ARCHIVED - The CF 2002 Supplement of the Statistics Canada Canadian Community Health Survey

This insert contains a summary of the main findings of the CF 2002 Supplement of the Statistics Canada Canadian Community Health Survey. Details on the CCHS are available at Statistics Canada. The CF 2002 CCHS supplement is available at the CFHS website.

The CFHS is bringing together a group of specialists to undertake an in depth analysis of the data provided by Statistics Canada. Major developments in this field will be communicated to CF members via The Maple Leaf, base/wing newspapers and other internal communication tools.

Table of Contents

• A major step in combating the stigma of mental illness
• Statistics Canada’s Survey: Objectives & Methods Used
• Most common mental health disorders
• Findings validate CF Health and Lifestyle Information Surveys
• Survey will help in developing a better approach to mental health care
• Extensive tools and services in support of psychological well being
• Easy and direct access
• Useful Websites
• Break the silence

The Canadian Forces (CF) believes that the mental fitness of its members is as important as physical fitness if members are to be able to accomplish the many arduous tasks they are called upon to perform.

However, until now, the CF has not had a solid handle on the extent of mental health issues and concerns facing its members and thus felt the need for assessing the members psychological well being in order to better evaluate the adequacy of the mental health care resources and services already in place and determine new ones, if need be.

The latest edition of the Canadian Forces Health and Lifestyle Information Survey (CFHLIS) conducted in 2000 had already indicated there was reason for concern in the area as rates of mental health issues were found to be higher than those in the general Canadian population. To obtain more accurate information, the Department of National Defence (DND) asked Statistics Canada to undertake a comprehensive survey of the mental health status of CF members. A special CF module was developed as a supplement to a planned Statistics Canada Canadian Community Health Survey (CCHS), which, for the first time, contained a significant mental health component.

The CF 2002 CCHS Supplement, as the survey has been called and which results have been released on September 5, involved a representative, randomly chosen sample with more than 5,000 Regular force members and 3,000 Reserve members responding and was conducted between May and December 2002. This study was designed to determine the level of need, not to investigate the causes of ill-mental health in CF members.

The CF survey was undertaken under the Statistics Canada Act and the Privacy Act that legally bound Statistics Canada to protect the confidentiality and privacy of survey participants. In addition to this guarantee of confidentiality, Statistics Canada offered a guarantee of quality as it enjoys high response rates and is internationally recognized for its expertise in conducting special surveys.

The role of DND, once the CF Supplement schedule, budget and design details were approved, consisted only of providing Statistics Canada with access to CF members.

“Our role as a military health care system is to understand the significant health care issues of Canadian Forces members, and to address those concerns in the most effective way possible,” said Colonel Scott Cameron, the Canadian Forces Surgeon General. “Mental health concerns are every bit as significant and legitimate as physical health concerns,” he added.

Detailed analysis of the data released on September 5 has yet to be undertaken and is expected to take place in the coming months. But already the survey is considered to be “an important milestone for the CF mental health services,” according to Colonel Randy Boddam, Director of Mental Health Services for the CF Health Services (CFHS).

“It was absolutely essential that we determine the mental health status of our members, so we create programs that help those who need treatment and that we promote and maintain a high level of mental fitness among all CF members”, said Col Boddam.

The survey will also allow the CF to assess the mental health of its members against the general Canadian population. With this valuable information it will be possible to determine what factors lead to good mental health, how to address mental health issues in the CF and the resources needed to support them.

Col Boddam believes that improvements to the CF mental health care system that will result from this survey will make a tangible difference in the lives of CF members: “We are ultimately working towards a mental health care system that is comprehensive, integrated and that delivers services to a standard of excellence that results in psychologically fit members.”

The CF has been enhancing its mental health services for some time now and is confident that the results of this survey, once analyzed, will validate that work and confirm the CF has been headed in the right direction. There is no question additional resources could be put to use in this area, as the CF has now, through this survey, a new tool to better understand the underlying reasons of mental health distress among some of its members.

The role of the military health care system is to understand the significant health care issues of Canadian Forces members, and to address those concerns in the most effective way possible.

A major step in combating the stigma of mental illness

By Colonel Randy Boddam, Director of Mental Health Services — CFHS

What is the state of the Canadian Forces’ (CF) members’ mental health? What issues face us? Do we, as members of the CF, have specific issues or needs that are different from the civilian sectors of Canadian Society? These questions formed the basis for which Project Rx2000 asked Statistics Canada to undertake our Epidemiologic Survey –– a survey designed mainly to determine the frequency of occurrence of certain mental illnesses experienced by members of the CF.

Mental health and mental illness have been issues that most people don’t like to talk about. Often mental illness is perceived to be something rare – “It won’t happen to me.” The stigma, that is the negative perception that mental illness and those suffering from it experience, comes mostly from misunderstanding of how common mental illness is and how it arises. Often people feel that a person suffering from mental illness must have done something that caused them to become ill. Another interpretation is that a person with mental illness is faking it to get some sort of benefit. In reality, studies have suggested that some of the illnesses within the broad group of diseases called “mental illness” can be very common. Our goal was to determine how common some mental illnesses are and what special health needs CF members have.

