1.0 Introduction

The focus of this evaluation is the Residential Treatment Clinic for Operational Stress Injuries (RTCOSI, hereinafter referred to as the RTC) located at Ste. Anne's Hospital outside Montreal, Quebec. Veterans Affairs Canada (VAC), defines an operational stress injury (OSI) as any persistent psychological difficulty resulting from military or police duty and includes diagnosed medical conditions such as anxiety disorders, depression, addiction, chronic pain, post traumatic stress disorder (PTSD) as well as other conditions that may be less severe, such as anger and relationship problems, that still interfere with one's daily functioning.

OSI is a de-stigmatizing term which focuses on an "injury", as opposed to an "illness"Footnote1 . An OSI can occur as a result of a variety of stresses including exposure to a traumatic incident, cumulative exposure to human atrocities, or simply the sustained exposure to intense military operationFootnote2. PTSD is an anxiety disorder that can occur after an individual has experienced a traumatic event. Symptoms usually start soon after the traumatic event, but they may not happen until months or even years later. They also may come and go over many years. The defining nature of an OSI is that it is a condition or problem that has been precipitated or exacerbated by military or police service.

The Broader Canadian Context

In May 2006, the Honourable Michael J. L. Kirby tabled a landmark national study of mental health, mental illness and addiction entitled "Out of the Shadows at Last - Transforming Mental Health, Mental Illness and Addiction Services in Canada". The reports recommendations continue to have a major impact on mental health issues and in the shaping of mental health policy in Canada.

The anti-stigma campaign of the Mental Health Commission of Canada continues to play a vital role in furthering public understanding and acceptance of mental health issues. Both the Department of National Defence (DND) and VAC are active participants in the evolution towards a broader understanding of mental health issues and improvements to care and treatment.

VAC's Mental Health Strategy

By virtue of the Department of Veterans Affairs Act, the Pension Act and, since 2006, the Canadian Forces Members and Veterans Re-establishment and Compensations Act, VAC plays a significant role in the health care and support of Veterans of military service including care and treatment which addresses the mental health conditions of those who have served. One of the key elements of VAC's early and continuing mental health strategy is to build capacity across the country to provide specialized care to individuals with mental health needs related to military service. This strategy underpinned VAC's decision to develop a network of OSI clinics across the country and later to expand this network. The Department's current mental health strategy focuses on a service continuum to prevent Veterans from falling through the cracks, and on capacity building, leadership and partnerships. In its efforts to build capacity, VAC has recently undertaken a pilot project in Newfoundland with the objective of building partnerships within the province to augment the capacity and skill sets of VAC staff, other federal and provincial delivery agents as well as private service providers.

The RTC is reflected within VAC's Continuum of Care for Operational Stress Injuries, Figure 1 below. It is an inpatient facility dedicated to providing third-or tertiary-level care and treatment to Veterans, CF members and RCMP members and their families who suffer from a complex or severe PTSD co-morbid with another mental health condition(s) such as depression, substance abuse, or anxiety disorders for which outpatient treatment was insufficient or ineffective. As a third-level care inpatient clinic, it offers specialized treatment providing these individuals their best, if not final, chance for recovery. (Figure 1 highlights in orange the RTC's programming within the third-level of care.)

According to the Canadian Mental Health Association, 1 in 10 people in the Canadian civilian population suffer from PTSD. For members of the military and policing sectors, traumatic events are far more likely to occur, and do occur more frequently.

Figure 1: VAC'S Continuum of Care for Operational Stress Injuries

Primary Care
Service Client Profile Description of Services offered Facility/ Setting
Emergency Services Provincial Hospitals Imminent Risk Acute Care Inpatient facility
Community Public Health Services (GPs community clinics) VAC Assistance Line Imminent Risk Acute Care Inpatient facility
Secondary Care
Service Client Profile Description of Services offered Facility/ Setting
VAC Private Service Providers OSI condition, mild co-morbidity (mostly non-complex) Discipline-specific interventions (pharmaco-therapy, psycho-therapy, etc.). Outpatient treatment services
OSI Clinics Complex OSI conditions (important co-morbid issues) Interdisciplinary team approach, specialized assessment and individual/group. Outpatient treatment services
Third Level Care
Service Client Profile Description of Services offered Facility/ Setting
Pain Clinic Complex pain conditions with co-morbid mental health issues Interdisciplinary team approach, monitoring continuous assessment and linage with VAC and community services, individual/ group psycho-educational and treatment services. Inpatient setting
Stabilization Program Complex OSI conditions (important co-morbid issues) Acute medical assessment and treatment services, management of physical symptoms. Inpatient setting
Private-public Addiction Centres OSI condition with co-morbid addictive disorder (primary presenting problem is addiction). Interdisciplinary team approach, continuous assessment and addiction-focussed individual counselling/group therapy services, aftercare, linkage with VAC and community services. Inpatient setting
PTSD Addiction Co-morbid Program Complex OSI condition with co-morbid addictive disorder (primary presenting problem is addiction). Interdisciplinary team approach, continuous assessment and co-morbid addiction/PTSD focussed individual counselling/group therapy services, aftercare, linkage with VAC and community services. Inpatient setting
New Residential Treatment Clinic Complex OSI conditions (important co-morbid issues) significant impairment in daily functioning, ready to engage in intensive therapy. Condition is psychiatrically stabilized. Interdisciplinary team approach, continuous assessment, individual/group/peer/family intervention, opportunities to practice newly acquired knowledge, skills and attitude, aftercare planning. Inpatient setting
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