Ombudsman Finds Progress and Outstanding Issues in the Canadian Forces’ Handling of Operational Stress Injuries


Ottawa, September 17, 2012 - The Ombudsman for the Department of National Defence and the Canadian Forces, Mr. Pierre Daigle, today released a special report, entitled Fortitude Under Fatigue: Assessing the Delivery of Care for Operational Stress Injuries that Canadian Forces Members Need and Deserve. This special report is the office’s third follow-up evaluation of the Canadian Forces’ ability to respond to the challenge of post-traumatic stress disorder and other operational stress injuries.

Following an extensive, ten-month investigation, including interviews with nearly 500 individuals across the country, the military Ombudsman concluded that the Canadian Forces has made considerable progress in implementing the office’s previous recommendations and addressing shortcomings in its identification, prevention and treatment of operational mental health injuries. Of the 16 recommendations made by the office in its broader 2008 follow-up report, A Long Road to Recovery, and its 2008 Petawawa case study, the Ombudsman found that the Canadian Forces has met, partially met or is in the process of meeting 12 of them. Of the remaining recommendations, two were found to be inconclusive, one was not met and one was considered no longer applicable.

In addition to assessing the status of the office’s previous recommendations, Fortitude Under Fatigue highlights a number of broader findings from the investigation. Most notably, the Ombudsman found that the Canadian Forces’ mental health care capability has evolved over the past decade from an ad hoc system to one that is structured to deliver integrated, holistic care for Canadian Forces members suffering from post-traumatic stress disorder and other operational stress injuries. The Ombudsman recognized the role and commitment of senior military leadership in the expansion and evolution of the military’s mental health structure between 2002 and 2012. He also recognized the professionalism and dedication of mental health caregivers as the most critical element in the overall functioning of the mental health care system.

 “Following our investigative work, I was pleased to see that care and treatment for Canadian Forces members suffering from an operational stress injury has improved since 2008 and is far superior to that which existed in 2002,” stated Mr. Daigle. “Unfortunately, the Canadian Forces’ mental health care system continues to suffer from significant shortcomings, which are seriously affecting the care and support provided to those suffering an operational mental health injury,” added the Ombudsman.

In terms of the major shortcomings, the Ombudsman found that a persistent shortage of qualified mental health care personnel is the largest impediment to the delivery of inclusive, high-quality care and treatment to Canadian Forces members suffering from mental health injuries. In this most recent follow-up, he noted that, while the Canadian Forces should be employing approximately 447 mental health practitioners, its mental health personnel strength has never extended beyond 380 and has not grown at all since 2010. Moreover, the Ombudsman found that the shortfall in the caregiver community at several military bases where the operational stress injury challenge is most acute was even greater than the persistent national shortfall of 15-22 percent.

 “Although the overall Canadian Forces mental health system has improved and is functioning, it is doing so largely because of the professionalism, passion and dedication of the Department of National Defence and Canadian Forces mental health providers,” stated the Ombudsman. He added, “They continue to deliver quality frontline care, despite being severely overburdened.” 

In Fortitude Under Fatigue, the Ombudsman also expressed frustration that the Department and the Canadian Forces continue to ignore a critical recommendation from the office’s 2002 and 2008 special reports: the creation of a national database that would accurately reflect the number of Canadian Forces personnel who are affected by stress-related injuries.

The Ombudsman was also critical of the extremely limited performance measurement regime in place to track and report on the effectiveness of the Canadian Forces mental health system. As a result of the investigation, he found that the mental health capability in the Canadian Forces has not undergone recurring, qualitative system-wide performance measurement over the past ten years, despite this being one of the institution’s top priorities and despite the tremendous money, time and energy that has been invested in the mental health system.

Given the chronic shortage of mental health caregivers and the lack of qualitative performance measurement, it was not possible to evaluate the appropriateness of the overall funding allocated to the operational stress injury imperative or whether or not the current mental health structure is sufficiently robust to meet the requirement.

 “I am troubled that the Canadian Forces still does not have an appropriate system in place to provide a current and consistent portrait of the number of members affected by post-traumatic stress disorder and other operational stress injuries,” said Mr. Daigle. He added, “How can the institution know if it has in place the most appropriate priorities and resource levels to manage its broader operational stress injury initiative when their data is incomplete and their research is not focused on measuring performance?” 

In his special report, the Ombudsman also documented outstanding concerns associated with the extensive outsourcing of treatment that is taking place in the military health care system, as well as the inability of the Canadian Forces to maintain a current national understanding of the scope of the operational stress injury challenge.

In releasing Fortitude Under Fatigue, the Ombudsman made six recommendations to help position the Canadian Forces to address future challenges related to post-traumatic stress disorder and other operational stress injuries and to ensure that Canadian Forces members suffering from a mental health injury are cared for appropriately. For example, he calls for an innovative recruiting campaign to increase the number of health care practitioners, the implementation of systemic performance measurement of the operational stress injury program, a holistic re-evaluation of the Canadian Forces’ operational stress injury capability, and consideration of a more modern application of the principle of universality of service.

In his recommendations, the Ombudsman also stressed the importance of maintaining a concerted focus on providing care and support for those suffering from post-traumatic stress disorder and other operational stress injuries. He noted that, despite the Afghanistan draw-down and government-wide fiscal constraints, it is unlikely that the Canadian Forces’ mental health challenge will subside for many years to come. The Ombudsman called for extreme caution in any future considerations regarding a reduction in resources or programs delivering care and support to Canadian Forces members suffering from an operational stress injury.

A respected Canadian Forces member with over 20 years of distinguished military service put things into perspective when he pointed out that ‘soldiers don’t break themselves,” stated the Ombudsman. He added, “Canada and Canadians must remain committed over the longer term to helping those who have sacrificed so much for our country.” 

A complete list of the findings and recommendations, and additional information on the Ombudsman’s report, can be found on the office’s website at:


For additional information, please contact:
Michelle Laliberté
Senior Communications Advisor
Office of the National Defence and Canadian Forces Ombudsman
Tel: (613) 995-8643

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