Special Reports
A Long Road to Recovery: Battling Operational Stress Injuries
December 2008
Letter to the Minister
November 12, 2008
The Honourable Peter G. MacKay, P.C., Q.C., M.P.
Minister of National Defence
Major-General George R. Pearkes Building
13th Floor, North Tower
101 Colonel By Drive
Ottawa, Ontario K1A 0K2
Dear Minister MacKay:
Please find enclosed six copies of our special report entitled A Long Road to Recovery: Battling Operational Stress Injuries: Second Review of the Department of National Defence and Canadian Forces’ Action on Operational Stress Injuries. This report was previously submitted to you on September 2, 2008. This report is submitted to you pursuant to paragraph 38(1)(b) of the Ministerial Directives respecting the Office of the Ombudsman.
With the re-submission of this Report to you, we will be publishing the report no sooner than 28 days from the date of this letter. As in the past, we will advise your Office of the exact date that we intend to publish.
We look forward to receiving your response to our recommendations.
Yours truly,
Mary McFadyen
Interim Ombudsman
c.c.: Mr. Robert Fonberg, Deputy Minister
General Walter Natynczyk, Chief of the Defence Staff
Enclosures (6)
Introduction
…the data we have so far from these four- to six-month detailed screening follow-ups suggest that about 27% of people coming back [from Afghanistan] have some difficulties. The vast majority, about 16%, have hazardous drinking behaviour. So more than half of that 27% – 16% of the total deployed – show hazardous drinking behaviour. But an important number of people are struggling with more serious mental health issues, depression and post-traumatic stress disorder being the two most notable.
Brigadier-General H.F. Jaeger, Surgeon General, Canadian Forces Appearance before the Standing Committee on Public Accounts, January 31, 2008.
On February 5, 2002, the Ombudsman for National Defence and the Canadian Forces published his findings related to post-traumatic stress disorder (PTSD) in Canada’s military. In his special report, entitled Systemic Treatment of CF Members with PTSD, he concluded that post-traumatic stress disorder was a very serious problem for hundreds – if not thousands – of members of the Canadian Forces. He also found that the military’s approach to mental health injuries was inadequate and that the organization was not treating individual members who suffered from it appropriately.
When the Ombudsman released his report, he provided 31 recommendations to the Department of National Defence and the Canadian Forces aimed at helping them to identify and treat post-traumatic stress disorder in the military. These recommendations addressed a wide range of issues, including the need to: track, on a national basis, members affected by these serious injuries; establish awareness, education and training programs across the Canadian Forces; determine the most effective ways of helping members returning from deployment reintegrate into family life; accelerate efforts at standardizing treatment for affected members; deal with the stress and burnout amongst caregivers; improve support programs for the families of members diagnosed with post-traumatic stress disorder; and create a senior position, reporting to the Chief of the Defence Staff, and responsible for coordinating mental health initiatives across the Canadian Forces. The Ombudsman also made a commitment to assess the implementation of these recommendations with an investigation to conclude nine months after the release of this initial report.
In December 2002, the Ombudsman released a follow-up report, which indicated that a number of new programs had been put in place to deal with post-traumatic stress disorder and other operational stress injuries. The report also highlighted a significant increase in the level of awareness of these mental health injuries. Unfortunately, the Ombudsman also found that little progress had been made in the areas of outreach and training, the collection of data, and the overall level and effectiveness of leadership and coordination at the national level regarding post-traumatic stress disorder and other operational stress injuries. He also found that negative attitudes towards these injuries remained widespread and that the required change in culture was slow to non-existent. In releasing this report, the Ombudsman made a commitment to continue to monitor this issue.
This second follow-up report is intended track the progress made by the Department and the Canadian Forces in implementing the office’s previous recommendations related to post-traumatic stress disorder and other operational stress injuries. In some cases, where the organization did not implement a recommendation exactly as presented, Ombudsman investigators assessed the degree to which National Defence and the Canadian Forces have addressed the intent or spirit of that recommendation.
This follow up also highlights some new and evolving problems that have been uncovered by Ombudsman investigators during their review of the status of previous recommendations – most notably, the lack of services and support available to military families – and provides several recommendations for improvement.
As part of their second follow up, Ombudsman investigators conducted more than 360 individual interviews with current and former Canadian Forces members suffering from post-traumatic stress disorder or other operational stress injuries, as well as a number of military families, staff of Military Family Resource Centres, management and staff of Operational Trauma and Stress Support Centres, professional caregivers, all levels of the military chain of command, staff of key programs and groups such as ‘Return to Work’ coordinators, Service Personnel Holding List coordinators and the Directorate of Casualty Support and Administration. Investigators also met with staff at Veterans Affairs Canada and conducted an extensive review of all relevant documentation, policies, procedures and programs within Canada’s military.
As a result of this work, Ombudsman investigators found that the Department of National Defence and the Canadian Forces have made progress over the past six years in addressing many of the issues and challenges related to post-traumatic stress disorder and other operational stress injuries. The office was pleased to learn, for example, of the organization’s intention to hire an additional 218 mental health professionals by the end of March 2009. In general, the findings made by Ombudsman investigators during this second follow up confirm the Chief of the Defence Staff’s testimony in June 2008 at the Standing Committee on National Defence that the military “healthcare system is meeting the vast majority of patient needs.”
