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Mental Health and the Canadian Forces - Recent Articles

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Bracing for war's hidden fallout

TheStar.com - Canada - Bracing for war's hidden fallout

July 13, 2009
Allan Woods
Bruce Campion-Smith

OTTAWA – Coalition troops in Afghanistan are being attacked by roadside bombs at record levels, leaving Canadian soldiers with a legacy of traumatic brain injuries that health experts are grappling to understand.

And the mental toll of having to patrol bomb-seeded roads is expected to show itself in the years ahead in a spike in the number of soldiers with post-traumatic stress disorder, military officials say.

"The view is, clearly, when you're involved with an IED (improvised explosive device), that you may have traumatic brain injuries," said Maj.-Gen. Walter Semianiw, chief of military personnel.

"If you've been exposed to a (traumatic brain injury) the prevalence of then having PTSD may be higher. The facts are very clear," he said in an interview.

"The biggest challenge is not here and today. It's in five years and 10 years. ... Are they going to get the support they need?"

As NATO forces launch offensives in southern Afghanistan, insurgents are fighting back with homemade bombs at levels never before seen in the eight-year conflict.

By the end of June, there had been 2,508 "incidents" involving improvised explosive devices this year, a 60 per cent increase over the same period last year, according to statistics from the Pentagon.

The number of coalition soldiers killed by roadside bombs rose by 21 per cent to 92 in that time – from 76. The number of wounded was up 46 per cent – 467 compared to 320.

July is shaping up to be a record month, with at least 28 coalition troops killed so far by improvised explosives. On Saturday, a roadside bomb killed two U.S. Marines. A day earlier, British officials announced that eight of their soldiers were killed in a 24-hour period.

While Canadian commanders say the bombs are the weapons of cowards, they have proven effective nonetheless, sowing fear and chaos among civilians and soldiers alike.

"I've seen people with all of their teeth gone. The explosion wrecks their feet and wrecks their ankles," said Senator Colin Kenny, chair of the Senate defence committee. "This is the visible problem. The less visible one is two or three years later when we're going to see a lot more post-traumatic stress."

The defence department's chief health concerns arising from the Afghan war are all linked to roadside bombs. The soldiers who have endured amputations – not more than two dozen – require years of recovery and rehabilitation. The other top health concerns – brain injury and mental health problems – are hidden wounds the military is struggling to understand.

"We really don't know about traumatic brain injuries," said Commodore Hans Jung, the new commander of the Canadian Force's health services.

Blast-induced brain injuries range from mild concussions to severe skull fractures and penetrating head wounds that can cause memory loss, anxiety, depression and post-traumatic stress.

The introduction of better armour and protective equipment means more soldiers are surviving explosions, but they are suffering internal injuries from the shock waves of the blasts.

In recent months, the military has put a greater focus on mental health issues. Last week, the Star reported the defence department will overhaul the way it tracks military suicides to give a more accurate accounting of the mental toll on soldiers.

Last month, a report from a Commons committee called on the military to do more to help soldiers suffering from psychological injuries. The report came on the heels of a Star investigation that found a growing problem of post-tour violence is landing soldiers in jail and their victims in hospital.

In Iraq, where the tactic of roadside bombs was first popularized, the U.S. military designated traumatic brain injury as one of the "signature" health problems. The U.S. is outfitting soldiers in Afghanistan with helmet sensors to measure the force of blasts to help diagnose brain injuries.

Jung admits "this is an uncharted territory." One of the priorities is to understand the link between a so-called minor traumatic brain injury – a simple concussion – and post-traumatic stress disorder (PTSD).

"What we know by evidence, by science – not conjecture – today is that there is a 95 per cent or more overlap between PTSD symptoms and mild traumatic brain injuries," Jung said, adding concussions and PTSD can be treated, while the truly traumatic brain injuries cause irreversible damage.

Senior leaders from both Britain and the United States warned last week of more casualties to come, due in part to bombs that are more sophisticated and deadly.

Copyright Toronto Star 1996-2009  

As a point to note, Veteran Affairs Canada is actually leading in the study fo MTBI's and how the symptoms are simmilar to PTSD.

Fairly good article.



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Healing the hidden wounds of soldiers

TheStar.com - Global Voices - Healing the hidden wounds of soldiers

July 13, 2009
Craig and Marc Kielburger

In yoga, the warrior pose represents the spiritual strength of the person performing the move.

As Lucy Cimini slowly leads her students into the posture at the Central Mass Yoga Institute, it takes on new meaning.

The men standing firm-footed with their arms outstretched are not your typical yoga students. They are warriors – actual ones, not just spiritual.

Cimini’s Yoga Warriors program, which was started for veterans of Vietnam and has grown to include those returning from Iraq and Afghanistan, uses the tenets of the meditative discipline to teach coping strategies for post-traumatic stress disorder.

“Men come out the service and they are just so stressed out,” she says. “It’s very hard to get veterans to come forward and join a group like that. When they’re in it though, they know it actually helps them.”

Help can be one of the hardest things to ask for, especially for veterans. PTSD has often held stigma in the armed forces. Historically, it was referred to as battle fatigue or shell shock before being officially recognized as an illness in 1980.

We’ve come a long way in combating that stigma since WWII, when Lieutenant General George S. Patton famously slapped a young man who wept in the hospital. But that stigma still there, and the incidence isn’t getting any lower.

It’s estimated about 20 per cent of soldiers returning from Iraq and Afghanistan suffer from the illness characterized by flashbacks, anxiety and depression. In January, the U.S. army disclosed they lost more soldiers that month to suicide than enemy fire. Britain this year launched an unprecedented suicide watch that encouraged soldiers to get help.

Asking for help in dealing with this life-altering disorder is tough enough, but actually finding care can be harder. Even though strides have been made in Canada and the United States to correct the problem, both countries suffer from a shortage of providers and compensation systems that are often difficult to navigate.

In 2007, the American Psychological Association pegged the vacancy rate for active-duty psychologists at 40 per cent. While the Army has invested more money into rooting out the problem, shortages still exists.

In Canada, an existing national shortage of psychologists, psychiatrists, mental health nurses and social workers has resulted in year-long waiting lists even outside the military for disorders relating to accidents and physical or sexual abuse.

“For every senior officer or departmental official who told us of initiatives being taken to improve military health care generally, and mental health diagnosis and treatment in particular, we heard at least one junior rank who told us the system was not working for them,” said a recent report from the House of Commons Defence Committee on the effects of PTSD. “The phrase ‘falling through the cracks’ was heard so often it lost its notoriety.”

Catching the symptoms of PTSD and depression early is essential to successfully treating and dealing with its effects. But, although emphasis is placed on preparing our troops for the physical aspects of fighting a war, the psychological aspects are often overlooked.

Cimini, whose Yoga Warriors program is currently being expanded across the United States, is now corresponding with an instructor in Iraq who could teach the art to soldiers in the field.

“What we’re trying to do is catch the combat stress and give the soldiers the tools to deal with it before they come back,” she says. While she is still discussing this expansion, the idea is the kind of initiative that could save money, distress and, most importantly, lives.

Providing adequate care to the men and women of our service is essential. But, it’s important to remember not all wounds are visible. Sometimes, it's the hidden wounds that need the most attention.

Marc and Craig Kielburger are children's rights activists and co-founded Free The Children, which is active in the developing world. Their column appears Mondays online at www.thestar.com/globalvoices

Copyright Toronto Star 1996-2009 




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Tess, FYI: Vince  now wants to set up a one hundred acre "Retreat for Emergency and Military Personnel".
He is asking for suggestions as to "What activities would you want available at the retreat." I hope he gets some horses!


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The Hill Times, July 20th, 2009
By Cynthia Münster

MPs push government to take action on PTSD in Canadian Forces

Some four per cent of Canadian Forces indicated signs of PTSD, 4.2 per cent depression, and 5.8 per cent either PTSD or depression.
The upper echelon of the Canadian Forces last month launched a national campaign to shed light on post traumatic stress disorder, but Liberal MP Bryon Wilfert says Canadian soldiers returning home from Afghanistan with operational stress injuries and PTSD, in particular, are falling through the cracks of the system and the government still hasn't officially responded to the Defence Committee PTSD report.

