NDDN Committee Report

OSI AND PTSD

The term Operational Stress Injury (OSI) is used by the Canadian Forces to include all types of psychological injuries resulting from the myriad stressors encountered in the course of military duty. Post-traumatic stress disorder (PTSD) is but one kind of OSI.[62] An OSI is any persistent psychological difficulty resulting from operational duties performed in the course of military service. It re-characterizes these conditions as injury, which is more in keeping with current thinking. OSI is not a legal or a medical term. Unlike PTSD, it is a strictly military term, used by Canada and NATO.

Mental health problems are no less real or legitimate than physical health problems. The brain is the most complex organ in the body and like other parts of the body it can be injured as a result of illness or injury. These injuries and the degree to which they affect brain functions are not a matter of personal will and not within an individual’s ability to control. Just as individuals vary so too does the range of severity of their symptoms.

PTSD is a psychological injury caused by the reaction of the brain to a very severe psychological stress such as feeling one’s life is threatened. In life threatening circumstances, the brain automatically kicks into ‘emergency mode.’ The fight or flight or freeze response is activated. The problem that arises in PTSD is the repeated reliving of the trauma leading to a continuous reactivation of this response. This can lead to difficulty functioning personally or professionally.

PTSD, one of the operational stress injuries, is a legitimate medical condition, like any other affecting the human body. It is considered a mental illness and is caused or aggravated by psychological trauma. PTSD often occurs in combination with other personal, social, spiritual and mental health difficulties. Associated problems may include depression, anxiety, alcohol and drug abuse, and difficulty dealing with family, friends, and co-workers.

It should also be made clear that there are a variety of other medical conditions that manifest very similar symptoms as PTSD but which are not PTSD. Symptoms of PTSD include: re-experiencing the event, sometimes by vivid dreams or through flashbacks; avoidance of situations or things that trigger memories of the event; difficulty enjoying or being interested in things the way they used to be, difficulty with intimate feelings; hyper-arousal symptoms such as irritability, the tendency to startle easily and to anger easily, (when these were not present before the event).

PTSD can be accurately diagnosed and effectively treated. As with other health problems, it is more effectively treated if identified early. Delay in treatment of PTSD can lead to aggravated symptoms and can also impede recovery.

Comprehensive care is best provided by skilled and experienced mental health care providers. Once PTSD is formally diagnosed treatment can include both therapy and medication. Medication is helpful and can help control symptoms, but the most effective therapeutic approach in most patients is Cognitive-Behavioural Therapy. The therapy deals with thoughts, feelings and behaviours that have been affected by the trauma. Literature supports this form of therapy as being the most effective.

The great majority of Canadian Forces personnel, approximately 87%, returning from deployment will not have to deal with any mental health issues. Some members, however, will have experienced symptoms of operational stress.

Overseas deployments expose military personnel to events that can cause psychological injury. Modern terms for the different kinds of operational stress are PTSD and OSI.

PTSD is an anxiety disorder. Other anxiety disorders are phobia, panic disorder and obsessive-compulsive disorder. PTSD is not an exclusively military phenomenon, and it is experienced by people regardless of their vocation or workplace. It is caused by an experience in which serious physical harm or death occurred or was threatened.
This includes the serious harm or death of a friend or colleague, the viewing or handling of bodies, exposure to a potentially contagious disease or toxic agent, and the witnessing of human degradation (such as sexual assault).

PTSD is a complicated disorder with a wide range of symptoms:

·         panic or anxiety (sweating, increased heart rate, muscle tension);

·         mood swings, irritability, sadness, anger, guilt, hopelessness and depression withdrawal or difficulty expressing emotion;

·         loss of interest in previously enjoyable activities;

·         loss of intimacy;

·         a preoccupation with the traumatic experience in the form of daydreams, nightmares and flashbacks;

·         difficulty concentrating, disorientation and memory lapses, disturbed sleep or excessive alertness (sometimes called hypervigilance);

·         erratic behaviour (in an attempt to avoid reminders of the traumatic experience); and

·         alcohol or substance abuse.

The CMHA estimates that one in ten people suffers from an anxiety disorder. Many Canadian Forces members dealing with PTSD have developed the disorder as a result of non-military traumatic experiences such as accidents, assaults and natural disasters. Canadian Forces personnel experience of PTSD is, however, coloured by factors that do not always apply outside the realm of military operations. These include isolation from home and loved ones; unfamiliar or hostile populations and climates; extended periods of medium- and high-level stress; and, in many cases, the inability to leave the source of the stress.

Diagnosis of PTSD is complicated by the fact that it is not uncommon for a person who has the disorder to experience another anxiety disorder or a physical ailment at the same time. Diagnosis of PTSD requires that a person experience significant impairment in functioning and that this impairment persist for over a month.

PREVENTION

Primary prevention of mental health problems is in its infancy as a field of study. There is extensive ongoing research into understanding the root causes of stress disorders and “resilience,” or resistance to their effects. This research will guide the continued development of Canadian Forces prevention programs. CFHS has identified several ways to reduce the risk of personnel experiencing service-related mental injuries.

