Heads Up! Community Mental Health Podcast

VETERANS’ MENTAL HEALTH: Personal & Scientific Perspectives on Healing

VETERANS’ MENTAL HEALTH: Personal & Scientific Perspectives on Healing
Heads Up! Community Mental Health P...

 
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Summary of Reviews

SUMMARY

Veteran/advocate Brian McKenna and psychologist Dr. Candice Monson explore veterans’ mental health issues.  Drawing on lived experience with PTSD – and the treatments and activism that helped him heal – Brian shares about the psychological challenges and opportunities faced by veterans who’ve served both at home and abroad. Dr. Monson, a clinician and researcher at Ryerson University, talks about the impacts of internal and external stigma on veterans’ mental health, and summarizes emerging trends in trauma research and treatment. Together, they address topics such as the impact of military culture on veterans’ mental health, the “Hollywoodization” of military culture, and the “silver lining” that comes with COVID-19.

 

TAKEAWAYS

This podcast will help you understand:

  • Veterans’ mental health statistics and common mental health challenges (depression, anxiety, PTSD)
  • Contributing factors to a veteran’s mental health challenges (e.g., type of traumatic experience, type of military service, personality type, culture of toughness, stereotypes, internal and external stigma, “Hollywoodization” of military training and war, misunderstanding of and/or lack of support for military service, the size of Canada’s armed forces)
  • Evidence-based treatments (e.g., cognitive processing therapy, prolonged exposure therapy, couple/family therapy) vs. symptom management tools (e.g., medication, cannabis, yoga/meditation, acupuncture, skill development, anger/stress management, transcranial magnetic stimulation)
  • The impact of veterans’ mental health on families and communities
  • The potential outcomes of veterans’ mental health challenges (e.g., substance use, poverty, unemployment, homelessness, suicide)
  • The role of government in veterans’ mental health and healing (e.g., Ministry of National Defence, Canadian Armed Forces, Veterans Affairs Canada, Office of the Veterans Ombudsman)
  • The role of advocacy groups in veterans’ mental health and healing
  • The impact of COVID-19 on veterans’ mental health and opportunities for systemic change
  • Veterans’ mental health care in Canada vs. the United States
  • Veterans’ mental health as a social justice/human rights issue
  • The role of new treatment technologies such as e-mental health

 

SPONSOR

Fresh Outlook Foundation

The Social Planning & Research Council of British Columbia (SPARC BC) is a leader in applied social research, social policy analysis, and community development approaches to social justice. Lorraine Copas and her great team support the council’s 16,000 members, and work with communities to build a just and healthy society for all. THANK YOU for supporting the HEADS UP! Community Mental Health Summit and the HEADS UP! Community Mental Health Podcast.

 

RESOURCES

 

GUESTS 

Brian McKenna

Heads Up! Community Mental Health PodcastBrian McKenna is a military veteran who served Canada at home and abroad for 20 years as a soldier, commander, and trainer, doing tours in Bosnia and Afghanistan. Although his tours in Bosnia weren’t dangerous for him, Brian’s world view began changing due to the suffering he witnessed. Afghanistan “was different, and harder to forget,” although sometimes “calming in the weirdest of ways.”

After contracting a stomach virus, Brian came home but then “gladly went back.” Apparently, “the Taliban wanting to kill you provides a consistency and predictability of purpose that’s actually quite comforting for the part of your brain that wants to plan and understand. And going back to that allows some of us to suspend what we’re thinking and feeling at home.”

After another year in Afghanistan Brian came home, still with the intestinal problem and a diagnosis of PTSD. After a period of resistance, he started getting the help he needed. Since then, he’s “found a new purpose in advocating for veterans, particularly those with mental health concerns.”  He was also appointed to Veteran Affairs Canada’s Mental Health Advisory Group, through which he regularly testifies to the senate and house committees on veterans’ concerns and provides input to the Office of the Veterans Ombudsman.

Brian is a member of the Royal Canadian Legion and was a member of the Equitas Society (a group that pursued action against the government for taking away Afghanistan veterans’ pensions). He has been involved with the Veterans Transition Network as a patient and a peer-support assistant for veterans.   

Email: brianrmckenna@hotmail.com

Phone: 604-649-8798

Twitter: www.twitter.com/brianmckennacd

 

Dr. Candice Monson

Heads Up! Community Mental Health PodcastDr. Candice Monson is a Professor of Psychology at Ryerson University in Toronto, Ontario. She is a renowned expert on traumatic stress and the use of individual and joint therapies for PTSD, especially among veterans. Her focus is on developing, evaluation, and implementing PTSD treatments and relationship factors in trauma recovery. A Beck Institute scholar, she was named Trauma Psychologist of the Year by the Canadian Psychological Association in 2013, and Outstanding Mentor by the International Society of Traumatic Stress Studies in 2014. And, she was inducted into the Royal Society of Canada in 2016.

Dr. Monson has co-authored seven books, including the treatment manuals Cognitive Processing Therapy: Veteran/Military Version and Cognitive-Behavioral Conjoint Therapy for PTSD. She has published more than 150 peer-reviewed publications and chapters, and is also well-known for her efforts in training clinicians in evidence-based assessments and interventions for PTSD.

Dr. Monson is affiliated with the International Society of Traumatic Stress Studies (President Elect), Canadian Psychological Association, American Psychological Association, and Association of Behavioural & Cognitive Therapies. 

Email: Candice.Monson@Ryerson.ca

Phone: 416-969-5000 (ext. 6209)

Website: www.ryerson.ca/psychology/about-us/our-people/faculty/candice-monson/

LinkedIn: https://ca.linkedin.com/in/candice-monson-0ba67362

Facebook: www.facebook.com/candice.monson

Twitter: www.twitter.com/CandiceMonson

 

HOST

Fresh Outlook Foundation Board MemberJo de Vries is a community education and engagement specialist with 30 years of experience helping local governments in British Columbia connect with their citizens about important sustainability issues. In 2006, she established the Fresh Outlook Foundation (FOF) to “inspire community conversations for sustainable change.” FOF’s highly acclaimed events include Building SustainABLE Communities conferences, Reel Change SustainAbility Film Fest, Eco-Blast Kids’ Camps, CommUnity Innovation Lab, Breakfast of Champions, and Women 4 SustainAbility. FOF’s newest ventures are the HEADS UP! Community Mental Health Summit and HEADS UP! Community Mental Health Podcast.

Website: Fresh Outlook Foundation

Email: jo@freshoutlookfoundation.org

Phone: 250-300-8797

 

PLAY IT FORWARD

The move toward upstream mental health care becomes possible as more people learn about its social and economic benefits for individuals, families, workplaces, and communities. To that end, please share this podcast with anyone who has an interest or stake in the future well-being of our communities.

 

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Brian McKenna, Candice Monson Interview Transcript

You can download a pdf of the transcript here. The entire transcript is also found below:

Rick  0:10

Welcome to the Heads Up Community Mental Health Podcast. Join our host Jo de Vries with the Fresh Outlook Foundation, as she combines science with storytelling to explore a variety of mental health issues with people from all walks of life. Stay tuned.

Joanne  0:32

Hey, Jo here. Thanks for joining me with my two guests, one a veteran and advocate, the other a clinical and research psychologist, as we explore the mental health challenges faced by military veterans. We'll also talk about emerging evidence-based opportunities for their recovery, and the role we can all play in their healing.

In the past, when I thought of a veteran, I'd envision a stooped old man wearing a navy blazer and beret, a Red Poppy, and perhaps some medals. That's a classic stereotype, I know, but what I've learned is that veterans represent a variety of ages, cultures, abilities and genders, with no two having the same story, nor the same psychological response to their time in service.