Civilian studies

Until our survey was started the only estimates that we had of how common mental illness might be in the CF came from studies done in the civilian sector. One of the first studies, called the Stirling County Study, was undertaken in Nova Scotia in the 1960’s. In the 1980’s a major study, The Epidemiologic Catchment Area survey, undertaken in the United States first demonstrated that about one in five people would suffer a mental illness at some point during a six months period. That survey also showed that almost one in three people would suffer from a mental illness in the course of a year. Up until then no one really had a sense of how many people should be getting care. In the late 1980’s the methodology of this survey was used in Edmonton. Similar results were found.

The National Comorbidity Survey of the United States done in the early 90’s followed. This study, as well as a similar one undertaken in Ontario in 1992, the Ontario Mental Health Supplement, demonstrated a one-year prevalence rate of any mental disorder of over 24%. That means that in one year about one in four people will suffer from a mental illness. The National Comorbidity Survey also found that about one in 13 people would suffer from Posttraumatic Stress Disorder (PTSD) at some point in their life.

Assessing CF members mental fitness

As Rx2000 set out to try to determine the amount of psychological suffering that was happening in the CF we found that similar questions were being asked throughout the world. We were able to take advantage of that work and tag along. That was how we were able to ask Statistics Canada to survey us at the same time as they were surveying Canadians in general. That will allow us to see where we stand in comparison to our civilian counterparts. We did, however, include some components to our survey that were not used in the Canadian Survey. One disorder that we felt important to examine was the amount of PTSD present. Unfortunately this was not being examined in the Canadian Civilian Sector although a research group in Hamilton has determined that about one in 11 Canadians would suffer from PTSD at some point in their life.

The CF Supplement to the Canadian Community Health Survey (CCHS) met with greater acceptance and cooperation by the CF than its civilian equivalent by the Canadian population. Statistics Canada could not believe how helpful CF members were in taking the time to participate in the survey. We ended up having more respondents to our survey than was originally needed. This level of support has ensured that we get the sort of data that we need to really get a sense of what the mental health needs of the CF are. The net result of all of this is that we are in a very good position to understand what challenges face CF members from a mental health perspective. It truly is the fact that so many CF members took the time to participate that has made this survey so successful.

The survey uncovered several important facts:

• The illnesses that are common in the civilian sector are also common in the CF;
• The most common illness that CF members face is depression;
• The next most common problem is alcohol dependency; and
• Following these two illnesses are social phobia and PTSD.

Depression: a major issue

For depression we found that about eight in 100 members of the Regular Force and four in 100 Reservists will suffer a major depressive illness at some point in the course of a year. This means that there is an incredible amount of suffering being experienced each year by members of the CF. This is a very important finding, because depressive illness can lead to a significant amount of disability. It’s also important because depression is an illness that, if not treated aggressively enough or soon enough, can develop into a source of chronic disability.

By recognizing how common depression really is, we hope that members of the CF who might be experiencing some worrying symptoms will feel free to see their medical officer, get treatment, and nip problems in the bud.

Alcohol: CF proactive programs paid off

Over the last couple of decades the CF has been very pro-active in addressing alcohol related problems. In some ways we have been more so than our civilian colleagues. This is no different today. What our current figures have shown us is that the efforts that we have made in the past have paid off. Twenty years ago we were thought to suffer from alcoholism and alcohol related problems at a rate higher than that seen in the general Canadian population. This is not the case anymore. When the Canadian results are age and sex standardized to reflect the younger, male CF population, rates are found to be lower in the CF than in the Canadian population. That doesn’t mean that we should stop addressing alcohol and other substance related problems or dealing with addictions in general. Alcohol abuse and dependence are still important problems for our members and we need to keep the focus on healthy living and early intervention when indicated to be able to live healthy lives and maintain operational readiness.

Social Phobia: a more frequent disorder than one thinks

We also found that social phobia is a common disorder. Social phobia is a disorder of excessive shyness. It is often not treated early and can lead to such complications as alcoholism and depression. Unfortunately the fear of embarrassment that people with social phobia experience is a major obstacle to presentation for treatment. Hopefully now people will realize that they are not alone and that care is available.

Posttraumatic stress disorder: military prevalence lower than anticipated

Finally, the survey found a prevalence of PTSD in the CF lower than anticipated. In people’s minds, PTSD is mainly related to combat or deployment trauma, but not only can a lot of traumas cause PTSD, similarly combat and deployment trauma can cause a number of problems besides PTSD. The CF has called these groups of problems Operational Stress Injuries, and is addressing them through a wide range of services. The rates of PTSD found by Statistics Canada were also consistent with the findings of the latest CF Health and Lifestyle Information Survey (CFHLIS), undertaken in 2000.

Over the next little while we will be looking at the information that the CF Supplement has provided to determine how we can best target activities such as education and care delivery. We are also hopeful that by showing how common mental illness is people will feel that they can get the care they need early enough to prevent the illness from becoming chronic or being complicated by other problems.

