For the first time since Canada went to war in Afghanistan, the number of soldiers who served there and retired will outnumber those still in the military, a tipping point that will shift a significant mental-health care burden from the army to overstretched provinces and Veterans Affairs.
As of late November, 22,059 of the 40,026 military personnel who served in Afghanistan remained in the Canadian Armed Forces, according to the military. At the recent rate of retirement, the number will slip below half in 2017 and fall rapidly from there.
Veterans Affairs Minister Kent Hehr says his department is ready for the sudden increase in volume of former soldiers with recent combat experience. Advocates and mental-health experts doubt the department's preparedness, noting civilian patients already face long waits for mental-health treatment.
A Globe and Mail investigation into suicide by men and women who served in the Afghanistan war confirmed 71 cases up until November. Among those people, 15 had been released from the military, but advocates like Mr. Harding say many more than 15 have died this way and gone undocumented. A study of Canadian veterans using data from a 2010 survey found 6 per cent had suicidal thoughts. Other surveys have found 25 per cent have suffered from post-traumatic stress disorder, depression or drug and alcohol abuse.
The Canadian Armed Forces invest heavily in the well-being of its personnel and has made progress screening, tracking and studying mental-health issues in the ranks – particularly suicide rates that seem to be growing among soldiers who fought in Afghanistan. But care shifts to overburdened provincial and territorial health-care providers as people leave the military and are no longer CAF's responsibility. Meanwhile, Veterans Affairs still has no comprehensive system for monitoring veterans' health.
"The day a soldier takes off the uniform, they cease to be systematically tracked," said Brian Harding, a veterans' advocate who is a member of Mr. Hehr's mental-health advisory group. For several years, Mr. Harding and others have been pushing Veterans Affairs to produce data on the scope of the suicides. "Canada did not previously have a reckoning of mental-health issues among veterans in any sizable cohort in modern history. We didn't have Vietnam. We had to deal with this fresh," Mr. Harding said.
Veterans Affairs officials say they are in contact with 250,000 of Canada's 600,000 military veterans, most of whom never served in Afghanistan. Under current legislation, veterans must initiate contact with the department. Veterans Affairs is setting up a system to collect statistical data on suicide among veterans from outside agencies. Details have not been released, and the first annual report is not expected until late 2017.
Veterans Affairs' share of caring for Afghanistan combat veterans has accelerated rapidly in recent years. In 2013, only 21 per cent of soldiers who served in Afghanistan had been released. In 2016, that figure reached 45 per cent, and will pass 50 per cent by the fall of 2017.
Mr. Hehr said his department is ready. "I believe we are," he said in a recent interview. "We understand that the people who served in Afghanistan will be coming out. We started mapping this out, that many will need mental-health support and physical support when they leave their service."
While Veterans Affairs cannot force veterans to get help or submit to public-health tracking, he said the department must continue to improve communications. "What we have to do as Veterans Affairs Canada is say we're open for business," he said. "We're here for support. But we can't force anybody to come through our doors."
Soldiers have a host of health advantages over veterans and other civilians, Mr. Harding said. "They have easy access to health care, better access to mental-health resources than civilians, and ready access to peer support," he said. "They get specific training in mental resilience. Leadership is trained to watch for signs of struggle. Sick-leave benefits are excellent."
Five veteran suicide cases examined in detail in The Globe investigation bolster the point that access to services drops when soldiers retire. The parents of retired private Tyler Hulme described how he overdosed on medication about a month after his release. He had been told it would be a four-month wait for a civilian psychiatrist in Ontario. Retired sergeant Raynald Côté did seek and receive treatment, but fell into isolation and despair with little of the peer support he had in the army.
Retired sergeant Claude Emond had a civilian psychiatrist and massage therapist. "He had services, but when he'd come back from sessions, he felt it was superficial. They didn't understand his military background and seemed to just be checking boxes," said his wife, Sylvie Duchesne.
Veterans Affairs provides an array of services from 1-800 crisis hotlines to education funding and mental-health treatment. The department started funding new clinics for operational stress injury in major centres in 2007. They have slowly spread across the country and are operated by provincial health authorities.
Most front-line services are provided by insurance companies, private contractors, service groups and the health ministries and social services of the provinces and territories. The system can be a bewildering tangle for vets.
Alexandra Heber, the newly appointed chief psychiatrist for Veterans Affairs, said untangling that web is one of the keys to planning for the biggest cohort of combat vets since the Korean War in the 1950s. "Over the years, we've had one service added on top of something else and something else. We are creating more organization for all of those services," she said.
But Deborah Harrison, a psychologist and retired professor, has studied the effects of deployment on military families and recently co-wrote a book on military children called Growing up in Armyville. She says Canada is unprepared for the mental-health burden the war will place on provinces already short of psychiatrists, psychologists and other providers.
"We don't always grasp how historically significant the Afghanistan deployment was," Dr. Harrison said. "It was the longest military engagement in Canadian history. It was a very dangerous deployment and much more stressful for soldiers and families than previous deployments.
"It was known there would be casualties, but nobody was prepared for the unmeetable demands on Canada's mental-health care system from that deployment."