Take Stephanie, a 26 year old from Ontario, who served two tours as an intelligence officer in Afghanistan. She's a veteran whose post-war relationships are being healed through family therapy.

Walter is a First Nations Lieutenant from Manitoba, who was honoured for bravery. He's a veteran now helping with research to understand PTSD among soldiers.

Charlene, who's known by her colleagues as Charlie, was injured in Iraq during her third tour. She's a veteran who's interested in the potential of e-mental health to help with the anxiety she often feels.

And David is a soldier who's gay. He enlisted to help protect his country and explore his own potential. Although he never left home to serve abroad, he is now a veteran who advocates for a military culture based on open and honest communication. So as you've heard, every veterans experiences and mental health outcomes are unique.

Before I introduce my first guest, let's set the stage for this conversation with some stark statistics from my researcher. So Rick, what do the numbers show?

Rick  2:33

Well, of the almost 130,000 veterans served by Veterans Affairs Canada today, at least 20% or about 26,000 people are experiencing mental health challenges such as anxiety, depression, and post traumatic stress disorder. PTSD is a common and debilitating condition that affects a full 10 percent of veterans. That's about 13,000 former military personnel, whose PTSD makes them more susceptible to substance use, unemployment, poverty, homelessness, and suicide. And those numbers don't take into account the Canadian Armed Force's 67,000 active troops, and the more than 13,000 of them who will be prone to mental health issues after serving this country.

Joanne  3:22

So what's the solution? Should we beef up recruitment and training measures to prevent mental health challenges in the first place, possibly ramp up the use of emerging trauma treatments, such as family therapy or prolonged exposure therapy, maybe boost research into the use of cannabis to manage PTSD, or perhaps as a country stop soldiering all together?

My first guest has strong opinions about these and other potential strategies for positive change to the military system in Canada. But first, let's learn about his tours in Bosnia and Afghanistan, the resulting bowel conditions and PTSD, and the work he now does at the local and national levels to advocate for everything from veterans housing, to the stigma veterans sometimes face from an uninformed public. Brian McKenna, it's such a pleasure and privilege to have you here with us today.

Brian  4:24

Good to speak with you as well.

Joanne  4:26

So tell us your story.

Brian  4:28

So for me, when people ask me about my background, they're normally asking about the military side of things. But if I just go a little bit before that, I immigrated to Canada when I was four years old, so I don't come from here. And in that regard, I do remember growing up as a kid feeling a little bit of a debt, if you could call it that, to something I didn't really understand. I had a family that obviously had been in Canada before, which is how we immigrated, but at the end of the day, I didn't really get why one country would turn to a person they don't know and say come on in. And there was always a desire to meet that need.

But the other truth of it is, I wanted to shoot guns and watch stuff blow up. I was a teenage kid, and I thought the army was cool. So there was some grandeur to what I felt as in paying back a debt. But there's the largest part of what I was doing when I was deciding to join the military was to scratch the itch that most young teenage boys have, and just do something interesting and exciting.

The first couple of years were largely in Canada for me, and I think the first experience I could say with things like Post Traumatic Stress Disorder wasn't my own. It was actually watching guys as they'd come back from Croatia and they were trying to adapt back in Canada. And one of the biggest learning lessons from me watching it was that our country at the time, for various reasons, was downplaying what was actually going on. You could see on the news that there was a conflict going on, but the portrayal of the operations and the jobs that our soldiers were doing, was often delivering aid or helping people, which was certainly part of the job.

But the government and the the media of the day wasn't telling the story so much of repelling attacks from the Croatian army, and the aftermath of that. So the soldiers were coming back, and they were essentially being told we don't talk about this. Well, if you don't talk about the event, you don't talk about what the event's done to you.

And it was a full almost a decade later, I remember I was in Winnipeg on a different job in 2003 training to go to Bosnia at the time, when the government finally came out and gave those soldiers, first of all, an award from the Governor General, but also the public acknowledgement that this attack did happen, that Canadian soldiers did serve valiantly, and that this was war. I mean, it was a couple of days of war. But the rockets, the grenades, and the bullets confirming that it's war. And I think that has as much to do with our story as anything else, but I'll continue with me.

So in 2000, I was just at a point in life where not too many other things were going on. I'd been in the military for a couple years, and so I did the things necessary putting in paperwork and volunteering to go over to Bosnia. I found myself in Winnipeg, interesting place, lots of bugs. And that was about my experience in Winnipeg.

And the next thing you know, I'm in Bosnia. And I will tell you that I can still remember the feeling of landing at the airport in Zagreb, capital of Croatia, because that's the normal way you do business is to fly into a relatively peaceful area and try move by land into the area you can operate in. And landing at the airport in Zagreb, there was a hill just to the right side of the tarmac. And as you land, you're probably about a good 500 meters away from that hill, but you can see dug out into it, were six Hind Soviet Warsaw Pact era attack helicopters, the kind you might have seen stories about flying over Afghanistan in the involvement that Soviets had there.

And they're a very ominous looking aircraft. It is not an aircraft that is armed per se. We tend to look at it as guns that someone built an aircraft around. It is aggressive. You know exactly what it is. And then as the aircraft does a horseshoe, we wind up closer to them. And I see another side of military life, which is most of the aircraft are actually broken, missing rotor blades and aren't actually functional at all. They're actually parked into the hillside just to do exactly what they did, give you a little bit of a jolt. But then you come around and you see the other side of the military.

Albeit, we've had this experience in Canada, where the equipment is falling apart, and it can't really do what it looks like it can. So I found that to be a really interesting 15 minutes greeting to the Balkans was those emotions.

Next thing you know, you're on a bus and you're being driven through the southern Croatian countryside. And as you get further out of Zagreb, you start to see where less and less recovery and repair from the war there has been done. So the bullet holes are more, the mine signs are all over the place, and that often means that there's more mines than just the ones that are marked. So from here on in, unless the thing underneath your foot is the vehicle you're in, it better be a hard pack road. And you spend the next year of your life, essentially, not walking on gravel, not walking on grass. And that includes after you come back.

I do remember coming back from Bosnia, going to my aunt's place in Burnaby for a barbecue, and looking at the lawn and realizing I don't want to step on that. Knowing full well there's nothing wrong with that lawn. But in Bosnia, that lawn can explode. So that's the frame of mind you have.

And on that tour, my first one, the war was over, the stress was certainly there, the people were very hesitant of each other, and I learned very quickly one of the things that causes war. I ran into people that had lived in their town for 60, 70 years and had never really left it. They've been convinced that the people a 20 minute drive down the road, lived in the lap of luxury and were the reason that they themselves lived in complete poverty and misery.

And then we would drive to that other town and realize no, they're in as much misery as the one we've just come from, where that next town would have the same story about the other one, about how they were the source of all the problems. And you basically wound up with three societies in Bosnia that all thought the other one was the rich one, all thought that their ails in life came from the activity of the other two, and we're naturally suspicious of anyone from the outside world.

You also have to remember that that country had been a country for a couple of years, a handful of years, and that decades prior to that, we were the enemy. We were those other guys and they were part of the Warsaw Pact. They were probably the most progressive side of it in Yugoslavia, but they were still part of it. And the look of someone that really doesn't trust you and doesn't want you there is a unique one. And it's one that's a little unsettling. But you learn to tell that apart really quickly from the one that actually wants to cause you harm. They are two very different looks, and they're very tough to take in.

And before I leave that and go on to the next one, I'll tell you of one thing that I think is really important to understand PTSD and other mental illnesses that soldiers go through is the concept of moral injury. One of the things that I encountered back home in Canada, I was raised quite largely by my grandparents. And when we were overseas in Bosnia, the Kosovo War was going on, and there was a lot of displaced elderly people in refugee camps.

