Afghanistan veterans not getting needed mental health care, audit finds

The Canadian Forces are falling short in meeting the mental health needs of soldiers returning from Afghanistan, the auditor general said in a report released Tuesday.

 By CanWest News Service-THE OTTAWA CITIZEN-October 30, 2007

OTTAWA — The Canadian Forces are falling short in meeting the mental health needs of soldiers returning from Afghanistan because the demand for care is “outstripping available resources,” Auditor General Sheila Fraser said in a report to Parliament Tuesday.

The shortfalls, which came to light as part of a broader audit of the rising cost of military health care, suggest the military has yet to learn some hard lessons of the past decade, when retired general Romeo Dallaire, now a Liberal senator, offered himself as a poster boy for the mental health suffering of many Canadian peacekeepers who served with him in Rwanda or on other operations in the Balkans.

This latest audit suggests that the Defence Department is failing to meet the needs of the new generation of men and women currently serving in Afghanistan as part of the military’s most demanding combat mission since the Korean War more than half a century ago.

One disabled veteran of Canada’s involvement in the first Persian Gulf War of 1991 questioned how the Forces can justify purchasing $20 billion worth of new planes, helicopters and other hardware, while neglecting the well documented mental health needs of their personnel.

“The care of families for mental health is quite small compared to some of these equipment purchases,” said Sean Bruyea, a former intelligence officer who has battled post-traumatic stress. “The most important resource of the military is the soldier, and the family is the primary support of that soldier.”

The audit singled out CFB Petawawa, Ont., near Ottawa, and CFB Gagetown, N.B., as two military bases where the mental health services offered to Afghanistan veterans and their families are inadequate.

“The department recognizes that treating mental health illnesses appropriately should also address the member’s environment, which for many members means helping the family cope as well. Thus, in order to meet obligations to treat the member, the department may also need to include the family,” the audit said.

“However, when surveyed by the department, mental health services in places such as CFB Petawawa and CFB Gagetown — bases with large numbers of members returning from deployment in Afghanistan — said they were unable to extend member care to include family support because of resource shortages.”

Officials with the auditor general’s office stressed that the Defence Department has no legal obligation to treat families, only military personnel. But the military itself has acknowledged that it has “a moral obligation” to include families in the treatment of military members.

But Bruyea argued that if the military neglects the mental health needs of soldiers’ families, that will ultimately drive more people out of the Forces.

Fraser’s team did not set out to specifically audit the delivery of mental health services. The issue came to light as part of a broader study of whether the military is effectively managing the $500 million it spends each year delivering health care to its 63,500 members.

The military spends almost twice as much on health care as the civilian sector, with an annual cost of $8,600 per member compared with the average of $4,500 that provinces spend on other Canadians.

The report turned up cases of “questionable transactions” by physicians who did contract work for the military, and those cases have been referred to the Defence Department’s chief of review services for a follow-up audit. In particular, some doctors appear to have double-billed for services, but the circumstances surrounding the payments remained unclear.

The audit concluded that, despite the rising cost of military health care, the Forces still lack the information to determine whether their members are getting appropriate care at the proper cost. Part of the problem is that the military still relies on paper records, which makes it difficult to compile the sort of broad analysis that computerized records would afford.

As a result, the Forces don’t know whether all their health care professionals are licensed or certified. Nor were they able to tell auditors how many Canadian troops have been injured in Afghanistan, or what treatment they received.

“This information was not readily available and was only partially captured because of a health care provider who took the time to compile the data for his region. We also asked how many members were receiving care from a mental health professional, but the department was unable to compile this data,” the report said.

CanWest News Service recently obtained data from the Canadian Forces Expeditionary Force Command that found nearly 400 of 2,700 soldiers returned from Kandahar with mental health problems. In all, that report found that 15 per cent of troops reported mental health problems, about five per cent reported major depression, while another five per cent reported post-traumatic stress.

But, as Fraser’s audit detailed, military health managers lack the ability to generate their own overview of health services delivery.

Fraser said the Forces have made some gains since instituting reforms seven years ago that were aimed at helping military patients navigate their health system and claim benefits.

“Getting consistent Canadian Forces-wide data on health care has been an ongoing challenge for senior management and has resulted in an ad hoc, (reactive) approach to gathering management information,” the audit stated.

Ottawa Citizen

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