“Self stigma” still barrier in military mental health: psychiatrist

CALGARY – The senior psychiatrist with the Canadian Armed Forces says strides have been made in reducing the stigma of mental illness in the military but some soldiers still suffer in silence.

Col. Rakesh Jetly, who’s also mental-health adviser to the surgeon general, says one of the positive legacies from Canada’s role in Afghanistan could be the military’s rethinking of how it deals with mental-health issues.

Jetly said depression rates in the Canadian military are a little higher than in the general population at about eight per cent. But the rate of post-traumatic stress disorder has doubled to 5.4 per cent from 2.7 per cent in 2002 – an increase “100 per cent” attributable to the Afghan war.

Jetly said the majority of military personnel can now see a mental-health professional within a day in a crisis situation and a psychiatrist in less than a month, while for many Canadians it can take up to nine months.

“The system by no means is perfect, but it’s pretty, darn good,” Jetly said in an interview.

He also said there’s “overwhelming” data that shows military members who have a mental illness, such as depression or post-traumatic stress disorder, are much more likely than a civilian to seek care.

“We’re more resourced than any town or community in Canada. I’m always careful when I say that … the point is Canada has too little.”

But despite more ready access, there are soldiers who still won’t seek help, Jetly said.

“I think that tough guy, suck-it-up kind of culture has changed, but self-stigma is still an issue. Some people who can be kind and caring about a colleague may not afford themselves that same kindness.”

Jetly also cautions that it’s not just active military personnel who may be struggling with their mental health.

“There’s this stereotype of this big, strong, strapping soldier who’s kicking down doors. There are people who do that, but when we look at PTSD, it’s not about this big guy who’s dangerous and running amok,” he said.

“You might have female nurses that were in the (hospital) exposed to people who have been blown up. There’s clerks (who work) in the morgue. It can be many, many people.”

Jetly believes Canadian society is at a point where mental illness can be demystified and treated like any other illness.

But he acknowledges that for military personnel, coming forward could still have an impact on their careers.

“One of the biggest barriers to care is, ‘what is it going to do to my career?’ You can’t guarantee that it’s not going to impact your career. You can’t guarantee bad knees, migraines or a bad disc problem isn’t going to affect your career either.”

Research released by National Defence last year showed that soldiers with mental-health conditions, especially those with Afghan war illnesses, are far more likely to be declared unfit for military service. Almost 70 per cent of them can expect to be mustered out within 10 years of deployment.

The conclusion came from a review of medical files belonging to more than 30,000 troops who deployed as part of the nearly 12-year Afghan campaign.

Meanwhile south of the border, the U.S. Department of Veterans Affairs (VA) continues to enhance health services provided to members. It recently reported increased use of chiropractic services as part of its standard medical benefits package for enrolled veterans.

According to a new study conducted by researchers from the VA Connecticut Healthcare System, published in the Journal of Manipulative and Physiological Therapeutics, the use of chiropractic services and the chiropractic workforce in VA has grown substantially since their introduction over a decade ago. The annual number of chiropractic visits has increased by nearly 700 per cent, thus demonstrating more veterans have access to chiropractic care than ever before.

“Our work shows that VA has steadily and substantially increased its use of chiropractic services each year following their implementation in late 2004,” states lead author of the study Dr. Anthony J. Lisi, DC, director of the VA Chiropractic Program, and Chiropractic Section Chief at the VA Connecticut Healthcare System.

He adds, “VA chiropractic care includes evidence-based, patient-centered treatment options that are in demand by veterans and referring providers. VA continues its efforts to ensure appropriate access to chiropractic care across the whole system, but as this paper shows, the progress to date has been remarkable.”

Among the findings of the study that covered an 11-year period include:

• The annual number of patients seen in VA chiropractic clinics increased by 821 per cent.

• The annual number of chiropractic visits grew by 693 per cent.

• The total number of VA chiropractic clinics climbed nine per cent annually, and the number of chiropractor employees increased by 21 per cent annually.

• The average VA chiropractic patient is male, between the ages of 45 and 64, is seen for low back and/or neck conditions, and receives examination, chiropractic spinal manipulation and other health care services.

“Chiropractic care is an important component in the treatment of veterans with spinal pain conditions. The trends we identified provide a foundation for further research to examine the optimal models of care delivery for patients,” says co-author and medical doctor Cynthia Brandt, health services researcher at the VA Connecticut Healthcare System and professor at Yale University School of Medicine.

The authors also state that the growth in VA chiropractic use has occurred without additional laws mandating expansion. This suggests an increasing recognition of the value of chiropractic care in VA. In a recent editorial, VA undersecretary for health, Dr. David J. Shulkin, cited VA’s chiropractic program as one example of the important health care expertise provided to veterans.

“The growing utilization of chiropractic services among veterans for pain management and other health concerns, particularly those in the Operation Enduring Freedom, Operation Iraqi Freedom, Operation New Dawn and older adult populations, showcases the clear-cut demand for chiropractic care and is a direct reflection of the improved clinical outcomes and high patient satisfaction scores that have been documented previously,” says Dr. Sherry McAllister, DC, executive vice-president, Foundation for Chiropractic Progress. “We commend VA for its participation in ongoing chiropractic research to help further improve the health and well-being of our respected and valued veterans.”

– With files from Canadian Chiropractor staff