I remember one of the last jobs I had to do was go check on the security of one of these refugee camps in a town called Bosanski Petrovac, so Bos P we called it, not so far down the road, I would say probably 30 minutes from where I was based. And we would go there enough that people, the belligerents that would want to harm those people, would think otherwise. So really, we're just to be there in that regard.

The southwest corner of this refugee camp had a big garbage pile. And on TV, you might see pictures of kids rooting through that. And this one was old people. And for some reason, that one bothered me more. A lot of times when you look at a conflict zone, people will say, you know, the children are suffering, and they were. But my emotional connection wasn't actually to the kids, it was to the plight of old people. And I think that's one of the parts where my morals had a little bit of a jolt was because, you know, we're supposed to give our seat to old people on the bus. We're supposed to help the old lady open the door. And it's traditional things you do as a gentleman, I could not do that.

Our rules were, we were to stay in our vehicle unless there was a security situation that we needed to fix. And starving old people isn't a security situation. And we don't have the capacity to fix that. We don't have the aid, or the tools, or the time. And most certainly, that's what you wind up doing. So when you don't find a problem that you're allowed by rules to solve, you look at it, you record it, and you leave.

And I remember that feeling more than some of the threat that I encountered. And I also remember we were supposed to never feed these folks, because what we're supposed to do is get them to go to the aid agencies that are supposed to feed them, and get them to get their country to do the job it's supposed to do. Our vehicle is loaded to defend ourselves if we need to, it's not loaded for aid.

And I remember all I had that day, I had already eaten most of the stuff out of my standard Canadian Forces box lunch, was a juice box left. And I remember as we were leaving, I chucked it at this old guy just to, you know, give them something, which again we're not supposed to do, but fair enough. And I threw it, and it hit him in the side of the leg. And he turned around and gave me what was equivalent to flipping me the bird, the middle finger from their point of view. And he stepped on it because he thought I'd thrown in garbage at him.

And then when he saw the juice pour out, he started to cry and tried to then bend down and pick juice up, and you can imagine how that doesn't work. And that was all I had to give him. So I remember watching him crying, holding an empty dripping juice box and me driving away. That was the last moment in that camp and was one of the last times there in Bosnia. I was on a plane home in a couple of days.

And before I wrap up, I mean, there were future tours after that. There was another one in Bosnia. I went to Afghanistan as a soldier, I also went to Afghanistan as a NATO instructor. Some of my soldiers, after I'd released, were in Iraq and so my only involvement in Iraq was actually back here, just talking to some of them over the phone and counseling them.

But I would say even though I was in worse threat later on in life, that first tour in a hot zone as a 21 year old armed in a foreign country, and yet you come home, realizing just how the world doesn't really work all that well in a lot of those places. And the interesting part is, and I'll kind of wrap up on this, 18 hours after that, after leaving Yugoslavia, I'm in Winnipeg. A day after that I'm walking down an escalator in Vancouver and I am not ready to come back. I'm not ready to not be with my platoon. These are 34 guys that I would live and die for. Not ready to never see them again. I certainly wasn't ready to go to my Aunt's house for a barbecue.

And subsequently, a lot of them I've run into, a lot I'll never see again, three died in Afghanistan, one died since that in a traffic accident in Manitoba. And that's the nature of it as well. Even though it's a rough experience, you come back with these salt of the earth Canadians, and then you hop off the plane and you largely don't get to see each other again. That's a struggle to work through. So maybe I'll stop there. Just at the beginning.

Joanne  17:52

Thank you so much for sharing Brian and especially for your service to this country and others as well. I love for you to talk a little bit more about PTSD and how that manifested for you when you got home.

Brian  18:10

You know, if you would ask other people around me, they might give you a different answer because they would have probably seen changes in me before I've seen them myself. I'd say the first time, I really had to say there was an issue was my driving. I was driving, I wouldn't say aggressively, but I'm pretty sure everyone else would say it was. And the speed was up and a lot of those things were just to kind of feel the, I would imagine, the rush or the buzz that we used to constantly live under.

I think one of the things that people don't understand about soldiering, it does have scary moments, it's got some rough times. You play a lot of volleyball, you play poker, you eat meals, you phone home. I did a parent-teacher interview from Kabul, Afghanistan one day just after a rocket attack, because that was the time I had, that's when the parent-teacher interview was. That's part of being a soldier as well is continuing to do the functions of life in a threat environment, and you get used to it.

The first time something really scary happens to you, certainly your adrenaline goes through the roof, but the second and third and fourth time, there's a normalizing function that comes with that. And by the end of a deployment to Afghanistan, to be honest, when you hear the siren for a rocket attack, most people by that time are just rolling their eyes. Here we go again, as opposed to the first time which you're sweating and struggling through.

So it's not to say that that's a good reaction. It's just to highlight the fact that you get used to a constant level of stress, you adapt to it. And then you come home and walk off the plane and go down the stairs after you've been in a place like that, and run into people that don't even know what country you came from, or that we're there, or that things that are nasty happened in the world. Instead, they're wrapped up in, you know, their Netflix subscription isn't working properly, or they've got a problem, they missed the bus, they got in a fight with their girlfriend. And you're trying to put on the same scale, your experiences of things that now cause you stress with what they're losing their mind about.

And the disconnect is such a struggle to deal with. And one of the things you find is soldiers will practically go out of their way to redeploy, because they feel calmer back there in that threat zone than they do here. I can tell you these days, I can get more stressed out over a computer program that won't load properly, than I ever get about something that's actually scary.

I remember one time when I was in the height of my reactions, I'd blown a tire on the highway. And I'm changing it on an area of the highway with no shoulder. I didn't have any flares or cones to mark my spot. And cars are flying by, and I'm laying on the ground, and vehicles going inches from you as you're changing a tire in the rain didn't bother me. And I remember getting back in the car and trying to get my voicemail to work, and losing my mind and getting ready to throw the phone out the window, and feeling all the stresses of being under attack, and largely because there was this thing I was handling that I couldn't handle.

Whereas to anyone else, they would look at that tire situation and go well, that's the worst part of today. That's the risk. Yeah, but not in my brain. And that's a lot of what you wind up dealing with is, you know, your 20 year old son will hop on the plane and he'll go to another country. And then he'll come back, maybe 21 years old, and he's completely used to real crazy stressful situations and is no longer adapted to having dinner, or having a long conversation or that kind of thing.

So what I've actually found is that it's the day-to-day stressors that give us the most grief. And I find soldiers routinely going towards the thing that used to bring them stress. Now whether that's deploying again, or getting in fights, or picking arguments for whatever that thing is that rises that part of their reaction. That's often what happens.

Joanne  22:45

So knowing that no two veteran stories are alike, what are some of the challenges you haven't faced that others maybe have?

Brian  22:55

I was in a fortunate enough place that after I'd come back from deployments, I could pick the courses I wanted to take, largely I could influence what was next for me. A lot of people in the military don't have that. I'll leave him nameless, but I'll described a situation of a friend of mine who just got back from Iraq in January. He's in Edmonton. He's now deployed on this COVID-19 mission in Quebec. He'll be going to Latvia next year, and in the meantime, between now and then, he's probably being moved to New Brunswick.

And a lot of times people will look at, whether it's the American forces or the Canadians, that go back-to-back tours, or you deployed, you know, five times in 15 years. What they don't look at necessarily is how many moves did you have during then. How many divorces, did anyone in the family die, all the regular things that come with normal life, on top of the things that come with deployed life. And then you have on top of that, the military structure just as it is, is going to throw extra stress into as well.

So if you think of the soldier that I've just explained to you, that in the next, if you look at last year, and next year, he'll be out of the country. Most of it is doing the COVID situation now, and he doesn't even know where his house is going to be in the next couple of weeks. What is the stress level with that?

