Q&A: Colin MacKay, Scott McLeod and Rakesh Jetly

I know for some that as they read the transcript they have a range of emotions from frustration to anger. Some may not be able to read it all and stop because of this.

I hope and ask that after you calm down and you have an opinion or comment post it.

Without feedback the CF and VAC will learn nothing and assume everything they are doing now is working! We know it is not perfect but we also know how the top brass/bureaucrats think.

There is going to be a sharp increase of mental health problems from the Afghan mission. We need to help these people before we have another 'lost' generation of veterans.

Teen it was all in 2004-05, and I released in January 2006, so most of the "protections" were supposedly in place. I even attended the briefing when the CDS announced that everything possible would be done to keep injured members employed.

To get an idea of how the programs the CF has put in place for reference it would be good to know what year these events happened.

All of my experiences were pre 2000 and that was when nothing was in place.

In the article the 3 Col's said programs started 99/2000. So to get a handle on the truth being told by the 3 Col's a year will help.

when I came back from Rwanda I was told I had to go on a CLC course in one week, of course they said I could refuse but I would never get another chance, and then when I started having problems was sent to some base doctor for a chat just before going to see this doctor I was warned to soldier on and be careful of what I said or my future in this job would be very limited if not short so say nothing Is what I did and suffer for it I have.

What year was this Rex?

Unfortunately, the mentality in the CF is similar to a wolf pack. Once a member is deemed ill or perceived as weak, the pack turns on them or leaves them behind. This also includes physical injuries. I had 2 major knee operations within 4 months of each other, and was still attending bi-weekly physio for the first surgery when the second was performed, so needless to say, I was away from work quite a bit, and my CO was calling the clinic everyday to find out how long this would continue. I was given a medical accommodation, for these very health reasons, but had to defend myself almost on a daily basis. I was discriminated against, called disloyal, lazy, a liar, and was verbally chastised for mistakes others had made. And as the lowest rank in an office of only 11 people, including the CO, I was powerless to stop them. I would go into panic attacks every morning because I didn't know how or why they were going to crap on me each day. There had been a course put on by the Arthritis Society on dealing with chronic pain, but was only held one afternoon a week for 3 weeks. I had requested permission to attend 2 months in advance, and registered for the course. My CO finally gave me permission to attend 2 days before the first class, and then I was crapped on for registering before getting permission to attend. It was if they had intentionally held off in hopes that the class would be full. I tried to be placed elsewhere to work, but the CO refused, the CM said he couldn't do anything because I was on accommodation, and all the Social workers and Priests did was call my CO, and accepted his word that they were fully supporting me, without actually verifying anything. Of course these phone calls only pissed off my CO, and the treatment grew worse, to the point I considered suicide. They even threatened to charge me for being adrift after I had fallen down some stairs and was 5 minutes late for work, and release as 5F, which would strip me of any military pension. It got so bad that I put in my release after only 1 year of a three year accommodation, and spent the last 6 months of an otherwise stellar career on sick leave. So after experiencing just how poorly the CF treats those who are physically injured, and developed a major depressive and anxiety disorder because of it, I can only imagine how those that only suffer from mental illness must be treated.

VVi and Chris Cobb, reporter for Ottawa Citizen, are looking for suggestions, opinions, or experiences if you have dealt with any of the mental health programs of the CF over the last 14 years.

Here is the transcript...

The Canadian military’s treatment of mentally injured troops came under fire from media and politicians after four recent suicides. The senior officers whose job it is to lead care for those troops met at their request this week with the Ottawa Citizen’s Chris Cobb.

Deputy surgeon general Colin MacKay, director of mental health Scott McLeod and senior psychiatrist Rakesh Jetly said they asked for the interview in an effort to promote the military’s mental health programs and to encourage trust in what they say is one of the leading such programs in Canada.

All three colonels are doctors and say that media emphasis on mentally ill soldiers “on the margins” — those not seeking care — is adversely impacting others who are “reachable.”

Cobb, who has been writing about mental injury among Canadian soldiers and veterans for more than two years, has interviewed and written about dozens of mentally ill soldiers who claim the system is not functioning properly and that fear of losing their careers is causing many to suffer in silence.

