By Sean O’Malley
Senior Media Relations Specialist
On Remembrance Day this Sunday, Silver Cross Mother Anita Cenerini will lay a wreath at the National War Memorial in Ottawa to represent all mothers who lost a child in the service of their country.
She will be the first Silver Cross Mother of a soldier who died by suicide.
Her son Private Thomas Welch, 22, died at CFB Petawawa three months after returning from active duty in Afghanistan in 2004.
Last month, the Canadian Armed Forces (CAF) unveiled another mental health initiative: The CAF Clinician Handbook on Suicide Prevention.
“Suicide is a deeply complex, multi-dimensional phenomenon with no single cause and no simple solution,” said Minister of Defence Harjit S. Sajjan. “I am optimistic the handbook will enable the Canadian Armed Forces Health Services Group to prevent suicide among our members.”
Dr. Juveria Zaheer, CAMH Clinician Scientist, Institute for Mental Health Policy Research, was the lead author of the guide.
I spoke to Dr. Zaheer about her work.
What are the biggest risk factors for people in the military when it comes to suicide?
The risk factors for military suicide are similar to the risk factors for all Canadians. A history of suicide attempts is the single most important risk factor for death by suicide in both military and civilian populations. Other risk factors include presence of major mental illness including mood disorders, trauma-related disorders, and substance use disorders. Sleep disturbances and health issues including traumatic brain injury and chronic pain can also increase suicide risk. Within the military, there is some evidence that people who are younger may be at higher risk for suicide. While deployment itself has not been shown not be an independent risk factor for suicide on its own, rates of PTSD and panic disorder are higher in this group, both of which are risk factors for suicide. Another important piece is access to firearms, which needs to be considered in a safety plan.
Are there unique issues in regards to mental health stigma within the military?
The Canadian Armed Forces and Veterans Affairs Canada have identified addressing stigma and supporting dialogue about mental health as a major priority of their suicide prevention strategy. These initiatives can reduce feelings of shame and weakness and help move beyond the culture of needing to be strong or suffering in silence. We need to understand the unique stressors service members have to go through – whether that’s deployment or being away from family or having traumatic experience in the field.
What advice is different in this guidebook than what you would provide to the civilian population?
All clinicians working in mental health benefit from having a thorough, evidence-based and consistent approach to suicide risk screening, assessment and safety and treatment planning. For CAF clinicians, it is also important to consider specific military-related risk factors. For example, military rank, or recent deployments, or symptoms of PTSD. There are also different reporting aspects in the military in terms of fitness to serve or access to firearms, so safety planning is going to be different. The CAF has their own structures and resources (for example, referral pathways to psychotherapy; structured health assessments) so we built that into the manual so they know who they can talk to and what resources are available for their clients.
Are there particular risks for people who have left active service?
Risk factors for suicide in veteran populations can include older age, a lack of social supports including homelessness and social isolation, and having psychiatric or medical complications following service. Any time there is a transition it can be really challenging. The military and Veterans Affairs are working together to help with transition and provide lots of support, especially around transitioning to other employment and family support because that’s a real change in the family dynamic or in someone’s sense of self.
Could there be longer gaps between traumatic events and the emergence of PTSD or depression. Can people go years and seem like they’re fine?
We know the rate of PTSD and panic disorder is higher among people who have been deployed. So knowing that, when people return from deployment we have to be careful to screen for mental health-related issues and suicidal thinking and substance use issues. A previous history of unrelated trauma can also be a risk factor for developing PTSD. It can happen all of a sudden or it can happen later. It is important to screen for suicide at every mental health appointment, within both military and civilian populations.