One Veteran-One Standard - Guiding Principles > PTSD - SSPT (Syndrome de stress post-traumatique)

Soldiers with severe PTSD have trouble finding help

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Canadian_Vet:
Soldiers with severe PTSD have trouble finding help

http://www.cbc.ca/news/canada/story/2010/05/25/post-traumatic-stress-military.html

Shawn Hearn, like many Canadian soldiers battling post-traumatic stress disorder, is having a tough time getting proper treatment back home after serving in a war zone.

Hearn, who served in Bosnia as a sniper in 1994, and those involved in helping soldiers with PTSD say changes to the treatment system need to be made.

And there's a lot on the line. Hearn recently attempted suicide and has been fighting hard to get the treatment he needs.
Shawn Hearn has suffered from post-traumatic stress disorder since he served as a sniper in the Canadian military during the Bosnia mission in 1994.Shawn Hearn has suffered from post-traumatic stress disorder since he served as a sniper in the Canadian military during the Bosnia mission in 1994. (Louise Elliott/CBC)

Hearn came back from Bosnia a different person. At first he didn't know why. He speaks in Guelph, Ont., near the Homewood private treatment centre where he says he's finally getting help.

"Basically I began to notice changes, my family began to notice changes, and in 1997 I ended up in hospital with an overdose," he says.

After that overdose, Hearn remained in the army another three years. In 2000, he was finally diagnosed with post-traumatic stress disorder. He left the military and began to try to understand his symptoms: severe depression, flashbacks, night fears.

"I had flashbacks of things I had seen and things we had done there. The inability to make sense out of it was really tough. Suffering of the young and old really, really bothered me. I was unsure what was happening to me."

Over the intervening years, Hearn found some recovery through a combination of counselling and medication in his native St. John's. He also helped found a national system of peer support called OSISS ? the Operational Stress Injury Social Support program, which has been lauded for helping soldiers help each other overcome the effects of battlefield trauma.

Despite his apparent recovery, Hearn's unresolved trauma began to surface once again. This January, he wound up in the psychiatric ward of a hospital. His stay was short, even though he told the doctors who discharged him he wasn't well.

"The medications weren't working for me," he says. "I had passed that through the system but nobody seemed to listen and I was kind of pushed out the door after three weeks of hospitalization. I was well aware what was wrong with me and I knew I wasn't feeling well both mentally and physically. But again, no one seemed to listen."

Discharged and left to his own devices, Hearn attempted to take his own life.

"I was home for roughly five or six days, three of which I spent in bed in a dark room," he says. "I wasn?t doing well at all. That Sunday I ended up taking pretty severe overdose and I was hospitalized."

Hearn landed in another civilian hospital, where he spent another three weeks and got better care, he says. At this point some of his colleagues in the OSISS program began working the phones, as did his case manager at Veterans Affairs.
PTSD a household term

In the past 15 years, post-traumatic stress disorder has almost become a household term. The constellation of symptoms such as depression, flashbacks and nightmares can be brought on by any type of trauma.

It's most often associated with military service, among soldiers who return from battle only to suffer the aftereffects of what was once called "shell shock."

It's been eight years since then-military ombudsman Andre Marin issued a report chastising the Canadian military for sticking its head in the sand about this difficult reality. Many of Marin's recommendations remain unfulfilled or partly finished, but another ombudsman's report is planned.

The military has come a long way: new stress-injury centres, education and screening programs, as well as peer support networks have grown up and begun to replace a culture of stigma and denial.

But for those soldiers who suffer from the most severe form of post-traumatic stress disorder, there are still serious gaps in the system of care.

With much arm-twisting, Hearn was finally admitted to Homewood, a private facility in Guelph, Ont., for a six-week treatment program for PTSD. He's still there now, and doing much better.

Some close to the situation say it represents the experience of many of Canada's sickest veterans who have PTSD.

St?phane Grenier, the military?s special adviser on operational stress injuries, says some soldiers are an 'anomaly for the mainstream mental health experience.'St?phane Grenier, the military?s special adviser on operational stress injuries, says some soldiers are an 'anomaly for the mainstream mental health experience.' (CBC)St?phane Grenier is the military's special adviser on operational stress injuries ? a military term that includes PTSD, anxiety disorders, and depression related to deployment. Grenier has close to a decade of experience working with soldiers as a peer trying to get them into the right kind of care, and fought to get Hearn into Homewood.

Grenier says the first problem is an overstretched and under-informed civilian system that can't handle soldiers and veterans.

"They come in, and they're an anomaly for the mainstream mental health experience," he says. "They don't fit the mold. They're absorbed as just another person in crisis."

He warns that while the majority of soldiers can be treated for PTSD on an outpatient basis, there is a significant number that cannot.

Statistics are a matter of some debate. But it's believed that about seven per cent of soldiers who deploy will develop PTSD. Another 4.5 per cent will develop anxiety, and another 13 per cent will develop depression.