This is an edited transcript of the interview.

Cobb: Do you accept that the military has a huge mental health problem?

Jetly: We know the rates. We know the prevalence. There is a mental health problem and I think we’re resourced to take care of it.

McLeod: Mental health and mental illness in Canada is a significant issue. Although we do screen a lot of folks out of the Canadian forces, we also send people to very dangerous areas and we certainly recognize that people are injured in those deployments. We have resources in place to ensure we look after those folks. Our goal is to reach everybody and one of the reasons we came to you is to reach people, tell them we have a quality program and come and access in those times of need. If you’re suffering make sure you come and get help.

Cobb: Is there a stigma among the lower ranks — among the guys who the mentally injured are reporting to and who still have this ‘suck it up buttercup attitude’? Does it exist and how do you deal with it?

Jetly: It exists everywhere in society …

Cobb: Let’s just talk about the military …

Jetly: We will, but stigma from mental illness will never completely go away. It has been reduced greatly. The level of discussion that occurs within our organization about suicide, mental illness — I don’t think there is a segment of society that discusses it more. Our own data comparing us to some of our closest allies show we have the lowest rate of stigma compared to our allies. When we survey soldiers — these are the troops not the generals (and ask) would you think less of somebody who sought mental health care? Only seven per cent of people said yes. When you ask those questions in society the figures are much higher

Cobb: What are you doing right now to rid the military of stigma?

MacKay: The Road to Mental Readiness Program is one of the main tools to help to educate the leadership from the very top all the way down to the sergeants and master corporals that are really close to the corporals and privates. It helps them to understand that some of these reactions are quite normal. It helps them to recognize when their subordinates are having issues and encourages them to get them to seek help as opposed to the ‘suck it up buttercup’ approach. We have come a long way with our education programs.

Cobb: I can give you examples of people who meet resistance, meet prejudice and are frightened to death of coming forward.

Jetly: When you have any illness in the kind of organization we have it can have an impact on your career — whether it’s bad knees, a bad back or mental illness. We continue to look at the barriers. Stigma is one of the barriers to care but the largest barrier, as in civilian society, is people not knowing they are suffering from mental illness. Worrying about career and not trusting mental health professionals: There are many reasons people don’t come for care. What we’ve done over the past 10 years is attempt to develop counter measures to each of those issues. One of the important things within the science of stigma is the concept of self-stigma. It’s an interesting concept in the sense that people may encourage someone else to get care but when it comes to themselves might have different feelings about what it says about me. People need to give themselves the same kindness that they would show their colleagues.

Cobb: So you’re saying then that some soldiers are, for want of a better phrase, self-censoring?

Jetly: Some people, yes.

McLeod: That’s why if you look at the mental health strategy we have developed, we know that an investment in enhancing mental health understanding is one way of reducing stigma. Just by improving what people understand about mental illness, making sure they can get in early and treated early and can return to work. Our goal is to keep people. We don’t want people to leave. There has been an enormous investment in their training and they have great experience. They are valuable assets and the last thing we want to do is see them leave.

Cobb: How much actual power do you exert over the day to day — over the people who have power over the soldiers?

McLeod: That influence comes over time. It’s something you do on a daily basis. You can’t reduce stigma to zero overnight. We’re investing heavily in education and trying to whittle away at that stigma.

MacKay: Our health and lifestyle information survey showed us that a large number of people who felt they might benefit from mental health care didn’t seek mental health care because they wanted to deal with it themselves. We haven’t given up on stigma.

Cobb: Are you going to bases and saying ‘look guys if you’re feeling like you have a mental issue come forward and if anybody stands in your way we want to know about it’?

McLeod: All the time. Soldiers are hearing about this from the moment they walk into recruit school. This is part of what we do. I’m not going to tell you it hits 100 per cent of the population right now but we are striving for that.

Cobb: Why do you always compare the military to civilian society? The military is a very specific workplace. You have always used the comparison of suicide statistics to downplay the problem in the military. Why?

Jetly: Mental illness is a reality of every human being.

Cobb: But most people have not experienced what these soldiers have experienced.

