Minds At War: Operational Stress Injuries

December 4, 2009 by Sharon Adams
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ILLUSTRATION: FRED SEBASTIAN

Sergeant Shawn Clarke knows how far the Canadian Forces has come in handling Operational Stress Injuries. If he’d met himself 10 years ago, as he is today—an Afghanistan war veteran with post-traumatic stress disorder—he’d have said, “‘Suck it up you wimp!’ That’s what I would have said to a guy like me.”

But a decade is enough to make major changes, if not complete a revolution.

Clarke is among a growing number of CF members and veterans recovering from operational stress injuries, OSIs, and like many he is not afraid to challenge people—even those of higher rank—who are insensitive or disrespectful to those with an OSI. “If I hear a comment, I’ll say, ‘stop it!’ And I don’t care who it is. I say, ‘Listen, I heard what you said. You might not believe it, but this is what the policy is and so you need to abide by the policy or I’m going to push it further.’”

At one time, that might have been a career stopper; today it’s recognized as necessary to creating a “culture of acceptance” about mental health issues.

“Raising awareness and overcoming stigma about mental health is a top priority for me,” said General Walter Natynczyk in launching a mental health awareness campaign he hopes will result in a serious change of attitude where injuries to the psyche are taken as seriously as injuries to the body. “All of us, regardless of rank, have a responsibility to take care of one another and help people in need.”

The people charged with the well-being of CF members and veterans have made remarkable progress on OSIs in the last decade. The CF has worked to minimize OSIs with screening, education, training and treatment. Veterans Affairs Canada (VAC) provides counselling and benefits to veterans diagnosed with OSIs—some who’ve suffered from symptoms for 60 years or more. The Royal Canadian Legion’s service officers, meanwhile, are identifying veterans—old and new—with OSI symptoms and arranging for treatment and offering support.

On the whole, it’s a success story, but there have been tragic twists. Only this is no work of fiction. When cries for help go unheard or unheeded, results are catastrophic for sufferers and their families.

The wife of a Canadian Forces officer in a Prairie city spent the spring and summer watching her husband Philip fall apart. He has a rare specialty and a keen sense of duty, so after returning from Afghanistan and being treated for post-traumatic stress disorder (PTSD), he returned to work, supposedly part time. “Somehow part time became full time,” says his wife Caitlyn (the couple asked that their identities be withheld). Philip participated in a training exercise even though it triggered his symptoms, even though he can’t sit still long enough to watch a movie, even though he’s developed a hair-trigger temper.

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All that kept him going was his decision to apply for release as soon as the exercise was over. Philip “lived up to the uniform” until he recognized that for the health of himself and his family he might have to take off the uniform for good.

While Philip was falling apart, the CF was launching its mental health awareness campaign, urging its members to fight stigma, support one another—and recognize when those they command, their buddies or themselves need help.

But fighting stigma and working towards self-care are hard nuts to crack. “To create a cultural change it will take us years to get where we need to be,” says Shawn Hearn, Atlantic Canada co-ordinator and Director of Casualty Support and Management with the Operational Stress Injury Social Support network (OSISS). An OSI survivor himself, Hearn understands warriors are trained to consider the mission first, their peers second and themselves a distant third.

There’s a long military history equating weakness of any kind with failure, and mental breakdown with weakness of character. Symptoms of battle trauma have been noted for thousands of years, and mostly dismissed as cowardice. During the First World War many victims of what was then called shell shock were tried and later executed under offences ranging from cowardice to desertion to insubordination.

In Canada, the pace of change has quickened. “Over the last seven years there has been a significant shift in attitude and culture and the way we look after our men and women with OSIs,” says Hearn. “That being said, we still have a ways to go.” A 2008 Douglas Hospital Research Centre study found a third of CF members would not seek mental health treatment for fear of stigma.

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For a long time, “there was a great reluctance (among CF brass) to admit there was a problem,” says Dr. Greg Passey, a Vancouver psychiatrist who spent 22 years in the military. When his research in 1993 showed a PTSD rate of about 15 per cent and a depression rate of 13 per cent among two returning peacekeeping units, “they said my statistics were flawed…there was huge resistance.”

Soon VAC experienced a wave of veterans with OSIs. “In the mid-90s we started to get a lot more veterans coming to us with mental health problems following the change in role (of Canada’s military missions) abroad,” says Raymond Lalonde, Director of the National Centre for Operational Stress at Ste. Anne’s Hospital in Montreal. “In 2001, we entered into an agreement with the Department of National Defence to try to work together.”

