The Canadian Forces Health Services Centre in Ottawa helps soldiers who are suffering from post-traumatic stress disorder.

"There aren't a lot of clinicians experienced in assessing and treating military members, and low pay leads to a competition for these limited resources," says Dr. Greg Passey, a post-traumatic stress disorder specialist who retired from the military in 2000.

"Since private clinics offer more money, the military won't be getting the superstars of a sports team, but just the regular players."

A private clinic could pay a mental health professional up to $170 per hour - two or three times more than what the Canadian Forces would pay, Passey says.

This means the military, he says, usually hires clinicians with limited experience.

"After a few years, some of them will be lured to private practice or other organizations that are going to be paying better."

CF officials have recognized their difficulty in hiring mental health workers. In a report released last December, military ombudswoman Mary McFadyen wrote that some Canadian military members with PTSD or other operational stress injuries (OSI) "are strained almost to the breaking point," because they aren't receiving the care they need.

A struggle to meet a growing demand

At the Canadian Forces Base Petawawa, there is one psychologist and one psychiatrist serving 5,100 military personnel, according to the report. Similarly, at CFB Edmonton there are five psychologists and three psychiatrists for 6,600 people.

The number of soldiers suffering from PTSD has more than tripled since Canada's mission in Afghanistan started, according to Veterans Affairs statistics released last year. Overall, about six per cent of soldiers have experienced symptoms of PTSD and depression, according to a post-deployment questionnaire from last November completed by 8,222 personnel, who returned from Afghanistan three to six months previously.

In 2004, the federal government committed $98 million to the CF Mental Health Initiative to hire 218 additional mental health workers by this month. The military is still 71 clinicians shy of that goal, which has now been extended to 2010, according to the CF website.

"In a big centre like Edmonton, for example, where the clinic down the road can pay professionals $20,000 to $30,000 more per year, it's very hard to even keep the skilled people that we have, never mind getting others," says Lt.-Col. Rakesh Jetly, a psychiatrist at the CF Health Services Centre in Ottawa.

"It's a recruitment issue, but also a retention issue."

There are three types of mental health professionals working for the military: uniformed clinicians, public servants and contractors. Jetly says the centre has made submissions to the Treasury Board in the past to increase their salaries.

"I realize we are in tough economic times, but I don't think there's anyone within our branch that wouldn't want us to be a little bit more competitive."

But Jetly also points out that working for the government also means generous benefits, such as pensions and vacations, which the private sector may not offer.

In a country as big as Canada, geography poses another challenge, Jetly says. In major centres with universities, like Ottawa or Halifax, hiring is not a problem.

The difficulty

is few clinicians want to work in smaller and more isolated places like Petawawa. But to handle this shortage, major centres also run satellite programs, sending clinicians to see patients in remote areas.

Show them the money

At the beginning of March, Defence Minister Peter MacKay announced the government will open eight new support centres across the country in the next few months to offer help to both military members and their families. Veterans Affairs Minister Greg Thompson also opened two OSI clinics in Ottawa and Vancouver in February.

In January the first residential OSI clinic opened near Montreal.

Canada's OSI clinics The locations of the eight operational stress injury clinics across the country. Requires FlashPlayer

Although the military is expanding its resources, salary is still very important, says Dr. Susan Brock, a Saskatoon-based psychologist working at a private clinic and specializing in military PTSD.

"My colleagues and I also looked at these OSI clinics, but we are simply not prepared to literally walk away from a third or more of our salary."

Brock says there aren't many mental health providers attracted to this type of job, and this is why there is a national shortage. One needs to learn the military culture and language to establish effective communication with the patient, she explains.

Building a good level of doctor-patient trust is another major issue, Brock says.

"Typically, people who have been attracted to join the military are not emotionally expressive, and when you have someone dealing with PTSD, it's even more difficult to get them to open up and have that trust."

Her thoughts are echoed by Passey, who says some soldiers returning from Afghanistan are still "programmed" for war.

"In a war scenario, you often have people trying to kill you, and often you don't know who those people are. Besides your military mates, everyone is a potential threat," he explains. "A clinician without much experience will not understand that type of thinking."

Passey will soon start part-time work as a psychiatrist at the Vancouver OSI clinic, but admits his pay won't be so bad. Although psychiatrists are the only ones paid at a more competitive rate, there aren't many with his type of experience, he says.

This job will also give him the opportunity to train more people.

"These soldiers put their life and their families on the line with their service to their country, so they deserve the absolute best when they come back," Passey says. "I want to look behind me and know there's somebody else to take my place."

Frontpage photo courtesy of the Department of National Defence, Sgt. Frank Hudec (Candian Forces Combat Camera)

Related Links National Defence and Canadian Forces Ombudsman special report Operational stress and PTSD backgrounder Veteran Affairs Canada U.S. National Center for PTSD