Veterans: the Next Battle
RICHARD BRAY
© 2013 FrontLine Defence (Vol 10, No 4)

After a decade of combat in Afghanistan, some Canadian veterans who suffered psychological injuries are still fighting to get the help they need to recover. More than three thousand Canadian Forces personnel who served in Afghanistan since 2001 may be suffering from Post Traumatic Stress Disorder (PTSD), according to a study published this summer in the Canadian Medical Association Journal. Of the 30,000 CF members who served before 2009, nearly 14% will or are suffering some form of mental disorder and 8% have or will experience symptoms of PTSD.

The Canadian Forces Ombudsman’s 2012 report, Fortitude Under Fatigue, found a considerable gap between the capability and the actual capacity to deliver Operational Stress Injury (OSI) care. That gap exists suggests the Ombudsman, because the military health care system is severely understaffed. “The impact this has had on the frontline delivery of care, treatment and support to CF members with PTSD and other OSIs and their families has been ­profound”, stated the report.

The Ombudsman’s report determined there is a caregiver manning shortfall of up to 22% for the “steady state mental health requirement” and that there is “poor situational awareness of strategic and functional leadership of the magnitude of the OSI imperative as it evolves”. In particular, the report criticized an “ad hoc approach to systemic qualitative performance measurement” – in other words, suggesting the CF does not know how effectively it is managing Operational Stress Injuries because it does not consistently collect and assess such statistics. The report concluded that: “In the absence of a more fully staffed capability, and the ability to qualitatively validate its effectiveness in providing the care that CF members suffering from PTSD and other OSIs need and deserve, DND/CF strategic leadership cannot know for certain whether the current funding level attributed to mental health care is sufficient.”

The issue of medical care for Canadian Forces members with Operational Stress Injuries (OSI) is beginning to make headlines. The general population doesn’t understand or care about the distinction between military doctors of the Medical Services Group (who provide medical care to deployable members of the Forces), and the public servants in the Joint Personnel Support Units (who coordinate care and support from civilian sources for those who cannot yet perform their military duties). All they know is that our soldiers are in trouble and we are letting them down. In August, an Ottawa Citizen story called “Canada’s broken soldiers, Canada’s broken system”, quoted documents and former employees saying the JPSUs are so understaffed and under-resourced as to be ­dysfunctional.

In reply, the Chief of the Defence Staff, General Tom Lawson defended the system while validating the concern, writing “Nevertheless, as the Citizen article illustrated, challenges remain. We recognize that the number of members suffering from operational stress injuries will likely continue to increase in the short term. With this in mind, we are working hard to fill vacant public service and military positions to ensure that we have a qualified and experienced professional team in place for our members to depend on.”

The issue of Veterans care has recently reached the courtroom. A class-action lawsuit on behalf of six injured Afghanistan Veterans reminds the government it has a “sacred obligation” to them. The legal focus of the case is the government’s New Veterans Charter that replaced a lifetime pension for injured veterans with a one-time cash payment, and there are powerful, emotional issues at play. As the Om­buds­man’s report noted, “As long as the Government of Canada continues to send CF members into harm’s way in order to protect Canadians and Canadian interests, and in so doing subjects them and their families to the mental stresses and consequences of modern military operations, then it is morally obligated to provide said members and families with a significantly more responsive care capability than that of the average citizen.”

To the contrary, University of Ottawa professor Paul Robinson points to the risks in singling out one group for privileged treatment. “It may lead to a culture of entitlement, and even within our democratic system it may become difficult to challenge the group in question. Canada does have a great obligation to its veterans, but not a ‘sacred’ or unconditional one,” he wrote.

The military leadership has worked to meet its obligations to members and veterans with mental health issues. Between 2002 and 2012, the CF’s mental health services underwent what the Ombudsman calls a “dramatic expansion” to meet the needs of solders with Post Traumatic Stress Disorder and Operational Stress Injuries – virtually doubling the numbers of mental health practitioners and support personnel.

General Lawson made it clear that the 350-member JPSU staff and its $19 million budget would be sheltered from any budget reductions, but it is clear that the status quo is not nearly enough.

The Ombudsman’s report forcefully makes the point that as of September 2012, while the CF’s capacity to meet the PTSD/OSI challenge is functioning, “it is doing so largely due to the determination and commitment of the mental health providers who continue to deliver quality frontline care despite being severely overburdened and operating in difficult professional environments.”

Many cases of PTSD or OSI can take years to develop to the stage where sufferers recognize the need to come forward, meaning pressure on Canada’s mental health resources will probably increase rather than decrease, as veterans of Canadian missions seek help to cope with the psychological injuries they ­sustained.

If history is a predictor of future commitments, Canada may feel international pressure to field expeditionary forces again soon. Beyond the political implications for the federal government, the treatment of mental health injuries could have a serious impact on the future of the Canadian Forces. Recruiting will undoubtedly suffer if prospective soldiers weigh the difference between the whole-hearted commitment the military demands from them against half-hearted support from the country they serve.
 
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Richard Bray is the Senior Writer at FrontLine Magazines.
© FrontLine Defence 2013 issue 4

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