Several events put the issue on the fast track. Retired general and now Senator Roméo Dallaire, who led a 1994 peacekeeping mission in Rwanda, disclosed he has PTSD and had attempted suicide in 2000. VAC surveyed 2,700 clients in 2000 and found 15 per cent had PTSD symptoms and 28 per cent had major depression. In 2003, the same year Dallaire’s book, Shake Hands with the Devil—the Failure of Humanity in Rwanda, was published, 25 soldiers and veterans with PTSD launched a lawsuit seeking $60 million in damages over alleged inadequate treatment. Some have since reached out-of-court settlements. In 2002, the DND ombudsman reported inadequacies and inappropriate treatment for OSI sufferers.

Against this backdrop, VAC and DND teamed up. The motivation is economic as well as humanitarian. Because OSIs are more difficult and costly to treat the longer they go undiagnosed, both departments can save money long-term with an efficient system to identify OSIs early and treat them effectively.

They established the DND-VAC Centre for the Support of Injured and Retired Members and Their Families, and built a national network of treatment clinics and Operational Stress Injury Support Services programs across the country to serve military members and veterans, and members of the Royal Canadian Mounted Police. “Our aim was to build a continuum of services and policies, no matter where the military member or veteran happened to be located,” explains Lalonde.

The CF added pre-deployment screening in 2003 after senior army officers expressed concern soldiers with mental health problems were being deployed. A five-day decompression stop at the end of operational tours allows mental health professionals to screen for problems and troops to talk about concerns before returning to Canada. Within six months after returning home, troops are examined again for OSIs.

The CF OSI education and training program is expected to have reached approximately 15,000 military personnel by year’s end. “More than 80 per cent of those who could benefit from mental health help don’t know they need it,” Sgt. Doug Brown told a score of junior officers at a daylong OSI course in May, part of their first formal training program. OSI courses are delivered by the Mental Health and OSI Joint Speakers Bureau, a CF/VAC initiative created in 2007 to educate the military community on mental health issues. Courses are taught by teams that include military members and veterans with OSIs. Military personnel of all ranks learn how to spot OSIs, how to cope with stress, how to help others cope with a trauma­tic event, what to do to combat stigma. They also hear the story of a soldier or veteran who has had an OSI.

“This education campaign is the foundation,” says Lieutenant-Colonel Stéphane Grenier, CF OSI special adviser charged with developing the national education strategy. By the end of the year, he says, pre- and post-deployment training will feature a mental health component. It takes time—and training—to develop resilience.

A new battle, stemming from the publicity surrounding OSIs, is fighting the misconception that everyone who deploys will develop an OSI. “Deployment doesn’t equal trauma. Deployment is a healthy thing for a military person who has been properly prepared and trained,” adds Grenier.

Preparation and training about OSIs wasn’t there at the beginning of his career, says Lt.-Col. Rakesh Jetly, a psychiatrist and CF mental health adviser charged with overseeing OSI clinical matters. There was “virtually zero (support) in terms of mental health. After Rwanda…within 20 hours we were back here in Ottawa, handed our kit and cut loose. Basically like young men, we…got drunk for a couple of days and went back to work. People became ill; people committed suicide.” Research shows nearly half of PTSD sufferers think of suicide and about 19 per cent attempt it, adds Passey. Now there is pre-deployment training and “robust mental-health services in theatre…. Half (of those affected by trauma) are already in treatment when they return,” he says. This will pay off: a study of casualties of the 1982 Lebanon War shows that even 20 years later those who received frontline treatment have lower rates of PTSD and psychiatric symptoms. They are also less lonely and function better socially.

Education also produces results. “People used to wait four to seven years after symptoms started, after their lives began to fall apart, before seeking treatment,” adds Grenier. “Now they come into care sooner.” Some had been afraid to ask for help, fearing it meant an automatic one-way ticket out of service.

“It’s far from true to think that if you’ve been diagnosed, you’re going to be released,” says Jetly. Grenier has been steadily promoted despite having an OSI himself. Having an OSI doesn’t necessarily mean return to Canada during a mission. “In theatre, if somebody has trouble they can be assessed and treatment started…it doesn’t mean they’re coming home. The vast majority continue with their tour. It’s an important message for soldiers,” adds Jetly.

Brown is a case in point. It took him 10 years to seek help, and he continued to work through five years of treatment. He went from weekly to monthly to bimonthly therapy sessions and even now doesn’t hesitate to ask for help if he’s having an off day. “You go through peaks and valleys,” he explains. Getting appropriate help at the right time keeps small issues from growing into bigger problems.

