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occupational stress

Cpl. Chris Dupee, and his wife Angel Nov 7, 2012. Dupee has been struggling with PTSD since he returned from Afghanistan in 2008.Moe Doiron/The Globe and Mail

When her raging husband punched his fist through walls in the house, Angel Dupee covered with a joke. "He was just trying to hit a fly," she told their young children. "Daddy doesn't know his own strength."

She made excuses for his erratic behaviour. At first, he had jet lag. Then, he was getting used to family life again. But Corporal Chris Dupee had returned home from his 2009 deployment to Afghanistan a changed man. Once easygoing, he was now withdrawn and quick-tempered. "It was just a constant roller-coaster ride," Ms. Dupee says.

Cpl. Dupee is one of 3,900 Afghanistan veterans the Canadian Forces estimate will be diagnosed with some form of occupational stress injury (OSI) within four years of coming home – 13 per cent of the 30,000 deployed. The figure doesn't include active soldiers and veterans impacted by previous high-risk deployments, or those with symptoms that may emerge in the future.

Nor do those statistics count the spouses and children who suffer at home, not sure who to reach out to for help. Ms. Dupee finally called the base padre, who directed her husband into counselling.

"I didn't want to screw things up for Chris and his career." But she was also suffering. "People don't realize how much you as the spouse change as well, and sometimes it's definitely not for the better. But you keep that to yourself."

Those damaging secrets prevent families from getting help, a serious issue that a new national public awareness campaign is attempting to correct. The campaign, spearheaded by the Vanier Institute of the Family, is trying to educate Canadians about the realities of military families. The organization is also working with the military, medical associations and mental-health providers to develop new military-specific training for civilian practitioners who may treat active military members or veterans, or their families.

After repeated criticism from Canada's military ombudsman, the military has developed new programs to reduce the stigma around OSI conditions, and the federal government announced $11-million for mental-health programs in September. But helping families is complicated because, unlike in the United States, only soldiers are treated by military health care.

And while most provinces have waived the waiting time that typically delays health coverage for new military families, they still go on waiting lists for new doctors and psychologists – an onerous burden for spouses who may move every two years. A survey of families in 2008 found nearly 30 per cent of spouses didn't have a family doctor. As well, the support programs that are available to families may not match up between bases, and medical records don't always transfer easily.

Today, more than 80 per cent of military families live on "civvy street." Like reservists, they may be isolated among neighbours who can't relate to the stress of deployment, let alone the impact of post-traumatic stress disorder.

"It's crazy-making," says Robin Whitford, whose husband has struggled with the illness since he watched two close friends die in a blast from an improvised explosive device in 2003. "If you live with someone who is not well, it is an impossible task not to be impacted by it."

Ms. Whitford, who works for military family support in Ottawa, became a strong advocate for her own care, eventually finding long-term therapy, most of it at her own cost, from a private-practice psychologist who was also a military wife. As she points out, when you only have about six therapy sessions covered by your health plan, and you spend half of them explaining the difference between postings and deployment, that doesn't leave much time to dig into the emotional issues. But Ms. Whitford knows the system: "What about the private's wife who has nobody, nowhere to go, and is not very assertive?" she asks. "I believe that progress has been made, but it's important to remember that what the policy says and the reality is are often two different things." That includes stigma, she says, which "is still huge and very real."

Colonel Russell Mann, the director of family support services for the Canadian Forces, points out the military is expanding online resources, and is trying to simplify the steps families take to get help. But understaffed bases often struggle to keep up with mental-health needs: In a 2011 survey of military personnel, only about half of respondents from the Petawawa and Cold Lake bases said they were satisfied with the help they had received, both for themselves and their families.

Greg Lubimiv, the executive director of the Phoenix Centre, which provides children's mental-health services for a region outside Ottawa that includes CFB Petawawa, says the majority of treatment for PTSD should happen at the family level – not as secondary to individual care. "It's at the family level that [the situation] starts to break down," he said. Over the past six years, as more units returned from combat tours in Afghanistan, the number of military families the centre treats grew from about 12 to 120, with a waiting list.

Last summer, 32 of the centre's families were posted mid-treatment. But grassroots social networking has expanded to fill gaps: The Dupees have created the Facebook page Military Minds, which now includes a discussion group for spouses.

But, Mr. Lubimiv said, many of the families who get moved would have to start over to get treatment. And the mental-health issues Mr. Lubimiv sees tend to be chronic, with long-term impacts. Experts are slowly learning about high-risk situations – it's harder, for instance, on spouses who have married into military life rather than being raised inside it, children have significantly higher rates of anxiety and depression when a parent is deployed, and tensions within households tend to peak about two months after the military member returns.

But Mr. Lubimiv says Canada is far behind on research that would show what programs work best. "The military still needs to move away from worrying about bad news," he said. As spouses such as Angel Dupee and Robin Whitford can attest, it's what happens after the news breaks that matters.