There is a 15 per cent to 20 per cent shortage of mental health professionals in the CAF and quality and consistency of the existing care is found wanting, exacerbated by sending military members to unmonitored outside providers. As well, by merely wiping their hands of those who don’t come forward, DND has perpetuated a profound abandonment of the injured who need new strategies to receive help.
OTTAWA—The recent spate of suicides by serving and retired Canadian Armed Forces members is indescribably tragic. If we truly wish to live up to our claims as a civilized and compassionate nation, then we have the highest moral obligation to ask tough questions and risk being profoundly changed by the answers.
First, we must remember and honour the most recent four victims of apparent suicide: Master Bombardier Travis Halmrast, Corporal William Elliot, Master Warrant Officer Michael McNeil and Corporal Sylvain Lelièvre. They are casualties of combat and military service. We can only imagine but we must understand the degree of darkness they endured to make such a difficult decision. The official government understanding is less than helpful.
The DND hierarchy after each suicide marches out the platitudes and rhetoric. DND claims Canadian Armed Forces (CAF) personnel have a lower suicide rate than the civilian population or that of the U.S. military. Such cold comfort allows the largest of Canada’s federal departments to sit on its hands, avoiding the deep critical thinking needed to make important changes. In fact, such statistical claims have often been massaged to show a seemingly benign picture of death. For five-year periods, the CF average has been steady at about 19 suicides per 100,000 soldiers, same or slightly more than the civilian population rate of 18 per 100,000 for males (the military is still overwhelmingly male) and approximately 20 per 100,000 for the American military.
The CF reportedly allocates $50-million to mental health. Since suicide rates are not decreasing and mental health issues are increasing in the CF then we need to ask whether existing programs are the right ones to address the needs of the psychologically injured regardless of the political dollar braggadocio.
DND claims that “CAF personnel are a screened workforce and have access to comprehensive, high-quality health programs and services.” Not surprisingly, DND defines “comprehensive” and “high quality.” Recent suicides and highly-visible quality of life issues for the psychologically injured render specious such claims. When an organization asserts it is doing things right, it has lost the ability to determine what it is doing wrong. Perhaps that is why the chief psychiatrist, Col. Rakesh Jetley, recently said that “we comfort the patients who are in care, we encourage any people who are struggling…to come forward…And as a genuinely caring organization, that’s all we can do.”
Using immeasurable claims such as the CAF is a “genuinely caring organization” reinforces DND’s inability to self-reflect in a critical manner. However, is that “all we can do”?
DND has poured most of its money into clinical programs. There is little doubt that clinical programs can benefit the psychologically injured. There is a 15 per cent to 20 per cent shortage of mental health professionals in the CAF and quality and consistency of the existing care is found wanting, exacerbated by sending military members to unmonitored outside providers.
Since the therapeutic alliance is key to any successful outcome, empathy is widely regarded the No. 1 condition to achieve that outcome and is essential for client-centered therapy. Understanding the vast complexities of military culture and the nuances of the organization is fundamental to empathizing with the psychologically injured. Often, health professionals treating the military don’t understand the difference between a corporal and a captain, let alone the expansive organizational and social demands put upon a soldier each and every day. Therapy by such providers is doomed to be less than successful.
DND has no inpatient program, one often necessary for the stabilization and management of psychological injuries and integral to “comprehensive” care. Instead, DND has a limited partnership with Homewood in Ontario, a trauma treatment centre. Barry Westholm emphasizes in a well-documented letter of resignation from the CF, Homewood focuses upon a civilian lifestyle model, for which therapists are nearly completely unaware of the intricate nature of the military ethos. It is no surprise that many do not complete the program. For those who do, they leave “buoyed by a sense of great confidence, however when the support of Homewood ends, this feeling can be replaced by abandonment” and result in “significant relapses.”
Betrayal and abandonment are at the crux of the clinical model’s limitations to treat psychological injuries. Due to the “family” nature of the military and deep indoctrination of military expectations and demands upon the soldier, one of the persistent cries for help by the psychologically injured is that of betrayal and abandonment by the military. This is not surprising. Academics, journalists and even clinicians in the U.S. such as Andrew Bacevich, David Finkel and Jonathan Shay are unravelling the nature of this betrayal as essentially a moral injury to the soul. Such profound psychological injuries which often obliterate the essence of who we are, cannot be reconstructed and healed by medication or a couch.
As the military is a highly-social organization, healing must also be done socially. The peer support network in the CAF is helpful but it too is limited. To join the military, soldiers are deeply indoctrinated to replace personal goals and priorities with military goals and priorities. DND calls this the “mission-soldier-self” ethos, in exactly that priority. How can the psychologically injured overcome such powerful, deeply ingrained institutional stigmas and fully care for oneself or seek help? By merely wiping their hands of those who don’t come forward, DND has perpetuated a profound abandonment of the injured who need new strategies to receive help.
Since the military endures the psychological injuries in the service of Canadians and government, both must also be intimately involved in the healing process. This shattering of the soul results in a pervasive sense of not belonging to the military or civilian society. Such social no-man’s land is a recipe for self-destruction.
Canadians have perhaps unwittingly contributed to the problem by viewing our military as heroes. Heroes do not ask for help nor do they allow themselves to be the vulnerable human beings necessary to integrate into society. Calling soldiers heroes robs the soldiers of their flawed humanity and Canadians can distance themselves from the difficult work of understanding and caring for our military. We can only belong when we know we are accepted as we are. And we can only heal when we know we belong.
Canadians like most nations with professional armed forces have left the role of caring for the wounded to government while busy lives choose not to think of the horrors of war or the demands of military service. Certainly government has been complicit in telling the public that the public need not worry, all is okay for our wounded. Clearly it is not.
The suicides are the tip of the iceberg for DND’s inadequacy in either directly providing care or involving Canadian society to help soldiers know they are accepted, belong and will have a life every bit, if not more fulfilling than a military career. This is the least of our obligations to our military.
Sean Bruyea is vice-president of Canadians for Accountability, a retired Air Force intelligence officer and frequent commentator on government, military and veterans’ issues.
The Hill Times