Mr. Wilfert (Richmond Hill, Ont.), the vice-chairman of the National Defence Committee that recently issued a report on PTSD, said that in its study the committee found there are better treatment facilities and opportunities in Western Canada than there are in Eastern Canada, and reservists are less likely to receive mental health assessments and attention than Canadian Forces personnel living on bases. He said that government should respond as soon as possible to the report in order to improve care for the soldiers.

"Clearly, there was better treatment facilities and opportunities in Western Canada than, say, in Eastern Canada for whatever reason. In part that might be because in Alberta they're closer to cities like Edmonton, whereas in Gagetown [New Brunswick] or Petawawa [Ontario] it's further away, so their facilities or support was not as good," said Mr. Wilfert.

The government has 120 days to officially respond, but a week after the committee released its report, on June 25, Chief of Defence Staff Gen. Walter Natynczyk and Defence Minister Peter MacKay (Central Nova, N.S.) launched the Canadian Forces Mental Health Awareness Campaign, following the committee's first recommendation that senior Defence and political personnel address the stigma surrounding mental health injuries in the Armed Forces.

"You're strong, you're well-trained, but guess what? We don't show weakness particularly well and therein lies the problem," Gen. Natynczyk told an assembly at DND headquarters. "We're tough and yet we won't ask for help."

"Not all injuries are visible and we have to be very open about that, to come out of the shadows to embrace the treatment of these very real injuries," said Mr. MacKay on the launch of the "Be the Difference" campaign.

The number of soldiers affected by PTSD remains largely unknown, however, the Canadian Forces have the results of 8,200 screening questionnaires. Some four per cent of the respondents indicated signs of PTSD, 4.2 per cent depression, 5.8 per cent either PTSD or depression and 13 per cent were consistent with any mental health diagnosis. These percentages were then applied to the total number of personnel deployed by the Canadian Forces in order to estimate the number of operational stress injuries the CF could expect of this mission.

Given past PTSD statistics, the report estimates that out of the approximately 27,000 Canadian Forces personnel deployed to Afghanistan since 2002, approximately 1,120 could exhibit PTSD symptoms, 1,176 depression symptoms, 1,824 could show signs of one or both conditions, and 3,640 could exhibit a mental health concern of some kind.

The report, entitled "Doing Well and Doing Better: Health Services Provided to Canadian Forces Personnel with an Emphasis on Post-Traumatic Stress Disorder," is the result of a committee study started in February 2008 and reiterates some of the recommendations and general findings of a February 2002 special report by the Canadian Forces ombudsman, and the ombudsman's subsequent follow up in December of that year.

The auditor general also looked at the military healthcare system in 2007 and issued some similar recommendations, says Canadian Forces captain Fred Doucette. Mr. Doucette wrote the book, Empty Casing: A Soldier's Memoir of Sarajevo Under Siege about his experience in Bosnia and his subsequent struggle with PTSD. He now works providing peer support to CF personnel and veterans suffering from PTSD in New Brunswick and was a committee witness. He said many of the report's recommendations are similar to those of previous reports and some of them are currently being implemented but "it may be another poke in the ribs."

"If two people tell you something's wrong and then three people, four people, you say, 'Oh, god, I better look at this,' so it's more ammunitions in the pouches of the people who are pushing for more support for the troops on the mental health side," said Mr. Doucette.

Conservative MP Laurie Hawn (Edmonton Centre, Alta.), the Parliamentary secretary to the minister of National Defence, said Canada has probably "the best system in the world" but no system is perfect and everybody, including Mr. MacKay, Gen. Natynczyk and all committee members, are on side for making the military health system "the best it can possibly be."

"We're continually making improvements, we've opened 20 joint personnel support units across the country, there's 32 military resource centres, we've got 350 mental health professionals working full time, we're continually trying to hire more, those people are hard to come by and that's not within the CDS, that's in society generally there is a shortage of those kinds of folks. So we're competing with everybody else in that regard, so it's a continuous process, we're continually looking for ways to improve it," said Mr. Hawn.

The report and campaign come at a time of increased media interest into mental health issues in the Canadian Forces and the ongoing investigation into the suspected suicide of Major Michelle Mendes in Afghanistan last April. Last week Private Sébastien Courcy was the 126th Canadian soldier to die in Afghanistan, who was killed Thursday during a firefight between NATO forces and Afghan insurgents.

According to an EKOS poll that came out last week, support for the war in Afghanistan is slipping, with a slight majority of 54 per cent of Canadians opposing the war and 34 per cent supporting it. Opposition is higher than support in all provinces and strongest in Quebec, where 73 per cent of respondents oppose the mission and 15 per cent support it. Alberta had the strongest support for the mission at 42 per cent, while 45 per cent of respondents opposed it. EKOS conducted the poll between July 8 and 14, 2009, surveying 2,713 Canadians from across the country over the age of 18. The margin of error for the survey is plus or minus 1.9 percentage points, 19 times out of 20.

Mr. Doucette said there have been many changes over the past few years, and a big difference from the late 1990s and early 2000s, when soldiers were released from service when they showed signs of psychological injury, "they weren't considered 'soldierable' anymore and they were punted," he said.

But despite increased attention and understanding, the stigma around mental illness in the Armed Forces still lingers.

"As long as soldiers have been soldiering, there's been mental stresses and problems that go with what soldiers do. A lot of people say for one physical casualty there's 10 that have a mental health injury and I think their biggest challenge is to change the atmosphere or whatever hindrance there is for those soldiers who are suffering to step forward," said Mr. Doucette.

"A lot of them won't open their mouths in fear of being judged, or maybe not being promoted, or maybe losing their job, there is a lot of unknowns that go with it so that's the biggest thing. You can create the best facility and everything, and the best support, but if they don't want to walk to it and step in and say, 'My head hurts for whatever reason,' it's not worth it," said Mr. Doucette.

Mr. Doucette also said the government needs to be building up the support system now and be ready for the soldiers coming out of this war, but also be aware that it may take a decade for PTSD signs to show so the government shouldn't slash the funds if demand is slower than expected.


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from CTV.ca

Military suicides up in 2008; top doc denies trend

The Canadian Press

Date: Wednesday Oct. 28, 2009 6:33 AM ET

OTTAWA — More Canadian soldiers killed themselves in 2008 than the year before, but the military says the overall suicide rate has remained steady throughout the war in Afghanistan, despite the obvious stresses of the mission.

Fifteen active-duty members of the military took their own lives last year -- a rate of 23 per 100,000 -- versus 11 confirmed suicides in 2007, according to newly released Defence Department statistics.

But the average rate of suicide over three years, from 2005 to 2008, was 17.9 per 100,000. Those are the years which involved the heaviest combat in Afghanistan and the highest number of troop rotations.

Surprisingly, the military does not track suicides among reservists who are filling an ever-increasing number of the positions in the battle groups that are deployed for six month rotations in Kandahar.

The figures, from the military's medical branch, come amid greater public awareness of the issue following the apparent suicide of Maj. Michelle Mendes in Afghanistan and media coverage of the growing number of cases among U.S. soldiers.

There were 128 confirmed U.S. army suicides in 2008 -- a rate of 20.2 deaths per 100,000. The U.S. Marine Corp suicide rate was 19 per 100,000.

A broadcast report last year claimed the number of suicides in the Canadian Forces had doubled, but that information was based on data that was compiled from military police logs, which included other kinds of "sudden" deaths, such as accidents.

In considering the latest numbers, the Canadian military's top doctor zeroed in on the three-year average and said Canadians appeared to be faring better than their biggest ally when it comes to dealing with the stresses of war.

Commodore Hans Jung said there are some important differences that contribute to the slightly better rate, including the fact that Canadian troops deploy for six month tours. American units serve between nine and 15 months in war zones.

"That tour length is a huge issue," the military's surgeon-general said in an interview.

Since Canadians became involved in major combat in 2006, there have been regular debates within the upper ranks of the Defence Department about extending Canadian tour lengths for battle group soldiers, but the idea has always been vetoed. Troops who serve with support elements, such as the headquarters, are deployed for longer stretches.

Jung said the invoking of stop-loss orders on U.S. soldiers, which essentially prevent them from leaving the military even though their term is up, is another factor in the higher, average suicide rate there.

Canada's military also has a superior mental health-education and support system, Jung claimed.

Part of the reason is the size.