“The reality is once you develop PTSD, it’s a lifelong disorder,” says Passey. “People have gone into remission and subsequently gone on tour, but the fact of the matter is it’s like diabetes. Once you’ve got it, it’s always working in the background even if the symptoms are not there.”

“I will always need to go see someone to stay level,” adds Brown. “When you’re down in the valley…either you’re forgetting something they taught you, or you don’t have a skill for it, so you need some help.”

However, if at the end of treatment an OSI prevents someone from fulfilling terms of universality of service—a CF policy requiring members to be “physically fit, employable and deployable for general operational duties”—he or she may be medically released from service. Clarke faces medical release, since his OSI prevents universality of service. Luckily, he has won a job at OSISS in Newfoundland, so his skills and experience won’t be totally lost to other serving members.

Yes, the CF is doing better, adds Dallaire. “But our systems are not as sophisticated as they need to be.” Troops do continue to develop OSIs and those who “fall through the cracks” have been much in the public eye, partly, says Jetly because those who are treated and continue working get little attention. Not only is confidentiality respected, but “we don’t exploit our patients” for media interviews.

But there has been no shortage of people with negative experiences who are willing to talk. Even with continuous improvements, some people fell through the cracks and criticism continued. In 2007, the Auditor General of Canada reported that in the CF “demand for mental health care is outstripping available resources.” That same Auditor General’s report stated that DND “does not have a performance measurement framework to provide reliable information on how the (CF) health-care system is performing.”

The CF health system, the report added, “still relies on paper medical records. As a result, unless the department undertakes a considerable effort to gather data file by file, it is very difficult to provide any overall health information to management for analysis or monitoring. For example, we asked how many CF members returning from Afghanistan were injured and what medical assessment they received. This information was not readily available….”

The DND ombudsman and the House of Commons Standing Committee on National Defence both expressed frustration with the CF’s inability to provide solid numbers about PTSD. In 2008, the DND ombudsman also lamented lack of a computerized national database to gauge the extent of the problem, determine needs for service and measure effectiveness of programs. The Canadian Forces Health Information System, a project started in 1999, is not expected to be online until 2011—the year the current commitment in Afghanistan ends.

The standing committee extrapolated PTSD incidence based on 8,200 questionnaires completed by troops within six months of returning from Afghanistan. The numbers showed that 27 per cent returned with problems, including PTSD, depression and heavy drinking. Considering that 27,000 CF personnel had served in Afghanistan to that date, about 3,640 could have a mental health concern.

What could really swell this figure is the number of non-Afghanistan-mission-related OSIs, perhaps from previous service in the Balkans, Somalia or Rwanda or from trauma while serving in Canada. The figures also don’t include those who develop symptoms (or hide them) until after they leave service. VAC currently has about 12,000 clients with mental health disabilities, more than 60 per cent of whom have PTSD, says Lalonde. Overall, the CF had 4,917 active mental health cases as of Jan. 31, 2008.

Veterans from the “suck it up” generation are still coming forward for treatment of injuries suffered as long as six decades ago, says Gerry Finlay, Alberta-Northwest Territories Command service bureau officer. “Older veterans have that pride factor. ‘I was just doing my job, no more than my comrades.’ They don’t complain.” When talking to them about VAC claims, Finlay hears their stories, like that of an 82-year-old veteran who spent the Second World War clearing mines, unexploded bombs and booby traps. A psychiatric assessment arranged by the Legion showed this sapper has suffered PTSD ever since—and was entitled to pension for the disability. “Imagine the relief, at 82,” says Finlay.

With decades of backlog, delayed onset of symptoms and people who don’t know they need help, it’s tough to say how big the problem is. A 2008 report for the Parliamentary Budget Officer estimates disability and health-care costs of the Afghanistan mission could range between $476 million and $1.7 billion, depending on annual troop strength.

Lack of data contributes to people “falling through the cracks,” a phrase heard so often in hearings that “it lost its notoriety,” the standing committee wryly noted in the 2009 report, Doing Well and Doing Better, an examination of CF Health Services, emphasizing PTSD. “If Canadians expect our troops to do what we ask of them, it is only fair that those troops be confident they will be taken care of, should they be injured in the course of doing their duty.”

While CF health services is among the best in the world states the committee report, some “wounded personnel, or members of their families, have not received adequate treatment.” It identified three root causes: a gap between policy and implementation, a national chronic shortage of health care professionals—and stigma.

