This is an excellent article and given that it is very recent, it also shows the support that is available in Canada.
Operational Stress
BG–08.003 - July 2, 2008
The great majority of Canadian Forces (CF) personnel, approximately 85%, returning from deployment will not have to deal with any mental health issues. Some members, however, will have experienced symptoms of operational stress.
Overseas deployments expose CF personnel to events that can cause psychological injury. Modern terms for the different kinds of operational stress are Post Traumatic Stress Disorder (PTSD) and Operational Stress Injury (OSI).
The concern of CF Health Services for those personnel who suffer from operational stress is twofold: to understand the problem as clearly as research and mental health care practice can reveal, and to provide the best possible medical care, with the objective of recovery to complete health.
The CF has a stronger mental health system than ever before, which is designed to ensure that personnel with PTSD/OSI get high-quality treatment when they are ready for it.
PTSD
Post Traumatic Stress Disorder (PTSD) is an anxiety disorder. Other anxiety disorders are phobia, panic disorder and obsessive-compulsive disorder.
PTSD is not an exclusively military phenomenon, and it is experienced by people regardless of their vocation or workplace. It is caused by an experience in which serious physical harm or death occurred or was threatened. This includes the serious harm or death of a friend or colleague, the viewing or handling of bodies, exposure to a potentially contagious disease or toxic agent, and the witnessing of human degradation (such as sexual assault).
PTSD is a complicated disorder with a wide range of symptoms:
The Canadian Mental Health Association estimates that one in ten people suffers from an anxiety disorder. Many CF members dealing with PTSD have developed the disorder as a result of non-military traumatic experiences such as accidents, assaults and natural disasters.
- panic or anxiety (sweating, increased heart rate, muscle tension)
- mood swings, irritability, sadness, anger, guilt, hopelessness and depression
- withdrawal or difficulty expressing emotion; loss of interest in previously enjoyable activities; loss of intimacy
- a preoccupation with the traumatic experience in the form of daydreams, nightmares and flashbacks
- difficulty concentrating, disorientation and memory lapses
- disturbed sleep or excessive alertness (sometimes called hypervigilance)
- erratic behaviour (in an attempt to avoid reminders of the traumatic experience)
- alcohol or substance abuse.
CF personnel experience of PTSD is, however, coloured by factors that do not always apply outside the realm of military operations. These include isolation from home and loved ones; unfamiliar or hostile populations and climates; extended periods of medium- and high-level stress; and, in many cases, the inability to leave the source of the stress.
PTSD AND THE CF
A post-deployment questionnaire completed by 6,383 personnel in April 2008 showed that since their return from Afghanistan three to six months previously, 4.4% had experienced symptoms of PTSD and 4.6% had experienced symptoms of major depression, for a total of 6.5% PTSD and/or major depression (an overlap in the numbers resulting from the fact that some personnel had experienced symptoms of both disorders). PTSD and major depression are closely associated.
Diagnosis of PTSD is complicated by the fact that it is not uncommon for a person who has the disorder to experience another anxiety disorder or a physical ailment at the same time.
Diagnosis of PTSD requires that a person experience significant impairment in functioning and that this impairment persist for over a month.
OSI
An Operational Stress Injury (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. It re-characterizes these conditions as injury, which is more in keeping with current thinking. OSI is not a legal or a medical term. Unlike PTSD, it is a strictly military term, used by Canada and NATO.
PREVENTION
Primary prevention of mental health problems is in its infancy as a field. There is extensive ongoing research into understanding the root causes of stress disorders and “resilience,” or resistance to their effects. This research will guide the continued development of CF prevention programs. CF Health Services has identified several ways to reduce the risk of personnel experiencing service-related mental injuries.
There are programs in place to enhance the self-help skills of CF personnel. These initiatives cover healthy living, stress management, anger management, addiction awareness and family violence prevention.
For those personnel deploying on stressful operations and missions, good mission preparation and training is critical. This includes education on stress-coping skills, unit cohesion and social support, and awareness of the potential effects of stress. Training is realistic and is designed to bolster confidence in both individual and team capabilities.
Personnel undergo a mental health screening as part of their pre-deployment physical assessment. Deploying personnel also undergo a psychosocial screening by either a chaplain or a mental health professional.
