Background Information

Psychological Injuries and the Canadian Military

As long as there have been wars and military conflicts, there have been resulting psychological injuries. What is known today as Post-traumatic Stress Disorder (PTSD) has been referred to in the past as "battle fatigue" and "shell shock." Other psychological injuries which may result from military service include depression, anxiety and addiction. In fact, a 2002 Canadian Forces (CF) supplement to Statistics Canada's Canadian Community Health Survey (CCHS), contracted by the Department of National Defence, found that the most common mental illness in the CF is depression, followed by alcohol dependency, social phobia and PTSD. The CF Mental Health Survey (external link), as it is known, found that 16.2 per cent of Regular Force members and 9.7 per cent of Reservists will develop depression at some point in their life.

The mental health of CF members is an issue of concern. Veterans Affairs Canada (VAC) and the Department of National Defence (DND) are responding to ensure the needs of CF members and Veterans suffering from PTSD and other operational stress injuries (OSIs) are met. Three specific client groups are the focus: still-serving CF members, VAC pensioners, and members who are releasing or have released from the Canadian Forces and making the transition to civilian life. As members release from the CF, responsibility for the treatment of their service-related conditions passes from DND to VAC. As a result, there are clear linkages between the two departments in managing the assessment and treatment of individuals suffering from psychological injuries.

VAC and DND are working together to improve access to assessment and treatment for CF members and Veterans suffering from psychological injuries. This strategy involves a network of mental health assessment and treatment facilities, educational forums, a continuing education program, and research efforts, which together will develop high quality, standardized mental health care for clients.

Networks of Excellence

VAC and DND are establishing a network comprised of care providers specializing in the assessment and treatment of CF members and Veterans suffering from PTSD and other operational stress injuries. This network includes the Ste. Anne's National OSI Centre; VAC sponsored OSI clinics; the Canadian Forces Operational Trauma and Stress Support Centres (OTSSCs) operated by DND; and health care professionals in communities across Canada involved in the care of these clients.

VAC-funded OSI clinics are currently located in Parkwood Hospital (London), La Maison Paul Triquet (Quebec), and Deer Lodge (Winnipeg). Future clinic sites include Calgary and Fredericton. OTSSCs operated by DND are located in Halifax, Valcartier, Ottawa, Edmonton, and Esquimalt. The network of treatment clinics can be accessed through a referral from either a DND or VAC medical officer.

The Role of the Ste. Anne's National OSI Centre

Ste. Anne's Hospital, the last VAC-owned and operated hospital for Veterans in Canada, continues to develop expertise in the treatment and assessment of psychological injuries resulting from military trauma. As part of the modernization, Ste. Anne's Hospital has been asked to assume a national leadership role in the field of mental health. Ste. Anne's Centre is divided into three distinct departments:

1. The National Mental Health Clinical Centre of Expertise has the mandate to advance mental health clinical care through clinical program development, research, clinical knowledge, education and outreach activities.
2. Ste. Anne's Operational Stress Injury (OSI) Clinic will continue to meet the mental health needs of its clients in the Montreal and outlying areas. In addition, the clinic will be responsible for piloting new clinical programs, protocols and approaches that will subsequently be implemented in OSI clinics throughout the country. Researchers from the Centre of Clinical Expertise and clinicians have the opportunity to work hand-in-hand in a clinical milieu.
3. The Network Development and Coordination Division (NDCD) will oversee the development and delivery of mental health clinical services across the country. The NDCD will be responsible for identifying the gaps in mental health clinical service delivery across Canada and for developing strategies to address these challenges within the joint Veteran Affairs Canada/National Defense network. The establishment of an integrated network of VAC/DND clinics will ensure that mental health needs of clients are being met, achieving a seamless transition from military to civilian life.

Building Capacity for Treating PTSD and Other Psychological Injuries

In addition to the creation of the Network of Excellence, VAC and DND are working to build the capacity both within the military structure and in the civilian health care community for the assessment and treatment of PTSD and other psychological injuries. This capacity is being built through educational forums, a continuing education program and research efforts.

Educational Forums

A series of educational forums is intended to offer network partners, and other interested professionals, the opportunity to share lessons learned and best practices in treating psychological injuries which can result from military service and to make further improvements in the areas of assessment, treatment, care planning and follow-up in the community.

For the past three years, VAC has hosted and/or participated in forums of this nature, which are attended by health professionals - both military and civilian. These gatherings highlight the compelling need internationally to develop additional professional capacity in all aspects of care for these injuries.

Continuing Education Program

The national Continuing Education Program assists in the standardization of OSI and OTSSC clinics and the providers serving VAC clients. The program increases knowledge and develops skills required for the assessment and treatment of PTSD and other OSIs.

The program is conducted through educational workshops, developed by Ste. Anne's National OSI Centre; advanced clinical training for health practitioners; a VAC OSI Education/Support Web-site which will offer educational content and on-line provider support; and a VAC-sponsored section of the World Health Organization education program Mental Disorders in Primary Care. Together, these components will help to increase the knowledge and skills of health care providers specializing in PTSD and other operational stress injuries to the ultimate benefit of VAC clients.

Research

Research is the focus of the fourth and final pillar in the joint VAC/DND strategy. Research will be conducted on the effectiveness of assessment and treatment modalities, as well as the causes and impacts of psychological injuries. A clinical and research database is being developed which will serve the VAC network of treatment clinics. In addition, an analysis of VAC Regular Force data was completed in the Summer of 2004 and a further analysis of the Canadian Forces Mental Health Survey is ongoing. This research has the potential to yield valuable information into the root causes of psychological injuries that will help guide VAC programs and services, policy-makers, and provide world-class data of potential interest to Canada and foreign countries.