Suicide in the Military
LOUISE MERCIER-JOHNSON
© 2014 FrontLine Defence (Vol 11, No 1)

The level of concern about mental health in the Canadian Forces has spiked in recent months after a series of military suicides – up to eight by the end of the holiday season: LCol Stephane Beauchemin (Limoges, Ontario); Cpl Camilo Sanhueza-Martinez (from Kingston Ontario), retired Cpl Leona MacEachern (from Calgary, Alberta); MCpl Sylvain Lelièvre (3rd battalion Royal 22nd Regiment of Valcartier, Quebec); WO Michael McNeil (found at CFB Petawawa, Ontario); MCpl William Elliott (a decorated veteran who died at home near CFB Shilo, Manitoba); Cpl Adam Eckhardt (a Belleville native serving with PPCLI in Suffield Alberta); and MBDR Travis Halmrast (from Lethbridge, Alberta). The question being asked, even in the House of Commons, is whether this is a coincidence or an impending crisis.

Despite progress and efforts by the CF, multiple barriers remain for servicemen and women to get the help they need. Inevitably, the question being asked is: why aren’t these soldiers asking for, or getting the help they need? What is wrong?

Even within the most tightly knit communities you can’t always recognize the signs or know how people are coping. The families and communities are left wondering why these soldiers lost hope. What was the final straw? Was it a bad deployment experience? A series of deployment traumas? Returning to a failed or failing marriage? Money problems? Drugs or alcohol? Lost relationships with children? Or any combination of, or all of the above?

When a buddy “quits”, those remaining are left to struggle with feelings of frustration and guilt over not recognizing it or not being able to change the outcome. What could they have done differently? Could they have stopped it?

The answers aren’t obvious
The issues are institutional, cultural and, in part, about education.  As a community, the military is a cross section of the Canadian cultural landscape and, as such, is a parallel “universe” or “society”.  An important question is whether the military medical community is keeping pace with its civilian care providers.  However, this is not exclusively a military issue, the challenges of providing sound mental health care also exist in provincial health care systems.

In Ontario the issue of suicide further escalated over Christmas following the death of Christopher Peloso, husband of former Ontario deputy premier George Smitherman. There have been calls for a national suicide prevention strategy, something that does not currently exist in Canada.

Peloso had suffered from depression, however, mental illness and depression are not the only factors that come into play. Tim Wall, executive director of the Canadian Association for Suicide Prevention, highlights the importance of recognizing the complexities of suicide and its many contributors.

“One of the things we think is important in a national suicide prevention framework or strategy is addressing the issue of psychological trauma and that there be both regional and national efforts to promote trauma-informed approaches to health care, to mental health, to suicide prevention,” he said. “We know that there is a very strong link between trauma and suicide, and if we’re serious about preventing suicides, we have to be serious about addressing head-on the issue of psychological trauma.”

Many continue to mourn the loss of some of our youngest members of society who have succumbed to trauma. Daron Richardson daughter of Senators Hockey coach Luc Richardson, and Jamie Hubley, the son of City of Ottawa Councilor Alain Hubley, are tragic examples of such complexities.

Introduced in Parliament by Conservative MP Harold Albrecht, the Federal Framework for Suicide Prevention Act received Royal Assent in December 2012. It requires the government to develop a federal framework for suicide prevention in consultation with relevant non-governmental organizations, provincial and territorial entities, and federal departments. Health Canada and the Public Health Agency of Canada have a mandate to produce a progress report for Parliament by 2016.
 
The framework is meant to provide guidelines for public bodies to improve awareness and practices to prevent suicide and publicize current statistics about suicide and its risk factors.

It’s unknown at this time how federal departments like DND will contribute to this Federal Framework, but as a parallel society, the awareness and practices to prevent suicide need to be reinforced. However, to those dealing with real issues and attempting to support veterans, so far this is all talk. But, ironically, talk is what is needed.

Mental Health Resources
The issues that are raised are plentiful and, despite current budget cuts, the CAF has attempted to make as many of the programs, services, and health professionals available. There is specialized training for the leadership, and there are multiple Mental Health Resources available that members can access for support and attention. They are briefed regularly, and most leaders have shown clear signs that they understand the importance of promoting this culture change, but so many still fall through the cracks; more must be done.

Other injured veterans are struggling with bureaucratic red tape and regular upheaval in their care, and may also be affected by a lack of resources, or moving resources. Being transferred multiple times from one case worker to another means restarting a program over and over without making progress. The frustration grows.

Obstacles to Seeking and Providing Help
According to the CF website that provides access to information about mental health, “CAF members like many civilians are reluctant to admit to having a personal problem. For many there is often a stigma associated with seeking help. Some view it as a sign of weakness. For others there is the fear that seeking help will negatively impact on their career.” The leadership within the CF rank and file needs to be aware and accept that these issues are normal post combat states and not necessarily superficial discipline problems, or cause for release. In fact, the fear of being released causes some members not to seek help or self identify.