Joanne  24:18

I assume then that those elevated stress levels, whether or not they lead to PTSD, can certainly trigger things like unemployment, poverty, homelessness, addiction, suicide. And one thing I heard you talking about Brian is hermiting. Can you tell us about that?

Brian  24:37

Well, what I would say is one of the things that a lot of people suffering with post traumatic stress disorder do to cope, is when they find that they're not coping, they try to find a way to turn the volume down on pretty much all aspects of life. And they can withdraw. They may even physically withdraw and actually move to smaller towns. They'll isolate themselves.

I do know people that have completely removed themselves off the grid. It is quite normal for us to find not only homeless veterans in this country, but comfortable homeless veterans, because they've chosen to be homeless. And I know that will actually ruffle a lot of people's feathers. But it is one of the situations we've found.

There's a number of them we've encountered that actually have decided to go live in the bush. Or they live a transient lifestyle from one shelter to another, because that constant motion is actually how they feel they're throwing someone off their track, or not going to be caught, if you might call it that. Those things, luckily for me, I haven't gone through that, but I've certainly found people and helped pull them out of it.

I would say that's a lot of what happens as well. And the hermiting is a big point of it. And so I would just tell you that the COVID-19 realities in my mind are just adding another layer on to that, because here we have situations where we're trying to pull people out of a hermited lifestyle. And now COVID-19 is putting them back in their basements, getting them to disconnect from their family and friends, and that's just going to present more challenges.

Joanne  26:18

So Brian, you were diagnosed with PTSD. Can you tell us what you did to heal from that? I assume that you're probably still healing, right? But what were the kinds of treatments or therapies or tools you used to kick start that process for you?

Brian  26:37

So to properly describe my situation, yes, I was diagnosed with PTSD. I also caught an intestinal bug in Afghanistan. And how they're related is the fact that stress reactions for me would often then raise my breathing, raise my body temperature, raise my pulse, and the result of that would be the parts of my gut that have been damaged by the bug, would then start bleeding. So stress reactions for me would often be followed almost immediately by intestinal bleeding. So that was a trickier one to handle.

The interesting part was sometimes I would notice the bleeding before I would notice that I was stressed. And you could almost look at it as a positive indicator, although it was certainly a negative one.

Treatments for me: If you'd met me two years ago, you would have seen me with my service dog Sasha. That was probably the biggest tool in getting back to a healthier life. And I'd also say, though, that I went through a couple of different programs. One of them was a ten-day program run out here called the Veteran Transition Program at the time.  It's called the Veteran Transition Network now. I'll never tell anyone that I know the special sauce for them, but I will tell them what worked for me. And that was one of the keys to me healing and getting my function back.

I think the last thing I would wrap that answer up on would be to say, helping others is a help to itself. When you feel that other people have kind of helped shepherd you, then it's natural to look at it as your turn. It's also one thing that when you leave the military as a leader in a leadership role, like I was, then you miss helping soldiers. And well, one of the ways to help soldiers is to advocate for them. So I found a lot of my own healing and peace came through being able to help others.

Joanne  28:35

Can you tell us a little bit more about your advocacy work and the wide range of initiatives that you're involved with?

Brian  28:42

Sure. So the last thing someone might recognize would be just over about a month ago, we were dealing with a homeless veteran that had materialized out in Chilliwack, an hour from me. And the folks that were looking through the file trying to authenticate that this person was indeed a veteran, were in Ottawa. The people that actually controlled the charitable organization that helped him, were in Halifax. I'm in North Delta, just a half hour outside of Vancouver. This man is in Chilliwack, never met him to this day, but through the internet and the phone, through those three different cities in Canada trying to coordinate their response to a person that we'll never find. And in the end, we're successful at doing that, but it's quite the the tricky situation to try do.

And so now imagine trying to do that down a logging road in Invermere, or somewhere off the beaten path in P.E.I., that just adds different layers of complication to it. That said, I've found homeless vets closer to me than that. And I'm not just wrapped up in the world of homeless vets, but it is one of the things that you can provide a tangible physical solution to. And so it's one of the things that were we to get our act together, I think we would be able to make some headway on. So that's why I bring that up. But I've also advised the minister, I've advised the Ombudsman, I sit on advisory councils for both of them. And I've been doing a lot of that in the last little while.

Joanne  30:20

I'm interested to know about the structure of the military and how it impacts soldiers' mental health. So first, a bit of background. Rick, what organizations in Canada have a role to play here?

Rick  30:33

Well Jo, there are three main arms of the military in Canada. The Ministry of National Defense is responsible for planning policies and budgets. The Canadian Armed Forces recruits trains and deploys troops in the Army, Navy, Air Force, and Special Services. Veterans Affairs Canada then provides physical, mental, and financial support to those whose service is complete. About 90 percent of the $4.4 billion VAC budget is earmarked for payments to veterans and their families.

Joanne  31:09

And I know that aligned with VAC is a veteran's advisory group, of which Brian is a member. And he also provides input to the Veteran's Ombudsman, who identifies and assesses existing and emerging veterans' issues, and also responds to veterans' complaints.

Rick  31:29

And new in March 2020 is VAC's Office of Women and LGBTQ2, which was established to identify barriers for these distinct groups of veterans and provide the specific support and services they need.

Joanne  31:46

Great info, thanks Rick.

Rick  31:48

My pleasure.

Joanne  31:50

So Brian, my question to you is are these bodies doing a decent job of protecting soldiers' mental health and mitigating the inevitable challenges that do arise,

Brian  32:02

I would say that they're doing probably a better job than the average person might think. When you look at joining the military, there is a basic psychological assessment that goes on. But my point is there is one, they do assess that and they do weed out some folks on those regards. So you might take that and say, well, we have this elevated population to some degree, at least in resiliency to trauma. But then you've got to add into that equation, the scale of trauma that you're going to go for. And I try to remind citizens when we wind up talking about this, that when we say there's no life like it, we're talking about not just what you got to do, but what you have to do when there's a problem.

So what I mean by that is, unfortunately the Canadian Navy and the Air Force have lost a six-person crew off the HMCS Fredericton last month, as it was conducting operations in the Mediterranean. Any other job site in this country that lost six people would shut down. And I can promise you, that's not what happened on Fredericton. They certainly would do their recovery operations that they would, but they also have to continue operations.

When we lost four or six or three soldiers in an event in Afghanistan, we don't stop the conflict. It keeps going.  Ask any local company or business or even law enforcement, what they would do if they lost three or four people, and they normally will pull back from that operation. That's not what happens in the military. If you get blown up on the way to escorting the ambassador somewhere, you still have to escort the ambassador. If you're trying to pick up someone that needs to be moved across the border and it costs your platoon four lives, you've still got to get that done.

So that's really what people have to keep in mind. The military does what it can do with what it has. But we don't have the luxury of stopping when there's a problem to see how everybody is. And this is one of the problems that happens with the, I would call it the institutional stress when you come back, is you wind up dealing with other departments in the government that treat you as if you could stop that.

We routinely have people that get injured, whether it's in Canada or overseas. And one of the questions they run into from other sides of the government, particularly when they're processing claims is, well, were you wearing ear protection at the time? Or did anyone see that happen to you? From the mentality that the rest of the government has that there's, you know, safety inspectors on site and people stopping anything that's dangerous, it's war. You know, and I really need people to understand what that means.

You know, if you look at our Air Force here. Every day, they are tasked with search and rescue operations on our oceans, and in the north. They don't get to turn that off. If someone dies on base, they've got to keep going. And that's got to be part of the consideration when people have the conversation about what the military is up to. It's doing what it can, but it cannot stop the war because you're suffering. And so it has to act in different ways.

