Mental health care in Forces: Let’s clear a few trees to see forest

Sean Bruyea

When it comes to mental health and suicides in the military, the Canadian Armed Forces can do much to come clean and diminish the self-serving rhetoric.

Chief of the Defence Staff Tom Lawson claims the public focus on military suicides could be aggravating the crisis in having “brought a slight honour to the act of suicide.” This unfortunate attempt to closet away debate on an extremely serious issue has little basis in scientific research. The ‘suicide contagion’ effect has been validated amongst hyper-connected and highly self-conscious teens, with the greatest vulnerability amongst 12 to 13-year-olds. There is scant basis to believe that mature professional adults in the military may be subject to this contagion.

Even with unprecedented public attention on the issue, the military still drags its heels in both hiring sufficient mental health-care staff as well as completing outstanding suicide investigations. Nevertheless, the CAF’s director of mental health, Scott McLeod claims “no other organization in Canada, and probably the world, has got a program that intensive to learn from these suicides.”

One month later in January 2014, Defence Minister Rob Nicholson announced that the military was finally going to clear a backlog of 50 uncompleted suicide investigations. There are approximately 50 suicides every five years in the regular force population. How could the military “intensive[ly] learn” from any suicides over the previous five years if apparently none of the investigations are complete?

In May 2012, the military cut almost half the research staff and epidemiologists who analyze mental health issues such as depression, PTSD and suicide.  Instead, the Forces would rely on research from Veterans Affairs Canada. VAC has a directorate of 11 employees representing an annual expenditure of perhaps $1.5-million. The last research report available on the internet is dated 2011. The US Department of Veterans Affairs had a research budget of over $1-billion in 2012.

Meanwhile, the investigation into the 2008 suicide of Corporal Stuart Langridge languished for years before a Military Police Complaints Commission was initiated in 2011. It has yet to release its findings.

The military maintains that Langridge’s suicide was not due to military service or PTSD in spite of testimony from his closest relatives and friends to the contrary. The military insists that substance abuse was the cause. Amongst the American veteran population, 91 per cent of inpatient PTSD sufferers experienced substance abuse and 73 per cent of  Vietnam veterans with PTSD suffered alcohol abuse.

The Langride case shows military culture intent upon blaming the victim and defending the perceived institution’s reputation rather than addressing the large gaps in mental health care. This is perpetuated by senior officers such as the chief psychiatrist, Rakesh Jetly who claims some soldiers are not coming forward because they are “self-stigmatizing.” Most research into self-stigma and mental illness focuses upon sufferers of psychotic disorders such as schizophrenia: the military screens out such serious mental illnesses. The research jury is still out when it comes to self-stigma as it relates to PTSD and depression. The shame and low self-esteem of self-stigma are also key symptoms of these two conditions; separating the stigma from the illness is difficult if not irrelevant.

Soldiers already experience much shame in their condition but now it is their “self-stigma” which prevents them from seeking help. Surely this is a recipe for negatively affecting their willingness to come forward. Self-stigma cannot exist without external stigma. When soldiers suffering psychological injuries know that they could be booted from the military, this is known as “structural stigma” writ large. An institution that refuses to employ certain psychologically injured is clearly stigmatizing.

The military indoctrinates its employees unlike any other secular institution. It refers to itself as the “military family” and calls its employees “members.” Most of all, the Forces persistently and vehemently reinforce an ethos of “mission, soldier, self,” a deep psychological commitment by each and every member to place the institution and its goals first, care of one’s fellow soldiers second and then care of oneself last.

How do psychologically-injured soldiers come forward for personal care let alone experience success after being kicked out of this all-encompassing military ‘family’ when their own care has been the last thing on their mind for sometimes decades?

In this military-first culture, is it surprising that sending uniformed individuals to investigate suicides fails to find a link between uniformed service, PTSD and suicide? The military link is crucial to receiving veterans’ benefits.

If military service is not to blame, why would any soldier come forward for help if both the illness is the soldier’s fault but also their reluctance in coming forward? How can any soldier trust an institution, which even after witnessing shame-filled self-destructive deaths would completely absolve itself of any responsibility?

This piece was first published in the Hill Times on March 10, 2014.

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