Dallaire says operational tempo has a lot to do with the policy implementation gap. Simply put, he says, there aren’t enough bodies. The size of the regular force is approximately 66,000 today from nearly 90,000 in the early 1990s. A report from the DND Ombudsman in December 2008 stated the CF and its members “are strained almost to the breaking point” due to the substantial increase in the level and intensity of combat operations. (CF is currently recruiting, with the aim of building a force of 100,000—70,000 regular forces and 30,000 reservists—by 2027).

“We now have in the Canadian military soldiers who have more combat time than Second World War veterans,” says Dallaire. When garrisons are understaffed, members are rotated into operations more frequently, and those left behind are “doing the work of two or three or four.” Due to the nature of modern warfare and foe, troops are on constant high alert on operations and are under intense and relentless media glare.

When asked if the personnel level is sufficient to comfortably perform missions, the CF response was that it does a detailed staff check prior to operations to ensure “requisite personnel, equipment and resources are available for the duration of the mission. Although we have experienced strains on some of the trades and capabilities, we have successfully met our mission requirements with our current personnel.”

Under current policy, a CF member returning from an operational tour of 180 days or more is exempted for one year from another such tasking; 60 days’ respite is accorded members who’ve deployed for at least six months. During this time they are excluded from postings, exercises, courses or temporary duties that would take them away from home for more than a day. Rates of PTSD and critical incidence stress start climbing sharply after 210 days away from home. “Members who spend more time away are more likely to suffer from PTSD,” states the 2007 PERSTEMPO Study, which analyzes factors that affect troop morale.

“CF members are not normally required to deploy for an operational tour of six to 12 months more than once in a three-year cycle,” the CF reply continues. “However, depending on operational demands and unit rotation capacity, that goal may not always be achievable.”

Commanders may “waive the deployment intervals if there becomes an operational need.” Since 2006 the CF has had a system to track the time members spend away from home, information used to identify over-tasked trades and spread the deployment load more evenly. The CF is “committed to balancing the current high operational tempo with the needs of CF members and their families,” in recognition that deployments, training, courses and temporary duties result in heavier burdens on families.

The policy looks good on paper, but the Doing Well and Doing Better report states that “the central issue facing the CF is shortage of personnel, almost everywhere, almost all the time.” It described one unit’s experience following a seven-month tour in 2007. Some fell ill on leave after returning home, and did not report the problem when they returned to duty—and they returned just when junior ranks were tapped to fill training positions of senior officers posted overseas, and during posting season when leaders are reassigned to new jobs in different locations. Just when experienced supervisors are needed most to spot and deal with OSIs, the report says, their ranks are “dissipated by the burden of taskings and postings.”

Sgt. Ted Peacock of 1 Combat Engineer Regiment in Edmonton who’s had five tours—to Kuwait, Iraq, Croatia/Bosnia and Afghanistan in 2004-05 and 2006-07—fell victim to the tempo. He’d asked for a less hectic job on return from post-Afghanistan leave in 2007, but was told he’d be away the month of June. During the three weeks he worked in May, he was away eight days. Then his summer leave was cancelled, and it was more than he could bear. One day he begged his wife not to bring their small boys home because he didn’t want them to see him in such a state. He’d destroyed his prize workshop and was crying uncontrollably. After that he began spending whole days in bed.

His wife Angelle was surprised to discover he’d been diagnosed two years previously with an adjustment disorder. “I get that everybody’s overworked, but he was diagnosed two years ago…and what did they do? They sent him on a course and they sent him on training.” He didn’t get treatment then. “I don’t blame the army completely for it,” she says. It’s always been duty first for Ted. “A lot of it is tour related, tempo related, life related.” This summer he was sent for inpatient therapy for depression, adjustment disorder and PTSD.

Soldiers like Philip and Ted didn’t see self-care as part of their duty. It just wasn’t part of their military culture. “Without strong and committed leadership, cultural change is much more difficult to bring about and takes even longer,” said former interim DND Ombudsman Mary McFadyen. “Lukewarm leadership has real and sometimes devastating consequences for those affected.”

A recent House of Commons defence committee report lauded progress identified in a 2006-08 CF survey indicating that 80 per cent of respondents disagreed with stereotypical stigmatization. In addition, the survey also showed that most CF personnel don’t believe people with mental health disorders are weak or that their careers will be affected if they ask for help. This is a stark contrast to a 2002 survey of 8,441 soldiers that showed four of 10 who needed psychological help refused to ask for it, citing fear of stigma and impact on careers.

