First of all, the injury happens when they're still serving. Once they're injured and are declared to be veterans because they've served at least one year, then they get a file from Veterans Affairs.
So coming back a bit for a second, the reason I talked about one ministry is that while a soldier is serving he also has a file at Veterans Affairs, which is providing resources there, and sometimes you have friction. You have two departments feeding the same problem, which is not necessarily coordinated.
The scale, because it's of great significance to your question.... The only country that reinforced me during the genocide was this country, with a couple of Hercs. Of the 11 officers who were with me in Rwanda, 7 out of the 12 of us have suffered significantly with PTSD. One committed suicide 15 years afterward, and he was under treatment. Families have busted up because of the pressures and the strains on family life from someone who is injured with this. The scale of the requirement is often underestimated, both by those who are injured and also by people around them.
Coming specifically to how we've been handling it, I think that pre-deployment awareness and training have achieved a very high level of capability. In-theatre requirements—although I was surprised the other day about not having services in French, though I'd be interested to know whether there are any psychiatrists who want to deploy in a war zone.... But putting that aside, contract it.
In the field we have found that the requirements—both the troops who are there and the way that amongst themselves they have been trained to take care of their own, plus the professional therapy there—have been quite effective. The transition back, with the four or five days in Cyprus or wherever to decompress, has been crucial. Even though it's a strain on the family, it's crucial.
You can't walk out of a firefight and within 24 hours walk the street downtown. We saw what happened with Vietnam. When I went to the Americans to get help in 1997 because we had no capability at all, they said they didn't want us to do what they had to live through. They said they had lost 58,000 or so, many identified on that monument in Washington, but by 1997, 22 years after the end of the Vietnam War, they had had more than 102,000 suicides directly related to Vietnam that they knew of.
So the follow-on is the crux. Is the follow-on as rigorous, as developed, as it should be? I mean not only for the regular force guys, whom you can take by the scruff to make sure they parade to get help—even though they're not volunteering, but are at least seeing a therapist who can do some assessment, hopefully—but also for the reservist who is in Matane, who has nothing around him, and a reserve unit that has no assets to help him, no special training days or money or capabilities locally to influence the situation.
I would argue that the follow-through is still weak, and the follow-through is very much dominated by the psychiatrist—which is no problem: they give you the pills. I take nine pills a day, and that keeps me sort of like this—reasonable. I need that.
But what I do need, however, is the psychologist who is making me live with this and is trying to bring me to a level at which I can be functional. I think this is the area in which the program is still very weak; it's why we still are seeing the casualty rates, not only in the military but in their families, continue to rise. The follow-through, the demand that they go through a rigorous review, every one of them.... They put them through a rigorous review to deploy them. So they come back, and all of a sudden we don't have to have that same rigour?
When I commanded my brigade, the dentist had more power than commanding officers, because he would come in and he'd have a list of those who were red-tagged. Anybody who was red-tagged—meaning that he was not deployable—we could put on charge for not having followed the rules by going to get good dental care. I don't see that for this injury. I would argue that maybe it has to go to that extent.
The therapists have told me, oh yes, but they have to volunteer to come in. Somebody even stupidly told me, oh yes, but they're stigmatizing themselves. I haven't heard bullshit like that in years. You don't self-stigmatize yourself; you're injured. That creates the isolation, and so it's a non-existent entity.
And the fact that the individual is not seeking help voluntarily is maybe due to the therapists' not being forthcoming enough. People don't like to go to a therapist. They're not all Woody Allen, who thought that having a psychiatrist or a psychologist was “in”. He thought that in his movies, although you don't want to imitate him in other stuff. The therapists have to sell their product and go much closer to the units and become more intimately engaged.
How do you hand all that over to Veterans Affairs? It just doesn't happen that often. You nearly have to start from scratch. I have had the same therapist for 13 years. If somebody walked in one day and told me I needed another therapist, we'd be in serious trouble.