"They're so much larger and they deploy for such a long time; I think they have higher stresses," said Jung.

The death of Mendes, a 30-year-old rising star within the officer corps, brought the question of suicide prevention within the military into sharp focus.

Specific questions about screening and whether she should have been deployed for a second tour into one of the most senior intelligence positions in southern Afghanistan remain unanswered six months after her death.

The Canadian Forces National Investigative Service has not released the findings of its probe and claimed last month it was still awaiting autopsy results from the Ontario coroner -- a report that has apparently now been delivered.

What's troubling to some opposition members is the lack of attention paid to reservists who take their own lives.

Generally, suicides among part-time soldiers are brought to the attention of the military by civilian authorities, but a plan is underway to cross-reference the names of all military members since 1972 onward to Statistics Canada's mortality database.

Liberal MP Dan McTeague, who championed the plight of wounded soldiers and reservists, said absence of such data eight years after the war started is startling and speaks to how the contribution of citizen soldiers is downplayed.

"It's a glaring omission," he said. "One would think, considering the structure of the Armed Forces and how important reservists are to operations such as Afghanistan, that there would be particular paid to their situation.

"Anybody whose been close to this mission recognizes how indispensable these guys are."

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BROKEN HEROES — We send them off to war as heroes, the men and women of the Canadian armed forces, to serve in places like Afghanistan. Now, more and more of them are returning from their tour of duty with invisible injuries. PTSD, post-traumatic stress disorder, has probably been with us as long as there have been soldiers and war, but until recently it was barely acknowledged and little has been done in this country to deal with its effects. Gillian Findlay meets three recently returned veterans of Afghanistan to hear their stories of flashbacks, depression, grief, guilt, even suicide attempts.





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Marching on the long road back

Post-traumatic stress survivor helping others now in that situation


By Kelly Egan, The Ottawa CitizenMarch 10, 2010

Ross MacDonald has come a long way since 2000, when he cried in the parking lot before speaking to a medical officer at CFB Petawawa.
Photograph by: Kelly Egan, The Ottawa CitizenOTTAWA — It was undeserved but, to this day, Ross Macdonald speaks of the shame.

It was the summer of 2000. As an infantry sergeant with The Royal Canadian Regiment, he had completed four tours of duty in seven years, led soldiers in Bosnia, Kosovo, seen his share of human misery.

He returned to CFB Petawawa to run a gunnery course, which should have been a cakewalk. "I couldn't think straight. I couldn't put the simplest of tasks together." He was, in his words, falling to pieces. Though his marriage was collapsing, he clung to the ability to "put on the dog," a military expression meaning he could still shine his boots, suck it up, and get on with the mission.

No longer. Post-traumatic stress disorder had brought him to his knees. "As soon as you walk into the medical officer in Petawawa and said the word PTSD, I knew right then my career was over. I actually sat in the parking lot for two hours, crying, before I went in to say those words."

Soldiers aren't supposed to cry, or whine, or be afraid. "I felt this intense amount of shame that I couldn't do my job."

Macdonald, now 42, began a long road back. He is well now and doing important work. More in a moment.

On Thursday, at 7 p.m., a public lecture will be held, Invisible Wounds: Recovery for Veterans and their Families, at the Royal Ottawa Mental Health Centre.

The Royal runs an Operational Stress Injury Clinic, which serves war veterans and members of the RCMP. It is also home to a peer-support group in which veterans help each other.

Post-traumatic stress disorder is a new label for an old condition: shell-shock, combat fatigue, soldier's heart.

The Vietnam War, in particular, helped sharpen attention on the malady by recognizing it as a psychiatric disorder with specific symptoms: depression, anxiety, insomnia, nightmares, abuse of drugs and alcohol, so-called hyper-arousal.

Avoidance is common. Sufferers will withdraw, develop emotional numbness and generally avoid situations that might trigger memories of trauma.

When Macdonald came back from his first six-month tour of Bosnia in 1992, for instance, he arrived at home base in Germany to find his wife and family had planned a picnic.

He was hours from the unresolved "moral injury" of his first mission. To this day, he recalls how -- even in serene surroundings -- he couldn't step on the grass, as though explosives awaited.

Years later, his wife would remark on how, metaphorically, his flak jacket never seemed to come off.

What soldiers will do, Macdonald explained, is stuff their "crap" in a mental rucksack, zip it up and hope it stays sealed.

"You can only handle so much. Eventually, my rucksack got so heavy, with personal and professional baggage, I fell over. And, like a turtle, I couldn't get up."

Kosovo, he said, was the straw that broke him. "The second my boots hit the ground, I felt this wave of depression." For the first time in his military career, he also felt scared, not a good quality in a reconnaissance sergeant in charge of young, possibly inexperienced soldiers.

When he finally reached out, Macdonald went on leave for six months. He went into therapy, was prescribed anti-depressants and anxiety medication. Things improved, but he was not nearly whole again. His sick leave stretched to two years.

In 2002, he stumbled onto a peer-support group in which veterans with PTSD tried to help each other. He had found a home.

"The most important part of that support is being among people who understand. Sometimes you don't have to say anything," Macdonald said. "When you finally meet someone who can fill in the blanks, finish your sentences for you."

The former soldier, discharged in 2003, had also found a new career.

He is now part of a National Defence unit that educates soldiers and the military leadership about stress-related injuries. The approach combines a clinician with an occupational stress survivor, like himself.

Getting over the stigma is one of the biggest barriers, but Macdonald believes much progress has been made in 10 years to demystify mental illness.

Dr. Michele Boivin is one of three psychologists that form the 10-member team at the ROH clinic. It was only opened in early 2009, but has already helped 140 clients.

Remarkably, some vets from the Second World War and Korea have come for help, the oldest 89.

Clients are first thoroughly assessed, then treated with a combination of therapy and possibly medication. Sessions are usually weekly and can involve having the veteran revisit and mentally "reorganize" the trauma.

There is also a recognition about the importance of family support.

"Social support, particularly for military trauma, is a huge key factor in whether someone will go on to develop PTSD," Boivin said.

"A lack of social support really behaves in a way that prevents that natural recovery from happening."

PTSD is much more prevalent in the military, Boivin said, possibly three times higher than in the general population. The evidence, though, is that treatment does work, helping as many as four in five.

Contact Kelly Egan at 613-726-5896 or by e-mail, kegan@thecitizen.canwest.com

© Copyright (c) The Ottawa Citizen


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Afghanistan vets at risk for homelessness: experts


As Canada prepares to withdraw from Afghanistan next year, veterans' advocates
say they worry shell-shocked soldiers may end up without a home, like many of
those who served before them. Veterans accustomed to the rigid structure and
unique culture of the military often find it difficult to adapt to civilian life -- a
struggle that can lead them to the streets or the bush, experts say.

"Sometimes when people come back and they've experienced very traumatic
experiences, if they don't have a good support network in place or they don't
have advanced coping skills, they may end up falling through the cracks,"
Adrienne Alford-Burt, director of the Veterans Affairs Vancouver office, told
CTV News.

It is unclear how many of the country's nearly 80,000 veterans are currently
homeless. In one Vancouver neighbourhood alone – the downtown eastside,
Canada's poorest postal code – Veterans Affairs found 33 homeless veterans,
as part of an outreach project launched last summer. All of them are men,
mostly in their mid-30s. That number has alarmed government officials.
"I was thinking around 10 or 15, so the fact that we've seen 33 in such a
small community is concerning," Alford-Burt said.

Canada's Veterans Ombudsman, retired Col. Pat Strogan, warns many more
will end up on the streets once the Afghan mission wraps up. "It's important
that we get this safety net established to prevent them from becoming
embedded in the homeless lifestyle," said Strogan, the first to hold the
ombudsman position established in 2007.

A handful of projects have cropped up recently to help ex-soldiers find their feet
once they return to Canada. Among them is Cockrell House, a facility just outside
Victoria, B.C., believed to be the nation's first homeless shelter for veterans. The
privately funded shelter opened in April. It presently houses six veterans, including
some who served as far back as the Second World War. Organizers plan to welcome
11 residents by the end of the year.

Luke Carmichael lived in the bush until he heard about Cockrell House during a visit
to a Legion. The Halifax native says serving 19 years in the Armed Forces, including
a stint in Cyprus, left him broken. He arrived in Victoria a decade ago with no money
and no place to stay. Carmichael says he found much-needed support at the shelter.
"Here I am, 69 years of age, and I'm starting to come to life again," he said.

