The Road to Mental Readiness (R2MR) program is part of the Canadian Armed Forces (CAF) Mental Health Services. This ongoing training is embedded into every stage of a member’s career, including deployment. The goal is to mentally prepare military personnel for the challenges they may face and to develop resilience. A survey revealed that suicide rates among military personnel using this program were lower than those of the general population. How important are mental health programs for the CAF? How effective has this program been? What are the implications of a move towards digital health records? FrontLine commissioned Dr Nicola Davies to investigate these questions.
The R2MR is a training program developed primarily to increase resilience, well-being, and performance in demanding environments such as war and civil unrest. The program is also intended to improve mental health literacy among military personnel, mitigating any possible long-term mental health problems for CAF members and their families.
As Lieutenant Colonel Suzanne Bailey, architect of the R2MR program explains, “Over the past several years, our knowledge of the brain, and what happens when confronted with stress, has dramatically increased. As we gain a clearer understanding of what happens physiologically, we gain more knowledge about what strategies and skills can be utilized in controlling arousal and improving performance. These same skills that improve performance, also increase resiliency and may then decrease the chances of suffering long-term stress injuries. The benefits of resilience training are numerous and are readily applicable to a wide variety of military contexts.”
There are three types of R2MR training: (1) Career Cycle; (2) Deployment Cycle; and (3) Family Members. The R2MR Career Cycle Training improves mental resilience from recruitment onwards. Every advancement in a CAF member’s career brings new challenges and stress, and so the Career Cycle is tailored for each level individually, and is continually being built upon. Resiliency in basic military training involves setting goals, visualization, self-talk, arousal control, and acceptance, as well as identification of the stages in the Mental Health Continuum Model (MHCM).
The MHCM is a four-stage spectrum ranging from green (healthy and adaptive coping), yellow (reacting and mild, reversible distress), orange (injured or persistent impairment), and red (clinical disorder requiring medical attention). In primary leadership training, these concepts are expanded to include mentoring and training as well as leader actions required in response to the MHCM. Resilience in advanced leadership training further builds upon these foundations and also includes stress exposure training.
The Deployment Cycle of the R2MR program is designed to help soldiers identify challenges and understand the possible impact they may have. They are taught to understand stress reactions and develop and apply strategies to reduce the impact of those challenges. Finally, they are advised when external support should be sought. These concepts are covered during the Pre-Deployment Training. During Post-Deployment Training, soldiers learn about the common challenges of re-integration, as well as strategies that may help to overcome them. They will learn to identify external sources of support, as well as the various stress reactions that are likely to require such support. They also learn to recognize barriers to seeking care and how to overcome such barriers.
An important part of the R2MR program is the involvement of Family Members in the well-being of CAF members. While deployment is unquestionably difficult for personnel, their families are also deeply affected by it. Over the years, they will encounter extended separations; feel concern for the safety of their loved ones; spouses may be required to raise children as (essentially) single parents for intermittent periods of time; and the whole family must later cope with the stress of reunion.
Although seldom recognized in the past, deployment can have detrimental effects on family dynamics if the impact is not adequately understood or managed. The R2MR program recognizes this and aims to help family members adjust to the military lifestyle. Family members are also, more often than not, most affected by any mental distress that may result from deployment. However, this also places them in the best position to notice any subtle changes in personality and demeanour that may indicate deeper psychological problems requiring professional support. Troubling symptoms that may require help include physical aggression, severe mood changes, thoughts of suicide, risk-taking behaviour, hyper-vigilance, and excessive drug or alcohol use.
Recent data of personnel post-deployment indicates that 8-12% develop mental health conditions as a direct result of experiences during deployment. When asked what impact the R2MR program has on troops, Col Bailey explains, “The CAF is now seeing evidence that the R2MR training is having a positive effect on our deployed personnel. Evaluation over a period of six years has demonstrated increased understanding of mental health and coping strategies that can be used on deployment, increased confidence in ability to identify members at risk for mental health issues and connect them with appropriate resources, and increased understanding of common transition and reintegration challenges and why they occur.”