Perhaps by recognizing how common mental illness is members of the CF will start to see mental illness for what it is, an illness or injury no different from any other physical illness or injury. We have an opportunity to overcome the stigma of mental illness.

The stigma, that is the negative perception that mental illness and those suffering from it experience, comes mostly from misunderstanding of how common mental illness is and how it arises. Mental illness are no different from any other physical illness or injury.

The more than 83,000 CF members (Regular Force and Reserve) are doubly concerned by mental disorders as they are exposed not only to the problems of a “normal” life, but also to those of a high-risk career.

By recognizing how common depression really is, we hope that members of the CF who might be experiencing some worrying symptoms will feel free to see their medical officer, get treatment, and nip problems in the bud.

Statistics Canada’s Survey: Objectives & Methods Used

Excerpts from the Canadian Forces 2002 CCHS Supplement Briefing Document (Special Surveys Division – Statistics Canada)

The Canadian Forces (CF) Mental Health Survey was conducted as a supplement to the larger Canadian Community Health Survey (CCHS) developed by Statistics Canada for the purpose of providing regular and timely estimates of health issues across the country.

During the development of the CCHS, mental health issues were consistently mentioned as high priority topics to be measured. In May 2002, CCHS began collecting data on mental health disorders in Canada.

As the CCHS target population excluded full-time members of the regular CF and as the Department of National Defence (DND) wanted to be able to provide reliable, analogous information for the military, DND asked Statistics Canada to undertake a special survey supplement on mental health with a representative sample of the CF, both regular and reservist members. A joint DND – Statistics Canada steering committee was then established to approve the CF 2002 Supplement schedule, budgets, design details, dissemination and communications plans.

The survey, known as the Canadian Forces 2002 CCHS Supplement, had similar objectives and content as the parent CCHS, but was adjusted in some aspects to reflect the specifics of the CF.

Objectives

The objectives of the mental health portion of the CCHS, were:

• To estimate how common certain mental disorders are;
• To collect data on the utilization of mental health services and perceived health needs;
• To examine the links among mental health and social, demographic, geographic and economic variables or characteristics; and
• To collect data on the disability associated with mental health problems both to individuals and society.

The CF 2002 Supplement had analogous objectives to those of the CCHS, against which results will be compared. With this information it will be possible to determinewhat the actual needs for mental health care are for the CF.

Topics and sample design

The target population for the CF 2002 CCHS Supplement was all full time regular members of the CF, and reservists who have paraded at least once in the past six months. It was decided that 5,000 responding full time members and 3,000 responding reservists would be required at survey completion to enable the analysis sought at satisfactory precision levels. To ensure the survey ended with the targeted responding populations, and assuming a minimum response rate of 70%, a total sample size of approximately 13,000 units was drawn initially: 8,000 full time members and 5,000 reservists. The sample was drawn from the DND CF Peoplesoft Human Resource Database.

Each target population (regular force members and reservists) was stratified by gender and rank. To avoid very small cells the rank characteristic was collapsed into three categories for the male group (Pte/AS to MCpl/MS, Sgt/PO2 to CWO/CPO1, Officers) and two categories for the female group (Pte/AS to CWO/CPO1, Officers).

Questionnaire Design

Psychiatric disorders to be covered by the CCHS and the Supplement were chosen using a set of criteria determined by experts. For the measurement of mental disorders, it was recommended that the US version of the World Health Organization (WHO) 2000 Composite International Diagnostic Interview (CIDI), Version 2.1 be used. This will enable comparability with other countries while providing well-tested and validated modules.

The well being and determinants of mental health questions were compiled from both the CIDI (social networks), and other sources (Canadian Community Health Survey Cycle 1.1, National Population Health Survey, Santé Québec, Ontario Health Supplement, etc.).

Health care utilization was principally a CIDI module. Disability was compiled from the CIDI and established Statistics Canada surveys.

Testing strategy

Due to the complex nature of this survey content as well as the rather probing nature of the questions, qualitative testing was undertaken for the CCHS and separately for the CF Supplement. This qualitative testing consisted of one-on-one interviews to test acceptance of the survey’s content and procedures as well as test questionnaire wording and flow. The qualitative testing specific to the Supplement was principally testing acceptance of the Post-Traumatic Stress Disorder (PTSD) survey content and procedures. Pilot testing of both the CCHS and Supplement was also conducted.

Both the CCHS and the Supplement conducted focus group testing. For the supplement, testing was important especially to determine how the CF membership would react to Statistics Canada, an external agency, and what measures the CF members would like to see to ensure confidentiality of the information.

Data collection

Data collection took place monthly for both the CCHS and the Supplement between May and December 2002. Those interviewing durations allowed the interviewer workload to be spread out in the field while eliminating possible seasonality effects on some mental health characteristics. They also, in the case of the Supplement, allowed for more time in which to contact respondents who might be departing/returning from field deployments and/or training courses. The vast majority of Supplement interviews were conducted face-to-face during working hours in private on-base rooms, reserved by DND for survey interviewing.