In New Westminster, B.C., crews broke ground late April for Honour House, a transition
home that will offer respite for soldiers and first-responders such as police and firefighters
as they seek medical or psychological treatment. The home has been described as a
Ronald McDonald House for soldiers and first-responders, who will receive free lodgings
while they or a member of their families are in treatment. Patients' relatives will also be

Honour House will also run the 14-day Veterans Transition Program, meant to ease
soldiers into civilian life. The program is funded by the Royal Canadian Legion with
help from the University of British Columbia.

Ottawa needs to do more: Ombudsman

While applauding initiatives such as Cockrell House, Strogan says it's time Ottawa
ramped up its support for veterans. The veterans ombudsman has previously urged
Canadians to help government identify ex-service personnel who haven't sought
assistance or can't find the services they need.

In 2008, he launched Leave Nobody Behind, a national campaign to raise awareness
of veterans' plight. "We don't leave our wounded on the battlefield, so injured
veterans should not be left to care for themselves," Strogan said at the time.
"I will leave nobody behind."

With files from CTV News's Rob Brown and The Canadian Press

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Veteran battles stigma of stress
By Bill Kaufmann, Calgary Sun
14 May 2010

More than anything, it was the drowning sensation of helplessness, futility.

In Croatia, it was staring into the barrels of automatic weapons wielded by Serb soldiers confident the Canadians’ rules of engagement rendered them powerless to respond.

In Uganda, it was standing by helplessly as a Rwandan refugee was raped in front of him.

“We could hear her screaming ... when someone’s raped 30 feet in front of you, it affects you,” says former Cpl. Christian McEachern.

Six years later, in March, 2001, McEachern became for Canadians the face of post traumatic stress disorder when he plowed an SUV through the headquarters building at CFB Edmonton Garrison.

In those days, Canada’s mentally wounded warriors were shoved under the carpet.

“I was the only guy they couldn’t cover up,” says McEachern, 39.

He avoided prison time but still resents the treatment during his trial meted out by a military he served for 14 years.

That wartime stress and courtroom anxiety left him sleep disordered and haunted by nightmares.

But the outdoor’s soothing properties delivered an epiphany and McEachern’s piloting into its second official year an outdoor retreat program for PTSD vets in Kananaskis Country.

Veterans who were once reluctant to leave their homes are bonding and adjusting through whitewater rafting, horseback riding and hiking.

“The guys are happy just standing around, chatting,” says the Calgarian, who’s parlayed degrees in ecotourism and outdoor leadership into the Canadian Veteran Adventure Foundation.

“I’ve made a lot of mistakes, learned a lot ... in a way, I’m trying to redeem myself.”

His notoriety is probably a double-edged sword, he says.

Doubts over his past can cast a long shadow over his efforts, he admits.

“I’ve had absolutely no help in this project from DND and Veterans’ Affairs,” he says, adding funding for the venture is always an obstacle.

“If I waited for Veterans Affairs to develop it, it wouldn’t happen.”

On the other hand, the incident he dubs “the most shameful in my life” has since proven a catalyst for PTSD programs and his own healing journey.

And while Canada and its military have made strides in how PTSD is handled, a stigma remains that feeds the distrust of many ex-warriors afflicted by it.

A December 2008’s ombudsman’s report prepared for National Defence cites victims’ lack of trust in the system and a failure to keep track of their numbers.

It’s all too familiar to McEachern, who saw friends fall away even before his 2001 Edmonton rampage.

“That hurt more than any bullets fired at us,” he says.

Only now, after eight years of Canadian troops in Afghanistan and a surge of PTSD, have doubters come around, says McEachern.

He’s expecting a bigger turnout for his outings that are expanding to B.C. and Saskatchewan.

It’s an acceptance that must be therapy in itself.

Still more is the ascension of retired Col. Don Ethell to the post of Alberta’s lieutenant-governor and his vow to make that affliction and other mental illnesses a priority during his reign.

The tsunami of PTSD cases crashing across the country has seen the number of sufferers more than triple since 2002, to well over 6,500 — a count that doesn’t include the currently-serving.

Canada continues to sacrifice the bodies and minds of its young on a bloody hamster wheel in Afghanistan.

McEachern doesn’t delve too deeply into the morality of it all, saying “I can only support the guys who are doing their jobs.

“Unfortunately, business is going to be good for us.”

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This, From the CBC, shared in accordance with the Fair Dealing provisions (§29) of the Copyright  Act:

Soldiers with severe PTSD have trouble finding help


Shawn Hearn has suffered from post-traumatic stress disorder since he served as a sniper in the Canadian military during the Bosnia mission in 1994. (Louise Elliott/CBC)

Read more: http://www.cbc.ca/canada/story/2010/05/25/post-traumatic-stress-military.html#ixzz0p2fTQV51

CBC News  - In the eight years since a military ombudsman issued a report chastising the Canadian military for sticking their heads in the sand about post-traumatic stress disorder, the military has come a long way. But soldiers who suffer from the most severe form of PTSD still find serious gaps in the system of care.
Shawn Hearn, like many Canadian soldiers battling post-traumatic stress disorder, is having a tough time getting proper treatment back home after serving in a war zone.

Hearn, who served in Bosnia as a sniper in 1994, and those involved in helping soldiers with PTSD say changes to the treatment system need to be made.

And there's a lot on the line. Hearn recently attempted suicide and has been fighting hard to get the treatment he needs.

Hearn came back from Bosnia a different person. At first he didn't know why. He speaks in Guelph, Ont., near the Homewood private treatment centre where he says he's finally getting help.

"Basically I began to notice changes, my family began to notice changes, and in 1997 I ended up in hospital with an overdose," he says.

After that overdose, Hearn remained in the army another three years. In 2000, he was finally diagnosed with post-traumatic stress disorder. He left the military and began to try to understand his symptoms: severe depression, flashbacks, night fears.

"I had flashbacks of things I had seen and things we had done there. The inability to make sense out of it was really tough. Suffering of the young and old really, really bothered me. I was unsure what was happening to me."

Over the intervening years, Hearn found some recovery through a combination of counselling and medication in his native St. John's. He also helped found a national system of peer support called OSISS - the Operational Stress Injury Social Support program, which has been lauded for helping soldiers help each other overcome the effects of battlefield trauma.

Despite his apparent recovery, Hearn's unresolved trauma began to surface once again. This January, he wound up in the psychiatric ward of a hospital. His stay was short, even though he told the doctors who discharged him he wasn't well.

"The medications weren't working for me," he says. "I had passed that through the system but nobody seemed to listen and I was kind of pushed out the door after three weeks of hospitalization. I was well aware what was wrong with me and I knew I wasn't feeling well both mentally and physically. But again, no one seemed to listen."

Discharged and left to his own devices, Hearn attempted to take his own life.

"I was home for roughly five or six days, three of which I spent in bed in a dark room," he says. "I wasn't doing well at all. That Sunday I ended up taking pretty severe overdose and I was hospitalized."

Hearn landed in another civilian hospital, where he spent another three weeks and got better care, he says. At this point some of his colleagues in the OSISS program began working the phones, as did his case manager at Veterans Affairs.

PTSD a household term
In the past 15 years, post-traumatic stress disorder has almost become a household term. The constellation of symptoms such as depression, flashbacks and nightmares can be brought on by any type of trauma.

It's most often associated with military service, among soldiers who return from battle only to suffer the aftereffects of what was once called "shell shock."

It's been eight years since then-military ombudsman Andre Marin issued a report chastising the Canadian military for sticking its head in the sand about this difficult reality. Many of Marin's recommendations remain unfulfilled or partly finished, but another ombudsman's report is planned.

The military has come a long way: new stress-injury centres, education and screening programs, as well as peer support networks have grown up and begun to replace a culture of stigma and denial.

But for those soldiers who suffer from the most severe form of post-traumatic stress disorder, there are still serious gaps in the system of care.

With much arm-twisting, Hearn was finally admitted to Homewood, a private facility in Guelph, Ont., for a six-week treatment program for PTSD. He's still there now, and doing much better.

Some close to the situation say it represents the experience of many of Canada's sickest veterans who have PTSD.