Jetly. Absolutely but as a senior psychiatrist I want to improve mental health awareness throughout society. Yes, we’re unique. We have our own health system, and a chain of command but mental illness, suicide substance abuse and those things are Canadian issues not especially Canadian Forces issues.

MacKay: We are all members of this society and have the same types of illnesses that society has. We can’t ignore that aspect. And if you look at our statistics for mental health in the Canadian Forces, a large number are not related to operational deployment.

Cobb: You say that suicide rates in the military are lower than in the rest of society but you don’t take into account reservists and if I’m a soldier who leaves the military on a Friday and commits suicide the following Saturday I’m not counted. How can those suicide figures be perceived as reflecting reality?

Jetly: This is about statistics and about how things are measured in a scientific manner. Every time I say that the suicide rate is lower I also say ‘so it should be.’ Every suicide is a tragedy.

MacKay: If you look at the analysis even further many of those (veteran) suicides happened quite a period of time after they left the military. So how to you relate those suicides to military service? So much has happened in life over that period of time.

Cobb: It’s also true that people can suffer from PTSD for a long, long time.

McLeod: We don’t just look at the statistics and numbers. We want to learn and improve our system so we can prevent suicide. We look at men, women and reservists. We look at all we can to make our system better. If there is something we find that we can implement immediately, we do that. No other organization in Canada, and probably the world, has got a program that intensive to learn from these suicides.

Cobb: Do you think Gen. Rick Hillier’s call for a public inquiry into military suicides is a good idea?

McLeod: I don’t we can comment on what Gen. Hillier thinks we should be doing. We need to strive to improve our program. But back to the trust component: If people are suffering they need to come in and get help. If they’re being told the system is broken and we’re doing a horrible job of looking after them they aren’t going to come for the help. What we want to communicate is that we do have a good system and we want you to come in for help.

Cobb: Many people have said to me that the overall public message coming out of the military has been, ‘We don’t really have a problem. Look at society, their suicide rates are far higher than ours.’ When people with mental injury hear that message would it not have the same (negative) effect on them?

McLeod: I’m not sure anyone has ever said we don’t have a problem. There are many people who have completed suicide who have never deployed and didn’t have PTSD. Even those who have deployed may be suffering from general anxiety or major depression that is not related to their deployment. It is related to mental illness as it exists in Canada today. Suicide is a public health issue and we want to make it better. We want to stop this.

Cobb: Col. Jetly, in the wake of the arrest of Cpl. Howard Richmond in the first-degree stabbing death of his wife you referred to the “Hollywood version of soldiers deploying, using drugs, abusing their wives, killing themselves … that’s the stereotype.’ How much more Hollywood can you get than a soldier who’s been diagnosed with PTSD, is in the Joint Personnel Support Unit system and has been arrested and charged with first-degree murder in the stabbing death of his wife?

Jetly: The point is that cases like that are by far the minority. The vast majority of soldiers with mental illness are responsible citizens, loving fathers coming to work every day and doing their duty. We have many cases — a schizophrenic doing something a Greyhound bus tars all schizophrenics. So I take issue with the stereotyping of mentally ill people as being deranged and dangerous.

Cobb: Do you see any merit in crisis response teams in place for weekends and holidays such as Christmas because the bases tend to close down don’t they?

Jetly: That’s been explored in different places. To a large extent it depends on the specific setting and what’s available after hours.

Cobb: Take CFB Petawawa. What happens if a soldier suffering from PTSD or some operational stress injury is left alone at Christmas?

Jetly: I would expect each clinician to have a care plan over holidays depending on who’s available — a duty medical officer, a duty chaplain, or duty officer from the unit or the relationship with the local hospital.

Cobb: How confident are you that you’ve got a grip on this problem? Or do you?

MacKay: From the mental health perspective we have a very good program in place to provide support for personnel who are suffering from operational stress injuries. State of medical science doesn’t allow us to get everybody back to the state before they went into an operational setting but I believe we have access to care that is beyond what is available in Canada and many other places — care that is the leading edge. We provide free of charge any treatment that is necessary and evidence based. We do struggle. One of the groups very difficult for us is the group that has post-traumatic stress disorder and the co-morbid alcohol and drug issues.

