The death of even one CF member by suicide is one too many. The CF have an extensive suicide prevention program in place, which includes primary prevention programs, clinical intervention, non-clinical intervention and mental health education. Great efforts are made to identify people at risk for mental health problems and to provide them with the assistance that they require.
Suicide is a concern for all Canadians. According to the Canadian Mental Health Association, suicide is the second leading cause of death among young people, after motor vehicle accidents (http://www.cmha.ca, 2009). Suicide rates among CF personnel are, however, lower than those among the overall population. This is not surprising given that CF personnel are a screened workforce.
Over the long term, CF suicide rates have been decreasing. Measured in five-year increments, the rate of suicide among male Regular Force personnel has declined since 1995. (See Table A.)Suicide rates
The CF collect information on sudden death, which includes suicide, from three distinct groups: the Directorate Force Health Protection (DFHP), the Directorate Casualty Support Administration (DCSA), and the Military Police.1
In tabulating suicide rates, the CF do not include the deaths of civilians on Department of National Defence (DND) property, DND employees or Canadian Rangers.
The figures in Table A originate with DFHP. These figures include male Regular Force personnel only. The rates in Table A are calculated, like those of Statistics Canada, as a rate per 100,000.
Given the low rate of suicide among female CF personnel, it is more useful to report the following numbers: there were no suicides among female personnel from 1995 to 2001, there was one in 2002, there were two in 2003, there were none in 2004 or 2005, there was one in 2006, there was one in 2007, there was one in 2008, and there were two in 2009.
The figures in Table B originate with DCSA. These figures include suicides in the Regular Force and suicides among “Class B” and “Class C” Reserve personnel. “Class B” Reservists serve full-time in Canada, while “Class C” Reservists are deployed on operations. “Class A” Reservists are not included in the figures in Table B because CF data in this area is unreliable.
Tracking suicides among personnel in the Reserve Forces is difficult, given the mobility of that population. “Class A” Reservists are the most difficult to track. “Class A” Reservists serve part-time, on evenings and weekends. Therefore, suicides among “Class A” Reservists who were not in service at the time of their deaths may not be captured unless the circumstances of their deaths were brought to the attention of the military by civilian authorities.
The CF have worked hard in recent years to improve record-keeping in this area. Plans are underway to link the names of all CF personnel from 1972 to the present to Statistics Canada’s mortality database, an arrangement which will permit a more complete understanding of sudden death, including suicide, in Canada.
No consistent relationship has been discovered between deployment and increased risk of suicide. Nevertheless, there is a pre-deployment mental health screening process in place for CF personnel, and troops are prepared in various ways to deal with possible trauma overseas.
For those personnel deploying on stressful operations and missions, good mission preparation and training is critical. This includes education on stress-coping skills, unit cohesion and social support, and awareness of the potential effects of stress. Training is realistic and is designed to bolster confidence in both individual and team capabilities.
Deployed CF personnel have access in theatre to mental health care providers, who are one part of the deployed Health Services team.
CF personnel about to return to Canada after a lengthy deployment experience a five-day decompression stop on the way home (commonly called Third Location Decompression, or TLD). At the TLD site, each member has the opportunity to speak with a mental health professional privately and to raise concerns that they may have at that time. Personnel are educated about Post-Traumatic Stress Disorder (PTSD) and other Operational Stress Injuries (OSI). The mental health team provides information about home, work and community life back in Canada in order to make reintegration less stressful.
Upon their return to Canada, CF personnel have access to a full range of mental health services and programs.
In addition, CF personnel returning from an international operation of 60 or more days’ duration undergo an Enhanced Post-deployment Screening Process between three and six months after their return to Canada, although nothing prevents an individual who has any concerns from coming forward to seek help at an earlier time. The Post-deployment Screening is meant to better identify those with deployment-related problems, with a particular focus on psychological problems. The CF member completes a detailed health questionnaire and has an in-depth interview with a mental health professional. If there are concerns regarding the member, he or she is referred to a physician for further assessment and treatment.
Additionally, the CF conduct periodic health assessments on personnel on a regular basis, where mental health problems can be diagnosed and treated. CF personnel undergo a Periodic Health Exam (PHE) every five years until age forty, and every two years after that. The Patient Questionnaire portion of the PHE features questions on mental health and addictions.
Programs and services
The CF have a strong suicide prevention program in place. The military community is educated on mental health issues. Personnel are trained to deal with the effects of stress in themselves and others. They are screened before and after high-stress deployments. The CF work diligently to ensure that personnel in distress, and their loved ones, are provided with the help that they need.
Care for those experiencing the effects of a mental health problem is collaborative and interdisciplinary, bringing together the expertise of psychiatrists, psychologists, mental health nurses, social workers and counsellors, addictions specialists and accredited chaplains.
