Message from the Ombudsman (September 17, 2012)

Ombudsman Releases Special Report, Fortitude Under Fatigue

I am very pleased to release today our latest special report, Fortitude Under Fatigue: Assessing the Delivery of Care for Operational Stress Injuries that Canadian Forces Members Need and Deserve. This is our 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, we concluded that the Canadian Forces has made considerable progress in implementing our office’s previous recommendations and addressing shortcomings in its identification, prevention and treatment of operational mental health injuries. Of the 16 recommendations made by our office in our 2008 follow-up report, A Long Road to Recovery, and our 2008 Petawawa case study, we found that the Canadian Forces has met, partially met or is in the process of meeting 12. Of the remaining recommendations, two were found to be inconclusive, one was not met and one was considered no longer applicable.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 our previous recommendations, our report also highlights a number of broader findings from the investigation. Most notably, we 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. We 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. We 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.
 

I am 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. At the same time, 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 and their immediate family members.
 

In terms of the major shortcomings, we 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. We 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, we 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.
 

In Fortitude Under Fatigue, we 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.
 

We were equally critical of the limited performance measurement regime in place to track and report on the effectiveness of the Canadian Forces mental health system. As a result of our investigation, we 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.
 

In our report, we 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 ensure that Canadian Forces members suffering from a mental health injury are cared for appropriately. For example, we call 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.
 

We also stress 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. 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. Therefore, we are calling 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 complete list of our findings and recommendations, and additional information on our report, can be found on the office’s website at: www.ombudsman.forces.gc.ca.
 

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