Table 1.
Key Milestones in the Evolution of the CAF Mental Health System, 1990-2015.
| Domain | Year | Milestone |
|---|---|---|
| Administrative | 1995 | Operation PHOENIX led to restructuring and cuts in CAF health services. |
| 2000 | The Rx2000 project was commenced, with the goals of reinforcing the CAF’s health system to address identified problems. | |
| 2001 | The Operational Stress Injury Social Support program is launched in partnership with Veterans Affairs Canada; the program provides trained peer support to personnel and veterans with operational stress injuries. | |
| 2003 | The Rx2000 Mental Health Initiative is launched, with the intention of renewing and strengthening the CAF mental health system. | |
| 2009 | The Rx2000 Mental Health Initiative is formally completed; a strategic Directorate of Mental Health is established. | |
| 2012 | $11.4 million in additional funding is allocated to support expansion of mental programs and services. | |
| 2013 | The CAF Surgeon General’s Mental Health Strategy is published. | |
| Clinical | 1995-1999 | Five Operational Trauma and Stress Support Centres are opened at major CAF bases, to provide assessment and treatment of those with PTSD and other service-related mental health problems. |
| 2002 | The Enhanced Postdeployment Screening Program is launched, requiring that personnel deploying to a special duty area for 60 days or more undergo a questionnaire and interview with a mental health clinician 90 to 180 days after return. | |
| 2002 | The Canadian Forces Member Assistance Program is established; it offers confidential access to short-term counselling provided by civilian clinicians outside of the CAF. | |
| 2003-2015 | Dramatic expansion of the number of CAF mental health clinicians occurs, approximately doubling their numbers; administrative staff are also reinforced. | |
| 2009 | The assessment and treatment model for the OTSSCs is standardized and promulgated. | |
| 2011 | Additional Operational Trauma and Stress Support Centres open in Petawawa and Gagetown, to better meet the needs of personnel with OSIs in those communities. | |
| Deployments | 1990-2002 | Tens of thousands of CAF personnel deployed on traumatogenic operations, especially in the Balkans, Africa, and the Persian Gulf region. |
| 2001-2014 | More than 40,000 CAF personnel deploy in support of the mission in Afghanistan, with 158 CAF fatalities. | |
| Education and training | 2002 | The CAF provides its first Third-Location Decompression program for personnel returning from combat operations in Afghanistan; the program involved several days of rest, recreation, and education designed to ease the reintegration process. |
| 2006-2015 | Third-location decompression becomes institutionalized for personnel returning from demanding deployments; this represents the CAF’s first experience with standardized, population-based mental health education and training. | |
| 2007 | The Road to Mental Readiness (R2MR) mental health education and training program is launched; the first module is provided to noncommissioned personnel completing the Primary Leadership Qualification Course. | |
| Research/surveillance | 2000 | The first iteration of the periodic HLIS is completed. |
| 2002 | Data collection for the 2002 Canadian Forces Supplement to the Canadian Community Health Survey, Cycle 1.2–Mental Health and Well-Being takes place. | |
| 2004 | Another iteration of HLIS is completed. | |
| 2008 | The third iteration of HLIS is completed. | |
| 2009 | Screening and surveillance of TBI is initiated during postdeployment screening. | |
| 2009 | The Operational Stress Injury Incidence and Outcomes Study, the CAF’s first major mental health services research project, is launched; objectives include assessment of the cumulative incidence of OSIs in a large cohort of personnel deployed in support of the mission in Afghanistan, as well as of occupational outcomes in those with mental disorders. | |
| 2010 | The Operational Mental Health Assessment (OMHA) surveys 2 rotations of Kandahar-deployed personnel to assess need for mental health care and barriers to care. | |
| 2010-2014 | Multiple publications relating to the evaluation of the CAF’s TLD program are released, showing that the program was perceived to help in the ways intended. | |