The CAF has noted that certain commands that were consistent with a heavy operational tempo, such as combat exposure, have resulting mental health concerns and higher suicide rates. The Canadian Forces Expert Panel on Suicide Prevention concluded, in a 2010 report, that training to enhance resiliency has strong common-sense appeal because of the significant adversity faced by soldiers, particularly when deployed on a difficult operation.
“The R2MR program highlights situations that may contribute to suicidal ideation and behaviour, such as relationship dissolution, as well as legal and disciplinary problems,” notes Bailey. “Throughout all phases of the training, CAF members are sensitized to the possible indicators of suicidal behaviour, the types of situations that may increase suicidal risk, and actions that peers and leaders can take to intervene with a colleague who may be at risk of suicide.”
While R2MR is an effective mental resiliency training program, there is currently no measurable criteria to definitively determine its impact on suicide rates within the CAF. Furthermore, no consistent relationship has been established between deployment and the risk of suicide in the CAF as yet. However, all CAF members undergo mental health screening as part of their pre-deployment medical assessment. Deploying members also undergo a psychosocial screening by either a chaplain or mental health professional.
“The CAF is working towards a formal way to measure the success of the Road to Mental Readiness Program. However, comments from soldiers who have been on tour and have received [this] training suggest that the program does indeed help them,” says Bailey. “We have also noticed a trend toward earlier care seeking for mental health distress.” The recent CAF Mental Health Survey conducted by Statistics Canada indicates that help seeking behaviour among CAF personnel has increased significantly in the past decade.”
The 2013 independent mental health data was collected by Statistics Canada for the Canadian Armed Forces Mental Health Survey in order to determine how the CAF mental health system is meeting the needs of the CAF members. The report provides valuable information on the mental health of the CAF members that will help ensure that resources are targeted and allocated appropriately, and that programs and services are meeting the unique needs of military personnel.
Founded in 2006, Soldier On aims to empower members of the Canadian Forces who have visible – or non-visible – illness or injuries to accept their ‘new normal’ by adopting an active lifestyle through participation in physical, recreational or sporting activities. The organization is supported 100% by donations from Canadians.
“The CAF is committed to further research into mental health and providing our members with the best services available. The CAF has partnered with a number of civilian mental health research facilities, notably the Canadian Institute for Military and Veteran Health Research and the Royal Ottawa Health Group,” Bailey assures.
The CAF has started to implement Mental Health Notes, a new function that will be part of the existing military electronic health records known as the Canadian Forces Health Information System. So, what impact will a move to digital health records have on the program and its efficacy? Bailey explains that “with the phased implementation of Mental Health Notes, clinicians will be able to enter patient data directly into the system and have clinicians, anywhere in Canada or deployed locations, view assessments and results immediately in a secure and confidential manner.”
Mental Health Notes is a program enhancement that will improve data availability and directly benefit the mental health care of servicemen and women using it. Bailey says CAF members will be “better served” by Mental Health Notes, “especially as they move geographical locations throughout their careers, including deployments both within Canada and abroad.” Mental Health Notes will ensure that attending physicians have instant access to the most current medical records of each CAF member, furthering a soldier's confidence in Health Services.
Even though there is no conclusive data on the efficacy of the CAF’s mental health program, which includes the R2MR program, its importance has been recognized by a number of organizations, including NATO allies and civilian organizations. It has also been adapted for use by agencies such as the Royal Canadian Mounted Police and the Calgary Police Force. Its robust approach to mental health care, its stigma reduction initiatives, its mental health research, and its mental health training and awareness programs are considered invaluable resources.
Members of our uniformed services, both military and civilian, regularly face extreme personal danger and very negative elements. Nurturing the mental health of those who are placed under tremendous emotional strain while performing their duties is clearly a vital concern for the whole of society. Removing the stigma of mental health issues and providing adequate education on the symptoms and potential treatments is an enormous step towards ensuring mentally prepared and resilient personnel. Perhaps the most important aspect of the CAF’s mental health program, is the involvement of family and friends – no person is an island and everyone needs the support and encouragement of those they love the most.
Dr Nicola Davies is a psychologist and writer with an interest in the psychology behind frontline work
© 2015 FrontLine Defence