Wounded warriors: Afghanistan trauma takes a greater toll on military careers than other disorders

Canadians who returned from Afghanistan bearing psychic scars find themselves traumatized and out of the military in far greater numbers than counterparts suffering from mental illnesses unrelated to the Afghan mission.

David Boulos, an epidemiologist with the Mental Health Department of National Defence, tracked thousands of military personnel in the years following their deployment.

Not only are people with Afghanistan-related mental disorders more likely to be professionally sidelined than people who don’t have mental illness, his research shows, they’re “medically released” from the military at more than double the rate of people with mental disorders not deemed to be caused by Afghan deployment.

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Boulos’s findings, published in the Canadian Journal of Psychiatry last month, build on previous work underscoring Canada’s failure to treat and reintegrate people whose war wounds aren’t visible.

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The extent of those wounds is at the fore again this week, with Prince Harry and Prime Minister Justin Trudeau kicking off the countdown to the 2017 Invictus Games — a sports competition for ill and injured troops.

Auditor General Michael Ferguson highlighted Canada’s struggles to rein in soldiers’ suffering in his latest report, which urged Veterans Affairs to rein in spending on its medical marijuana program.

But if people with diseases of the brain remain marginalized in an environment that prizes toughness, people who owe their diseases to Afghan service are even more marginalized.

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The cause could be as simple as Afghanistan’s punishing combat environment. Other studies have found correlations between incidence of mental disorders and the danger or stress associated with different Afghan locations, Boulos says: Kandahar tops the list, followed by Kabul.

Boulos and his colleagues tracked personnel from a variety of deployments: Some went to Kandahar; others to Kabul or elsewhere in Afghanistan; others to the United Arab Emirates or the Arabian Gulf or elsewhere in the Middle East or to an “unspecified location.”

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It’s extremely difficult to identify a mental disorder’s cause. Boulos used designations the Canadian Forces’ mental health clinicians gave their patients and divided individuals he studied with mental disorders into two groups: the people whose illnesses clinicians deemed “Afghanistan-related,” and everyone else.

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“As part of their duties they need to make a judgment as to whether a diagnosis may be related to a deployment or not,” Boulos said in an interview.

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Almost four times as many people with Afghanistan-related illnesses had post-traumatic stress disorder: 59.3 per cent, compared to 15.8 per cent of people with unrelated mental disorders.

The Canadian Forces’ “Universality of Service” requirement sets strict benchmarks all its personnel are expected to meet, with the implication being that they can be deployed anywhere at any time to do just about anything.

People with brains sickened thanks to Afghan service are the least likely to meet those expectations.

More than four in 10 (40.9 per cent) of them were found to have a “career-limiting” medical condition, compared to 23.6 per cent of people with other mental disorders.

The first finding that someone’s in violation of “Universality of Service” doesn’t mean you’re out of the military right away, said Boulos, adding it’s  “kind of a precursor, a warning.”

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People with Afghan-related mental disorders scored dangerously on two of six universality categories in particular, Boulos said: They’re found to be less flexible geographically, less able to move far away with minimal clinical support; and less likely to be found fit under the Canadian Forces’ required occupational skill set.

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Sometimes there are accommodations made, occupations found that are better-suited to people who return from combat wounded in a million different ways.

But if you’re continually found not to meet that universality benchmark, you’re out — “medically released” from the Canadian Forces.

And here, too, people with mental illness from their service in Afghanistan are grossly over-represented: 29 per cent of them had been medically released within five years of their diagnosis, compared to 13 per cent of individuals with other mental disorders.

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It it inevitable that deployment to a challenging combat zone will derail a military career?

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National Defence could be more flexible in its “Universality of Service” requirements — a bit more accommodating of wounded warriors’ limitations.

But that can only go so far, Boulos said.

“The universality of service is kind of to protect the individual as well as to protect those around the individual.”

There are also more steps being taken on the prevention side, Boulos said.

“They have been trying to build up resilience, mental health resilience, in their members, so let’s say they were exposed to a trauma-inducing event, it would be less stress-causing.”

And a lot of it comes back to getting sick people the best possible treatment as soon as possible.

“You’d want to ensure individuals get the quality of care they need.”

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