Joanne  35:29

When we talked earlier, Brian, you mentioned that the size of Canada's military can have an impact on mental health.

Brian  35:37

Well, I would say that I don't think there's any argument in the country that our military is small. I will leave it up to other people to argue about what's the right size or if something's too small, but I will say we have millions of square kilometers. We have the largest coastline in the world. We are involved in a number of different countries. As I've told you, we don't have the luxury of having soldiers that are focused on just a mountain environment, or a brigade ready for going to the desert, it doesn't work like that.

In a military of this size, everyone has to be able to do everything. And that also leads to other stuff when it comes to injuries. Like if you aren't able to do everything, you're probably going to get released. Whereas in some other militaries around the world, they might be able to find a place for you. Canada doesn't really operate that way. If you can't fight tomorrow, you're probably going to be released from the military.

How to fix that? Well, that's complicated, and is it fixable, and I would suggest to you that the smaller your military gets, the more every single person needs to be capable of doing a basic level of combat. And so that's something that has to be considered. It's, as I said before, very, very normal for someone to come out of a war zone and then go into a domestic operation.

This country calls on his military routinely for domestic operations. You know, it's the Winnipeg flood, it's COVID, it's the Olympics, it's the G8 Summit, it's a whole host of forest fires and floods. And if you would go back a couple of months, we're doing snow removal in Newfoundland, all the while keeping our air picture up on NORAD, all the while keeping ships at sea.

And that's the thing, it's all too often people see the military from what's on in the news. And I'll tell you, one of the things I find the most insulting is when I see a comment that we have there in the media or even on social media, of why can't we use the military for x, y and z. They're not doing anything. And that one is actually harder to stomach than someone saying, off you go on your next mission. It's that idea that the military comes back and sits on their laurels.

I tell you, it's just not the case that you come back to moving, to taking a course, to teaching a course, to deployments, to exercises. It's just, it's such a constant stream, and the size of your force and the amount of jobs handed to it. And that's just math we can't deny.

Joanne  38:18

Given that you have your finger on the pulse of all things veteran related, and the fact that you sit on the Veterans Advisory Committee, what do you think are the major issues veterans face today?

Brian  38:32

Personally, I have a claim I'm still working on for myself that's been going on for a long time. I could tell you that there's a lot of mental peace when those things are solved. And when they're still in the process, there's just this feeling of unfinished business that goes on for a while in anyone's workplace.

If in your workplace, there was an injury and you would apply to a Workers Compensation Board for that to be rectified, and you are waiting for answers 19 months down the road, that would add levels of stress that really ought to be fixable. We'll put it that way. That's one of the things that is out there.

But I tell you, what are the biggest problems, and I don't actually know how to solve this one all that well, is coming home to a country that doesn't know you're at war. And right now, I don't know how else to tell this to you, other than your country is in war zones. A couple right now, and some that I don't even know about, because that's the nature of Special Forces. But Iraq is a warzone. You know, Iran launched missiles just a couple months ago in Erbil. And that's the base in northern Iraq that has Canadians based at.

You know, we were at a base that was under ballistic attack from the neighboring country. But would you think that that's the situation that's on the average Canadians mind? That is wondering when Starbucks will open or whatever the local problem is. That is one of the biggest things that's going on every day. Thousands of Canadians are doing their job in the military in a high-risk situation. And they come home to a country that largely doesn't know that.

Joanne  40:20

Or maybe doesn't care.

Brian  40:22

I think they would care if they knew it.

Joanne  40:24

You've also mentioned that we sometimes ignore or undervalue the work being done by non-combat forces. From what I understand, these folks can be equally stressed, even if they never leave Canada.

Brian  40:39

Yeah, that's true. I mean, I'd say it's a pretty daunting responsibility to stare at a screen looking for foreign aircraft coming over the north of the country. It's pretty challenging to be the one that responds to a ship sinking off the coast of Newfoundland. And I do have friends that wear medals of bravery and stars of courage that their action happened in this country.

I'm reminded of one man I used to work for, I admire him greatly, and he wears the Star of Courage from a moment where they had to parachute onto an ice floe to save an Inuit hunter who had gotten separated from the rest of his crew. Just think about that, parachuting on the ice. I've parachuted before for fun, and it's terrifying. Doing it into that environment, it's such a challenge and yet, the average Canadian wouldn't think about that. And yeah, I I hope we don't get obsessed with deployments when we're trying to figure out where the next case of mental illness is going to come from.

Joanne  41:50

You've also talked about the fact that many non-combat forces are moving regularly if they're in a teaching role or a supervisory roll, and that that takes them away from their families for long periods of time.

Brian  42:06

Promotions often come with moves in the military, specifically, if you're in the full-time in the regular force. They can do that in reserves, but generally not. So yeah, there's almost a trepidation sometimes of getting promoted, because that means do I leave.

I remember cases of where, you know, friends of mine when they were in Winnipeg, and they might have to move down the road three hours to a base called Shiloh. And the consideration from the military's point of view was, well, do we move the soldier or do we not? Do we move the unit or do we not? And nowhere in there did it seemed that there was a consideration of well, his wife is a bank manager at CIBC, or this person's kid just got into the school, and now you're posting the family to Quebec. So those things present challenges as well and they take a beating on mental health.

Joanne  43:05

I know there are dozens of veteran's groups around the country who do advocacy work. But what can individual veterans do to further the cause of mental health?

Brian  43:15

I believe, you know, when you know better you do better. And there's smarter ways to advocate than others. I know this because in my beginning, I wasn't necessarily doing it as smart as I could. I've seen policy change from Ottawa that has spread out across the country, and when it changes, it can affect hundreds of lives overnight.

I've seen people struggle as well to try and fix these cases one at a time. And while we need that personalized care, that certainly needs someone to contact them and help them manage their situation. And in the end, I'm of the opinion that dollars to donuts, if you're spending your time as wisely as you can, there's some solutions to be had at the national level, and we need to realize where those powers are.

It took me a while to realize, I don't think it was until I was in my 30s that I realized exactly what the power of a parliamentary committee was. And I learned that through advocacy. I knew of them in the past. I understood what a textbook might tell you about it. But I never really understood how it can frame the tone of what the government is going to do for the next little bit, or how you can ask them questions, and then they can go to the people in the departments and ask them that exact same question and demand an answer, which you don't necessarily have the right to do.

And so that was what I would call smart advocacy is sometimes groups have to bury a hatchet. Sometimes they have to coordinate and get together and if they can produce a homogenized message and ask it at the right point, you can make things move.

Joanne  44:57

Before we open up the discussion to our next guest, Brian I'd really like to dig deeper into your experience as a peacekeeper representing Canada abroad. First, did your service help build a more peaceful world?

Brian  45:16

I do believe it does. I also think it's very difficult to rationalize them all at the same time. I mean, I think if you look at conflict around the world, and you look at the fact that we're not in every conflict zone, you're forced to ask yourself the question, why did we go to this country versus that one? And that's a tough question to answer sometimes. So yeah, we're certainly providing value where we go, I have no doubt about that.

At the very least, you at least sustained some semblance of peace for a while and that buys time. People go to Croatia and Bosnia on vacations, that's becoming more normal. If you would have asked people that 30 years ago, watching, you know, sniper alley in Sarajevo 25 years ago, I should say, that's just not the way people would envision.

But Canadian soldiers are directly attributable for the fact that that country lives in a relative peace. You can't say it's all fixed. And there's certainly tensions there, you know, with a lack of attention to the tension, it could simmer over at any point. But today, in the world we have not the world we want, it's fairly improved, and it's peaceful, that's a good thing. And we have to be able to see that and I speak about that country because that's a lot of my own experience. But leading up to that point, Canada has a track record of doing that in a lot of places that people weren't paying attention to.

