Hundreds of soldiers from Canadian Forces Base Petawawa who sought counselling at a nearby hospital in eastern Ontario must get help elsewhere.
The Pembroke Regional Hospital says it can no longer afford the adult outpatient service that saw more than 400 soldiers a year seeking treatment outside the military health system.
Individual counselling has been dramatically scaled back with the retirement this year of four social workers who are not being replaced. Marital sessions are no longer offered.
Soldiers had received free counselling for anger, stress, depression and relationship problems.
The program's end comes amid an emotional public debate about whether troops are getting the support they need. Frontline counsellors say many soldiers still won't use beefed up military mental health programs for fear of tarnishing their careers.
Others simply won't admit they have a problem.
Bernadette Wren, the Pembroke hospital's director of mental health services, said there were no dedicated funds for outpatient counselling. It was a service provided "sort of out of the goodness of the hospital's heart," she explained.
Staff must focus on growing needs among the most severe and chronically ill patients, she said in an interview.
"If we had more funding, I would happily continue to provide the service."
Local social workers have stepped in to offer counselling, but Ms. Wren said more help is needed.
The cumulative stress of repeated tours in Afghanistan "is a big concern," she said. "I think the military needs to get better at ... supporting and helping people recognize the signs and symptoms."
Troops need more mental preparation for the reactions they may face once the relentless intensity of surviving a war zone has waned, Ms. Wren said.
"Flashbacks, nightmares, anxiety attacks, depression.
"We have a huge bunch of people that are impacted by these tours. And I think there just needs to be more (help) all the way around."
The Department of National Defence has stepped up support for traumatized troops in recent years while it tries to reduce the stigma of mental breakdown. The number of those wrestling with mental demons is significant.
A military survey two years ago suggested almost six per cent of 8,222 soldiers who'd recently returned from Afghanistan - about 500 troops - had symptoms of post-traumatic stress disorder or major depression.
What was once derided as shell shock or battle fatigue is now referred to specialized mental health services on larger bases. It's also treated at operational trauma and stress support centres in Halifax, Ottawa, Edmonton, Esquimalt, B.C. and Valcartier, Que.
Ottawa committed $98-million to hire another 218 mental health staff by March 2009 - a timeline that had to be extended because psychiatrists, psychologists and social workers are in such high demand.
The recent growth of military acceptance and recognition of stress disorders is "remarkable," said Celine Thompson, director of military family services for National Defence.
Her office oversees 41 military family resource centres in Canada, the U.S. and Europe.
"The shift has just been amazing," Ms. Thompson said in an interview. And the help is needed, she said.
"There has always been the risk of injury or death," she said of service in the Canadian Forces. Afghanistan, a mission that has claimed the lives of 152 soldiers, has escalated the potential of both physical and mental injury, she added.
"They're coping with things that they've never seen before. Definitely, there's going to be a residual impact of that.
"And we're told that there may actually be a spike later on, that we're probably not seeing all that we need to see right now. So we're just being ever vigilant in trying to manage the cases as they come up."
Military family resource centres offer everything from child care to crisis intervention and discrete referrals for treatment, Thompson said. Some counselling is provided depending on local funding, but there are plans to introduce national mental-health support programs in 2011.
Penny Fitzpatrick, a support worker at My Sister's Place, a shelter for abused women near CFB Borden about an hour north of Toronto, says such changes are overdue.
"The military women, over and over, tell me they're told that there's no services and no support for them," she said. "They're being referred off base all the time.
"It's quite atrocious, really," Ms. Fitzpatrick said of what she called "a huge gap" in services for families affected by the fallout of Afghanistan and other missions.
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