Monday, March 5, 2007

does cnd defense really give a damn? why are they sent back?

Stressed-out soldiers sent back to Kandahar
JEFF ESAU Mar 5 Globe and Mail

The Canadian military is sending soldiers to Afghanistan who are suffering from mental illnesses, including depression and operational stress injuries such as post-traumatic stress disorder.

This shift in practice is based on a radical overhaul the Canadian Forces promised to undertake in its approach and attitudes toward soldiers' mental health.

The Afghanistan mission has been the bloodiest and fiercest combat Canadian soldiers have seen since the Korean War. Recently declassified daily briefings delivered to the Chief of the Defence Staff, General Rick Hillier, show the latest toll includes 39 soldiers killed in action, five dead from accident and 83 suffering what the Forces describe as non-battle (NBI) injuries. Although no breakdown is kept, the NBI number includes those considered not mentally fit for duty.

The issue of mental illness among those in uniform is being increasingly studied, with the Canadian Forces' chief psychiatrist, Colonel Randy Boddam, currently serving a four-month stint in Afghanistan.

He told The Globe and Mail: “Let's acknowledge it [mental illness], let's bring it out of the shadows and get people in so they get treatment sooner, and be employable and living their lives the best they can.”

Col. Boddam added that deployment to a combat zone can benefit some depression and PTSD sufferers. However, he said, “we do not deploy knowingly anybody who is suffering from a mental illness that would impair their ability to function in this environment.”

Rather, the Forces “deploy people who are on maintenance phases of their treatment or who may have a minor illness that is not really impairing their function,” such as a phobia.

The precise work these soldiers carry out is withheld because of privacy issues but combat work is not ruled out.

Dr. Mark Zamorski, head of the military's deployment health section in Ottawa, said most soldiers posted to operational theatres who are being or have been treated for a mental illness “do just fine.”

To find out how well they really are doing, Defence Minister Gordon O'Connor asked Forces medical authorities in November about the psychological effects of the Afghanistan mission on the troops. He received this blunt response in a briefing note obtained under the access to information law: “The impact the Afghanistan mission is having on our soldiers is not yet known.”

Mental health statistics from U.S. and British forces returning from the Afghanistan and Iraq wars have been inconsistent. The 2.8-per-cent prevalence rate of PTSD in the Canadian Forces is roughly the same as for the general Canadian population. A Statistics Canada survey conducted Forces-wide in 2002, however, revealed that depression was “almost twice as high as in the general population” – a finding medical authorities cannot explain.

In a lengthy 2003 analysis, military medical authorities conceded that the Canadian Forces have been faced with a “declining capability” to deal with soldiers' mental health issues even while there's been a “steady and significant increase in the prevalence of mental health conditions among CF members.”

After being “increasingly targeted by media criticism” for its failure to keep up with the times, the military must own up to its “obligation to the well-being of its service personnel,” said the analysis, which is built on the premise that mental fitness is “an essential component” of operational readiness and mission success.”

Said Col. Boddam: “We want to point out that mental illness does exist, that we can pretend it doesn't but it does and, yes, some soldiers [with mental illness] are going to deploy.”

Both Dr. Zamorski and Col. Boddam emphasize that – with the exception of the most severe cases – a soldier's mental health can be pegged somewhere along a continuum from extremely poor to extremely good. It is possible for an individual with excellent mental health to suffer a decline during or after a deployment, but still not be diagnosable as mentally ill.

Each case is handled individually to ensure that seriously ill soldiers are not sent into a tension-filled or life-and-death situation. Col. Boddam says the decision to deploy a soldier who is ill is based on “medical employment limitations” assigned by a medical officer prior to deployment. Having symptoms of mental illness “does not mean you're a psychological cripple,” he says, and dismisses “cookie-cutter-ish” judgments about mental health that put symptomatic soldiers in “a little pigeon hole.”

“Not all post-traumatic stress disorders are created equal,” Col. Boddam said.

A rigorous screening protocol for mental illness was introduced in 2003 after senior army officers voiced concern that soldiers with mental health problems were being deployed overseas.

The new screening process, involving the completion of several validated health questionnaires and a 20- to 40-minute interview with a mental health professional, was designed and administered to 95 per cent of the 5,562 soldiers deployed to Afghanistan between July, 2003, and July, 2005.

The screening precluded fewer than 1 per cent of soldiers from deployment.

Those results did not surprise Dr. Zamorski “because of all the distortions that are inherent in the predeployment context, such as enthusiasm for the mission.” Soldiers were not untruthful during the screening process, he said. They were just demonstrating what he calls “predeployment health inflation,” which occurs when a soldier overstates his health because he is highly focused on the mission and thriving on the support of his family and friends. Then, when soldiers return home, Dr. Zamorski says, some exhibit “a tendency to understate their health post-deployment,” often because “they want to get on the record and want people to recognize their sacrifice.”

Once in Afghanistan, soldiers with mental health issues can seek treatment at the multinational hospital at Kandahar Air Field, which has on staff a psychiatrist, two psychiatric nurses and a social worker, a dedicated mental health cadre unseen in recent Canadian Forces operations. Soldiers who come forward are not necessarily sent back to Canada, Col. Boddam says.

“If you can keep people in the game as long as their illness doesn't preclude that, then for them the outcome is substantially better. The risks of longer-term things like PTSD are reduced.”

“Assuming all else is equal, to put them in an operational setting may not in any way exacerbate their illness,” Col. Boddam said. “In fact, depending on their overall condition, the camaraderie in the unit and sense of accomplishment may be at least of some benefit to them.”

Dr. Zamorski, however, points out there are serious risks to keeping mentally ill soldiers in a combat scenario, which is why detection and treatment are so important. “Is there somebody who's died in Afghanistan because they weren't paying attention because they were mentally ill? It's possible... it is even likely.

“We know these illnesses cause deficits that can realistically interfere with performance while deployed,” Dr. Zamorski said. “If I were a commander I'd want to know about that. But wanting to know about it and having a way to know about it are, unfortunately, two separate things.”

Canadian Forces medical authorities say they are addressing mental health aggressively. Between 2004 and 2009, $98-million is earmarked for “a comprehensive, holistic, but diagnostically rigorous and evidence-based approach to mental health.” The mental health professional cadre will be increased to 447 from 229 across the Forces.