Joanne  46:53

So from your own perspective, do the outcomes justify the sacrifices you made?

Brian  47:00

Yes, yeah, absolutely. There's no doubt about it. I mean, half the problems that I'm illustrating to you are the result of just how good it is here. And other people made it this way. You know, like I said, I immigrated here to a country that looked after me. And I came to a land that has the things that it has because other people fought for it. And yeah, absolutely. There's just no question about that. I never spent time really worrying about it. Was it worth it? Of course it was worth it. I would do it again today.

Joanne  47:35

Brian, I can't thank you enough, not only for joining us, but for sharing your incredible story. You are articulate and engaging and such an amazing advocate for your fellow veterans. So thank you very much for being here today and for being who you are.

Brian  47:54

I appreciate that. I appreciate the opportunity to speak. As I've said to you before, you know, educating the Canadian public i think is one of the key things to advancing the cause of vets. And on that note, I want to hear what your next guest has to say.

Joanne  48:08

Before introducing our next guest, I'd like to thank a major Heads Up sponsor, the Social Planning and Research Council of British Columbia, or Sparc BC, which is a leader in applied social research, social policy analysis, and community development approaches to social justice. Lorraine and her great team support the council's 16,000 members, and work with communities to build a just and healthy society for all.

Our next guest is a professor of psychology at Ryerson University in Toronto, Ontario. She is a renowned expert on traumatic stress and the use of individual and joint therapies for PTSD, especially among veterans. Her more than 150 publications focus on developing, evaluating, and implementing PTSD treatments and relationship factors in trauma recover. A Beck Institute scholar and author of seven books, she was named trauma psychologist of the year by the Canadian Psychological Association in 2013, an outstanding mentor by the International Society for Traumatic Stress Studies in 2014, and she was inducted into the Royal Society of Canada in 2016.

I'm thrilled to welcome Dr. Candice Monson. Thank you so much for being here.

Candice  49:34

Thank you so much for having me.

Joanne  49:36

You've had an extensive and celebrated career in the research and treatment of veterans with PTSD. What drew you to that specialty and what continues to stoke your passion for it?

Candice  49:49

My passion for PTSD and veterans specifically dates back to my training. So when I went to graduate school, I was really interested in violence and perpetration, and thought I was going to be a forensic psychologist, evaluating people who had committed crimes and perhaps had mental health issues. And in my capstone training year before I got my PhD, I was very fortunate to get placed at the Boston VA, working in the National Center for PTSD.

Joanne  50:26

So Candice, for those of us in Canada who don't know what VA means, can you explain that?

Candice  50:34

Oh, for sure. So in the US, VA means Veterans Administration. So it's the network of hospitals that serve veterans in the US. So I am originally a US citizen, now proudly a Canadian citizen as well. And my upbringing and training was in the US, and as I was saying, that training that really took me to serve veterans was originally at the Boston Veterans Administration Hospital, or the Boston VA.

And, at that time, so this would have been 1997, and I was training and serving a lot of mostly, at the time, Vietnam veterans, some Korean veterans, and some World War Two veterans, but predominantly Vietnam veterans. And, at the time, people were really thinking about PTSD as this life sentence like this was a chronic, pernicious mental health problem, and that really the best you could do was provide palliative care. Meaning let's try to relieve as much suffering as possible.

And that led to, honestly, a lot of polypharmacy like trying to medicate various symptoms. So sleep problems, agitation, attentional problems, in some cases, aggression, or trying to give therapies, talk therapies that were focused on skills like, so how do we improve their interpersonal skills or their anger management, stress management.

And at the time, there was some work that was going on outside of the VA system, so outside of veterans, with civilians mostly with women who had been victims of interpersonal violence, to show that taking people back to focus on what happened to them, and working through that in different ways, different methods, could actually relieve the symptoms of PTSD and that by going after the cause of those symptoms, not only could you ameliorate the suffering, but by going after the cause, could actually maintain those gains over time.

And I think my experience of treating veterans and being fortunate to start to learn those treatments that took people back to move them forward, was extremely compelling hearing people's most intimate experiences that were horrifying. And as Brian mentioned, or other guests, at some point, it's devastating to their sense of who they were, and what they thought they would be doing in the course of their experience in the military.

And watching them come out the other side to this day, 23 years later, is really what's kept me in the field, that there is this potential for people to come out the other side, stronger, grittier, more nuanced, and textured, and interesting, and to be thrivers, not just survivors but thrivers. And to me that is an incredible honour to be able to bear witness to that. For someone to allow me to be a part of that process is just such a privilege and has really, I think, sustained me and my career since then, and kept me committed to PTSD as a field, but also veterans more specifically.

Joanne  54:36

So before we talk about your research and treatment successes, I'd like to take a step back and build on what Brian shared about veteran's mental health. So let's say there's a trauma continuum or spectrum. On one end is a private, who perhaps breaks his arm in a minor altercation, on the other end is a soldier who maybe loses his legs and/or watches as his best friend is gunned down? And along that continuum, can you predict who will experience what kinds of trauma and how they should be treated?

Candice  55:15

Sure, it's good question. So, in terms of the question about who will experience what kinds of trauma, certainly there are certain units or occupations within the military or even outside the military. So we know first responders can be particularly high risk for exposure to trauma. And so, obviously, there are certain occupations that put you at higher risk, that you're more likely to be involved in the exposure.

I think a really important thing, though, to remember is that what is traumatic to one person may not be traumatic to another. And so all of our efforts to develop trauma severity scales have kind of failed, because it's so individualized about the kinds of experiences that people have. And based on their backgrounds, based on also factors that are going on at the time of what happened, like within their unit, or within their family, or within the environment in which they're serving. There's so many, it's just so multifactorial, about what can conspire, all of in that alchemy, what can conspire to ultimately lead to mental health problems.

Now, that said, the epidemiological data would tell you that, interestingly, men are much more likely to be exposed to traumatic events and much more likely to be exposed to accidents and military related traumas, whereas women are more likely to be exposed to interpersonal violence and specifically sexual assault. So there are some, I guess, patterns of the type of exposure. But there are just so many factors that go into then how people experience those events as traumatic or not.

Joanne  57:21

We can't have a conversation about mental health without talking about stigma. So I'm wondering if you can talk about internal and external stigma, and the impacts that each has on veteran's mental health, and maybe even on their recovery.

Candice  57:39

Just to start with stigma, I think we probably generally think about stigma in terms of the external type. So the messages that people around us, and those people forming society tell us about, in this case, mental health, and the appropriateness of seeking treatment. What it means if you do have mental health problems after you're exposed to stressful events, and then those messages obviously can influence the kinds of messages that we send ourselves which is the internalized stigma. And both the external and the internal can serve as major barriers to people, accepting that they have mental health problems, accepting help for them, and can be important to getting to treatment but then also profiting from treatment.

So let me give you an example. Something that I think we run into with veterans and military members is some gendered messages about toughness and masculinity. And the idea that getting to treatment signals weakness. So that obviously can be an impediment to people getting the help that they need, maybe not even recognizing it or not wanting to recognize it. But then within treatment, some of those stereotypes about toughness can also get in the way of doing the treatment.

So, the treatments that I've developed, for example, and others, require people or recommend that people feel the natural feelings that one would have when you're presented with life threatening or injury producing situations, or watching really sad situations like Brian shared, with the old man and the juice box. That's a really sad scene. And part of people getting beyond those kinds of experiences, whatever they may be, is, we know that health is having people feel those feelings. But if you've been sick, the message that feeling your feelings is less than, weak, is a sign of not being masculine, that that can actually even get in the way of benefiting from the treatment.

