temporary and reversible. This model recognizes the spectrum of health concerns, be they mental or physical, that may impact CAF members during their careers. The model goes from health, adaptive coping (green), through mild and reversible distress or functional impairment (yellow), to more severe, persistent injury or impairment (orange), to clinical illnesses and disorders requiring more concentrated medical care (red).


The Mental Health Continuum Model. Description follows.

Directorate of Mental Health - Adapted from the US Marine Corps

The Mental Health Continuum Model

Hide: Mental Health Continuum Model: Text-Only

The Mental Health Continuum Model consists of four coloured blocks. From left to right: 1. Healthy (Green), 2. Reacting (Yellow), 3. Injured (Orange), 4. Ill (Red).

A two-way arrow goes from left to right, right to left. Within each block is the Chain of Command and Health Services.

Adapted from the US Marine Corps.

The arrows under the four color blocks denote the fact that this is a continuum, with movement in both directions along the continuum, indicating that there is always the possibility for a return to full health and functioning. In this way, no one is ‘written off’ simply because they are showing symptoms of an illness, or are being treated for a disorder or disease. There is also a recognition that the earlier that intervention of some sort is provided, the easier it is to return to full health and functioning (green).

The health and well-being of CAF members is the shared responsibility of the member, the chain of command, and the individual. Leaders are responsible for their personnel and have a vital role to play in preventing and managing distress. As the severity of the illness increases, this may result in a more robust Health Services intervention, but the Chain of Command never abdicates responsibility of the member. Leaders always have a role and responsibility to maintain contact and support their members throughout the continuum of mental health.

The actions of the chain of command also have an impact on the movement of the CAF member along the continuum. Significant life events certainly impact one’s mental health - however what is even more significant is the impact of small daily hassles that overtime can cause distress. The leader has a role in affecting the little things in day to day work life that can cause distress in their troops.

Recognizing Signs of Distress


[Start of video]

[Fade in to Sergeant (Sgt) Andrea Coté]

[Sgt Andrea Coté, speaking to the camera: ] There were plenty of signs, but I choose to ignore them. For example, when I would go driving, any time I’d get into traffic, I would start getting very nervous and very anxious and I just wanted to get out of the traffic. On time I was coming back from Home Depot, which was across town, and I actually had to stop halfway, park in a parking lot, get out of the car, go into the mall and go and sit in the bathroom to calm down. Then I got back in my car and finished driving home, because I was so anxious, I thought I was going to be sick. I had no idea at the time what that indicated, I just thought it was because I had just come home off of tour. Any time I was in a situation where there was a crowd. If I was going out to a club with friends, and all of a sudden I was caught in a crowd. I got very nervous and I had to get out and I had to leave and go stand outside for a while. And sometimes I couldn’t even go back in. Waiting in line ups, I couldn’t wait in line ups. I couldn’t do it I just got angry and frustrated and had to walk away… Many different things like this, nightmares, not being able to sleep through the night. But I just attributed it to being back off tour and I ignored it and carried on.

[Fade in to Sgt Rob Dolson]

[Sgt Rob Dolson, speaking to the camera: ] I can’t, I couldn’t go to malls, way too many people and you know, and being, having anxiety and being hypervigilent, there’s so many people you’re constantly heads turning, trying to watch all of these people, cause that’s what you’re doing over there. You know, when you’re driving through Kandahar city you’re constantly watching people. So, you know, going to malls would just be, would wipe me out. And especially having a little daughter, you know, I felt like a protector, you know, so it was really hard to do that. Driving in streets, constantly being in convoys, and, you know, Afghanistan, you got to be hypervigilent when you’re driving. Cars some close to you, you know, you got to warn them and then shoo them away. Well you can’t do that in the civilian world. You know, so it was really hard for me to be driving closed areas … A lot of anger, you know, people move out of my way because overseas people get out of your way, you know, here people don’t, you know what I mean. So it’s really hard, you know, to adjust yourself back to, you know, the civilized world, the best way I could put it, you know. And, you know, that’s where it brought up a lot of anger issues, frustration, you know, stuff like that. And my wife would be just sitting there looking at me going “what’s wrong with that guy?” You know, as like, we couldn’t go to restaurants. It was really hard for me to be in unfamiliar places. If we went to a restaurant with friends and it was a new restaurant that I hadn’t been at before it would really bother me. Cause I’d like, you know, I wouldn’t know how to, you know, I’d be looking for the door. OK that’s a safe place to get out I know how to get out if I have to get out of here, stuff like that.

[Fade in to Sgt Shawn Clarke]

[Sgt Shawn Clarke, speaking to the camera: ] My ... my Afghanistan tour was my fourth tour so I’d been through the post deployment stuff a couple of times before that. So, you know, I got home from my first tour I was 20 year old. You come home you have all of the money in the bank and you’re just so happy to be home and all you want to do is drink and party and go see your friends and have a good time. You go do that for a while and then, you know, it’s back to the routine again, back to work and then, you know, doing your day to day job. Same thing in 94, you know, I was a little older, 22 I think I was at that time when I came home from that one. Same thing, you know a bunch of money in the back, have a good time for a little while, get back to work. Came home in 2003 a little older, a little wiser, so it wasn’t so much let’s blow all my money on booze and partying this time but, you know, it was good to get home and I enjoyed being home and you know, it was just nice to be home. And then ah, when I cam home from Kandahar it wasn’t like the times I got home before - you know, I was happy to be home, visiting friends, you know, just enjoying life – when I got home from this deployment I didn’t want to see anybody, I didn’t want to do anything, I just wanted to stay at home in the dark doing nothing.

[End of video]

Here are some behavioural indicators of what you may notice in each phase of the Mental Health Continuum Model.


Mental Health Continuum Model









Mood Normal mood fluctuations; Calm & takes things in stride Irritable / Impatient; Nervous; Sadness / Overwhelmed Anger; Anxiety; Pervasively sad / Hopeless Angry outbursts / agression; Excessive anxiety / panic attacks; Depressed / suicidal thoughts
Attitude and Performance Good sense of humour; Performing well; In control mentally Displayed sarcasm; Procrastination; Forgetfulness Negative attitude; Poor performance / Workaholic; Poor concentration / decisions Overt insubordination; Can't perform duties, control behaviour or concentrate
Sleep Normal sleep patterns; Few sleep difficulties Trouble sleeping; Intrusive thoughts; Nightmares Restless disturbed sleep; Recurrent images / nightmares Can't fall asleep or stay asleep; Sleeping too much or too little
Physical Symptoms Physically well; Good energy level Muscle tension / Headaches; Low energy Increased aches and pains; Increased fatique Physical illnesses; Constant fatique
Social Behaviour Physically and socially active Decreased activity / socializing Avoidance; Withdrawal Not going out or answering phone
Alcohol and Gambling No/limited alcohol use / gambling Regular but controlled alcohol use / gambling to cope Increased alcohol use/gambling - hard to control with negative consequences Frequent alcohol or gambling use - inability to control with severe consequences


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