But noting “attitudes toward mental health issues in the CF remain largely negative,” the committee recommended the Defence minister and Chief of Defence Staff make a public statement to all ranks outlining a high-profile effort to address stigma.

The next week Natynczyk launched the CF mental health awareness campaign. He addresses CF personnel in a video on the forces.gc.ca website about his seriousness in tackling the issue. “Those who receive the support of unit co-workers and leaders have the greatest chance of returning to duty. I expect leaders at all levels to create a command climate of understanding, acceptance and support.…”

The Joint Speakers Bureau and OSISS are considered the mainstays in the Be the Difference campaign. Meanwhile, the CF Joint Personnel Support Unit (JPSU) was devised to fill in some of the cracks, offering benefits and support for ill, wounded and injured military personnel and their families. With its 19 Integrated Personnel Support Centres (IPSCs) across the county, the JPSU allows all military personnel, regardless of service or location, access to the same standard of care.

The IPSCs are a huge improvement over the old system, says Lt.-Col. Joe Pollock, regional commanding officer for JPSU Alberta/Northern Canada. The first IPSC was established at CFB Edmonton in March. “It’s a revolutionary step in the support we provide,” he says. The former system was complex and disjointed, he adds, and “now it’s co-ordinated with CF and VAC programs and services available under the same roof, including social workers, therapists, case managers, OSISS and the Military Family Resource Centre.… There are also 14 VAC employees, a padre—and The Royal Canadian Legion. Before we had all these great experts spread all over hell’s half acre.” Now, when someone is assigned to an IPSC, a team looks over the file together, deciding who can do what, when.

It’s hoped these services will help retain personnel. For example, it costs about $315,000 to train one infantryman, an investment that can be lost when personnel lose faith and leave the service. A case in point is a 23-year-old private who suffered a severe head injury in a vehicle accident in Afghanistan and was sent home. He was diagnosed with post-concussion syndrome and an anxiety disorder. While he recovered, his unit had also returned to Canada, but red tape delayed the necessary paperwork that would allow him to return to his unit. He was assigned to “the cooks’ section, with all the broken people.” Then he had a humiliating experience, walking past friends lined up for platoon as he delivered coffee and pastries to officers. “I didn’t sign up for that.”

With nine months until his contract ran out, he decided to get out. “If I got hurt again, what would happen? Where would I be sent…back to the cook’s section? ”

Assigned to an IPSC ideally near their families, injured soldiers will now have the support of a traditional unit while they heal and regain strength, plus access to programs and benefits from service partners, including VAC client and transition services, Service Income Security Insurance Plan (SISIP), the Military Family Resource Centres. IPSCs will also provide a smoother transition back to regular units or into civilian life.

Peacock, for example, has been assigned to the IPSC in Edmonton which has already helped slice through red tape to reduce the number of trips into base. When he’s ready, the integrated work program will help him return to school or prepare for a job. “Once again they’ve accommodated me as best they can.”

“A big difference from the ’90s versus this decade is support,” says Passey. “Lack of support can be as traumatizing as the actual traumatic event.” Support is very important to resilience, which is critical in protecting against OSIs. “I think the CF is doing much better.”

Getting Back On Track

Sometimes an Operational Stress Injury creeps up on you, gradually wearing down your resilience, like the sun slowly sinking, leaving you in pitch dark. Such was the experience of Sergeant Shawn Clarke. 

When he began serving as a reservist in 1990, “nobody cared about anything but how much you could carry, how fast and far you could run. If you want to complain, you’re weak.” That was his mindset on deployment to Yugoslavia in 1992, to Croatia in 1994, to Bosnia in 2003. “My first tours were fairly stressful, but at that time I was a lot younger and things didn’t really bother me as much.” At least he didn’t think so. “But it’s like you have a leak in your roof and you put a bucket under it.” Drip…drip…drip.

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ILLUSTRATION: FRED SEBASTIAN

Clarke’s also spent six years as a member of the regular force. After that he spent two years at civilian jobs before rejoining the reserves in 2000 in full-time contract positions.

During his last tour to Afghanistan in 2006-07, he worked as a tactical expert with a counter-improvised explosive device (IED) team. He told Legion Magazine that this was “more stressful than anything I had ever experienced in my life.” When his beeper went off, he’d jump into a helicopter and “I didn’t know if I’d be gone three hours or three days—or more.”