Grenier says a rough estimate would indicate as many as 60 soldiers per year require in-patient treatment for severe PTSD. He believes the civilian health-care system doesn't know how to deal with those soldiers in part because that number is relatively small.

"Because we don't have a critical mass, I think it's very difficult for the health-care system to deal with. It's treated as another mainstream crisis case," he says. "It's not understood, and they're not referred to the right places for longer more in-depth care."

He says the second obstacle to care is that the entry criteria for residential treatment programs are simply too onerous.

Many treatment programs will exclude a patient who has any anger problems, who may have developed an addiction, or who recently attempted suicide ? all of which are common among veterans suffering with PTSD. The criteria may be there to protect other patients and ensure program success. But the result is that the programs screen out people ? like Hearn ? who most need help.

"To me it doesn't cut the mustard to ask somebody to go home and if he doesn?t kill himself then we'll take him into inpatient treatment cause that?s what it boils down to," he says. "I know it?s crude, but that's what it boils down to."

Rakesh Jetly, the military's chief psychiatrist, says he understands there are many soldiers and veterans who won't be able to benefit from out-patient care, but he explains the military gave up its in-patient mental health capability more than a decade ago.

He argues it's simply not possible to have in-patient programs because the numbers are too small, relatively speaking, and he believes the best route is to build a stronger relationship with institutions like Homewood.

"There certainly is a need," Jetly says. "I personally intend to visit residential treatment [centres] and revitalize our relationship with them. We are a major client of these folks. And [we are] looking at the needs and services they can deliver in order to streamline them even better.?

In particular, Jetly says he wants to improve the process for soldiers with PTSD who also suffer from addictions ? and who need residential programs to address their multiple problems. He says the military is about to re-evaluate the criteria for programs at private institutions where soldiers are commonly referred.

Jetly notes that veterans don't fall under his watch technically speaking ? they are the responsibility of Veterans Affairs ? a jurisdictional issue that brings its own set of problems.
'I very rarely went out my door'

Former soldier Joanne Curnew is well-aware of these problems. Curnew, a military veteran who developed severe PTSD after serving in places like Haiti and Alert in Nunavut, took a turn for the worse late last year.

While DND has no in-patient treatment programs, Veterans Affairs runs an in-patient program for PTSD sufferers out of Ste. Anne's Hospital in Ste. Anne de Bellevue, near Montreal. It recently opened the doors on a revamped in-patient program.

Ste. Anne's Hospital stats

2005-2010 statistics for referrals to the Ste. Anne's Hospital stabilization program (these include ex-service members, Canadian Forces members and reservists, and RCMP):

2005-2006: 11.

2006-2007: 11.

2007-2008: 20.

2008-2009: 16.

2009-2010: 22 (includes some residential treatment clinic referrals).

Curnew?s psychologist immediately tried to get her in there.

"They interviewed, they requested so much paperwork and so many documents, your medical, your reports from your psychologist, psychiatrist,? Curnew recalls. "They dug into every little details they could possibly think of."

It took three months of back and forth before Curnew was finally admitted to the program at Ste. Anne's. During those long months, she continued to spiral downwards.

"It was extremely difficult I even reached the point where I was thinking suicidal thoughts," she says. "Every time the phone rang, you hoped it was Ste. Anne's, you hoped you'd met the criteria and were going to be a patient there. It put a lot of strain on me, as well as my marriage, and my home life. I isolated so bad I very rarely went out my door."

When she did finally get there, Curnew got better. Now, she has nothing but praise for the program, saying it saved her life because it was so well designed for military experience. She just wishes there were more people in it.

"It's a shame in a way because they have a 10-bed floor that I was the only patient on for all three weeks," she says. "At the end there was only two of us in the whole class."

The program is based upon group therapy, but even today there are only four patients in the 10-bed facility, according to Veterans Affairs.
Minister defends criteria

Veterans Affairs Minister Jean-Pierre Blackburn defended the criteria in place for the treatment program.

He says his department has created a rigorous program specifically designed for soldiers, and needs to have high standards in order for those patients who are admitted to benefit.

"It's like if myself, I go to see a doctor, and I say to the doctor, 'I want to go there for this or that reason,'" Blackburn says in an interview. "The doctor may say to me, 'Mr. Blackburn, you feel like that but it doesn't mean [your] point of view is the good one.' And it's for that we have specialists who analyze the situation of each of our veterans who need some specific health care."

Blackburn adds that soldiers who don't meet the strict criteria at Ste. Anne?s will be referred to the appropriate form of care in the civilian system.

Grenier says those referrals rarely happen, and the provincial system is not equipped to handle soldiers properly. He says the criteria at Ste. Anne's are a reflection of what private clinics in Canada are also doing. In the case of Veterans Affairs, it's doubly troubling because it's supposed to be even more tailored to the reality of military PTSD, he says.