Overall, the Supplement achieved excellent response rates: approximately 80% and 83% respectively for the regular and reserve forces. A large part of this success was due to good coordination between DND and Statistics Canada in tracing/tracking members to be interviewed and in the many communications activities undertaken to ensure the CF membership was aware of the survey and its objectives and that the data is being collected under the authority of the Statistics Act and is, like the whole survey process, strictly confidential.

Most common mental health disorders

Approximately one in four people will suffer at some time in their lives from mental illness, according to various studies and surveys done in Canada and around the world. These disorders can range from a general state of anxiety to depression, social phobia, alcoholism, or posttraumatic stress disorder (PTSD), to name a few.

The more than 83,000 CF members (Regular Force and Reserve) are doubly concerned by these disorders as they are exposed not only to the problems of a “normal” life, but also to those of a high-risk career.

Good news, though: most mental illnesses, whether they are linked to deployments or to the stress of everyday life, can be treated effectively provided they are identified correctly and in time.

The following is a quick overview of the symptoms, probable causes, diagnosis and treatment of some of the disorders that have been identified by the Statistics Canada Survey as causes for concerns within the CF.

Depression

The CF Mental Health Survey has found a one-year depression prevalence of 7.6% and a lifetime prevalence of 16.2% within the CF regular force. The prevalence for reservists is respectively 4.1% and 9.7%. This means that 7.6% of regular force members and 4.1% of reservists will get a Major Depression Disorder in the course of a year. 16.2% of regular force members and 9.7% of reservists will develop the condition at some point in their life.

People often talk about feeling depressed when they experience negative or bad things happening to them. After a relatively short period of time their mood returns to its normal level. However, in Major Depressive Disorder the person is unable to experience that normal mood for most of their day. They either feel down or they don’t feel anything or they have lost interest in a significant number of activities and are unable to recover unlike a person who is having a bad day. This problem lasts for at least two weeks and often exists for months. It considerably affects the life and functioning of the person suffering with it.

Major Depressive Disorder is a mood disorder. Mood disorders include bipolar mood disorder (or manic depressive illness), cyclothymia (chronic mild depression) or dysthymia (mild version of manic depressive illness). Major depression can be treated effectively, but is considered a serious illness because it can lead to suicide.

A depressed person experiences feelings of worthlessness, helplessness and guilt, possibly accompanied by bouts of deep sadness, a lack of energy and a lack of interest in all kinds of activities and in other people. Depression can profoundly change a person’s attitude and perception of life and can considerably alter how he or she functions, especially since it is often accompanied by sleep disorders and eating disorders.

A number of causes of depression have been suggested, including stress related to upsetting life events, a biochemical imbalance in the brain, certain psychological factors and even genetic predisposition. Some people with serious health problems, such as cardiovascular disease, cancer, Parkinson’s disease and other problems affecting the brain, may also develop depression.

Although it can take various forms and may recur, depression is considered one of the most treatable of mental illnesses. However, if left untreated, recovery may take a lot longer, if it happens at all or it may increase the risk of developing a chronic recurrent course. Early and aggressive treatment is highly recommended.

Depression can be treated by medication, psychological counselling or both. Support from family and friends is also extremely important for the patient’s recovery.

Anxiety

Anxiety Disorders consist of a group of mental disorders, including Generalized Anxiety Disorder, Panic Disorder, Social Phobia and PTSD. Taken as a group, Anxiety Disorders are the most common of all the mental disorders.

Social Phobia

In the CF regular force, the prevalence of Social Phobia, the most common of Anxiety Disorders, is 3.6% (one year) and 8.7% (lifetime). The reservists have a prevalence of 2.3% and 7.1%.

Persons with social phobia fear social situations in which they think they may be humiliated, embarrassed or judged by others. This fear often occurs when the person has to deal with strangers. In some cases, people with social phobia fear only situations in which they have to make a presentation of some kind in public (conference, concert, presentation of a project and so on). In other cases, the phobia is generalized and causes the person to avoid all public places outright.

As with other phobias, social phobia, also called “social anxiety disorder”, is a disorder that runs in families. Children who are shy and who are loners are also more at risk for developing this phobia later.

In certain social situations, a person with social phobia disorder reacts almost immediately with anxiety, exhibiting symptoms such as rapid or skipping heartbeat, excessive sweating, gastrointestinal discomfort, tense muscles and confusion. Some of these symptoms resemble those of panic disorder, described further on.

Social phobia interferes with the sufferer’s normal day-to-day functioning. However, it is a disorder that can be treated effectively and that has a satisfactory recovery rate.

Posttraumatic Stress Disorder (PTSD)

According to the Statistics Canada survey the one year and lifetime prevalence of PTSD is 2.8% and 7.2% for members of the regular force and 1.2% and 4.7% for reservists.

PTSD is a group of symptoms of anxiety that affect a person who experienced something terrifying such as a car accident, plane crash, natural disaster, imprisonment, being taken as a hostage or combat. Some adults can still be experiencing PTSD from trauma experienced in childhood (sexual or physical abuse).

