Canadian Forces ignored advice to set up drug, alcohol treatment

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The Canadian Forces rejected an internal recommendation to expand its addictions program to better help military members struggling with substance abuse, despite being aware that nearly six in 10 soldiers who died by suicide in recent years had been dependent on alcohol or drugs.

The recommendation, made last year by a group set up to examine the Forces' addictions services, is laid out in military records obtained by The Globe and Mail through the federal access to information law. The proposal to create intensive outpatient treatment programs at up to seven military centres was initially approved by the Forces' Surgeon-General's clinical council. However, it was soon abandoned for "a less ambitious plan," because of staffing shortages and other mental-health demands, according to a council document dated September, 2014.

This was the second time in six years that the Forces' did not move forward with proposals to re-establish addictions treatment clinics, which were nearly all shuttered in the late 1990s – part of cost-cutting measures that hit the military's health services not long before Canada became involved, in late 2001, in the Afghanistan war.

More than 40,000 Canadian soldiers deployed to Afghanistan during the 13-year NATO-led combat mission, which wrapped up last year. The military has seen rises in alcohol abuse and mental illness, such as post-traumatic stress disorder (PTSD), in connection with the war. In many cases, soldiers are struggling with both PTSD and addictions.

Veterans' advocates and military watchdogs have long criticized the Forces and Canadian governments for not providing enough health services and support for soldiers who returned from Afghanistan with severe mental scars. The mission claimed many lives, including 158 soldiers who died in theatre. But they aren't the only casualties.

A Globe investigation found at least 54 soldiers and vets have killed themselves after serving in the Afghanistan war. The effects of the mission were a factor in some of the suicides, though it's unclear in how many. And there are undoubtedly more: The military has incomplete data on reservists and the government does not regularly track veterans' suicides.

The 54 fallen include Corporals Jamie McMullin and Scott Smith, Sergeant Paul Martin and retired Sgt. Ron Anderson, who were all husbands and fathers, and in the infantry at the Gagetown base in New Brunswick.

After returning from battle – serving in different periods of the war – these four soldiers turned to alcohol to numb their mental trauma, according to their families and military records. Three were diagnosed with PTSD: None ever attended an alcohol-rehab program.

"Jamie was hard into the alcohol when he came back," his father, Darrell McMullin, said. His son began receiving therapy and medication for PTSD soon after returning from Afghanistan in the spring of 2008. "He would sit at the table by himself and just drink, drink, drink. That wasn't Jamie before," his father added. "He drank to forget."

It's impossible to know whether addictions treatment would have made a difference in the fate of Cpl. McMullin, who took his life in 2011, or in the case of the other three Gagetown infantrymen. Cpl. McMullin's parents tried to persuade him to seek alcohol treatment, but he told them he wasn't ready to quit drinking.

According to a presentation made in June, 2014, to the Surgeon-General's clinical council, 59 per cent of soldiers who had taken their lives since 2011 were known to be struggling with alcohol or drugs, and 35 per cent were intoxicated at the time of their suicide.

The Forces used to operate five alcohol and drug-rehab centres in Esquimalt, B.C., Winnipeg, Kingston, Valcartier, Que., and Halifax. All but the Halifax centre were closed in the cutbacks that took place in the late 1990s. As a result, most military members requiring rehab were sent to private clinics that also treat civilians. For some, the rehab centres were very far from home. The three main private clinics the Forces refers members to are in Nanaimo, B.C., Guelph, Ont., and Toronto.

Other cuts included no longer designating a military general-duty medical officer to be in charge of addictions. This move meant other medical officers in the Forces stopped receiving basic training on alcohol and drug abuse. In turn, central oversight of base addictions counsellors fell by the wayside, notes a copy of the military's 2008 addictions review, obtained through the Access to Information Act.

The cuts essentially led to the Forces' addictions-treatment system being "dismantled," the review states, adding: "Currently, we need to play catch up with what is happening nationally."

The Forces made several improvements after the 2008 review, but the 2013-14 examination showed many shortcomings remained in the addictions program.

A long list of challenges was outlined in the military records obtained by The Globe. Compiled in March, 2014, the list of concerns included: a lack of standardized policies for addictions assessment and treatment; insufficient training of base-addictions counsellors and poor communication among them; inadequate post-rehabilitation care for soldiers; and questions about the ability of some private addiction treatment centres to treat PTSD. The military was also not readily tracking whether members were relapsing.

Colonel Rakesh Jetly, a senior psychiatrist and mental-health adviser to the Forces' Surgeon General, said the military is continuing to improve its addictions services. The Forces have enhanced addictions training for general-duty medical officers and have increased scrutiny of private rehab clinics, as well as communication with these centres. Standardized qualifications for base addictions counsellors are also being developed, Col. Jetly said.

"Is there room for improvement? … Absolutely," he said. "Are we finished? Absolutely not."

However, it's clear that improvements have been made in the shadow of the outgoing Conservative government's tight fiscal leash. In the instructions provided to the review group, it was told changes to the addictions program "should ideally not require an increase in CF [Canadian Forces'] staffing or public service establishments."

The group's draft strategy stated that heaving drinking was on the rise in the military and that "substance use has also been noted as a possible factor in a large number of recent suicides in the" Forces.

The review group found that outsourcing intensive inpatient treatment to three private clinics had cost the military about $5.8-million to treat roughly 147 patients in the 2013 fiscal year. The review group contended creating outpatient treatment centres at up to seven military centres, such as Edmonton, Winnipeg and Ottawa, would increase the quality of patient care, because the Forces would have more oversight and military members would get more treatment options.

The military review group also suggested the annual treatment cost would drop, even with the hiring of more military and government staff for the creation of treatment centres. But the chair of the Surgeon-General's clinical council questioned the cost estimates, and the group was asked to do additional analysis.

Ultimately, the proposal to re-establish addictions treatment centres "was a bridge too far," Col. Jetly said in an interview in June, a few weeks before Canada's election campaign began.

"We're not going to have the resources, the manning for that, and in some ways, I'm okay with it," he said. "If we have good, seamless continuity of care … I'm satisfied that the care that our soldiers are going to need is going to be satisfied."

Psychiatrist Greg Passey, who served in the Forces for more than two decades and works with veterans suffering with PTSD, said about half of the veterans being treated at the B.C. Operational Stress Injury Clinic, where he works, are using alcohol or marijuana to block painful memories and to help them sleep.

He said the military needs an addictions program that is easy to access and one in which soldiers are encouraged to get help early. Doing so could make a big difference in a soldier's struggle with alcohol or drugs and prevent the need for intensive rehab down the line.

"If you can get in early," Dr. Passey added, "you may not necessarily have to engage in the full treatment program, beyond early intervention."

Are you a military family with a similar story? E-mail reporter Renata D'Aliesio at RDaliesio@globeandmail.com as she continues to bring attention to this important issue.