There are programs in place to enhance the self-help skills of Canadian Forces personnel. These initiatives cover healthy living, stress management, anger management, addiction awareness and family violence prevention. For those personnel deploying on stressful operations and missions, good mission preparation and training is critical. This includes education on stress-coping skills, unit cohesion and social support, and awareness of the potential effects of stress. Training is realistic and is designed to bolster confidence in both individual and team capabilities.

Personnel undergo a mental health screening as part of their pre-deployment physical assessment. Deploying personnel also undergo a psychosocial screening by either a chaplain or a mental health professional.

Canadian soldiers about to return to Canada after a lengthy deployment are required to experience a five-day decompression stop on the way home (commonly called Third Location Decompression, (TLD). At the TLD site, each member has the opportunity to speak with a mental health professional privately and to raise concerns that they may have at that time. Personnel are educated about PTSD/OSI. The mental health team provides information about home, work and community life back in Canada in order to make reintegration less stressful.

The Canadian Forces screening and reintegration policy requires that all personnel returning from an international operation of 60 or more days duration undergo the Enhanced Post-deployment Screening Process between 90 and 180 days after their return to Canada. This screening is meant to better identify those with deployment-related problems, with a particular focus on psychological problems. The Canadian Forces member completes a detailed health questionnaire and has an in-depth interview with a mental health professional. The interviewer completes a form recording a clinical impression and a recommendation for follow-up care. Regular periodic medical check-ups continue the mental health assessment of the Canadian Forces member.

TREATMENT

CFHS, in conjunction with military and civilian partners, is researching treatment options for stress disorders. At present, treatment of PTSD/OSI typically involves a combination of medication and psychotherapy.

The Canadian Forces maintains numerous sites for treatment of PTSD/OSI. The first point of contact for most military personnel who are experiencing mental health problems is the primary care physician at a Base Medical Clinic, who will either provide the required assistance or refer the member to the most appropriate resource. In the case of an emergency, personnel can access a physician during daily sick parade.

Mental Health Programs (MHP), specialized mental health services, are available at the larger Canadian Forces Bases. Elements of these programs will be available at smaller bases depending upon population size and local resource availability. Psychiatrists, psychologists, social workers, mental health nurses, addictions counsellors and Health Services chaplains normally staff the multidisciplinary teams of the MHP.

Operational Trauma Stress Support Centres located across Canada employ a mixed military and civilian staff of psychiatrists, psychologists, social workers, mental health nurses and chaplains. The Operational Trauma Stress Support Centres use a multidisciplinary treatment model to provide assessment, educational outreach, treatment and research. In addition to providing direct service to Canadian Forces personnel, these centres are involved in consultation with other treatment facilities around the world, and in reviewing the professional literature on trauma, stress and PTSD/OSI. There are five centres: in Halifax, Valcartier, Ottawa, Edmonton, and Esquimalt.

Veterans Affairs Canada operates six operational stress injuries clinics to serve veterans, members of the Canadian Forces and former Royal Canadian Mounted Police officers who have suffered OSI as a result of their service. These clinics are located in Fredericton, Montreal, Quebec City, London, Winnipeg, Calgary, and Vancouver.

SUPPORT

Canadian Forces members, Regular and Reserve, in need can call a 1-800 hotline number to contact the Member Assistance Program, 24 hours a day, from anywhere in the world, for a confidential referral to someone who can help them. The program provides external, short-term counselling for members seeking assistance outside military health services. Family can also receive treatment through the program if this would influence the member’s well-being. The program is civilian-based in that it uses professional counsellors provided by the Employee Assistance Services of Health Canada, but it is funded by the Canadian Forces.

OSISS

The Operational Stress Injury Social Support (OSISS) program was established in 2001[63] to provide one-on-one support, peer support groups for serving military personnel, veterans, and families, and social support to bereaved families. This program has grown into a robust partnership between the Canadian Forces and Veterans Affairs Canada. Within the Canadian Forces, OSISS is backed up by an educational campaign to help increase general awareness of mental health, provide information on how operational stress can affect individuals, their peers, their subordinates, and those around them, and teach military personnel what they can do to assist those with mental health issues. The goal is to enable Canadian Forces members to recognize early signs of mental health challenges and issues and to take positive action. This educational campaign has been expanded to include Canadian Forces families too, to help them, help them support their loved ones and help them better deal with the effects of mental health problems in their home.

The National Operational Stress Injuries Centre in St. Anne de Bellevue, Quebec, enable close cooperation between the Canadian Forces and Veterans Affairs Canada medical staffs, particularly in cases governing the transition of Canadian Forces members being released to civilian status and the continuity of their care. The centre provides assessment, treatment, prevention and support services to currently serving personnel, veterans and their families who are suffering from mental health problems related to operational stress.

The Military Family Resource Centres located at all major Canadian Forces Bases are able to provide information on a wide range of subjects of interest to military families, including mental health. Staff at these centres can direct family members in greater need to appropriate service providers.

---