BG 08.009 - November 17, 2009
The health needs, including mental health needs, of military personnel are a top priority for the Canadian Forces (CF) and the Government of Canada. The death of even one CF member by suicide is too many. The CF take the issue of member suicide very seriously and ensure that all personnel undergo regular suicide awareness and intervention training programs. Extensive efforts are expended to identify people at risk for mental health problems and to provide them with the assistance that they require.
Suicide is a concern for all Canadians. According to the Canadian Mental Health Association, suicide is the second leading cause of death among young people, after motor vehicle accidents (http://www.cmha.ca, 2009).
Suicide rates among CF personnel are lower than those among the overall population. This is not surprising given that CF personnel are a screened workforce. Moreover, suicide rates in the CF have been generally decreasing. The rate of suicide among male CF personnel during the period 2005-2008 was lower than the rate during the period 2000-2004, which was lower than the rate during the period 1995-1999.
Suicide rates
In tabulating suicide rates, the CF do not include the deaths of civilians on Department of National Defence (DND) property or the deaths of DND employees, off-duty Reserve Forces personnel or Canadian Rangers.
It should be noted that the records of the Military Police (MP), on which all CF suicide figures are based, are subject to misinterpretation due to the fact that MPs log all investigations of “sudden deaths” together, whether these later turn out to be suicides, accidental deaths or deaths from natural causes.
The figures in Table A originate with the CF Director Force Health Protection (DFHP). These figures include male Regular Force personnel only.
In order to better understand CF suicide rates, DFHP compares their numbers to those collected by Statistics Canada among the Canadian population, after standardizing the figures for age (as CF personnel are limited to the age range 17-60). So that a comparison is possible with the Statistics Canada figures, CF rates of suicide appearing in Table A are calculated, like those of Statistics Canada, as a rate per 100,000.
Table A
Suicide rates among male Regular Forces personnel,
1995-2008 |
| Year |
Number of male CF personnel |
Number of suicides among male CF personnel |
CF male suicide rate per 100,000 |
| 2005-08 |
217,606 |
39 |
17.9 |
| 2008 |
55,627 |
13 |
23.37 |
| 2007 |
54,673 |
9 |
16.46 |
| 2006 |
53,985 |
7 |
12.97 |
| 2005 |
53,321 |
10 |
18.75 |
| 2000-04 |
262,472 |
50 |
19.1 |
| 2004 |
53,522 |
10 |
18.68 |
| 2003 |
53,752 |
9 |
16.74 |
| 2002 |
52,326 |
9 |
17.2 |
| 2001 |
51,008 |
10 |
19.6 |
| 2000 |
51,864 |
12 |
23.14 |
| 1995-99 |
282,865 |
56 |
19.8 |
| 1999 |
53,134 |
10 |
18.82 |
| 1998 |
54,485 |
13 |
23.86 |
| 1997 |
55,041 |
13 |
23.62 |
| 1996 |
57,608 |
8 |
13.89 |
| 1995 |
62,597 |
12 |
19.17 |
From 2000 to 2004, the rate of suicide among Canadian males approximated 25 per 100,000, or one in 4,000. Over the same period, as Table A illustrates, the rate of suicide among male CF personnel approximated 19.1 per 100,000, or one in 5,236. This means that the rate of suicide among male CF personnel between 2000 and 2004 was about 75% of the rate among Canadian males, once the two figures have been age-standardized. (Statistics Canada has recently released figures for 2005 which do not alter significantly the basis of this comparison.)
The rate of suicide among Canadian females over this same period ranged from one-fifth to one-third the rate among Canadian males. The rate of suicide among female CF personnel is extremely low. It is more useful to report the following numbers: there were no suicides among female personnel from 1995 to 2001, there was one in 2002, there were two in 2003, there were none in 2004 or 2005, there was one in 2006 and there was one in 2007 and one in 2008.
Statistical comparisons with the overall population since 2005 are not possible, as Statistics Canada has not yet made information on Canadian mortality rates available for this period. However, the rate of suicide among male CF personnel in 2005-2008 was 17.9 per 100,000, or one in 5,587.
The figures in Table B originate with the CF Director Casualty Support Administration, which coordinates benefits. These figures include some Reserve Forces personnel.
Table B
Suicide rates among Canadian Forces personnel, 2002-2008 |
| Year |
Number of suicides among CF personnel |
| 2008 |
15 |
| 2007 |
12 |
| 2006 |
11 |
| 2005 |
11 |
| 2004 |
13 |
| 2003 |
11 |
| 2002 |
12 |
The CF do not have complete records on Reserve Forces suicides. There is considerable turnover in the Reserve Forces, especially among part-time Reservists. Suicides among part-time Reservists may not be captured unless they are brought to the attention of the military by civilian authorities. Plans are underway to link the names of all CF members from 1972 to the present to Statistics Canada’s mortality database to correct this situation.
The differences between figures in these tables relating to any given year reflect the complexities involved in tracking suicides among members of any population. CF leadership is continually engaged in discussions on the subject of improving record keeping.
Deployed personnel
No consistent relationship has been discovered between deployment and increased risk of suicide. Nevertheless, there is a pre-deployment mental health screening process in place for CF personnel, and troops are prepared in various ways to deal with possible trauma overseas.
For those personnel deploying on stressful operations and missions, good mission preparation and training is critical. This includes education on stress-coping skills, unit cohesion and social support, and awareness of the potential effects of stress. Training is realistic and is designed to bolster confidence in both individual and team capabilities.