There are several symptoms groupings that occur in PTSD. One grouping of symptoms is known as the re-experiencing symptoms. Examples of such re-experiencing include living through a flashback or having the memory replay through the person’s mind in spite of efforts to try to prevent that from happening. Another dramatic grouping of symptoms is the hyperarrousal group. Being forced to relive trauma repetitively can leave you feeling on edge with difficulty sleeping, calming down, or concentrating. You may find yourself to be quite irritable, constantly scanning the environment for signs of danger.

PTSD was first labelled as a disorder in 1980 in response to the experience of American Vietnam War veterans. Of course, many different experiences can lead to the development of PTSD but the first thought that tends to come to most people’s minds is one of the combat or peacekeeping soldiers. Not only can a lot of traumas cause PTSD but similarly trauma can cause a number of problems besides PTSD. The CF has called these groups of problems Operational Stress Injuries.

PTSD symptoms tend to come on immediately after the experiencing of the trauma although they can be delayed up to several years in some cases. PTSD can also be quite a chronic disorder. While many of the symptoms that we described above would come on in just about anyone exposed to a critical incident, what causes PTSD to stand apart from critical incident stress is the failure of the symptoms to go away with time. PTSD can only be diagnosed after a minimum of a month of experiencing PTSD symptoms.

Many treatments can be helpful for people suffering from PTSD. These include medications and psychotherapy. Cognitive Behavioural Therapy, while difficult at times for some people, has been demonstrated to be particularly effective for the management of PTSD. Antidepressants such as Prozac, Paxil or Zoloft can also be quite helpful. The first and most important step is to discuss the symptoms with your medical officer.

Generalized anxiety disorder (GAD)

According to Statistics Canada survey the one year and lifetime prevalence of GAD is 1.8% and 4.6% for members of the regular forces, 1.0% and 2.9% for reservists.

People with General Anxiety Disorder experience excessive worry or anxiety about a number of events or activities. The objects of their anxiety vary according to their personal situation and the anxiety they feel is not associated with any one particular thing. In fact, people with this disorder worry almost all the time and about everything.

Generalized Anxiety Disorder affects twice as many women as men. A person is considered to have generalized anxiety disorder if he or she experiences excessive anxiety about a number of things, accompanied by certain related symptoms (fatigue and poor concentration), for several days at a time, over a period of at least six months.

Generalized Anxiety Disorder can be treated by means of certain relaxation techniques and cognitive behavioural therapy. Medication is also often helpful.

Panic Disorder

Statistics Canada survey showed a one year and lifetime prevalence of Panic Disorder of 2.2% and 5.0% for members of the regular forces, 1.4% and 3.3% for reservists.

A person is considered to have Panic Disorder if he or she is subject to recurrent and unexpected panic attacks, followed by at least one month of persistent concern about having additional attacks, worry about the implications of the attack or its consequences, or a significant change in behaviour related to the attacks.

The symptoms of a panic attack include trembling, shortness of breath, feeling suffocated, pain, nausea or abdominal discomfort, dizziness, unsteadiness or fainting. These physical symptoms are generally accompanied by a fear of losing control, of going crazy or dying.

Treatment of Panic Disorder is also based on cognitive behavioural therapy and the prescribing of antidepressants.

Alcoholism

According to Statistics Canada survey the one year and lifetime prevalence of Alcoholism is 4.2% and 8.5% for members of the regular forces and 6.2% and 8.8% for reservists.

Alcoholism is a chronic and progressive illness that claims a very large number of victims, essentially because alcoholic beverages are widely available and consumption of alcohol is part of social rituals.

A person is considered alcoholic if he or she feels a continuing need to consume alcohol and if, in the absence of alcohol, he or she shows specific physical symptoms (tremors, rapid pulse, fever, insomnia, hallucinations, seizures and so on). Alcoholics feel the need for more alcohol drink to function and steady their nerves or to fight a hangover. Comments by those around them about their alcohol use greatly upset them and they tend to drink alone or in secret.

The direct effects of alcohol abuse on a person’s health include hepatitis or cirrhosis of the liver, but alcoholism can cause an endless list of health problems affecting nearly every major organ system in one way or the other, as well as psychological, family, social, economic and health problems. Excessive drinking of alcohol is also associated with domestic violence and crime, as well as with traffic accidents. Finally, alcoholism reduces the alcoholic’s life expectancy by at least 15 years.

Certain social or cultural influences, frequent exposure to alcohol, personal problems, anxiety disorders and depression can lead to alcoholism. There can also be a hereditary predisposition: some studies have shown that children of alcoholic parents are more at risk than children of non-alcoholic parents.

The field of alcoholism treatment has undergone a significant amount of research over the past several years. Often the best form of treatment is abstinence but a major focus of treatment has to be on relapse prevention.

Because it is a chronic illness, alcoholism requires a long-term strategy to help the person recover from it. Initial treatments often involve detoxification and may involve in-patient care. Later, certain drugs and group therapies can help relieve the physical symptoms of withdrawal and can help combat habituation.

In the CF we have a cadre of skilled and knowledgeable clinicians, the Base/Wing Addiction Counsellors who can help find the right fit between the person suffering the problem and the treatments that are available.

Most mental illnesses, such as depression, whether they are linked to deployments or to the stress of everyday life, can be treated effectively provided they are identified correctly and in time.