| 2011 | The first results of the OSI Cumulative Incidence and Outcomes Study are released, showing a high risk of service-related disorders in those deployed in support of the mission in Afghanistan; much higher rates of disorders are seen in those deployed to high-threat areas. | |
| 2013 | Data collection for the 2013 CFMHS is completed. | |
| 2013-2014 | Data collection for the fourth iteration of the periodic HLIS is completed. | |
| 2013 | Findings on occupational outcomes from the OSI Incidence and Outcomes Study are released, showing a very high absolute and relative risk of developing career-limiting medical employment limitations in those with service-related mental disorders. | |
| 2013 | The Mild TBI Outcomes Study is launched, with the objectives of assessing the prevalence of self-reported TBI and postconcussive symptoms and assessing the impact of TBI on long-term occupational fitness. | |
| 2014-2015 | Findings of the Mild TBI Outcomes Study are published; lower prevalence of mild TBI is seen than in US military personnel, and most are free of postconcussive symptoms, which are more closely linked to mental health problems than to TBI. | |
| 2014 | Initial findings of the 2013 CFMHS are released. | |
| Review | 1999 | Chief of Review Services identified numerous weaknesses and deficiencies in health services in the CAF. |
| 1999 | The Croatia Board of Inquiry explored potential toxic exposures in personnel deployed to Croatia; multiple weaknesses and deficiencies in medical services were identified, including weakness in the mental health system. | |
| 2002 | The CAF/DND Ombudsman’s office issues its first report on treatment of personnel with PTSD; multiple recommendations to strengthen the CAF’s policies, programs, and services are made. | |
| 2004 | The CAF/DND Ombudsman releases a favourable evaluation of the CAF’s TLD program; wider use of TLD after demanding missions is advocated. | |
| 2006 | The Standing Senate Committee on Social Affairs, Science and Technology releases a report on mental health in the general population: “Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada”; it identifies many weaknesses and deficiencies in the public system. | |
| 2007 | The Office of the Auditor General reviews CAF medical services; problems with access to mental health care and with outsourcing of care are identified; the lack of data on the performance of CAF health programs and services is highlighted. | |
| 2008 | The CAF/DND Ombudsman releases a second report on care and support for those with OSIs; progress is noted, but not all recommendations from the first report had been implemented. | |
| 2008 | The first CAF Expert Panel on Mild Traumatic Brain Injury in the Operational Setting sits; clinical practice guidelines for in-theatre and postdeployment care are promulgated. | |
| 2009 | The Canadian Forces Expert Panel on Suicide Prevention sits; it finds that the CAF has a strong and comprehensive program, but a number of recommendations are made to reinforce it. | |
| 2010 | The CF Expert Panel on Mild Traumatic Brain Injury in the Operational Setting sits for a second time; updated in-theatre management guidelines are released. | |
| 2012 | The CAF/DND Ombudsman releases a third report on care and support of those with OSIs; continued progress is noted, but areas needing additional attention are identified—particular criticism is made on the lack of a database to keep track of diagnosed OSI cases. | |
| 2012 | The Canadian Forces Expert Panel on the Prevention of Family Violence sits; the CAF’s approach is deemed sound, but many recommendations to further strengthen it are issued. | |
| 2012 | The Mental Health Commission of Canada issues its report: “Changing Directions, Changing Lives: The Mental Health Strategy for Canada.” | |
| 2012 | The Office of the Auditor General releases a report on transition to civilian life in CAF personnel with illnesses and injuries, including OSIs; the need to streamline and better coordinate policies, programs, and services is identified. |
CAF, Canadian Armed Forces; CFMHS, Canadian Forces Mental Health Survey; DND, Department of National Defence; HLIS, Health and Lifestyle Information Survey; OSI, operational stress injuries; OTSSC, Operational Trauma and Stress Support Centre; PTSD, posttraumatic stress disorder; TBI, traumatic brain injury; TLD, Third-Location Decompression.