At Ste. Anne's, soldiers can be refused admission, for example, if they are not stable, cannot manage their medication, recently attempted suicide, have other medical or psychiatric problems, have substance abuse problems, or anger management problems.

"It really gives ability to systems to say, we don't agree with the referral agency. It?s very subjective," he says. "We know that veterans with PTSD and [operational stress injuries] will exhibit anger. So why do we design programs that deliberately ignore that reality? We need to embrace that reality."

Grenier also says most clinicians he talks to agree with him, but getting them to move en masse to change the criteria remains a challenge.

The price of not treating those soldiers is too high, he says.

"This is where Canadians need to pay attention," he says. "The longitudinal outcome [of the current system] is somebody who remains dysfunctional for the rest of their life. And that's not good for any society, any community."

Curnew says she's worried about the future of the program at Ste. Anne's if it can't admit more people into care more quickly.

"We have troops over in Afghanistan that are coming back with PTSD that need help and have to wait around for six to eight months or 10 months to get it. That's a sin. That's a real sin. And the problem's not going to go away."

She?s also troubled by a recent decision to transfer the entire hospital to provincial management. Veterans Affairs says the province of Quebec has agreed to maintain the PTSD in-patient program.

As for Hearn, he didn't even apply to Ste. Anne's hospital because there was only one patient there at the time, and he felt he needed group therapy.

At Homewood, he says there are eight other soldiers and veterans on his floor alone, and many more in the rest of the hospital.

He's now hoping his experience will somehow prevent other soldiers and veterans from experiencing the same fate.

Hearn says he's speaking out because he knows he was lucky and had strong advocates who got him into the system. He's worried about those who may not get the chance to feel better.

"Yes, I was sick, but I was still able to articulate what was happening to me," he says. "For the average soldier or veteran some of these folks are unaware what's happening to them. These individuals are unable to advocate for themselves."

For information or questions, contact Louise.Elliott@cbc.ca

walt.moore.94:
To all,
I'm a USA Vet who has PTSD also, and like so many of our Canadian friends, found it hard to find help over the years.
Now I have to say that the VA in the States has finally figured out just how many Vets do have PTSD, and are really trying to help us deal with it.
They have helped me, and a lot of other Vets that I know.
One of the biggest programs that the VA has helped us develope is the Certified Peer Support Specialists, (CPSS) that are trained to help our fellow Vets on a variety of Mental Health issues. And I am proud to say I am one of them. We help by talking and LISTENING to what they have to say, and try to point them in the right direction for help. We've found that at times the Vets don't really want to talk to a Doctor, but are willing to talk to someone "who has been there-done that". This program has surprised everyone on how well it has worked, and how valuable it is becoming in all areas of the Mental Health field.
Anyway, I'm wishing the best for all of our fellow Vets in Canada, and I'm just putting out what has helped me to be able to "maintain" my lifestyle as I want it to be. I've still had my relapses at times, but they are less violent as they were before.
If I can be of any service or help, feel free to contact me at anytime - waltergm@comcast.net.
God Bless to all, Walt CPSS.

docdeerajska:
Walt, it's great to see you on here, my dear friend. Thank you once again for your past service to your country, as well as for your current, continued commitment to serving your fellow vets. Your strength and courage are, as always, an inspiration to me. :-)

Now, to switch gears and comment on the original post: in my view, the strict admission criteria for the program are completely backwards. In particular, I take offense at the statements made by the Veterans Affairs Minister, Jean-Pierre Blackburn, that "the program needs to have high standards in order for those patients who are admitted to benefit" - no, no, no, no. NO.

If the admission criteria for the program are so restrictive that many of the most severely ill veterans (that is, those most vulnerable and most desperately in need of assistance) do not qualify, then it would seem to me that the goal of the program is to help the program, and not to help the veterans whom it is supposed to serve.

In my view, a more appropriate approach would be to adapt the admissions criteria, and the treatments offered, to match the needs of the patients whom the program is meant to help.

I am particularly unnerved by the comment in bold - that is, the notion that "soldiers who don't meet the strict criteria at Ste. Anne's will be referred to the appropriate form of care in the civilian system".

Would the minister care to specify what, exactly, would be the "appropriate care" in the civilian system? That is, exactly which civilian facilities does the minister propose have greater expertise in military cultural competence, as well as in treating patients with combat-related injuries, than physicians and mental health professionals at Ste Anne's, who have specialized training and expertise in caring for exactly these types of individuals?

Dumping the patients who are most vulnerable, and therefore most challenging to care for, onto other facilities is a solution that serves the needs of Ste. Anne's, not the needs of the patients.

When our brave men and women sign up to wear the uniform and serve their country, they do so - not just when the job is easy and convenient, but whenever it needs to be done. When they come home hurt and in need of care, we owe them the same kind of commitment - to care for them and help them heal, no matter what it takes. Anything less is simply disrespectful.

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