Stéphane Grenier is the military's special adviser on operational stress injuries - a military term that includes PTSD, anxiety disorders, and depression related to deployment. Grenier has close to a decade of experience working with soldiers as a peer trying to get them into the right kind of care, and fought to get Hearn into Homewood.

Grenier says the first problem is an overstretched and under-informed civilian system that can't handle soldiers and veterans.

"They come in, and they're an anomaly for the mainstream mental health experience," he says. "They don't fit the mold. They're absorbed as just another person in crisis."

He warns that while the majority of soldiers can be treated for PTSD on an outpatient basis, there is a significant number that cannot.

Statistics are a matter of some debate. But it's believed that about seven per cent of soldiers who deploy will develop PTSD. Another 4.5 per cent will develop anxiety, and another 13 per cent will develop depression.

Grenier says a rough estimate would indicate as many as 60 soldiers per year require in-patient treatment for severe PTSD. He believes the civilian health-care system doesn't know how to deal with those soldiers in part because that number is relatively small.

"Because we don't have a critical mass, I think it's very difficult for the health-care system to deal with. It's treated as another mainstream crisis case," he says. "It's not understood, and they're not referred to the right places for longer more in-depth care."

He says the second obstacle to care is that the entry criteria for residential treatment programs are simply too onerous.

Many treatment programs will exclude a patient who has any anger problems, who may have developed an addiction, or who recently attempted suicide - all of which are common among veterans suffering with PTSD. The criteria may be there to protect other patients and ensure program success. But the result is that the programs screen out people - like Hearn - who most need help.

"To me it doesn't cut the mustard to ask somebody to go home and if he doesn't kill himself then we'll take him into inpatient treatment cause that's what it boils down to," he says. "I know it's crude, but that's what it boils down to."

Rakesh Jetly, the military's chief psychiatrist, says he understands there are many soldiers and veterans who won't be able to benefit from out-patient care, but he explains the military gave up its in-patient mental health capability more than a decade ago.

He argues it's simply not possible to have in-patient programs because the numbers are too small, relatively speaking, and he believes the best route is to build a stronger relationship with institutions like Homewood.

"There certainly is a need," Jetly says. "I personally intend to visit residential treatment [centres] and revitalize our relationship with them. We are a major client of these folks. And [we are] looking at the needs and services they can deliver in order to streamline them even better."

In particular, Jetly says he wants to improve the process for soldiers with PTSD who also suffer from addictions - and who need residential programs to address their multiple problems. He says the military is about to re-evaluate the criteria for programs at private institutions where soldiers are commonly referred.

Jetly notes that veterans don't fall under his watch technically speaking - they are the responsibility of Veterans Affairs - a jurisdictional issue that brings its own set of problems.

'I very rarely went out my door'
Former soldier Joanne Curnew is well-aware of these problems. Curnew, a military veteran who developed severe PTSD after serving in places like Haiti and Alert in Nunavut, took a turn for the worse late last year.

While DND has no in-patient treatment programs, Veterans Affairs runs an in-patient program for PTSD sufferers out of Ste. Anne's Hospital in Ste. Anne de Bellevue, near Montreal. It recently opened the doors on a revamped in-patient program.

Ste. Anne's Hospital stats

2005-2010 statistics for referrals to the Ste. Anne's Hospital stabilization program (these include ex-service members, Canadian Forces members and reservists, and RCMP):

2005-2006: 11.

2006-2007: 11.

2007-2008: 20.

2008-2009: 16.

2009-2010: 22 (includes some residential treatment clinic referrals).

Curnew's psychologist immediately tried to get her in there.

"They interviewed, they requested so much paperwork and so many documents, your medical, your reports from your psychologist, psychiatrist," Curnew recalls. "They dug into every little details they could possibly think of."

It took three months of back and forth before Curnew was finally admitted to the program at Ste. Anne's. During those long months, she continued to spiral downwards.

"It was extremely difficult I even reached the point where I was thinking suicidal thoughts," she says. "Every time the phone rang, you hoped it was Ste. Anne's, you hoped you'd met the criteria and were going to be a patient there. It put a lot of strain on me, as well as my marriage, and my home life. I isolated so bad I very rarely went out my door."

When she did finally get there, Curnew got better. Now, she has nothing but praise for the program, saying it saved her life because it was so well designed for military experience. She just wishes there were more people in it.

"It's a shame in a way because they have a 10-bed floor that I was the only patient on for all three weeks," she says. "At the end there was only two of us in the whole class."

The program is based upon group therapy, but even today there are only four patients in the 10-bed facility, according to Veterans Affairs.

Minister defends criteria
Veterans Affairs Minister Jean-Pierre Blackburn defended the criteria in place for the treatment program.

He says his department has created a rigorous program specifically designed for soldiers, and needs to have high standards in order for those patients who are admitted to benefit.

"It's like if myself, I go to see a doctor, and I say to the doctor, 'I want to go there for this or that reason,'" Blackburn says in an interview. "The doctor may say to me, 'Mr. Blackburn, you feel like that but it doesn't mean [your] point of view is the good one.' And it's for that we have specialists who analyze the situation of each of our veterans who need some specific health care."

Blackburn adds that soldiers who don't meet the strict criteria at Ste. Anne's will be referred to the appropriate form of care in the civilian system.

Grenier says those referrals rarely happen, and the provincial system is not equipped to handle soldiers properly. He says the criteria at Ste. Anne's are a reflection of what private clinics in Canada are also doing. In the case of Veterans Affairs, it's doubly troubling because it's supposed to be even more tailored to the reality of military PTSD, he says.

At Ste. Anne's, soldiers can be refused admission, for example, if they are not stable, cannot manage their medication, recently attempted suicide, have other medical or psychiatric problems, have substance abuse problems, or anger management problems.

"It really gives ability to systems to say, we don't agree with the referral agency. It's very subjective," he says. "We know that veterans with PTSD and [operational stress injuries] will exhibit anger. So why do we design programs that deliberately ignore that reality? We need to embrace that reality."

Grenier also says most clinicians he talks to agree with him, but getting them to move en masse to change the criteria remains a challenge.

The price of not treating those soldiers is too high, he says.

"This is where Canadians need to pay attention," he says. "The longitudinal outcome [of the current system] is somebody who remains dysfunctional for the rest of their life. And that's not good for any society, any community."

Curnew says she's worried about the future of the program at Ste. Anne's if it can't admit more people into care more quickly.

"We have troops over in Afghanistan that are coming back with PTSD that need help and have to wait around for six to eight months or 10 months to get it. That's a sin. That's a real sin. And the problem's not going to go away."

She's also troubled by a recent decision to transfer the entire hospital to provincial management. Veterans Affairs says the province of Quebec has agreed to maintain the PTSD in-patient program.

As for Hearn, he didn't even apply to Ste. Anne's hospital because there was only one patient there at the time, and he felt he needed group therapy.

At Homewood, he says there are eight other soldiers and veterans on his floor alone, and many more in the rest of the hospital.

He's now hoping his experience will somehow prevent other soldiers and veterans from experiencing the same fate.

Hearn says he's speaking out because he knows he was lucky and had strong advocates who got him into the system. He's worried about those who may not get the chance to feel better.

"Yes, I was sick, but I was still able to articulate what was happening to me," he says. "For the average soldier or veteran some of these folks are unaware what's happening to them. These individuals are unable to advocate for themselves."

For information or questions, contact Louise.Elliott@cbc.ca [louise.elliott@cbc.ca]

Canadian Broadcasting Corporation



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I recently returned from Homewood Health Center. I am a soldier with PTSD. I think that Homewood is a great place and it was nice to receive some treatment there. But I don't think that it cured me of any of the symptoms of PTSD. It just helped to "deal" with them. That is a good start I guess.


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Turner said:
I recently returned from Homewood Health Center. I am a soldier with PTSD. I think that Homewood is a great place and it was nice to receive some treatment there. But I don't think that it cured me of any of the symptoms of PTSD. It just helped to "deal" with them. That is a good start I guess.

