Changing perceptions around mental injuries from combat

Changing perceptions around mental injuries from combat
Major Alex Heber

Major Alex Heber came to work for the Canadian Forces as a civilian psychiatrist in the early 2000s, when the department of National Defense increased its focus on dealing with Post Traumatic Stress Disorder (PTSD).

Heber was so dedicated to her work that three years later she joined the Forces herself. Since then she has done a tour of duty in Afghanistan and been instrumental in advancing work on PTSD within the Forces.

“It’s the best job I’ve had, in terms of being able to work with Canadian Forces members and help them, these people that help others around the world,” Heber said.

In eight years of working on mental health issues within the Canadian Forces, Heber has seen attitudes and approaches to PTSD and other mental health conditions evolve drastically.

From a decade ago when many soldiers and military leaders held the attitude that a soldier should put up with everything and never talk about personal problems, the Canadian Forces has worked hard to accept and deal with mental health problems, Heber said.

PTSD symptoms – which afflict an estimated seven per cent of military personnel – have been at the forefront of that change. Twenty-six military bases across Canada now have mental health clinics, treating depression, insomnia and operational stress injuries including PTSD.

Seven of these clinics are called “centres of excellence,” where soldiers undergo treatment, but also where much of the leading research into military PTSD and other mental health issues occurs.

But besides the clinical treatment provided to soldiers suffering from PTSD, Heber emphasized that the education and outreach work done by the Canadian Forces has been equally effective.

In order to deal with PTSD, two major obstacles had to be overcome. The first was the stigma attached to mental illness, which often prevented soldiers from coming forward to get diagnosed.

The second was the belief that a soldier who had PTSD or other mental illnesses would have to leave the military, and never serve again.

As for dealing with the latter, Heber was very clear that every patient who clinicians treat within the Canadian Forces is viewed with the goal of getting the member back and ready for duty, if possible.

Dealing with the stigma of mental illness was a different challenge. A big part of the effort was geared at changing the mindset of leaders in the military, as peers and leaders are often the first to notice when soldiers show signs of not being themselves, Heber said.

“When their leadership says ‘this is a problem like any other problem, and you can get help,’ that can be a big relief to the member,” Heber said.

Heber said the shift in attitude towards mental injuries was very apparent during her time in Afghanistan in 2009. The old discomfort with mental health symptoms, and the belief that these symptoms were a sign of weakness, has changed as military leaders liken mental injuries to physical injuries.

As for soldiers themselves, training on mental resiliency, PTSD and other mental illness has been incorporated into pre-deployment training. Then before returning home they undergo a mental health briefing during their decompression time. And finally, three to six months after returning to Canada, each soldier is given a comprehensive mental health screening to look for signs of PTSD or other problems.

The results of this screening are that from 2005-2010 half of the members reporting signs of PTSD during the mental health screening are already in treatment.

Meanwhile, DND psychiatrists like Heber are being sought out by other groups, like the Ontario Provincial Police, to help set up similar systems for dealing with PTSD.

“We know we’re doing great work, but to be able to share our knowledge with colleagues outside the military is a very rewarding experience,” Heber said.

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