In his first week, a soldier he knew was wounded and another killed. He’d trained both, but there was no time to grieve. “Within 24 hours so much has to happen, there’s no room for grief.” Later that week, more Canadian fatalities—men Clarke knew well. He found a few minutes to crawl into his tent…and cry. “And the next day it was back out again.”

For six and a half months he was short of sleep, on high alert, working flat out, with the knowledge that on any call someone he knew could have been killed. Those drips he talked about turned to a slow and steady stream. “I had a big bucket, and the roof kept dripping and dripping and dripping. Eventually the water spilled all over the floor.” And he didn’t want anyone to see it.

Hoping to rest up, Clarke took six weeks leave when he got back in April 2007. But he couldn’t sleep. “I’d be days without sleeping, without a shower, or brushing my teeth.” He avoided things he used to love, and if he enjoyed anything, he’d feel guilty about it.

He couldn’t stop crying and didn’t understand why. With the crying came shame. “I’m a very social person and have a large circle of friends, but I sat in my room in the dark for days. I didn’t want anybody to know what was going on because I thought ‘I can handle this.’”

Then he started drinking. It was easier to be around people, but “little things would set me off.” He’d drink five or six nights a week until he passed out—or was thrown out. Things didn’t improve when he went back to work. “The guys at work hated me because I was angry.” No matter what they did, it wasn’t good enough. “I went from the happy, fat guy to punch-you-in-the face, overnight.”

He dodged and delayed his post-deployment briefing and when finally forced to go was intent on “giving all the right answers just to get me the hell out of there.” A few probing questions and “suddenly I broke down and just started to bawl and sob.” He was diagnosed with post traumatic stress disorder and depression, put on sick leave and into treatment.

Guilt pushed him back to work too soon. “I said everything they wanted to hear: ‘everything’s good; I’m not drinking so much; I’m feeling better.’ I was lying to myself and to them.” One day he left his office in a rage. “I was going down to HQ to give some people down there a piece of my mind, and maybe a piece of my fist.” But he stopped long enough to call Shawn Hearn, then-peer counsellor with Operational Stress Injury Support Services. Their chat changed everything. “I said to myself, ‘if I don’t look after this now I’ll never get it sorted out.’”

A combination of weekly therapy and antidepressants—and his OSISS peer support group—have allowed him to get on with life. He still has deep emotion, still riles easily but his peer group helps him cope. “One of the biggest things for me was…knowing it’s not just me. This happens to a lot of people.”

Life is back on track; slowly he returned to work, made plans to marry and recently, got a new job—as the OSISS peer support co-ordinator for Eastern Newfoundland. “Two years ago I was standing on a cliff wondering if I should jump. I’ve gone from ‘should I end it all’ to ‘this is my future and these are the steps I’m taking.’”

“A lot of guys been through same thing I’ve been through.” At 37, he’s learned, “There’s no need for anybody to suffer alone.”

LOOKING FOR HELP?

Canadian Forces Member Assistance Program and Veterans Affairs Canada 24-hour Crisis Help Line: Both offer confidential, professional counselling 24 hours a day, every day of the year. 1-800-268-7708.

Canadian Forces Operational and Trauma Stress Support Centres: These centres are situated across Canada and their individual contact information can be found through the Canadian Forces Mental Health Services link at www.forces.gc.ca/health-sante/ps/mh-sm/otssc-cstso/default-eng.asp

Department of National Defence Centre for Support of Injured and Retired Members and Their Families: Offers information and services to ill and injured CF members, veterans and their families. 1-800-883-6094

Operational Stress Injury Social Support (OSISS): This service network is available to serving members and veterans (and Royal Canadian Mounted Police) and their families. It offers peer, family and bereavement support. www.osiss.ca

Veterans Affairs Canada Operational Stress Injury Clinics: Contact information for each clinic can be found under the Mental Health heading at www.vac-acc.gc.ca/clients

The Royal Canadian Legion: Canada’s largest veterans’ organization has service officers across the country. They can be found at Legion branches, at provincial command offices coast to coast and at national headquarters in Kanata, Ont. Call toll-free at 1-877-534-4666 or visit www.legion.ca and look under the words Service Bureau. Operational Stress Injuries, for example depression and post-traumatic stress disorder, may qualify for disability awards and/or pensions. Provincial command and Dominion Command service officers guide and represent veterans through the application process. You do not have to be a Legion member to receive help.

Email the writer at: writer@legionmagazine.com

Email a letter to the editor at: letters@legionmagazine.com

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