I think the CF and Veteran's Affairs also use Bellwoods:
"This is a specialized program open to persons employed in hazardous occupations such as members of the Canadian Forces and Veterans Affairs, RCMP, police, firefighters, and paramedics.":

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Turner said:
I recently returned from Homewood Health Center. I am a soldier with PTSD. I think that Homewood is a great place and it was nice to receive some treatment there. But I don't think that it cured me of any of the symptoms of PTSD. It just helped to "deal" with them. That is a good start I guess.

Good on you brother.

The ultimate goal, is to have our lives returned to us.  It is about regaining empowerment, in how we control lives.

Bellwood, Parkwood, and many other OSI clinics have discovered ways to address the issues that serving members, and Veterans deal with.

As marionmike pointed out, many of these clinics are covered, and promoted by VAC.

Turner, if you are interested with help, regarding outside programs like OSISS please PM me, ad I can give you more information.

In fact, I encourage anyone reading this thread, that if you have questions, click the link or pm me.





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Turner said:
I recently returned from Homewood Health Center. I am a soldier with PTSD. I think that Homewood is a great place and it was nice to receive some treatment there. But I don't think that it cured me of any of the symptoms of PTSD. It just helped to "deal" with them. That is a good start I guess.
A very good start. Keep it up!


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Thanks for the link Regulator. I see someone at the Winnipeg OSISS clinic on a weekly basis. I don't know for sure if she is helping me or not. It's hard to tell. I was sent to Bellwood too but I only lasted 24 hours. I had such a hard time being there I demanded that they sent me home. Too bad I guess.

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Military does take PTSD seriously: Worthington

More than at any time in the past, Canada’s military today is alert and concerned about PTSD

By Peter Worthington

Last Updated: November 4, 2010 10:09pm

A recent Sun Media editorial slammed the Defence Department for not doing enough to help soldiers returning from Afghanistan with post-traumatic stress disorder (PTSD).

While well-intentioned, aspects of the editorial were grossly unfair.

For one, the editorial urged Defence Minister Peter MacKay to “force” the military “to face the fact that PTSD within its ranks cannot simply be macho-ed off as mere weakness.” The editorial scolded: “Ignoring PTSD our military’s shame.”

Of all institutions in Canada, the military is arguably the one most aware of the realities of PTSD. To suggest it is viewed as “mere weakness” is not only wrong, but grotesquely unfair.

That may have been a common view back in the First World War, when soldiers who cracked under fire were occasionally executed by firing squads for desertion or cowardice. But those days have long since passed.

The military today needs no reminding that “PTSD is real, and it is destructive.”

Canada’s Mental Health Association reckons 10% of Canadians endure some degree of PTSD. During their lifetime, 90% of Canadians will suffer some form traumatic stress.

The editorial’s view that “upwards of 40%” of soldiers returning from Afghanistan suffer varying degrees of PTSD, seems a stretch. If that were so, it doesn’t leave too many unaffected soldiers to “macho off” PTSD as “mere weakness.”

Acutely aware

For all the criticisms directed at it, Veterans Affairs Canada (VAC) does not ignore PTSD. They are acutely aware of the problem, and though they make errors and have difficulty sifting and determining valid cases, they are not impervious to its realities.

In the past, what is regarded as PTSD today has been variously called “battle fatigue,” “shell shock,” “lack of moral fibre.” In the First World War, only Australia seemed to recognize it as a valid byproduct of too much battle, and unlike the British and Canadians, refused to execute soldiers who had volunteered and who cracked under fire.

To suggest that DND needs reminding, or needs to be “forced” to recognize the reality of PTSD, is a canard. For heaven’s sake, we have made a hero out of Lt. Gen. Romeo Dallaire, who is now a senator and a poster boy for PTSD which he contracted while a brigadier-general commanding UN troops in Rwanda and witnessed horrible things.

No Canadian soldier mocks PTSD — though wry comments have been made about soldiers who come down with the affliction from watching training films. The hazard of roadside bombs arguably makes Afghanistan the most tense of all wartime missions — and every soldier feels vulnerable.

DND and VAC are not ignoring it.

Of course, PTSD is real and not “a figment of imaginations” as the Sun editorial warns. It does no harm to remind people it is an ongoing concern, and PTSD may last for years, or emerge years later. That, too, can be a problem.

Statistically, in past wars, roughly 5% of combat soldiers might suffer debilitating PTSD. Not unknown, however, is some soldiers claiming PTSD to avoid combat situations. The difficulty is distinguishing the genuine from the phony — a task for both DND and VAC.

Individual mistakes can be made — witness the callous treatment of Cpl. Stuart Langridge, whose PTSD drove him to suicide.

But more than at any time in the past, Canada’s military today is alert and concerned about PTSD, and does what it can to protect and help soldiers who are afflicted — which is what the Sun editorial advocates.

Copyright © 2010 Toronto Sun All Rights Reserved


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Effects of PTSD still to come from Afghan war: Dallaire

By BRYN WEESE, Parliamentary Bureau

Last Updated: November 18, 2010 9:11pm

OTTAWA — It's been 16 years and Senator Romeo Dallaire still can't go into a grocery store.

"I literally become paralyzed — I can't move — because it brings me back to food distribution points where I saw people were trampled to death," Dallaire said Thursday.

He's been in therapy and medicated for 13 years, but still his operational stress injury carries vulnerabilities.

"The therapy and the medication permit me to be what I am, but it doesn't mean that I'm what I was," he said.

Dallaire was speaking to Parliament's veterans affairs committee, which is studying the effects of combat stress on soldiers and their families.

Unfortunately, the retired lieutenant-general is all too familiar with combat stress.

Having been in charge of the UN peacekeeping mission in Rwanda during the 1994 genocide, Dallaire was left helpless by the international community to stop the murder of about one million Tutsi and Hutu moderates.

Since then, he has come forward about his post traumatic stress disorder, a combat injury that drove him to attempt suicide.

"Suicide can happen in two minutes, it can happen any time. A smell, a noise can bring about this catastrophe and be the trigger," he said. "In my case, it was four years before all of a sudden I wasn't functional at all, I was let go from the Forces because of my injury and after that I became suicidal because there was no system in place. There was no follow up."

But things have changed since the 1990s "when nobody gave a damn," Dallaire said. In particular, operational stress injuries are now treated as such — not mental illnesses that carry a stigma.

Where there is still room for improvement, he told the committee, is following up with reservists who, upon their return, don't keep the same close contact with Canadian Forces personnel as full-time members.

Instead they scatter and it's incumbent upon the department of defence and veterans affairs to go the extra mile to follow up with reservists.

"They're serving like the regular guys, they bleed the same way, so we should treat them the same way when they return," Dallaire said.

Also, the operational stress effects of the current war in Afghanistan won't be known for some time, he added, because problems really begin to arise after the "adrenaline rush" is over.

"It's not only the sights and the smells and the sounds, because often you're in the midst of it, you're busy trying to save people and so there's a sort of film in front of everything when you're in theatre," he said. "It's when you come home and you're sitting at home having a beer, that all of a sudden — boom! — it hits you, or at night, or on a dark day.

"Veterans affairs has a program. It has yet to be tested to see whether it really works."


Copyright © 2010 Toronto Sun All Rights Reserved



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So far all we've seen is the tip of the iceberg. Mark my words, in a few years....

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The battle back home

Injured, scarred troops adapt to 'new normal' after Afghan war


Last Updated: January 23, 2011 12:00am

LOS ANGELES — The combat mission in Kandahar will soon be over for Canadian soldiers, but the legacy of pain and suffering will last a lifetime for thousands of wounded troops.

Afghanistan veterans return to Canada to fight a new battle on the home front. Some have lost limbs, skin, hearing or sight. Others are traumatized from witnessing bloodshed or encountering close calls with their own death.

Most are grieving fallen friends.

Lt.-Col. Rakesh Jetly, adviser to the Canadian Forces surgeon general on mental health and psychiatry, said one of the biggest challenges is helping these troops adjust to "the new normal" — and ensuring they don't fall off the radar after warfare ends.

"It's naive to think just because the combat mission ceases or changes that these cases aren't going to continue to surface," he said. "There could be cases from Afghanistan for many years to come. This has affected a whole generation of soldiers, and it will be a generation's worth of work for the mental health professionals within our organization."

Jetly was among a group of Canadian and American academics, doctors and chaplains taking part in a joint symposium at the University of Southern California this week. The panel was collaborating on innovative therapies and treatments to help the swelling ranks of psychologically scarred and physically injured veterans.

