ARCHIVED - The Current State of Mental Health Care In the Canadian Forces

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Backgrounder / January 8, 2009 / Project number: BG–09.002

Military personnel are the most important resource of the Canadian Forces (CF). They and their loved ones deserve the best possible care and support. Over the last ten years, the Department of National Defence (DND) and the CF have put into place a full range of programs and initiatives to contribute to the identification, prevention and treatment of mental health problems such as operational stress injury (OSI), which includes post-traumatic stress disorder (PTSD).1

Now, the Enhanced Post-deployment Screening Process, a survey conducted 90-180 days after the return of deployed troops to Canada, tracks personnel experiencing deployment-related mental health problems. The CF’s five Operational Trauma and Stress Support Centres (OTSSCs) created in Halifax, Valcartier, Ottawa, Edmonton and Esquimalt in 1999 have been joined by six Veterans Affairs Canada (VAC) Operational Stress Injury clinics in Montreal, Fredericton, Quebec City, London, Winnipeg, and Calgary, which also treat currently serving CF personnel. The Operational Stress Injury Social Support (OSISS) network provides peer support, family counselling and bereavement services across the country.

On the administrative side, a Special Advisor on Operational Stress Injuries oversees the management of non-clinical matters related to OSI, such as the development of an education campaign to raise awareness and counter stigma. An Operational Stress Injury Steering Committee, which includes key senior leadership of the CF, explores innovative ways of dealing with OSI, while a DND/VAC arm’s-length Mental Health Services Advisory Committee (MHSAC) reports to the Chief of Military Personnel (CMP) and to VAC leadership on mental health issues.

Changing attitudes

The CF has learned from experience and become proactive. The CF has recognized for some time that the stigma surrounding mental illness is a leadership issue, and has been exploring ways of creating a culture of acceptance. There is evidence that initiatives developed to combat stigma are working. At a U.S.-Canada Forum on Mental Health and Productivity meeting in November 2008, the CF was praised for its success in reducing the stigma associated with mental illness, which has become a significant workforce and productivity issue in North America in general. An increase in funding last year is being used to combat stigma through the expansion of formal presentations and other communications tools. For example, the CF’s Mental Health and Operational Stress Injury Joint Speakers Bureau, a collaboration of the Special Advisor on OSI and CF Health Services, has developed a national education campaign to increase the general mental health literacy of CF personnel at all ranks and to remove social barriers to care. To date, over 8,000 CF members have received training and education through the campaign.

Supporting families

The CF recognizes the sacrifices made by military personnel and their families, and continually strives to be responsive to the stresses associated with military operations. Families of personnel with mental health concerns currently have access to a range of CF and VAC services and programs including counselling under the Member Assistance Program and the OSISS network; various support initiatives of the DND-VAC Centre for the Support of Injured Members, Injured Veterans and Their Families (“The Centre”) and the National Operational Stress Injuries Centre in Saint Anne de Bellevue, Que.; crisis intervention through the Veterans Pastoral Outreach Program; and the guidance of the more than 40 Military Family Resource Centres located at CF installations across the country, in the U.S. and in Europe. There are new initiatives under consideration to improve support to families and to better align CF and VAC services.

Coordinating care

The CF feels the need to ensure that all personnel, former personnel and their families are provided an acceptable level of care and support regardless of environment or location, through centralized command and control. With this in mind, the CF is joining forces with VAC to develop a support facility for the ill and injured and their families. Leadership has recognized that the current system of care management is complex, and that simplifying it will benefit personnel in need, as they progress through the stages of recovery, rehabilitation and reintegration into military or civilian life and employment.

Keeping track

CF Health Services has numerous means of tracking personnel with particular health issues, including OSI. To complement physicians’ records, the CF is developing a method for tracking personnel diagnosed with an OSI by one of the five OTSSCs. CF Health Services is undertaking a study that will collate information from Blue Cross referrals, human resources records, the Recruit Questionnaire and other sources to create a virtual data warehouse with multiple uses. Information obtained during the mandatory Periodic Health Assessment (PHA) of personnel and the Enhanced Post-deployment Screening survey, both of which include screening for mental health concerns, alcohol and substance abuse, depression and suicidal ideation, is also being compiled. Additionally, the CF’s Health and Lifestyle Information Survey (HLIS) collects information on physical and mental health status. The electronic Canadian Forces Health Information System (CFHIS) currently nearing completion will make possible even more sophisticated medical record keeping.

Growing the Force

The current shortage of health care providers is a concern for all Canadians. Regardless, the CF feels a strong obligation to provide high-quality health care and support to personnel dealing with illness and injury. At present, CF Health Services is over 5,600-strong, with Regular, Reserve and civilian personnel serving across Canada or deployed overseas, working out of more than 120 units, detachments and health-care centres. CF Health Services personnel maintain close professional ties with their civilian counterparts at home and abroad, ensuring that troops receive excellent care from civilian hospitals, emergency services and the community at large. The federal government has committed $98 million to implement the CF Mental Health Initiative, which will permit the hiring of over 200 additional mental health practitioners. In the meantime, the CF has implemented a range of creative interim staffing and care delivery strategies. Additional military care providers are being posted to installations with personnel issues resulting from their more remote location – such as CFB Petawawa – while neighbouring bases and urban centres are lending support as required. 

In the provision of care and support to its ill and injured personnel, the CF is far ahead of where it was ten years ago. Programs have been expanded and enriched. Leadership has increased its involvement. Military culture is beginning to change. We know that more and more commanders at all levels see a focus on mental health as an important way to keep their troops strong in the face of adversity. The system is not perfect and more needs to be done. But with a renewed commitment from the federal government and the resources to grow and develop beyond present capabilities, the CF will maintain its status as a world leader in the area of mental health.

1 PTSD is an anxiety disorder caused by an experience in which serious physical harm or death occurred or was threatened. An OSI is any persistent psychological difficulty resulting from operational duties performed in the course of military service. OSI is a more comprehensive term than PTSD; it may be thought of as an umbrella term for PTSD, other anxiety disorders and depression.

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