However, investigators also found evidence to substantiate the Chief of the Defence Staff’s assessment that the system is not perfect. Indeed, investigators found – and the office is aware of – a number of individual cases where military members and/or their families were not treated fairly by the Canadian Forces or, for a variety of reasons, did not get access to the care and treatment that they so desperately needed. The consequences for individuals who fall through the cracks are often devastating and long lasting. Although the Department and the Canadian Forces have made progress in identifying, preventing and treating post-traumatic stress disorder and other operational stress injuries within Canada’s Defence community, it is clear that more needs to be done.
Most notably, Ombudsman investigators found that 18 (out of 31) recommendations from 2002 – particularly those dealing with broader issues of leadership, governance, data collection and monitoring – have not been fully implemented to the satisfaction of the Ombudsman’s office. The office believes that this has hampered the overall coordination of efforts and consistency of care received by military members across the country suffering from post-traumatic stress disorder or other operational stress injuries. This must change.
At the same time, Ombudsman investigators found that the negative stigma associated with post-traumatic stress disorder and other operational stress injuries remains a real problem at a number of military establishments across the country. Indeed, mental health caregivers from every region in Canada raised this as one of the biggest challenges still facing the Canadian Forces. Although a number of training and education programs have been created to help bring about culture change associated with these serious mental health injuries, it is clear that more is required. It is also clear that stronger leadership at the local level is needed at certain military establishments.At the same time, Ombudsman investigators found that the negative stigma associated with post-traumatic stress disorder and other operational stress injuries remains a real problem at a number of military establishments across the country. Indeed, mental health caregivers from every region in Canada raised this as one of the biggest challenges still facing the Canadian Forces. Although a number of training and education programs have been created to help bring about culture change associated with these serious mental health injuries, it is clear that more is required. It is also clear that stronger leadership at the local level is needed at certain military establishments.
One of the 2002 recommendations addressed the inflexibility and delay in the bureaucratic processes by which a Canadian Forces member can move from one occupational group to another. It was evident in the original investigation that the Canadian Forces was losing dedicated, trained and operationally experienced members who were capable of continued service if allowed to transfer to another occupation. During this second follow up, Ombudsman investigators found that, although the Canadian Forces had accepted the original recommendation, no real progress has been made in making the process of occupational transfers less complicated and more responsive to the needs of members suffering from post-traumatic stress disorder or other occupational stress injuries.
A lack of resources (including an insufficient number of caregivers) and caregiver burnout were also major concerns for the Ombudsman in 2002. The anticipated addition of 218 mental health professionals by the end of March 2009 may finally begin to address these significant shortcomings.
In assessing the overall status of recommendations made in 2002, Ombudsman investigators also found new and evolving areas of concern. Clearly, the environment in which Canada’s military has been operating in recent years has changed dramatically. With the mission in Afghanistan, the level and intensity of combat operations have increased substantially. And, as noted by the Surgeon General in January 2008, a significant number of soldiers are returning from overseas deployments suffering with mental health issues. In addition, with the high operational tempo, the transformation initiative, the emphasis on recruitment and retention, and the introduction of a number of other priorities in recent years, it has also become evident that the Canadian Forces and Canadian Forces members are strained almost to the breaking point. Given these factors, the Ombudsman’s office believes that the need for a robust system focused on identifying, preventing and treating post-traumatic stress disorder and other operational stress injuries is even higher today than it was in 2002. Furthermore, knowing as we do that post-traumatic stress disorder and other operational stress injuries can, and often do, manifest over a number of years, the need to have a knowledgeable and supportive military culture in place will only grow over time.
It is also apparent now – in a way that was not necessarily evident in 2002 – that the challenges and difficulties associated with post-traumatic stress disorder and other operational stress injuries are not restricted to military personnel alone. Through their work, Ombudsman investigators found that family members of an individual who sustains a mental health injury on deployment also suffer with a variety of problems. They may suffer indirectly as a result of having to care for the military member. They may develop stress-related mental health problems themselves. Or the dynamics within families may be adversely affected. Family members may also suffer from the stress of having a Canadian Forces member on a dangerous deployment, whether or not that military member himself or herself suffers an operational stress injury. Regardless of the problem, the Ombudsman’s office believes that the Department and the Canadian Forces must do more to assist and support military families.
The overriding aim of this second follow-up report is to answer the basic question: Are Canadian Forces members who suffer from post-traumatic stress disorder or other operational stress injuries being diagnosed and getting the care and treatment they need so that they can continue to be contributing members of Canadian society – either within the Canadian Forces or as civilians? Unfortunately, the answer is that some members are not. In some cases, injured soldiers, sailors, airmen and airwomen who have served their country with courage and dedication are slipping through the cracks of an ad hoc system.
Given the very dangerous and demanding nature of the current mission in Afghanistan, it is clear that post-traumatic stress disorder and other operational stress injuries will become an even greater challenge for the Canadian Forces – and a real hardship for Canada’s soldiers, sailors, airmen and airwomen – for many years to come. In many respects, this will be a generational challenge for the Department, the Canadian Forces and the Government of Canada as a whole.