At least 5% of Canadian soldiers report symptoms of Post-Traumatic Stress Disorder (PTSD) or depression within six months of deployment.

Sgt. Patrick Bedard has been finding his "new normal" since April 13, 2009, when an improvised explosive device blast lifted up his armoured vehicle, flipped it over and pinned him underneath. The Valcartier, Que.-based patrol commander survived massive wounds: an open pelvis, crushed legs and internal injuries.

"I went beyond what we were all expecting, including all the physicians, on where I could go on the recovery road," he said.

Bedard has been focused on physical healing but knows he remains at risk for PTSD.

"I have been thinking about the incident and talking about it, so I think I should be good to go. But I'm careful, because I know it can hit sometimes later," he said.

Lt.-Col. Markus Besemann, CF's head of rehabilitation medicine, said you can't separate body from the mind when it comes to war injuries. And because of advanced medical services in the field of operations, there are now about 10 injuries for each soldier killed in action.

He gets the grim statistics delivered to his desk daily from Kandahar Airfield.

"I have to be honest with you, there are days when you hope the member will not survive," he said. "It's because rehab doesn't end — it's the beginning of a life-long process. It starts on the battlefield and goes on for a whole life. And everyone is involved — the families, the community, the unit. Sometimes we save lives, but the cost of rebuilding those lives is tremendous, and I don't know if we have it within us to be able to deliver on the goods in terms of what we owe to that member."

Latest figures show there have been 136 killed and another 615 wounded in action in Afghanistan since 2002. Another 18 soldiers died and 1,244 more suffered non-battle injuries in Afghanistan.

Cpl. Jayson Nickol of Winnipeg suffered nightmares and flashbacks after he took an AK round through his right femur during firefight, but they subsided over time. He is left with chronic pain and lack of mobility - but says leaving comrades behind was the worst.

"That was the hardest part - they were still over there and I was back home, and getting used to life again. "

Lt.-Col. Stephane Grenier, who works with the Mental Health Commission of Canada's peer project team, said physical and emotional injuries from war can take time to "grow roots" and that the human toll will be calculated over the decades that follow this campaign.

Grenier said it's important to maintain existing programs to deal with mental health issues - and to develop new ones. He believes the military leadership is committed to caring for wounded troops over the long haul - but said the public must also be onside.

"I think that's a question Canadians need to ask themselves: at the end of hostilities, what is every Canadian's vision of how we take care of our soldiers after the hostilities have ended?"

Virtual healing for soldiers coming to Canada

Avatar patients, virtual reality caves and social networking sites are the latest allies in the battle to help wounded veterans.

At the University of Southern California, students in a first-of-its-kind program that focuses on the care of physically and psychologically injured soldiers interact with virtual "avatar" patients training for a meeting with their first real veteran.

Anthony Hassan, director of USC's Center for Innovation and Research on Veterans and Military Families, said this "virtual immersion" helps prepare students for complex patients through simulated interactions, but said it's not a replacement for face-to-face contact.

"We see it as an opportunity to immerse them into an environment they've never been into before - help them work and interact with a veteran who may be using slang and may be angry or even suicidal," he said. "They can work with a virtual patient before they work with a real one."

The idea is coming to Canada, too. Two new CAREN therapy systems will be installed in hospitals in Ottawa and Edmonton in coming months to help rehabilitate physically and psychologically wounded soldiers.

Canadian Forces Lt.-Col. Rakesh Jetly, adviser to the Canadian Forces surgeon general on mental health and psychiatry, said each $1-million system features a 180-degree screen displayed in a cave-like atmosphere. With a split treadmill and surround sound, it can recreate cobblestones, climbing and stumbling scenarios, and allows troops with PTSD to relive their traumatic event in a safe, controlled environment that slowly desensitizes them.

Social networking sites are also offering new forums for injured troops to get treatment, connect with peers and heal.

Lt.-Col. Stephane Grenier, special adviser with the Mental Health Commission of Canada's peer project team, said while emerging technologies present many positive support opportunities, they can't replace personal connections.

"I think when the rubber hits the road, we still need to encourage human-to-human contact and I think that social distancing in a sense is not causing the problem, but may not be as much a part of the solution as we would like it to be," he said.

U.S. takes closer look at Canada's soldier decompression program

A Canadian program that sends battle-weary troops to a sunny seaside resort to wind down after a tough tour of duty is being eyed as a model for a pilot project in the U.S.

The Canadian Forces' "Third Location Decompression" program diverts soldiers from Kandahar to a spa resort in Cyprus, where they spend three to five days in sea and sun before heading home. Soldiers have time to grieve fallen comrades, shed combat stress and rest up.

Along with formal sessions on anger management, recognizing warning signs of post-traumatic stress disorder and reintegration back to family and community, troops have a chance to drink, relax and play. Lt.-Col. Rakesh Jetly, adviser to the Canadian Forces surgeon general on mental health and psychiatry, said the main objective is to smooth the transition from war zone to home front in a setting where soldiers don't have to wear a uniform or worry about their weapon.

"Sometimes you can come home too fast from today's battles," he said.

Surveys have found soldiers consider the decompression program helpful for making the transition home, but there is no scientific data proving a reduction in post-war mental health problems.

"Three days in Cyprus is a wonderful thing, but if I have the biological abnormalities in my brain from the trauma, this isn't going to stop me from getting PTSD," Jetly said, noting the sessions may prompt soldiers to seek professional help sooner.

Last month, a team of military experts and academics from the University of Southern California travelled to observe the program in Cyprus and now hope to replicate it for a pilot project in the U.S.

Col. Darc Keller of the California National Guard said more must be done to ease the transition for this highly vulnerable group of soldiers, but the number returning home to the U.S. is huge.

"There are cultural differences in terms of the military experience, but there's also a difference in magnitude," he told QMI Agency. "Where the Canadians talk about thousands of soldiers coming out, we're talking about tens of thousands, hundreds of thousands. So we're talking about scales of magnitude — obviously that relates to costs."

The decompression program has not been without problems, with reports of excessive drinking and violent brawls.


Copyright © 2011 Toronto Sun All Rights Reserved


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Home is new Afghan war front

David Bruser Staff Reporter

Warrant Officer Roger Perreault trained 20 years for his chance at a combat tour.

The army engineer knew how to blow up walls and bulldoze new roads – important work in a war zone where doors are booby-trapped and old roads are lined with hidden bombs.

Perreault took those critical skills and a good-luck charm aboard a bus full of soldiers departing CFB Petawawa on Aug. 1, 2006. His mission: to build a route for the Canadian infantry in Panjwai district, Afghanistan.

"My great-grandfather was an engineer in World War I," Perreault says. "I had his cap badge. I brought it over there for good luck."

Perreault's wife, Fran, remembers his departure day very clearly, because her family would never be the same again.

"On Aug. 1, I put one man on that bus. Nov. 3, a different man came home. He looked like my husband. He talked like my husband. But it wasn't my husband. Part of him is still over there somewhere and I don't know if I'll ever get it back."

Before his deployment, Perreault spent long hours in the gym building his body. His friends called him Rhino. The extra muscle would prove critical. The cap badge was of no help. He lost that during a firefight in the desert.

Warrant Officer Roger Perreault hits his wife.

"He doesn't even realize he's done it, even though I wake him up at that point. He gets off me, rolls back over. The next morning he asks me why I have bruises on my neck, why I have black eyes."

On occasion Fran has had to rely on makeup and scarves so she can leave the house for the base, where she manages a cleaning company.

"I'm a pretty small woman. He's a pretty big guy. He would cry. He would be ashamed. I would say, `Don't worry about it. It's not your fault.' He really took it hard."

It's after 8 p.m. on a Tuesday in Petawawa. The Perreaults live a couple of blocks off base. She sits at the dining room table, the family collie, Sapper, panting nearby and the four kids padding about the small, two-storey house. In a few days, Fran and Roger will mark their 16th wedding anniversary.

"I did get strangled one night." Fran says. "I woke up, I couldn't breathe. I kneed him in the stomach. I had marks on my neck. I covered it up with turtlenecks and makeup. My closest friends understood. They've dealt with the same things.

"He wasn't doing it to be vindictive or mean. He was someone else in his sleep. He'd been dreaming he was under attack."

A knock at the door.

