For the Record
Suicide is a public health issue and, therefore, the CAF monitor suicide rates and mental health issues throughout its entire population in order to determine trends and mitigate risks.
Suicide rates for serving Regular Force male personnel have remained consistently lower when compared to those of the Canadian population since 1995 when we began closely tracking the rate. This could be explained by the fact that CAF personnel undergo health screening prior to enrolment and during their service, are fully employed in an organization with strong and engaged leadership, and have ready access to comprehensive mental health care. Reserve Force suicides are also tracked and investigated. However, due to the nature of the part-time service, Reservists, who are often embedded in local communities where they receive their health care and sometimes make limited contact with their unit, the CAF cannot be certain that all suicide deaths are reported to the CAF. Additionally, the low rate of suicide among female CAF personnel makes the numbers statistically insignificant and difficult to compare as a rate per 100 000 over time. Therefore, Regular Force male suicides are the most accurate to report and provide the best insight into the impact of suicide on the CAF population.
Wait times for mental health care
In general, medical wait times in the CAF are much shorter than in the civilian medical system. Walk-in or crisis assessments are treated the same day, usually within one hour of arriving at the base clinic. The target for a psychosocial assessment is two weeks, while the target wait time for both general mental health assessments and assessments at the Operational Trauma and Stress Support Centre, is four weeks.
Strategies have been put in place to ensure members are properly and medically supported as needed until the specialist assessment appointment. The referring primary care provider can build in clinical support such as more frequent appointments or seeing another clinician within the primary care team. Appointments can also be made with a clinician from psychosocial services until the assessment date. The CAF also has the flexibility to refer patients to pre-screened and pre-approved mental health clinicians in the community.
Hiring of mental health practitioners
The Canadian Forces have approximately 400 full-time mental health workers and more than fifty applicants are currently in the hiring process to fill additional positions. The Department of National Defence and the Canadian Armed Forces are committed to the recruitment of psychiatrists and other mental health professionals to meet the needs of CAF members requiring these services. Canada as a whole currently faces a shortage of healthcare providers and the CAF must compete with the private sector for psychiatrists and other medical professionals. The CAF takes all opportunities to recruit psychiatrists and mental health professionals, including the use of a contracting firm, advertisements online and in trade journals, recruitment at conferences such as the annual Canadian Psychiatric Association conference, and working collaboratively with the Canadian Medical Association and the Royal College of Physicians and Surgeons.
Each suicide death in the CAF is investigated. When the CAF is made aware of a suspected suicide, an initial medical record review is conducted immediately. When the responsible civilian coroner has determined that the death is the result of a completed suicide, Canadian Forces Health Services initiates a Medical Professional Technical Suicide Review.
A Medical Professional/Technical Suicide Review is conducted by a team of health professionals who were not directly providing care to the member. The objectives of the suicide review process are to identify potential opportunities for enhanced suicide prevention and to provide more detailed and reliable information for the CAF’s suicide surveillance system. The findings have provided greater insight into suicide in the CAF, and into how to enhance the high quality of mental health care the CAF provides.
A Board of Inquiry is also convened in cases where the cause of death is determined to be from self inflicted means. Normally, the motivating factors that led to the event are among the issues examined during this process. The Chief of the Defence Staff shares the concerns of the Minister of National Defence regarding the number of outstanding Boards of Inquiry, and the CDS has stood up a dedicated team whose sole objective is to finalize all outstanding Boards of Inquiry within six months.
Release of CAF members
The goal of mental health treatment is to return the patient to optimal health and to retain the patient to service in the CAF. For some, however, return to service in the CAF may not be in their best interest due to the nature of the military operations and a career within the civilian workforce may be more beneficial to their recovery. CAF members are transitioned to civilian life only when necessary, and then only when they are found to be mentally and physically prepared to do so. Additionally, they are provided with significant support through case managers to plan and access appropriate re-training, return to work, compensation, benefits and other services which help to make the transition to civilian life as stress free as possible.
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