So this issue of stigma, I think, is really important for us to try to address as a society, both as the people who are providing services, but the advocates like Brian who are out there sending a message and trying to normalize that it's okay to say you have problems, it's okay to get help. And also that it's possible to get better. Going to get help doesn't mean that you're forever going to be in the state that you are when you go to get that help. So really important for us, I think, to address to ultimately help people.

Joanne  1:00:45

So speaking of people getting help, based on your research and experience, what are the most effective treatments for the big three, and by those I mean, depression, anxiety, and PTSD?

Candice  1:01:04

So the various countries and organizations have issued treatment guidelines for these conditions. So PTSD and depression and anxiety and across all of them, cognitive behavioral therapy emerges as the most tried and true and effective treatment for these conditions.

In the case of PTSD, the frontline recommended treatments are generally cognitive processing therapy, which is heavy on the cognitive part of cognitive behavioral therapy, and prolonged exposure, which is heavy on the behavioral part of cognitive behavioral therapy, which is systematically taking people back to those memories of what they experienced. Also people, places, situations that are reminiscent of the trauma that they may be avoiding.

And across the guidelines, they tell us that those should be the frontline treatments. They're short term, and they're very structured, and they're very active in terms of the person with these problems really engaging and being an active ingredient in their own healing and recovery.

Joanne  1:02:28

So can you tell us about a veteran, for example, who you might be helping through prolonged exposure therapy? What are the steps that you would go through in that process?

Candice  1:02:40

So one of the first steps is just making sure that the person has PTSD, has anxiety, has depression, so a really good assessment. So just thinking for the consumers who might be hearing this talk, that would be for this podcast, that this would be something I would look for and might ask about is how will you know what i have? And so really starting with a good assessment, and then part of that assessment will be finding out with the person, what are the experiences that they had, that were most traumatic.

So going back to your prior question. For that person, what of the range of things they may have experienced in their lifetime was really challenging, difficult, distressing for them. And then with prolonged exposure, the clinician would give them a lot of education about the idea of approaching versus avoiding what it is they fear. And that approaching can take the form of approaching the memory. So the memory of what happened in those distressing events and really explaining that it's a memory and that memory can't hurt you. It can't happen again.

But it needs to be digested. And in this case, the digestion is to go back to it and approach it just like you would any other phobia. So if you were afraid of spiders, that you would systematically keep approaching that spider until you didn't fear it. And so the same would be true about the memory. So in the session, the client would walk through that memory, typically eyes closed, first person present tense, walking themselves out loud through that memory from the beginning, all the way to the end, and they would retell the story over and over until there was less anxiety about the memory.

The other part would be working with the client to figure out what's in their day-to-day life that they may be avoiding. So is it driving in the case of someone with a motor vehicle accident? Is it open places? Is it the smell of petroleum, or perhaps a veteran, and then systematically having them approach those things in the environment, to again, get rid of the anxiety that is associated with it?

Joanne  1:05:16

We've also talked about family therapy, and how can that be used to help ease veteran's challenges?

Candice  1:05:25

I have to admit my bias. I think all trauma occurs in context and most all trauma is very interpersonal in nature. And so it's perpetrated at the hands of another person, or it's simultaneously experienced in a community. And so really, for us to understand how to get people better, I think we have to look at the relational parts of people and the effects that trauma has on peoples' relationships. And one of the, I think, really compelling things to know about trauma is that the best predictor of whether or not someone goes on to have PTSD, is how much social support did they have after the trauma.

So that might be within their unit, from their leadership, from their loved ones, from their family, from their friends. That support is crucial, and people moving forward, more important than your IQ, more important than how much money you've made, more important than your childhood history. So I think, it's a real opportunity for us to think about, including loved ones to try to bolster that and at the same time, we know that loved ones, family, friends can really be affected by the symptoms of the disorder, can really constrict people, as Brian talks about hunkering down.

Like we don't go out to restaurants or we go out to restaurants but only certain places, or go at certain times and that can really impact on people's relationship quality if they don't feel like they can be out enjoying the things that people in connection do with one another.

So, my colleagues and I have now tested a particular form of cognitive behavioral conjoint therapy for PTSD, with the idea of improving not just PTSD, but also the relationships that surround the person who has PTSD, and to help the loved ones who are living alongside the person who has been traumatized.

Joanne  1:07:39

So is that the kind of research or treatment that you're most excited about these days?

Candice  1:07:57

One of the treatments that we didn't talk about from an individual level of cognitive processing therapy. So that's the other kind of frontline individual therapy and I, in the last 10 years, have been really trying to raise the level of competency of clinicians in Canada in cognitive processing therapy, just so that veterans and others with PTSD are more likely to get these treatments that work, because that's kind of the sad part about PTSD and its treatment and other mental health conditions, is that we know there are treatments that work, but people aren't getting them. And so I'm very excited about that.

And that's true of CPT, cognitive processing therapy, but also the couple therapy. But in the last year, I've been really thinking about if we have these treatments that work and we want to try to make them accessible, how do we go straight to the consumer? And that has meant trying to get creative about the use of technology, and stripping down these treatments to what we think are really the things that work, and putting them online to give greater access to veterans' loved ones, who are as you know, very remote in our geographically dispersed country, or who may have stigma, who don't want to go to a therapist, or are housebound, or don't have financial means to really get the treatments to them.

And to provide some support alongside those online interventions, by paraprofessionals, or coaches to try to get people to engage and use them. So I would say that's what I'm really excited about is how do we increase access? If we know there are things that work, but no one's using them, what does it matter? We've got to figure out how to get it to the people.

Joanne  1:09:59

Great, and just a plug here, we have an episode on e-mental health talking about the vast and profound opportunities that it provides for us, and we really encourage you to listen to that episode as well. It's pretty obvious that you are really stoked about these evidence-based treatments, and wondering is there a case in certain situations for symptom management, and this might include things like medication, cannabis, yoga, acupuncture, transcranial magnetic stimulation? I don't pretend to know what that means.

Candice  1:10:43

Sure, I think it's important to say that I'm a clinician who happens to like math. So I'm trying to test these treatments and show that they work. But there's always place for innovation. And what we're practicing now, we may not be practicing 10 years from now, that hopefully the field keeps evolving. And there are clients who may not be willing to do the trauma-focused treatments that I mentioned before, or haven't profited fully from them.

And so I do think it's important for us to think about other strategies that may be complementary to those treatments, or maybe the treatments that are used only. I think the caveat I might add, is that with these symptom management strategies, people should have informed consent about how likely are they to cause or to result in symptom management, because, for example, the available medications for PTSD are not that great in terms of symptom management. I mean, they do help some, but they are not particularly robust. And you're going to have to stay on them to be able to maintain those improvements that you get.

So everyone gets to make their informed decision. And while I might have a bias for a particular format of therapy and hope people would try it, that doesn't mean there shouldn't be other available options. And for us to be testing new ones, like some of the ones that you mentioned, testing cannabis. I've been involved in a recent trial of using MDMA, also known as ecstasy or Molly on the street, as a strategy to try to catalyze or improve these talk therapies that are trauma focused. So I think we always have to be trying to push the envelope to see how we can get more people better, and more people better faster.

Joanne  1:12:57

Thank you so much, Candice. I'm so grateful for those of you with scientific minds who help us figure these all out at the scales that you do. So I'd like to bring Brian back into the conversation now. So what I'd like to ask both of you first is why is it difficult for veterans to seek help? I know, Candice, you mentioned that there's stigma and there's stereotypes that prevent people from coming forward. But I know there are other reasons for that, and have these reasons changed over time, as our cultures have changed?