"Come in," Perreault says, but doesn't get off the couch. He cannot move about as he once did. An aluminum cane is within reach.

Fran is at work on the base and the kids are at school.

He wears a T-shirt that reads, "Courage is being afraid but going anyway."

In a quiet voice, the 39-year-old tells his visitor the story of his tour. He moves through the details cautiously.

Perreault and the 180 other guys from Petawawa landed, relieved soldiers from Edmonton, and immediately headed to a patrol base. The troops would remain "pretty well out of the gate most of the tour" – that is, out in the countryside, off base, 30 days at a time, returning only to resupply and shower.

"On the way out (to the patrol base) we got ambushed for 5 kilometres and one guy got injured," Perreault says. "That was the start. Right there, it set things in stone.

"I've been in Bosnia and it doesn't even compare to Afghanistan. The whole time we were in Panjwai we were always under contact."

A month into the tour, during Operation Medusa, Perreault and about 100 other men prepared to take "the white school."

"It was an actual school the Taliban were in. Several days prior we had dropped in leaflets telling the locals to get out of the area. We were coming in to capture or remove the Taliban. Early morning, we crossed the Arghandab River.

"We weren't using existing roads because of IEDs (improvised explosive devices). We were building our own (using) a big loader and dozers. Things were going well. Seemed like there was nothing going on, and then we got ambushed.

"They were shooting RPGs (rocket-propelled grenades). We lost two warrants and then I lost a sergeant. Sgt. (Shane) Stachnik."

Perreault looks out the living room window, his eyes welling.

"Just a moment... "

"We lost a private, too. Basically we got our ass kicked.

"We pulled back. The worst thing I had to do, we had to bag the guys, the two warrants ended up in the bottom of the LAV (light armoured vehicle). We had to pull 'em out and bag them. F---ing sucked."

Perreault chokes up.

"Stachnik, he was one of my guys. He was in an LAV. When the round came in and hit the turret on the side, hit him in the neck, and it severed his main artery and he bled out, fast."

A month after the battle for the white school, Perreault's military career, at least the career he had envisioned, would end.

It was around 5 p.m. on Oct. 7, the sun fading, and Perreault and others from 2 Combat Engineer Regiment were standing on the side of a dirt track discussing their progress on a road-building project.

"We were moving another 100 metres down the road, and I decided that I'm not going to get back in the LAV. I'll just walk. I started walking along aside the LAV. For some reason, I thought: `This (road) hasn't been watched in a while.' And as I said that to myself it went off. Bang.

"The blast threw me in the air. It kicked me up backward. I was airborne. Landed on my butt."

Perreault says he later learned the vehicle had hit a road bomb made of an Italian land mine with a flechette round, which contains little daggers. He figures the bomb was a partial dud; otherwise, he'd be dead.

"I was a body builder. I was around 220. I was in the gym all the time. That's what held me together – my muscle mass."

Standing in the turret of another vehicle 20 metres away, Sgt. Neil Coates watched as the bomb detonated.

"It was very hot and sunny," Coates recalls. "The ground was very dusty. Dust that's six inches deep. There was like a fireball and then a big cloud of dust. It blew Roger over."

Perreault says he got up and walked away from the vehicle. "You get hit by an IED and chances are you can get ambushed. Some of the people that observed me afterward said I walked like I was a drunk. I thought I was walking straight."

He sat in a firing position.

"I remember my ears were ringing really bad.

"I kept saying, `I'm all right. I'm all right. Just leave me alone.' Someone said, `Well, then stand up.' I couldn't. I got carried out of there."

Perreault suffered a cracked tailbone and other damage to his spine, and underwent three surgeries in an Ottawa hospital. After one of the operations, an infection set in, some organs showed signs of shutting down, and on a Saturday night Fran called their eldest child, Marissa, and told her that dad might not live through the weekend.

Roger recovered after doctors found that his spinal cord was nicked during surgery, causing a leak of cord fluid. He struggles with nerve pain; he takes blood thinners to help prevent clots in his legs. In February he underwent hip surgery to repair bone damage from the blast. He has a desk job on base. Perhaps the worst of his problems is post-traumatic stress disorder.

"There's a lot of things involved in it," Perreault says. "Guilt. One of my best friends (Stachnik) died. That's what I'm having a hard time with. He lived right down the road from me. Just driving by there friggin' bothers me. It hurts."

Interrupted sleep. Nightmares. Flashbacks. Sleep deprived, Perreault has had trouble remembering things told to him just two minutes earlier. For a year he denied he was suffering from the disorder. "It's kind of something that you're not really proud of."

But his hair-trigger anger made the disorder impossible to ignore.

On a summer evening in 2007, Perreault went to pick up his daughters from dance class and parked in the furniture store's lot next to the studio. He says the store owner came out and told him to move if he wasn't there to buy furniture.

"I got out of the vehicle. In my mind I was going to kill the guy. That was my mission: to beat the f--- out of him. I was boiling." Perreault kept advancing, barking at the man, until Fran shouted him down.

"It's not normal. It's stress. When we're over there, under contact with the Taliban every second or third day, the enemy shooting at you, it's like constant go, go, go. The solution there is to shoot. You get back here, you don't know how to deal with it.

"We come back and we're just a bag of nails. It's like, why am I yelling at my kids all the time?

"To me, that's sinful," Perreault says, his eyes welling up again, "when your kids can't even approach you because they're afraid of you."

About 16 kilometres southeast of Petawawa, the Phoenix Centre for Children and Families in Pembroke has seen its military family caseload jump from 12 in 2005 to 85 today, with another 20 on the waiting list.

The Perreaults are among those 85. Fifteen-year-old Marissa gets counselling there, and she says her brothers, Mathew, 11, and Derek, 9, sometimes go to group therapy.

"It's really hard to live with someone who has (post-traumatic stress disorder)," says the teenager. The night Fran called with the news Roger was failing in the hospital, Marissa got so drunk a friend's mother had to take her to the hospital. She stayed there until morning.

Marissa says that for a short time after her father returned from Afghanistan, she cut herself.

"It was like a razor blade off a (pencil) sharpener. I did it on my wrists and then my sister noticed and told my parents, so then I started doing it on my legs. I haven't done any of that in a long time."

She hopes her counsellor can help her build a better relationship with her father.

"I understand what he did was really good and stuff, but some days I just wish he never went there."

Perreault lives on a steady diet of pills – a blood thinner, an antidepressant, an anti-psychotic, Lyrica for nerve pain and slow-release morphine – and on anger.

There are many sources:

That delays by various groups meant his daughter had to wait two years for help.

That the military allowed his squadron to split up shortly after the tour. "They rip the squadron right apart; they get posted all over the place. There's no cohesion. I went through the first year dealing with all aspects of things on my own. There was no support."

That a new system of compensating injured soldiers means Perreault gets not a cent for having post-traumatic stress disorder. His numerous other injuries maxed out allowable payout, leaving several injuries uncompensated. And the money he did get was paid in a lump sum, not in monthly instalments over time.

"This is stuff you suffer the rest of your life. If this stuff gets worse with age, f---, there's nothing there. I have four kids. That's the thanks you get for going overseas to fight for your country."

When questioned for this story, military spokespeople said a veteran like Perreault can max out, but is eligible to be reimbursed for medicine and therapy. As to family counselling, a spokesperson said it is not the military's responsibility, though referrals are made to outside counselling agencies.

Perreault plans to keep working his desk job on base until his scheduled release in three years. This publicity likely won't make life any easier on CFB Petawawa.

"The only reason why I'm speaking about some of it now is because my career is over," Perreault says.

"I don't regret going there. It was my job to go there.

"I trained my whole career to go do something like that. The sad thing of it is the aftermath."

Every day at work, Fran sees fit and vigorous soldiers marching around the base, and it's a reminder of what Roger will never be.

"He was the warrant everyone wanted to be under. He knew when to be the hard-ass, he knew when he had to lay down the law, and when to ease up. They liked him for that.

"He's been pushed in a corner. He's useless to the regiment; he's useless to the military.

"We have other friends who are injured, same tour. We all sit together at functions. It's almost like we have the plague.

"It's like we were the diseased outcasts. We all have leprosy. Don't talk to the people in the corner. You know what they are.

"They're the forgotten ones. That's what me and my friends call them."

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