Cobb: So do you have a grip of this problem? Are you in control of the situation?

MacKay: We still have room to improve. Absolutely. I believe that the system we have is providing high quality care across the Canadian forces.

Cobb: Have, as Gen. Hillier says, men and women of the forces lost confidence in the country to help them?

McLeod: That’s one of the reasons why we want to talk to folks like yourself. To help build the confidence. There are people out there struggling and we want them to come in. We can’t help them if they don’t come in. They won’t come in if they don’t trust the system.

Cobb: So you think there is some validity in what Hillier says?

MacKay: I don’t believe that all members of Canadian armed forces have lost trust in the country to support them. Some people continue to struggle who have perhaps lost some trust but I don’t believe all members of the armed forces would fit in to what Gen. Hillier is referring to.

Cobb: Has the amount of mental injury out of the Afghanistan deployment come as a surprise to the Canadian military?

MacKay: We had no data going into that operation that would have given us a good indicator of what we might expect. We had built a very robust mental health capability in the Canadian forces which has put us in pretty good stead.

Jetly: We didn’t have the Vietnam experience so the absolutes of combat experience weren’t there. Because of the events of the ’90s — Rwanda, Somalia and the early Gulf War and the former Yugoslavia — we began our trauma centres in 1999 so we did develop sort of an expertise in PTSD. I don’t know if we expected the numbers. Did we expect mental health casualties? Yes.

Cobb: As the head of mental health do you ever go to bases like Petawawa and sit with the mentally damaged soldiers and talk to them?

McLeod: I haven’t done that because our folks on the ground do that. I have spoken to our folks on the ground. I visit the clinics, ask how things are going and how the programs are working and what they need

Cobb: Are you confident you are getting the true picture?

McLeod: Yes. Soldiers are very open when they’re talking to you on a one-to-one basis.

Cobb: A Parliamentary delegation went to Petawawa a few weeks ago and I’m told a couple of people spoke plainly to the parliamentarians but were chastised later for doing so. Does that surprise you?

McLeod: It does because from my experience working with the chain of command they are very supportive of people talking about their mental illness and the challenges they have. What concerns a lot of people is that they don’t bring issues to their chain of command to their supervisors or to the health care providers … They skip those steps and go to parliamentarians or the media. So sometimes being chastised is the perception of being ‘you should have brought that to me I could have helped.’ In most cases people want to help but in some cases that’s not true. It happens in all walks of life.”

Jetly: From my perspective the chain of command is genuinely caring. Why wouldn’t they be? It’s in their best interests to have them well and functioning. From an organizational point of view it makes sense.

Cobb: Does Universality of Service need changing or eliminating?

MacKay: The Canadian armed forces need to have a standard we can apply to ensure we can maintain a level of operational readiness that the government needs us to be able to maintain. Is it time to re-evaluate universality of service? I’m not sure we’ve gotten to that stage.

Cobb: It’s a barrier to people continuing their military career isn’t it?

MacKay: And that’s why you are encountering soldiers who say that if they come forward it will be an end to my military career. But we have to have standards and from the mental health perspective we need to help people understand when maybe it’s not good for them to continue on and they need to progress to something different that might be better for them.

Cobb: But not everyone is going to be fighting on the front lines are they? You have thousands of people in support roles. Isn’t that better than pushing them out the door?

McLeod: It’s not pushing them out of the door. It’s helping them transition to a new normal. And not all the places we go are that benign. On the base in Kandahar there were rocket attacks on a regular basis and we had trauma running through the hospital on a regular basis. Should we put people in situations that might reactivate their PTSD or their depression? Would that be reasonable?

Cobb: But you don’t have to do you? Not every member of the armed forces went to Afghanistan.

McLeod: But there was an expectation that you would. We are a very small military and everybody needs to be deployable. We are there to defend Canada. Even in Canada, during training, the military is a dangerous job.

http://www.ottawacitizen.com/news/Colin+MacKay+Scott+McLeod+Rakesh+Jetly/9312224/story.html