On Military Suicide and PTSD

“A Canadian Armed Forces chaplain who was sent to Afghanistan to give spiritual support to the troops came home with post-traumatic stress disorder himself, despite never seeing combat.

Maj. Michel Martin takes listeners to his dark corner of reality, describing a heart-wrenching descent into anguish, depression and anger in a CBC Radio documentary entitled Looking for a Place to Rest. It was produced by John Chipman for The Sunday Edition with Michael Enright.”

  • Post-traumatic stress: looking for a place to rest, CBC News Last Updated: Feb 24, 2013 8:39 AM ET

“Data provided to CBC News Network’s Power & Politics from Veterans Affairs Canada shows the number of veterans, soldiers and federal police officers receiving disability benefits for mental health conditions has swelled to 16,206 at last count, from just over 11,050 in 2008. That marks an increase of 47 per cent.”

  • Mental health issues for soldiers, police up 47% since 2008, By Kathleen Harris, CBC News, Last Updated: May 1, 2013 6:59 PM ET

When dealing with PTSD, the Canadian Military had a previous example. For, it is much like the Dental Issues that the Canadian Military suffered from in World War I. We forget today that PTSD – then called “shell shock” – was not as dangerous as Dental Care. In the early part of the twentieth century, “Trench mouth” was a serious threat to the war effort. For many, Recruits were rejected because of Dental Ailments; while many soldiers were shipped back from the front due to oral care. Or put differently, oral care was as big a threat to the fighting force as bullets and bayonets.

Now this was not to say that the military did not have dentists. They had 26 of them before 1915 but they were attached to various medical units and could not be effectively deployed. In fact, much of the military’s dental work was provided by civilian dentists who were asked to volunteer their services. However, this patch work of military and civilian service providers could not keep our military in good working order. Consequently, on 13 May 1915, the Canadian Army started to make a change. It proclaimed General Order No 63 – the order which authorized the formation of the Canadian Army Dental Corps (CADC) as a separate corps under administrative and professional control of the Director of Medical Services. This change had many consequences. Canadian dental officers were attached to the field ambulances and did wonders in the forward area. In fact, British Army consultant, Sir Cuthbert Wallace, stated in 1918 that, “the Canadians had a very perfect dental organization” and suggested that the British service copy the Canadian model which enabled them to provide advanced treatment in the forward areas.

The dental force was not a big one. When the CADC began operations in July 1915, it had 30 Dental Officers and 74 other ranks – a ratio of 1 dentist for every 1400 personnel. From then to December 1918, both in Canada and abroad, the Corps preformed more than two million dental treatments including 97,000 treatments for British troops and 50,000 treatments for ‘trench mouth’. This Corp is one of the unsung heroes of World War I and allowed Canada to have a fit fighting force. It was a cheap and practical solution to a medical issue that ravished the ranks.

With that being said, one would ask why the Canadian Government and the Military have not learned its lesson and used the same type of approach to deal with the rising threat of Post-Traumatic Stress Disorder (PTSD).  As Veterans Affairs Canada knows, there are a rising number of veterans, soldiers and federal police officers, who are suffering from PTSD related injuries. In other words, with the great medical advances and new protective armour wore by many soldiers and federal police officers – at home and on overseas missions – many soldiers are surviving injuries that they would not have survived previously. One can hear stories of soldiers who survive the destruction or bombing of their Armoured Personnel or tank. One can hear stories of soldiers who survived the carnage that can be imposed by Anti-Personnel Mines or Improvised Explosive Devices. In comparison to previous conflicts, one can say that stories of survival have become common place. However, the devastating reality is that while many more soldiers survive the physical ailments, they are still exposed to psychological trauma of the event. Consequently, we have had a rise in PTSD related injuries.

The bigger problem is that to date, we have not had a solution. Like in World War I, we have had a patch approach. We have hired civilian therapists and we have created Apps for cellphones. However, what we have not done is learned from our past. We have not created is a 21st Century equivalent to the Canadian Army Dental Corps (CADC). What we have not done is created a larger Psychological Corps – a separate corps with administrative and professional control.

It was a solution that was brought to me by a former Officer, but it is a suggestion that makes lots of sense. His argument was a “tribal one”. Or put in other words, military personnel feel more comfortable talking to military personnel about military issues because military personnel understand the strains of military life. This is why the military has a clergy and a police force. This is why the military has its own doctors and dentists. Military personnel live by a different code and that code permeates all forms of life. Unlike most civilians, their jobs are to run into the “jaws of death” without concern for their own life. This could mean running into gunfire or a forest fire. This could mean dealing with flooding, snow storms, floods or ice storms. They are sent to the places that the rest of us dare not go. If this is the case, they need to have a large group of people that understand the mindset of honour and loyalty that comes with wearing the uniform. The easiest way to achieve this is by having psychologists or psychiatrists wear the uniform.

From a cost point of view, this could be done cheaply. If we use the same ratios used by the CADC in 1915, we would have a corps of less than 200 people: some officers and some non-commissioned officers. Given that the Canadian Forces Health Services (CFHS) maintains the Canadian Forces Medical Service and the Canadian Forces Dental Services (CFDS), it could maintain a psychiatric wing without any incremental cost increases. Since there would not be any specialized labs required to treat soldiers and officers, all the Canadian Government would be paying for is the psychiatric staff. Furthermore, by having a corps that works with existing military personnel and the larger PTSD community (i.e. spouses and families, veterans’ and federal police officers), one could see reductions in long term social costs.

So we have a model, which Canadians developed about a century ago to deal with a modern day problem. By creating a large and robust Canadian Forces Psychiatric Service, Canada could continue to lead the world in developing a strong health component for our military community. The only question is will Canadians accept a simple and objective solution that benefits the “Other” and society at large. I believe they will.

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