From the perspective of the soldier, sailor or airman, the stigma of asking for help matters. Who wants to self identify? Who wants to be that guy who asks for help with PTSD? Their first concern is admitting a weakness, and the first question by the unit will be one of trust. Can you do your job? Can you be relied on in a moment of stress? But in truth, it’s the other distractions that come with PTSD that coworkers struggle with. The late arrivals, the surly attitudes, the seeming lack of ability to take responsibility, or the ongoing negativity that seems to surround the PTSD member like a cloud, or their inability to engage.

The “system” provides almost no training to identify issues, and much of the treatment options are left to the member to initiate and self identify. As the DND Web site states: “Unfortunately, without self-identification, this sometimes means that problems escalate to the point where they get out of hand and ultimately do end up damaging the member's career. It is important for supervisors to create a work place climate that encourages service members to come forward and access the services available to them.” The creation of this new work place climate is a challenge when old school management styles collide with new school military members.

Emerging Buddy Systems
More and more peer-to-peer systems are starting to emerge to complement the institutional support services. Two Canadian veterans of Afghanistan began a social media campaign “to encourage their fellow soldiers to get in touch with buddies from battles gone by and ensure no one is unwell, slipping into depression or heading toward suicide.”

Master Cpl. Jordan Irvine initiated a campaign called “Send Up the Count”, made public by Sgt. Brian Harding of the Cameron Highlanders of Ottawa. This program encourages deployed Vets to reach out to each other.

Send Up The Count was named after a military command given on patrols to have each soldier in turn reach out and tap the soldier in front and announce their presence. This is not meant to double check with soldiers already in treatment, but to reach out to those who may or may not be part of the system, 2-3 years or even 5 or 6 years after deployment. Everybody is in touch with somebody.

The RCR is initiating a Veteran Care Cell, coordinated by Sgt Renaud out of Petawawa, Ontario, where they are working at reaching out to all the deployed soldiers, regular and reserve, serving and retired, to keep in touch, and again, to ensure those who deployed have a presence, a contact, with someone who “gets it” and can relate.

Changing an organizational culture is a slow process, but the culture within the military leadership must continue to fortify a foundation of understanding that a mental combat injury as important as a broken back or a seared leg.

Progression System
The change in culture must also extend to Veterans Affairs, where services are being reduced or pushed over to Services Canada. However, the key change to effect is the bureaucratic mindset that looks at enterprise-wide options and seems to regularly forget that at the end of the bureaucratic trail are real people with real problems, for whom delays of 9-12-18 months lead to desperation.

A real option for consideration is a revamped system that ­creates a blended interdependent system for progressing between the military, Veterans Affairs and the provincial health care systems. The Service Canada approach is being criticized as a “cut spending at all costs” focus.  According to Minister Shea of PEI, they have “taken a Veterans Affairs employee who is well-versed in veterans’ programs and put them at Service Canada in Charlottetown, so that’s one point of contact. There are many points of service, many ways that veterans can access service.”

This move is indicative of changes to the Veterans Affairs delivery model, where a VAC employee will be made available to assist veterans looking for services. A toll-free number and website are also available for at-home access, and if home visits are necessary, they too will happen, Shea said.

“I know that change is always difficult, but you know, governments have to change things all the time because we have to respond to the need and it’s our job to spend taxpayers’ money as efficiently as we can.”

The difficulty seems to be the sense of abandonment felt by retired service members who are in need of services. Bundling Veterans Services with Social Insurance Number applications and tax questions sends a message that the Veteran in need of assistance is simply a number in a queue.  This approach also doesn’t provide a series of cohesive services that military professionals can engage easily after completing their military service. A system without an advocate is daunting, regardless of whether you’re in modest or desperate need.

The good news is the leadership example of General Tom Lawson, the Chief of the Defence Staff. In a CTV interview in December 2013, he publicly announced: “Although suicide is an international public health concern for an ­organization built on leadership, built on camaraderie, and built on strength, it hits us especially hard. We have an expert health-care system to support us, but in order for us to help each other, it’s essential that all military personnel, like all Canadians, recognize mental health issues as they develop.”

General Lawson is absolutely correct. Support needs to come from every part of the community; the military alone cannot change the culture of stigma attached to mental health, but the military also needs a health care system that transitions more effectively into the various provincial systems that are aligned and coordinated with offerings from Veterans Affairs Canada.

The various grassroots movements, military and civilian, including Send Up the Count and Do It For Daron, are all about sending the right message for our military and our community: inspire conversations, raise awareness, transform mental health – and help make mental health in our entire community a priority.

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Louise Mercier is a senior defence associate at Hill + Knowlton Strategies.
© FrontLine 2014

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