In June 2009, the Chief of the Defence Staff launched the CF Mental Health Awareness Campaign, which has the dual aim of educating CF personnel on mental health issues, and building a culture of understanding. The campaign’s theme of “Be the Difference” communicates the idea that all personnel can make a difference to those affected by mental health issues.
The awareness campaign brought greater attention to the CF’s Mental Health and Operational Stress Injury Joint Speakers Bureau, a collaboration of the Special Advisor on OSI and CF Health Services. The Joint Speakers Bureau has developed a national education campaign to increase the general mental health literacy of CF personnel at all ranks and to remove social barriers to care. To date, an estimated 8,000 CF members have received training and education through the campaign.
CF suicide intervention training ranges from a two-day, skill-based workshop called “ASIST” (Applied Suicide Intervention Skills) to shorter awareness sessions based on identifying the signs and symptoms of mental health disorders and the resources available to help. This training takes place under the CF’s larger scheme of promoting healthy living and preventing injury and illness through the development of self-help programs. Similar workshops educate CF personnel on anger management, addiction awareness and prevention, stress management, and family violence prevention.
The first point of contact for a CF member who is experiencing mental health problems will likely be the primary care physician at one of the CF Medical Clinics, although the member may have been directed to the clinic by a buddy, a chaplain, a frontline medical technician or social worker, or the chain of command. This physician will either provide the required assistance or refer the member to the most appropriate resource.
In the case of an emergency, CF personnel can access a physician at any time during normal working hours at one of the CF Medical Clinics, or present themselves at a civilian health-care centre during quiet hours. Or, they may call 1-800-268-7708 to reach the Member Assistance Program, 24 hours a day, from anywhere in the world, and receive a confidential referral to someone who can help them.
Mental Health Programs, specialized mental health services, are available at the larger CF bases. Elements of these programs will be available at smaller bases depending upon population size and local resource availability. Psychiatrists, psychologists, social workers, mental health nurses, addictions counsellors and Health Services chaplains are all contributors to the multidisciplinary teams of the Mental Health Programs.
Operational Trauma and Stress Support Centres (OTSSCs) located across Canada employ a mixed military and civilian staff of psychiatrists, psychologists, social workers, mental health nurses and chaplains. The OTSSCs use a multidisciplinary treatment model to provide assessment, educational outreach, treatment and research. In addition to providing direct service to CF personnel, these centres are involved in consultation with other treatment facilities around the world, and in reviewing the professional literature on trauma, stress and PTSD/OSI. There are five centres: in Halifax, N.S.; Valcartier, Que.; Ottawa, Ont.; Edmonton, Alta.; and Esquimalt, B.C.
Veterans Affairs Canada (VAC) operates nine operational stress injury clinics primarily to serve veterans and former RCMP officers who have suffered OSIs as a result of their service. These clinics can also assist currently serving CF personnel. The clinics are located in Fredericton, N.B.; Montreal and Quebec City, Que.; Ottawa and London, Ont.; Winnipeg, Man.; Edmonton and Calgary, Alta.; and Vancouver, B.C. A residential treatment (live-in) clinic is now open at Ste. Anne’s Hospital in Sainte-Anne-de-Bellevue, Que.
CF personnel and families in need can call 1-800-268-7708 to reach the Member Assistance Program, 24 hours a day, from anywhere in the world, and receive a confidential referral to someone who can help them. The program provides external, short-term counselling for members of the military community seeking assistance outside military health services. Reserve Force personnel and their families also have access. The program is civilian-based in that it uses professional counsellors provided by the Employee Assistance Services of Health Canada.
The Operational Stress Injury Social Support (OSISS) network provides peer support, family counselling and bereavement services across the country. The network is accessible through an interactive map located at http://www.osiss.ca. A joint venture of the CF and VAC, this very successful initiative was started by a group of military veterans.
Families of personnel with mental health concerns currently have access to a range of CF and VAC services and programs including counselling under the Member Assistance Program and the OSISS network; crisis intervention through the Veterans Pastoral Outreach Program; and the guidance of the more than 40 Military Family Resource Centres located at CF installations across the country, in the U.S. and in Europe.
The CF are working, and will continue to work, to strengthen the suicide prevention program.
For example, in September 2009, a CF-hosted Expert Panel on Suicide Prevention brought together civilian and military representatives from around the world to explore literature and best practices. CF Health Services has long embraced a collaborative care model, maintaining close relationships with the medical services of military partners and with civilian care providers, in order to ensure that ill and injured CF personnel receive the best care possible from the whole community. The panel will deliver a report of its findings to the CF Surgeon General later this year. The report’s recommendations will contribute to enhancing the current suite of CF suicide prevention programs and initiatives.
1 It should be noted that the Military Police log all investigations of “sudden death” together, whether these later turn out to be suicides, accidental deaths or deaths from natural causes. Care must be taken so that there is no misinterpretation of data.