In the CF we have a cadre of skilled and knowledgeable clinicians, the Base/Wing Addiction Counsellors who can help find the right fit between the person suffering the problem and the treatments that are available.

Alcoholism is a chronic and progressive illness that claims a very large number of victims, essentially because alcoholic beverages are widely available and consumption of alcohol is part of social rituals.

Findings validate CF Health and Lifestyle Information Surveys

The results of the Statistics Canada Mental Health Survey are good news for the Force Health Protection (FHP) team involved in the ongoing CF Health and Lifestyle Information Surveys (CFHLIS). Until the Statistics Canada survey was done FHP did not have a means of validating their study questions and findings in the area of mental health. Now they do.

The CFHLIS is an anonymous, confidential and voluntary health survey that is conducted on a regular basis. Its sixth edition conducted in 2000 was based on a new and improved design and was more important in scope and content.

The Statistics Canada findings are similar to what were found in the CFHLIS done in 2000 in terms of mental distress and illness. “This means FHP was asking the right questions in the right manner,” says Dr. Jeff Whitehead, epidemiologist with FHP. “We were sure we were going in the right direction, now we have validation that was indeed the case in terms of our mental health questions.”

The CFHLIS found that a significant proportion of members reported some form of mental distress during the month preceding the survey, most commonly occasional feeling of nervousness or restlessness. CF members were found to be more likely than other Canadians to experience mental distress, and consistent with the general population, mental distress is more common among women and younger members.

While the findings are cause for concern, only one in 10 who indicated they felt some kind of mental distress reported consulting a health professional about their emotional or mental health issues in the past year. That being said, CF members are twice as likely as other Canadians to use mental health services.

“There is still a stigma attached to mental illness across society,” said Dr. Whitehead. “We have to find ways to overcome that so people seek out and get the help they need.”

The CFHLIS found that seven percent of men and 14% of women in the CF suffered from depression in the previous 12 months. This rate was approximately twice that found in the general Canadian population; a tendency also confirmed by the Statistics Canada survey.

While these issues are cause for concern, an area where the CF was startled by the CFHLIS results has to do with social support or a perceived lack of it. The study results indicate that CF members are less able than other Canadians to draw upon the different forms of social support available to them on a day-to-day basis.

“This is an area where work needs to be done”, said Dr. Whitehead. “We need to know why our people are not able to draw upon the support networks available to them. We will need to look at a whole range of issues right back to how and who we recruit.”

The CFHLIS is administered every two years. The Statistics Canada survey now provides a baseline from which FHP will draw information for coming studies.

While the findings are cause for concern, only one in 10 who indicated they felt some kind of mental distress reported consulting a health professional about their emotional or mental health issues in the past year.

Survey will help in developing a better approach to mental health care

Significant changes are taking place in the way the Canadian Forces Health Services (CFHS) provides mental health care to its members, both regular and reserve force.

“Mental health issues are assuming increasing prominence throughout Canadian society, and they are especially important for the men and women of the Canadian Forces”, said Colonel Scott Cameron, the Canadian Forces Surgeon General. “It is critical to a successful recovery that CF members be able to access the care they need within the CF health care system, and that they be able to deal with their problems within the context of the CF. This is especially true for operational stress injuries.”

“Under the Rx2000 mental health initiative we have been assessing the mental health services currently available and trying to develop a system that better meets the needs of all our members,” said Colonel Brian O’Rourke, DCOS Health Services Delivery. “The key to validating where we need to go is in the data obtained from the Statistics Canada CF Mental Health Survey.”

“It is safe to say we will be looking for additional mental health care providers in everything from more psychiatrists and psychologists to social workers and nurses. We are also stressing the link between primary health care providers and mental health care providers. The primary care providers play a significant role in the identification and management of individual members who are suffering from mental health illnesses. We call it shared care,” said Col O’Rourke.

CF members need to know the medical community is going to look after their health care needs, physical and psychological. A lot of effort has gone into, and will continue to go into, educating the Chain of Command about the importance of recognizing mental health as a health care issue that needs to be recognized and treated just like any other ailment or medical complaint. The Operational Stress Injury Social Support (OSISS), a peer support network of former operational stress injuries survivors, has taken on a key role in trying to eliminate the stigma of mental health illness through education and outreach to the general CF population as well as the Chain of Command.

The health care system is trying to better position itself to help the individuals and the CF leadership is taking a significant role in trying to make the environment more conducive to members who are suffering from mental illnesses.

To meet the needs of CF members with mental health issues, a concept has been developed that takes a more structured approach to the provision of mental health services both in-clinic and operationally. The CF has also been working closely with Veterans Affairs Canada (VAC) to assist CF members in the transition to civilian health care services or VAC should they be released for medical reasons. That is a significant change.

“We have developed a strategy with VAC that focus on four key areas (i) networks of excellence, (ii) best practices forums, (iii) continuing education programs for clinicians and (iv) collaborative research,” said Col O’Rourke.

