On soldiers, invisible injuries, and a culture of stigma
This is an opinion piece authored by Nujma Bond, Manager, Communications, The Royal Canadian Legion National Headquarters and Patrick Dion, Past Vice Chair, The Mental Health Commission of Canada. A shorter version appeared in The Ottawa Citizen on January 28, 2019.
When Canadian Lieutenant-Colonel Stéphane Grenier was dispatched to Rwanda to support the 1994 UN peacekeeping effort, he was hardly a novice. He knew what he might face and was no stranger to difficult experiences. What he did not foresee is how embedded those new experiences would become.
In his recent book “After the War,” Grenier describes his thinking as he left Africa and its tragedies: “Now, as we flew over the continent, I took solace in the fact that I was finally leaving all this behind – or so I thought.” He describes not physical injury – as he was spared – but debilitating “moral injury.”
Canadian soldiers have long faced combat and non-combat situations that test their resolve both physically and mentally. It’s not new, but what is new is that we’re talking about it more than ever before. Even so, we’re hearing of soldiers waiting for help that sometimes comes too late, or those for whom suicide feels like the only option.
Several questions arise. Do we offer the right kind of preparatory mental health training before thrusting soldiers into situations that could mentally scar them for life? What needs to happen when they return? What should happen in between?
Yes, members of the Armed Forces voluntarily step forward to serve and die for their country. We repeat: die for their country. This dedication requires the highest level of respect and care. We need to increase knowledge and action when tackling the nightmare that is post-traumatic stress or Operational Stress Injury (OSI).
Experts tell us that a daunting, but surmountable hurdle remains – stigma. While progress has been made to reduce it, our military and civilian cultures need to make clear that an OSI is not a sign of weakness; it’s a result of what can happen when a person is traumatized. We need to do a better job of helping our wounded veterans, and others who walk similar paths.
In the Canadian Armed Forces, The Road to Mental Readiness (R2MR) program is embedded in basic training and beyond. While program experts recently outlined its implementation challenges, many feel it’s a necessary starting point. It is critical for future soldiers preparing for a military career to spend adequate time developing resilience and gaining coping tools. While it may be impossible to fully prevent operational stress injuries, we can help reduce their effects by lifting the weight of stigma, increasing the likelihood of soldiers asking for help.
When a challenging incident occurs, soldiers can consult with peers, leadership or access walk-in services available at bases or wings. The Canadian Armed Forces have 450 mental health care providers who are trained to provide an array of mental health services. But there is stigma attached to admitting to a mental health challenge, and we are aware of cases of soldiers being untruthful about mental wellness, to qualify for redeployment or to avoid the feared possibility of discharge down the line. There is no way to know for sure if the soldiers who really need support are asking for help at the right time, or suffering in silence. Recent research revealed that even after completing the R2MR program, some participants reported they would not seek help if they faced a mental health issue. Why? Stigma, both internal and external, may be mostly to blame. We believe tackling stigma through research and education is a societal responsibility.
The Canadian Forces Expert Panel on Suicide Prevention reported in 2010 that the three essential pillars of suicide prevention were informed and engaged leadership, excellent care, and members coming forward. We need to better understand why some members don’t come forward. If a member does not ask for help, the problem remains unchecked.
We need to know more about culture – military and civilian. What exactly keeps people from coming forward to ask for help when they need it? We need to spend more research dollars delving into such questions. We already know that research dollars for mental health pale in comparison to those spent on physical illnesses, yet the societal burden of mental illness is both staggering and growing.
The Royal Canadian Legion’s new Operational Stress Injury Special Section is a work in progress, whereby Legion volunteers help reach veterans who may not realize how or where to turn for help. By recognizing the OSI issue and providing assistance, it’s also a step forward in battling stigma. In addition, a veteran can walk into any of the Legion’s 1,400 branches across this country and access information to help begin their journey to recovery. These are useful tools and there are others in the works.
For example, a new partnership recently announced between Veterans Affairs Canada and The Royal Ottawa Health Group will create a nexus for groundbreaking research that will help those dealing with PTSD trauma. Any new treatments developed will mean new and immediate actions to confront mental illness.
Soldiers’ families also need to be prepared. The Mental Health Commission of Canada’s (MHCC) Mental Health First Aid program has helped many hundreds of Canadians learn about signs and symptoms and how to help someone experiencing a mental health emergency. It is something that could be worthwhile for family members.
People may not realize that Canada actually has an action plan to combat mental health issues. Released by the MHCC in 2012, the Mental Health Strategy for Canada is a detailed blueprint for change and we believe all levels of government would do well to take a fresh look, with a focus on implementation.
Canada has many mental health resources available to an individual soldier or citizen, but it can be a maze to figure out. With better coordination and communication by and among service providers, we could better reach and assist soldiers and members of the public.
“By the end of my Rwanda tour, the moral conflict I’d undergone had led me to a dark place, in which I no longer cared about risk, danger, or death,” recounts LCol Grenier. While he still travels a difficult road, Grenier has a strong background in understanding mental health issues and now advocates for peer-support solutions.
As a society, we must do a whole lot better. We ask much of our men and women in uniform, they require more rigorous and guided mental health assistance before, during and after their tours of duty. And more compassion – from all of us – when they face an “invisible injury.” We are hopeful this is on the horizon.