NDDN Committee Report

After the end of the Cold War, Canadian Forces operations in Croatia, Bosnia, Macedonia, Somalia, Rwanda, Cyprus, and elsewhere produced casualties, some of whom are only being identified now. Throughout the 1990s, as operations increased in both number and intensity, the Canadian Forces was downsized, including health systems and health services. The result was a dramatic reduction of military health care capacity, leaving only those services deemed necessary for future operations.

A government decision was taken to reduce in-garrison health care in Canada and use the civilian health care system where it could. Military in-patient capabilities, all with a psychiatric care capacity, were closed in Ottawa, Valcartier, Halifax and Esquimalt.
In-patient addiction rehabilitation services were closed in Valcartier, Kingston, Winnipeg and Esquimalt.

At the same time, the civilian health care sector was under severe financial pressures and in some areas it could not easily accommodate additional Canadian Forces patients. By the late 1990s a Chief of Review Services report confirmed that the Canadian Forces health care system was in trouble. As a result, the Canadian Forces launched a health care project called Rx 2000. Its initiatives continue today.

When the Canadian Forces returned to Afghanistan in 2003 and started to suffer combat casualties, there was increasing public awareness that effective military medical services were required on the battlefield, at home and at many points in between.
As casualties mounted, particularly after the redeployment of Joint Task Force Afghanistan from Kabul to Kandahar in 2005, wounded soldiers were being evacuated from combat locations, treated at a military hospital in theatre and sent home for further care and recovery. Some of the more grievously wounded were first sent to the world-class United States (US) military hospital in Landstuhl, Germany, for emergency critical care and stabilization, prior to being evacuated to Canada.

Canadians also learned, as they had during the First and Second World Wars, the Korean War and many of the more intense UN missions during the Cold War, that in addition to physical wounds, our troops were also liable to sustain a range of psychological injuries. While the vast majority of our injured military personnel received excellent care at all stages of treatment and recovery, there were a small, but unnerving number of casualties coming forward to reveal that they had not received the level of attention and care to which they were entitled. There were particularly poignant cases found among those suffering psychological wounds.

In February 2002, the Department of National Defence and Canadian Forces Ombudsman published a comprehensive special report entitled Systematic Treatment of Canadian Forces Members with PTSD.[5] It found there was a need for improved procedures dealing with the identification, treatment and administration of Canadian Forces members suffering from PTSD, as well as a requirement for more attentive care for their families. At the same time, it noted that the Canadian Forces recognized these challenges and was being proactive in dealing with them.

An initial follow-up report was published in December 2002. It reported on improved deployment related procedures, enhanced social support mechanisms and renewed commitment and determination on the part of senior leaders to improve the quality of all medical care. On the other hand, it expressed disappointment at continuing negative attitudes, at lower levels, about psychological injuries and the continuing lack of low-level unit support.

Beginning in 2006, a number of media stories discussed cases of soldiers returning from combat operations in Afghanistan suffering from PTSD.[6] Moreover, in
May 2006, a Senate Standing Committee complimented Canadian Forces mental health care initiatives and provided some helpful recommendations for improvement.[7]

Shortly thereafter, in 2007, the Auditor General of Canada produced a report on the military health care system.[8] It raised a number of procedural concerns within the military health care regime and offered recommendations for improvement.
The government agreed with all of them.

This and continuing media coverage of the death and injury of Canadian troops in Afghanistan attracted the attention of the Standing Committee on National Defence, which then decided to conduct a detailed study of health services provided to the Canadian Forces, with a focus on PTSD. The study was conducted between February 2008 and February 2009.

In the course of our study, three more relevant reports were published by the Department of National Defence and Canadian Forces Ombudsman. The first, in
April 2008, examined the treatment of injured Reserve Force members.[9] It found significant inequities in four areas: provision of health care to Reservists; inconsistent standards of care; inadequate benefits for Reservists; and a lack of timely administration of Reserve medical releases. The second report specifically examined the state of mental health services at CFB Petawawa.[10] It generally found that there was a shortage of mental health resources at the Base. Finally, the Ombudsman published a special report in December 2008, which constituted a second follow-up review of the original 2002 special report on PTSD.[11] Notable among its findings were that some Canadian Forces members suffering from OSI and their families were still not receiving the care and treatment they needed and that over half of the 31 recommendations in the 2002 report, had not been implemented.

The Committee was cognizant of the fact that while concern for wounded military personnel has tended to center on those injured in Afghanistan, Canadian Forces personnel are sometimes injured in the course of normal garrison or training duties at home in Canada, as well as occasionally in the conduct of other Canadian Forces missions abroad, at sea, in the air or on land.[12]