Canadian soldiers about to return to Canada after a lengthy deployment are required to experience a five-day decompression stop on the way home (commonly called Third Location Decompression, or TLD). At the TLD site, each member has the opportunity to speak with a mental health professional privately and to raise concerns that they may have at that time. Personnel are educated about PTSD/OSI. The mental health team provides information about home, work and community life back in Canada in order to make reintegration less stressful.
All CF personnel returning from an international operation of 60 or more days’ duration undergo an Enhanced Post-deployment Screening Process. This takes place between 90 and 180 days after their return to Canada, although nothing prevents an individual who has any concerns from coming forward to seek help at an earlier time. The Post-deployment Screening is meant to better identify those with deployment-related problems, with a particular focus on psychological problems. The CF member completes a detailed health questionnaire and has an in-depth interview with a mental health professional. The interviewer completes a form recording a clinical impression and a recommendation for follow-up care.
Additionally, the CF conduct periodic health assessments on personnel on a regular basis, where mental health problems can be diagnosed and treated.
Programs and services
The CF have a strong suicide prevention program in place. We educate the military community on mental health issues. We train personnel to deal with the effects of stress in themselves and others. We screen them before and after high-stress deployments. We work hard to ensure that personnel in distress, and their loved ones, are provided with the help that they need.
Care for those experiencing the effects of a mental health problem is collaborative and interdisciplinary, bringing together the expertise of psychiatrists, psychologists, mental health nurses, social workers and counsellors, addictions specialists and accredited chaplains.
Prevention
In June 2009, the Chief of the Defence Staff launched the CF Mental Health Awareness Campaign, which has the dual aim of educating CF personnel on mental health issues, and building a culture of understanding. The campaign’s theme of “Be the Difference” communicates the idea that all personnel can make a difference to those affected by mental health issues.
The awareness campaign brought greater attention to the CF’s Mental Health and Operational Stress Injury Joint Speakers Bureau, a collaboration of the Special Advisor on OSI and CF Health Services. The Joint Speakers Bureau has developed a national education campaign to increase the general mental health literacy of CF personnel at all ranks and to remove social barriers to care. To date, over 8,000 CF members have received training and education through the campaign.
CF suicide intervention training ranges from a two-day, skill-based workshop called “ASIST” (Applied Suicide Intervention Skills) to shorter awareness sessions based on identifying signs, symptoms and resources. This training takes place under the CF’s larger scheme of promoting healthy living and preventing injury and illness through the development of self-help programs. Similar workshops educate CF personnel on anger management, addiction awareness and prevention, stress management, and family violence prevention.
Care
The first point of contact for most CF personnel who are experiencing mental health problems is the primary care physician at one of the CF Medical Clinics. This person will either provide the required assistance or refer the member to the most appropriate resource. In the case of an emergency, personnel can access a physician during daily sick parade.
Mental Health Programs, specialized mental health services, are available at the larger CF bases. Elements of these programs will be available at smaller bases depending upon population size and local resource availability. Psychiatrists, psychologists, social workers, mental health nurses, addictions counsellors and Health Services chaplains normally staff the multidisciplinary teams of the Mental Health Programs.
Operational Trauma and Stress Support Centres (OTSSCs) located across Canada employ a mixed military and civilian staff of psychiatrists, psychologists, social workers, mental health nurses and chaplains. The OTSSCs use a multidisciplinary treatment model to provide assessment, educational outreach, treatment and research. In addition to providing direct service to CF personnel, these centres are involved in consultation with other treatment facilities around the world, and in reviewing the professional literature on trauma, stress and PTSD/OSI. There are five centres: in Halifax, N.S.; Valcartier, Que.; Ottawa, Ont.; Edmonton, Alta.; and Esquimalt, B.C.
Veterans Affairs Canada (VAC) operates eight operational stress injuries clinics to serve veterans and former RCMP officers – along with currently serving CF personnel – who have suffered OSIs as a result of their service. The clinics are located in Fredericton, N.B.; Montreal and Quebec City, Que.; Ottawa and London, Ont.; Winnipeg, Man.; Calgary, Alta.; and Vancouver, B.C. A ninth clinic will open soon in Edmonton, Alta.; and a Residential Treatment (live-in) clinic will open at Ste. Anne’s Hospital in Sainte-Anne-de-Bellevue, Que., in early 2010.
Support
CF personnel in need can call 1-800-268-7708 to reach the Member Assistance Program, 24 hours a day, from anywhere in the world, and receive a confidential referral to someone who can help them. The program provides external, short-term counselling for members seeking assistance outside military health services. Family can also receive treatment through the program if this would influence the member’s well-being. Reserve Force personnel and their families have access. The program is civilian-based in that it uses professional counsellors provided by the Employee Assistance Services of Health Canada, but it is funded by the CF.
The Operational Stress Injury Social Support (OSISS) network provides peer support, family counselling and bereavement services across the country. The network is accessible through an interactive map located at http://www.osiss.ca. A joint venture of the CF and VAC, this very successful initiative was started by a group of military veterans.
Families of personnel with mental health concerns currently have access to a range of CF and VAC services and programs including counselling under the Member Assistance Program and the OSISS network; crisis intervention through the Veterans Pastoral Outreach Program; and the guidance of the more than 40 Military Family Resource Centres located at CF installations across the country, in the U.S. and in Europe.
Looking forward
CF Health Services has long embraced a collaborative care model, maintaining close relationships with the medical services of military partners and with civilian care providers, in order to ensure that ill and injured CF personnel receive the best care possible from the whole community. In keeping with this, in September 2009, a CF-hosted Expert Panel on Suicide Prevention brought together civilian and military representatives from around the world to explore literature and best practices. The panel will deliver a report of its findings to the CF Surgeon General later this year. The report’s recommendations, once they are validated, will contribute to enhancing the current suite of CF suicide prevention programs and initiatives.
