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4.0 Background

4.1 The Rise of OSI-related Clinics

In the mid-1990s, the Canadian Forces experienced an increased operational tempo with engagements in the First Gulf War, Bosnia-Croatia, Rwanda and Somalia. This increased operational tempo continues today with the deployment of troops to Afghanistan. The nature of these conflicts however, is different than those in which members of the Canadian Forces (CF) were previously engaged. More than ever CF members are placed in harm's way for longer periods of time, and with less time to recuperate. Anyone who has gone through an event such as combat can develop PTSD or another OSI condition. This increased exposure to conflict and traumatic situations has led to a growing number of OSIs. Although most individuals readjust smoothly upon returning to civilian life, many will benefit from additional mental health support and some will be diagnosed with an OSI. Among the most common mental health problems faced by returning troops are post traumatic stress disorder, depression, addiction/substance abuse and social phobia.

The growing demand for specialized mental health services and the strong public support for assistance for returning soldiers prompted the DND's involvement, in the late 1990's, in the establishment of five Operational Trauma and Stress Support Centres (OTSSCs) at key CF bases across Canada - in Halifax, Valcartier, Ottawa, Edmonton and Esquimalt. These OTSSCs were developed to provide specialized mental health services for CF members and their families dealing with an OSI resulting from military operations. While these clinics helped fill the need for mental health services for CF members, insufficient capacity still remained within the centres and within communities in general, for Veterans who were the responsibility of VAC.

In 2001, VAC opened its first OSI clinic at Ste. Anne's Hospital as a pilot project. By 2002, VAC and the DND had jointly announced a mental health strategy to enhance the services and support provided to the growing number of individuals with an OSI. With demand for treatment and services on the rise, VAC responded by developing four additional clinics in Quebec City, London, Winnipeg and Calgary based on the Ste. Anne's pilot.

With the support of the DND and the RCMP, VAC received federal Treasury Board approval in 2007, to establish an additional five clinics, bringing the total of OSI clinics under VAC's purview to ten. The new clinics were established in Vancouver, Fredericton, Ottawa, Edmonton and an additional clinic was established at Ste. Anne's Hospital. The latter differed from the other clinics - it was established as an inpatient facility for those Veterans, CF and RCMP members suffering from more complex PTSD and co-morbid (in combination with) conditions such as chronic pain, depression, anxiety disorders and addictions/substance abuse.

Eight of the ten OSI clinics operate under the terms of a Memorandum of Understanding (MOU) between VAC and the host health organization from whom VAC purchases services. The OSI clinics are a unique type of external health service provider as the operations of each clinic is fully funded by VAC to provide exclusive service for VAC clients. The two remaining clinics, an OSI outpatient clinic and an inpatient clinic are operated from the federally owned Ste. Anne's Hospital for Veterans in Ste. Anne-de-Bellevue, Quebec. All of the OSI clinics serve Veterans, Canadian Forces (CF) members and members of the Royal Canadian Mounted Police (RCMP) and their families. In Figure 2 below, VAC's most recent Mental Health Quarterly Statistical Report illustrates the number of active files and new referrals to its network of OSI clinics as of March 31, 2011.

Figure 2: Mental Health Quarterly Statistical Report – OSI clinics March 31, 2011

OSI Clinics – by Referral Agency (Active files)
Number Active files Total West Ont. Que. Atl.
97 Veterans Affairs Canada 1,191 286 338 458 109
98 Department of National Defence 319 122 71 68 58
99 Royal Canadian Mounted Police 79 43 * * 26
100 Family members (VAC,DND,RCMP) 159 57 29 65 8

* Numbers which may permit the identification of individuals are displayed with an asterisk
Source: VAC's Mental Health Directorate

OSI Clinics – by Referral Agency (New Referrals)
Number New Referrals Total
101 Veterans Affairs Canada 190
102 Department of National Defence 51
103 Royal Canadian Mounted Police 17
104 Family members (VAC, DND, RCMP) 34
OSI Clinics – by Referral Agency (Files Closed)
Number Files Closed Total
101 Veterans Affairs Canada 115
102 Department of National Defence 54
103 Royal Canadian Mounted Police 5
104 Family members (VAC, DND, RCMP) 16

Source: VAC’s Mental Health Directorate

Operational Stress Injury Social Support (OSISS) Program

The Operational Stress Injury Social Support (OSISS) program reference appears throughout this report. The OSISS is a joint VAC-DND program that has, as a mission, to establish, develop and improve social support programs for current and former members of the Canadian Forces and their families affected by operational stress; bereaved families of military members and Veterans, as well as to create an atmosphere and environment which leads to a better understanding and acceptance of OSI. After more than a decade in operation, this program continues to make a significant contribution to the recovery process. The role of peer support is briefly discussed in Section 5.3 of this report.

4.2 The Founding of a Residential Treatment Clinic (RTC) for Operational Stress Injuries at Ste. Anne's Hospital

Early Vision

The experience gained from VAC's pilot OSI centre established in 2001 at Ste. Anne's Hospital led to a renewed vision for what was then referred to as the Ste. Anne's Centre. The vision called for a PTSD Residential Rehabilitation Program (PRRP) "to provide a structured 24 hour-a-day supervised therapeutic setting which promotes strong treatment and recovery values. Admissions to the program are to be housed in a separate building from the hospital centre and must be clinically stable to be self-sufficient for their everyday care and safety needs. All members of the PRRP will be required to participate in at least 25 hours per week of specified therapeutic or rehabilitative activities" Footnote3. The vision also included the establishment of a pain management clinic and tele-mental health capability at Ste. Anne's.

Stabilization Program Introduced

Continuing to build on its experience and in line with its vision, Ste. Anne's introduced an Inpatient Stabilization Program in 2002, with four beds allocated for 24/7 care. The medical stabilization of an individual's mental health condition is essential and fundamental for any further therapeutic effects and benefits of ongoing care. "A person living with an operational stress injury (OSI) may experience a period when their ability to face personal, social or work situations is significantly reduced. This can happen if medication needs to be adjusted or if clinical supervision or more intensive psychological support is needed. The Inpatient Stabilization Program for OSI can help individuals develop skills to better manage their symptoms and eventually allow them to continue outpatient treatment in their community.

Clients stay in a structured, clinical environment at Ste. Anne's Hospital while the most immediate difficulties are addressed. Medication is adjusted while multiple therapeutic approaches help rekindle a sense of well-being" Footnote4.

Residential Rehabilitation Program Added

Over the next few years, clinicians, OSISS and VAC administrators identified the need for residential treatment services for Canadian Veterans. The rationale for the inpatient clinic derived, in large part, from the research and experience gained in working with OSI patients in the Ste. Anne's outpatient clinic. Co-morbid conditions had presented significant challenges to treatment protocols given the complexity of the interaction, and as already indicated, outpatient care had either been insufficient or deemed ineffective in dealing with these conditions. The Treasury Board submission for the expansion of the OSI network in 2007 included the request for support to an inpatient clinic at Ste. Anne's Hospital. A full concept paper, prepared in October 2008 by the Clinical Expertise Sector of the National Centre for Operational Stress Injuries (NCOSI), laid the groundwork for the development of the Residential Treatment Clinic for Operational Stress Injuries. The RTC opened its doors in February 2010 with six beds available for inpatient care and dedicated to the provision of rehabilitative services including more intensive group therapy and an increased emphasis on life skills and coping strategies. Within a month of its launch, the stabilization program and its four beds were co-located within the RTC facility thus bringing the two programs under its auspices and raising the total number of beds dedicated to inpatient care to ten.

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