PTSD and the armed forces

“I would submit the winner of the Afghanistan war was mental health,” said Dr. Rakesh Jetly to a crowd at a recent breakfast event in Vancouver.

Dr. Jetly is the Chair of Military Mental Health and he has been studying post-traumatic stress disorder (PTSD) for much of his career.

“What we’ve learned is that it’s not about PTSD. It’s about mental health in the workplace,” he stated at the breakfast event hosted by Calian Health.

The purpose of the event was to discuss some of the unique challenges of providing health care in correctional facilities. Dr. Jetly spoke of lessons learned from military experience that can be  applied to a wide-range of industries, including corrections.

“The military’s mental health program is probably the envy of the world,” said Dr. Nick Withers, Calian’s Medical Director responsible for the Surrey Jail and a retired Lieutenant-Colonel from the Canadian Armed Forces.

“The military has adapted its mental health care over the years from what was relatively basic, to what is now a very robust patient-centred system focusing on mental and physical well-being across the entirety of a member’s career with emphasis on screening pre- and post-deployment,” said Dr. Withers.

Stress as a weapon
The use of psychological weapons began during the First World War with the use of gas. While the gas may not kill a large number of people before blowing away, soldiers in the area of the blast would question their health and their equipment, which heightened their stress levels.

One hundred years later, we have asymmetrical war – the type of war we saw in Afghanistan – with no battle line or clearly identifiable enemy.

“The Taliban had a mystique about them – they showed up out of nowhere,” said Dr. Jetly. “[The soldiers] were tired, sleep deprived, dehydrated, stressed.”

And then came improvised explosive devices (IEDs). While IEDs don’t always kill large numbers of soldiers at a time, the fear of facing one was enough to cause stress to soldiers before and during patrols and travels off-base.

“The stress that’s there all the time is the issue,” Dr. Jetly said. “Even if [the soldiers] come back and they’ve had an uneventful day, they have that heightened arousal and that heightened stress, which a lot of first responders can relate to. Even when nothing happens, it can still take a toll.”

As soldiers cycled through Afghanistan and the mental toll became evident, the Canadian Armed Forces developed a program called ‘The Road to Mental Readiness,’ a resiliency and mental health training program embedded throughout a soldier’s career.

To prepare for stressful situations, members are taught controlled breathing techniques, visualization, self-talk, and goal setting.

But both Dr. Withers and Dr. Jetly agree keeping employees mentally well comes from a much broader approach.

“It’s not just a mental health approach,” said Dr. Withers. “It’s exercise, good relationships, and setting a good culture in your work environment.”

500,000 Canadians will miss work this week because of mental health problems
The Mental Health Commission of Canada reports 500,000 Canadians will miss work in any given week because of mental health problems. Statistics Canada found work continues to be the leading cause of stress among Canadians, over finances and family.

According to Dr. Jetly, change has to come from the top — companies and organizations have to make a cultural change to recognize mental health as being a priority. Something as simple as adding flexibility to the schedule of a father who must drop his child off at daycare and stresses about arriving to work a few minutes late can make a big difference and show employees you care about their overall well-being.

He suggests putting some money into research to understand the problem in your sector. He also said it’s important to consider the mental health impact of each decision a company makes.

“We’ve started to do that now in the Canadian Armed Forces. When we are planning anything, we are constantly asking ourselves, ‘What is going to be the psychological impact of this?’”

Another important step is creating a culture where your managers know their team well and can recognize the warning signs, which means talking and listening to each other.

“Part of the problem with electronics and emails is that we have stopped walking down the hall and talking to each other,” Dr. Jetly told the crowd. “It’s not about diagnosing, it’s just that ‘hey, how are you doing?’ You also have to create a culture that encourages help seeking and ensures help is there.”

When you know staff have been through a traumatic or stressful situation, make sure to have a screening process in place, which can be as simple as having somebody ask each team member if they are doing OK.

Dr. Withers, who is also an Emergency Room physician, says it’s something he hasn’t seen in his experiences outside the military.

“I’ve never seen a formal health and wellness approach, or stress management approach for workers, in any of the emergency rooms I’ve worked in,” he said, “and let’s face it, the emergency room can be a pretty stressful place.”

Dr. Jetly says putting a program in place will make all the difference. He points out while police departments always have money to train their members on the shooting ranges, they often scramble to find cash for mental health programs.

He suggests all organizations or businesses whose staff deal with high-stress situations should make mental health a priority.

“If you have a solution for mental health in the workplace, it’s going to take care of the PTSD situation.”