The networks of excellence includes the Operational Trauma Stress Support Centers (OTSSC) located at Halifax, Valcartier, Ottawa, Edmonton, and Esquimalt; the VAC Saint Anne Center within the Saint Anne Hospital in Montreal; priority access to a number of beds at clinics where VAC has agreements for priority access and eventually will include partnerships or contracts with civilian mental health facilities across the country and into individual practitioner’s offices as is deemed necessary.

These networks are there for current serving members, those who are clients of VAC and that key group that is transitioning from the CF to VAC or the civilian world. This is the group that in the past often fell through the cracks as they were attempting to navigate their release.

Changes taking place to enhance both the pre and post deployment medical screening process will have an impact on early identification and intervention for those with mental health issues. The enhanced process will help identify individuals who otherwise may not have come forward or who may not have even recognized potential mental health issues in themselves. It allows for early intervention and where significant progress is most likely to result. There is evidence the longer a person suffers from an untreated mental health issue the harder it is to get them back to full health and the harder it is to get them back to work as well.

“It is important for members of the CF that we do this and get it right,” said Col O’Rourke “We recognize there is a big stigma on mental health that still exists in Canadian society and in the military population as well. There are likely a lot of individuals who perhaps are suffering and have not come forward because the services were not readily available or we were not reaching out to them at first. That’s why it is important to have the resources available for prevention, education, treatment when necessary, and rehabilitation with the ultimate goal to return the member back to full health and a functional member of the CF. This is one of the key reasons why we have a military health system- to get members back to their military function (role). But when we can’t do that we have to ensure we have the systems in place to transition them to the civilian health care system.”

“These changes will make the CF a leader among its allies in the treatment of mental health issues,” said Col O’Rourke. “We see this as a very serious issue- the physical and mental wellness of our people is an essential component of our operational readiness.”

CF members need to know the medical community is going to look after their health care needs, physical and psychological.

The CF must have the resources available for the prevention, education, treatment, and rehabilitation with the ultimate goal to return the member back to full health and a functional member of the CF.

Extensive tools and services in support of psychological well being

The Canadian Forces (CF) has been, and continues to be, pro-active in the area of mental health awareness and the provision of services striving to provide members with the tools, programs and services they need to deal effectively with stressful situations.

Mental health professionals can be found within the clinic structure on bases and wings and they can be accessed directly or through referrals, whichever the individual wishes.

“The Force Health Protection (FHP) team has taken a lead role in two areas when it comes to stress management,” says Lieutenant-Colonel Jean-Robert Bernier, Acting Deputy Chief of Staff – FHP. “By extensively assessing health hazards that might be encountered by deployed forces, we hope to alleviate unnecessary worry about harmful exposures. Through Strengthening the Forces (StF), we have also developed a comprehensive national Stress Management Program.”

Deployable Health Hazard Assessment Teams made up of Industrial Hygienists and Preventive Medicine Technicians and supported by a variety of other FHP medical and scientific experts conduct extensive pre-deployment assessments of potential health hazards in CF areas of operations, including air, water and soil sampling for chemical, biological, and radiological hazards. If any hazards are identified, appropriate health protection measures are put in place before the main force deploys. They also permit medical staff to provide CF members a more accurate understanding of potential health hazards and allay stressful concerns about harmful exposures when they are unwarranted. Preventive Medicine Technicians are also routinely deployed to conduct ongoing health hazard surveillance throughout missions, and additional sampling is conducted if there is any reason to suspect the possibility of harmful exposures.

Through StF, all CF members are encouraged to take part in the newly developed Stress Management Program that has been piloted at four locations and is being rolled out nationally through Health Promotion Officers at bases and wings across the country. Stress: Take Charge! is designed to help CF members increase their stress hardiness and make them more resilient when faced with stressful situations. It is a skill-based program that offers an effective approach to managing stress, says Nancy Snowball, national manager for StF.

Stress: Take Charge! is a self-directed approach to stress management through self-awareness, behavior change and skill building. It will support those who participate in the identification of the strategies they already use and those they will begin to implement in order to optimize their stress hardiness.

The program consists of eight modules offered through the health promotion teams on the various bases and wings. The course can be adapted to the operational requirements of the local population and is unique in that it is designed to understand the stress reaction in the military context and its links to stress hardiness.

Enhancement of both the pre and post deployment medical screening processes have been put in place and are working well to support early identification of potential medical problems, psychological and physical, in an effort to get CF members the help and support they need as early as possible. It is well understood the earlier a problem is identified and treatment begins the better the chances are for full recovery.

On major deployments the CF has for a number of years included a mental health nurse or social worker with the medical support team. For Op Athena, the current major deployment to Afghanistan, both a mental health nurse and social worker will be there to offer support to deployed members.

For CF members who have identified Operational Stress Injuries there are five Operational Trauma and Stress Support Centres (OTSSC) across the country offering a range of services from treatment options to peer support. An adjunct treatment centre to current Mental Health Services, its purpose is to provide individualized assessment, education, and initial treatment for members suffering from Operational Stress Injuries. The primary focus of these centres will be those psychological, emotional, spiritual and social problems that arise from military operations. When a person contacts the OTSSC, he or she has access to a multidisciplinary team. Members of the team include psychiatrists, psychologists, mental health nurses, a social worker, and a chaplain. Contacting any one member of the team enables easy access to the other members whose knowledge may assist with problem solving or treatment.