Canadian soldiers about to return to Canada after a lengthy deployment are required to experience a five-day decompression stop on the way home (commonly called Third Location Decompression, or TLD). At the TLD site, each member has the opportunity to speak with a mental health professional privately and to raise concerns that they may have at that time. Personnel are educated about PTSD/OSI. The mental health team provides information about home, work and community life back in Canada in order to make reintegration less stressful.
The CF screening and reintegration policy requires that all personnel returning from an international operation of 60 or more days duration undergo the Enhanced Post-deployment Screening Process between 90 and 180 days after their return to Canada. This screening is meant to better identify those with deployment-related problems, with a particular focus on psychological problems. The CF member completes a detailed health questionnaire and has an in-depth interview with a mental health professional. The interviewer completes a form recording a clinical impression and a recommendation for follow-up care. Regular periodic medical check-ups continue the mental health assessment of the CF member.
TREATMENT
CF Health Services, in conjunction with military and civilian partners, is researching treatment options for stress disorders. At present, treatment of PTSD/OSI typically involves a combination of medication and psychotherapy.
The CF maintains numerous sites for treatment of PTSD/OSI.
The first point of contact for most CF personnel who are experiencing mental health problems is the primary care physician at one of the CF Medical Clinics. This person will either provide the required assistance or refer the member to the most appropriate resource. In the case of an emergency, personnel can access a physician during daily sick parade.
Mental Health Programs, specialized mental health services, are available at the larger CF bases. Elements of these programs will be available at smaller bases depending upon population size and local resource availability. Psychiatrists, psychologists, social workers, mental health nurses, addictions counsellors and Health Services chaplains normally staff the multidisciplinary teams of the Mental Health Programs.
Operational Trauma and Stress Support Centres (OTSSCs) located across Canada employ a mixed military and civilian staff of psychiatrists, psychologists, social workers, mental health nurses and chaplains. The OTSSCs use a multidisciplinary treatment model to provide assessment, educational outreach, treatment and research. In addition to providing direct service to CF personnel, these centres are involved in consultation with other treatment facilities around the world, and in reviewing the professional literature on trauma, stress and PTSD/OSI. There are five centres: in Halifax, N.S.; Valcartier, Que.; Ottawa, Ont.; Edmonton, Alta.; and Esquimalt, B.C.
Veterans Affairs Canada (VAC) operates six operational stress injuries clinics to serve veterans, members of the CF and former RCMP officers who have suffered OSIs as a result of their service. The clinics are located in Fredericton, N.B.; Montreal and Quebec City, Que.; London, Ont.; Winnipeg, Man.; and Calgary, Alta.
In 2004, the federal government committed $98 million to implement the CF Mental Health Initiative. These funds will permit the hiring of 218 additional mental health practitioners, for a total of 447, by March 2009.
SUPPORT
Mental health professionals have reached a new understanding of the importance of community support for those diagnosed with a stress disorder. In keeping with this, CF Health Services has been working on strengthening social support systems for CF personnel dealing with the effects of operational stress.
CF personnel in need can call a 1-800 number at the Member Assistance Program, 24 hours a day, from anywhere in the world, for a confidential referral to someone who can help them. The program provides external, short-term counselling for members seeking assistance outside military health services. Family can also receive treatment through the program if this would influence the member’s well-being. Reserve Force personnel and their families have access. The program is civilian-based in that it uses professional counsellors provided by the Employee Assistance Services of Health Canada, but it is funded by the CF.
The Operational Stress Injury Social Support program (OSISS) provides peer support and family counselling to PTSD/OSI sufferers. OSISS also works to reduce the stigma attached to those suffering from PTSD/OSI through formal presentations and other communications tools. A joint CF-VAC initiative, the program was founded by a group of CF veterans.
The DND-VAC Centre for the Support of Injured Members, Injured Veterans and Their Families (“The Centre”) combines the efforts of DND, the CF and VAC to provide services to ill and injured personnel, veterans and their families. One initiative at the Centre, the Transitional Assistance Program, assists medically released CF personnel in making the transition from military to civilian employment.
The National Operational Stress Injuries Centre in St. Anne de Bellevue, Que., contributes to close cooperation between the CF and VAC medical staffs, particularly for cases governing the transition of releasing CF personnel to civilian status and the continuity of their care. The centre provides assessment, treatment, prevention and support services to currently serving personnel, veterans and their families who are suffering from mental health problems related to operational stress.
The Military Family Resource Centres located at all major CF bases can make information available on a wide range of subjects of interest to military families, including mental health. Staff at these centres can direct family members in greater need to appropriate service providers.