“Social workers stationed at bases and wings across the country are available to members and at times their families, who are in need of support,” said Lieutenant-Colonel Henry Matheson, DCOS Med Policy, Social Work Policy and Standards. “As an integral part of the health care team available to members, social workers are well aware of the variety of programs and services that are available to support members as they work through their individual situations and challenges and are available to help members and families.”

CF members can make direct contact with the social workers or they can be referred.

For members and their families who are facing crisis or difficult situations but may not be ready to access the military system there are two routes that can be tapped for fast and anonymous service. The CF Member Assistance Program (CFMAP) is a voluntary and confidential service, initiated by the CF where members or their families wishing to talk to a professional counsellor or to make an appointment can simply call the CFMAP 24 hours a day, 365 days a year.

The CFMAP is not therapy but is a short-term problem-solving service and very often only a few short sessions are required. If long-term help or a more specialized service is needed, a referral to an appropriate professional resource can be made. CFMAP can be contacted at 1-800-268-7708 and an actual person will answer the phone.

The Military Family Resource Centres located on or near bases and wings across the country have crisis intervention coordinators and staff who can help members and their families find a variety of support services they might need in times of stress and crisis.

Enhancement of both the pre and post deployment medical screening processes have been put in place and are working well to support early identification of potential medical problems, psychological and physical, in an effort to get CF members the help and support they need as early as possible.

On major deployments the CF has for a number of years included a mental health nurse or social worker with the medical support team.

Mental health professionals can be found within the clinic structure on bases and wings and they can be accessed directly or through referrals, whichever the individual wishes.

Easy and direct access

Members of the Canadian Forces (CF) who wish to access mental health professionals have a variety of avenues open to them.

“It is not necessary to go to the base clinic and ask for a referral, although that is one available option,” says Lieutenant-Colonel Henry Matheson, DCOS Med Policy, Social Work Policy and Standards. “Members have the option to contact a range of service providers directly and request an appointment.”

• The majority of bases and wings across the country have mental health professionals on site. All have access to these professional services. Members can make contact with social workers, chaplains, mental health nurses, case managers, doctors, and health promotion teams to seek support.
• The services of a psychologist or psychiatrist will normally require a referral from a medical officer.
• Members suffering from operational stress injuries can make contact directly with the professional teams at one of five Operational Trauma and Stress Support Centres (OTSSC) across the country offering a range of services from treatment options to peer support.
• The CF Members Assistance Program offers short-term support outside the military system and is available to members and their families. The CFMAP can be contacted at 1-800-268-7708 on a 24/7 basis.

“It’s entirely up to the member where they wish to seek support and advice,” said LCol Matheson. “Many bases have health and wellness committees so health care professionals are well aware of the range of resources and services that exist and can guide the member in the direction best suited to their individual needs.”

Useful Websites

If you are interested in Mental Health Disorders and would like to know more about most common mental illnesses, check some of the following websites:

• Canadian Mental Health Association
• Canadian Health Network
• Canadian Institute for Health Information
• Canadian Institutes of Health Research – Institute of Neurosciences, Mental Health and Addiction
• Canadian Medical Association
• Canadian Psychiatric Association
• Canadian Psychiatric Research Foundation
• Canadian Psychological Association
• Centre for Addiction and Mental Health
• Health Canada, Mental Health
• The Mood Disorders Society of Canada
• National Network for Mental Health
• The National Eating Disorder Information Centre
• Canadian Network for Mood and Anxiety Treatments

Break the silence

Members who are suffering from stress or mental health issues are encouraged to seek out the support systems that are available to them. The CF is working very hard to overcome the stigma that has long been attached to mental illness issues and encourages members not to suffer in silence but to seek out professional help as early as possible when they or their family recognizes a problem may exist. The earlier intervention takes place the better the chances for members to return to full good health.

If you have any questions or concerns related to mental health, you are strongly encouraged to contact your local medical officer at one of the following numbers:

• Goose Bay: (709) 896-6900 x 7357
• Halifax: (902) 427-0550 x 8777
• Greenwood: (902) 765-1494 x 5046
• Gagetown: (506) 422-2000 x 4257
• Valcartier: (418) 844-5000 x 7815
• Bagotville: (418) 677-4000 x 8307
• Montreal: (514) 252-2777 x 4916
• Ottawa: (613) 945-6800
• Petawawa: (613) 687-5511 x 5392
• Kingston: (613) 541-5010 x 5070
• Trenton: (613) 392-2811 x 3480
• Toronto: (416) 633-6200 x 3900
• Borden: (705) 424-1200 x 2409
• Winnipeg: (204) 833-2500 x 5595
• Shilo: (204) 765-3000 x 3153
• Moose Jaw: (306) 694-2222 x 2280
• Edmonton: (780) 973-4011 x 6262
• Cold Lake: (780) 840-8000 x 8707
• Comox: (250) 339-826
• Esquimalt: (250) 363-2000 x 4122

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