Brian  1:13:35

So I'll take a shot at that. I would say one of the things, you categorize this under an external pressure but it's the institutionalized side of it, that I think is certainly prevalent for me. Whenever you go into a doctor in the military, you're risking your career. Now we try and tell people to not think about that before they walk into a doctor's office, but that is certainly one of the things that's occurring in the world of mental health. And when you look at any other part of your body, we generally know that a broken leg will be fixed in six months, and so on and so forth.

So there's an acceptance level that's different when someone is going in with one of those known conditions, on what their path is going to look like for the next couple months. And I'm sure Candice could probably answer this one better than I can. But I would say from a patient and a veterans perspective, I don't know when depression gets better. I don't know what the lifespan of the problem of handling severe anxiety is. And even if I did, then what would be the complicating factors of having that in your family, and having separation anxiety in your children and so on and so forth.

So it's a lot more complicated once it's higher than the shoulders in terms of understanding what the projected path is in the next couple months. And it carries risk on your career, the career you have and the career you might want. After a lot of our soldiers leave the military and go on to conservation, corrections, to work at Canada Border Services, the RCMP, all of which will have their own screening. And a significant diagnosis can have strong implications on that.

The term within the Canadian military is being put on category. And what that essentially means is while they're working on your problem, you are largely undeployable, which some people might look at and go, well good, because your problem came from Afghanistan. But then you're also unpromotable. You start entering a pathway where you'll get reassessed in six months and reassessed in six months, but if you start ticking those boxes in the wrong direction for too long, now you're on the path to getting kicked out. And that happened to me. And so that's one of the strongest barriers I would say, and one of most hard to tear down is the risk the soldier feels to their career by speaking up.

Joanne  1:16:20

Candice, what do you see?

Candice  1:16:22

Yeah, yeah, I agree with Brian. And you know, just to kind of add a compare contrast. This is one thing that I've kind of noticed looking on at Canadian versus American policy about that. I think the American policy has been a little bit more liberal about, we'll treat people with PTSD and we'll redeploy them. I think trying to change the view about peoples' fitness that people may be fit and have problems within a certain bandwidth. I mean, obviously, if people are more debilitated by their problems, it may be hard for them to perform their duties. And I think there's a difference in that culturally across the two countries.

And I also think, I'm just thinking like broad view, think about World War Two veterans who kind of came back and sucked it up, right. So I think our views about in some ways, I think there is a liberalizing of veterans being more willing to seek help. And I think it's really important for us to differentiate between, as Brian mentioned, what are the barriers for active duty service members, and what are the barriers for veterans after they're discharged, right.

So, and I think those are different barriers for the veterans. Just maybe to speak a little bit about the veterans is, I do think one of the interesting differences in Canada, in the US Veterans Health Care is the socialized medicine that exists in the US. And here, it's kind of its flipped, right?

So I think a lot of veterans are in places where they may not have access to providers who understand veterans. I mean, it's own subcultural competency in my mind for providers to understand, like, what was it like to serve? And what is it like to have that designation to be a veteran now. And they may also not know, the most recent updates in mental health care. And so I think there are different barriers and impediments, and probably good for us not to group them together, but to try to work on each as they affect both service members and veterans, and maybe differently.

Brian  1:18:49

Joanne, if I could add to that, because this has been a central point of my advocacy and the stuff I've been trying to get people to realize is the military is a culture. We have our own food, it's not good, but we do have it. We have our own music. We have traditions. And we're not understood by people that aren't us. We have a lot of the telltale signs of a unique and distinct culture. And I think if people realize that more, they would be able to help in a more direct and easier to access way.

I can tell you one circumstance, for example, in my own care when I went forward. The first doctor I wound up dealing with was a military one who was there to figure out if I was a risk to the military. And the next one they sent me to on the civilian side, would ask me questions like, well, if this incident happened yesterday, why would you go out the next day, and had this completely unnuanced version of what a soldier would be up to in a conflict zone.

She would approach her questioning of how I was doing and what was wrong with me, from the idea of I was at some union job where I could decide to not go into work. And I found the questioning just to be so off-putting, like, we are not going to get anywhere. And that might have been a really highly skilled clinician that I wound up walking away from. But I had to, because she had no context at all of the culture I came from. And I think that's a really, really big thing to poke out a little more because for me, it was a big deal.

Joanne  1:20:33

So if you talk about the military having a culture that's unique to that group of people, how would you describe it?

Brian  1:20:40

If you ever encounter someone that gets in an argument with their own family member, but will defend that family member to everyone outside the family, you start to understand how the military tends to be. I worked with people that I found to be quite frustrating individuals, but that wasn't allowed to really be commented on by anyone that wasn't from inside the family. As soon as that was outside, you would defend them. I think that is a good thing.

But that can also push away health. It can push away even family members sometimes. This is one of the things we found with spouses is that the soldier will come home and the spouse certainly wants them to get care, but when they do, one of the questions is, well, why can't you talk to me? And even though you might love that person intensely, you're trying to associate with people that understand what you're talking about, and that can create a bit of a problem.

Joanne  1:21:40

Candice, anything else to add there?

Candice  1:21:42

I just think Brian's making such a good point. I think I've been surprised about in being in Canada is just, most Canadian veterans are getting their care through Blue Cross, Blue Shield. A relatively small portion go to the operational stress injury clinics, for example. And there's yet not a lot of requirement for people to understand this is its own oxygen, right? Culturally, the idea that you will put your country, you will die for your country, you will drive on, that's its own thing.

The idea that you're relying on other people to have your back in life and death, that's its own subculture. The idea that you will kill someone if you need to kill them, that's a different notion, just to rattle off some examples. And I think a lot of people don't get that. And so I can imagine, Brian did a great job of saying, it's frustrating for someone. You're going to a provider and they're supposed to help you and get you. I feel like some basic competencies are really needed to be effective for me to develop a relationship with a veteran. For them to think like anything I have to say, would be sensible based on them thinking I get them, that I understand them, even if I didn't serve as part of the military.

Joanne  1:23:13

So continuing on about the two countries, how do you think American and Canadian soldiers' experiences and resulting mental health outcomes, how do those vary given that the US is focused on combat, while Canada is a peacekeeping nation?

Brian  1:23:33

So I'll take a shot at that. I actually don't like the way that's framed, but I get what you're saying. The Canadian Forces is good at humanitarian aid, and it is good at peacekeeping as a byproduct of what it does. Those are things we just happen to be good at, because we are always focused on the thing that is worse. The Canadian military trains for war, and it is ready to fight a war at any given time, and then when the mission changes, well, then we go and do specified training for that. So that's an issue there. That's a difference between our populations, but not between our militaries.

The Americans know they're training for war and so do we. I would say there's probably a difference between what the American population thinks they're doing ,and what the Canadian population thinks we're doing. And that's something that actually really gets under the skin of veterans. And I would say, because we see that distinction that shouldn't be made in the first place, as part of the lack of education of what it is we're doing to the point that even when we went to actual war zones, people in this country still thought we were peacekeeping. I can assure you there was no peace to keep it Afghanistan, and the very beginnings of the Balkans, there wasn't a peace there either. And I think that's part of the injury from that conflict that people still don't get.

Joanne  1:25:00

Thank you for correcting me.

Brian  1:25:01

And I'll add one more thing if you don't mind is one of the things I know, because I served with American forces when I was overseas, is actually the military context can change your own culture. If you would look at, say, a period in American history, like the war in Vietnam, where you would say one grouping, one class of people tended to go to the war, and another didn't. And you watch what that did to the psyche of the country and what it did to the cultural play in the country. And that was a huge situation for America. For us not so because our military is so small, and it doesn't necessarily draw from any one area more than the other.

So if you follow what I'm saying there, I would look at an event like the war in Vietnam to be a great point, not a fantastic point, but a very important point in American history. Whereas if I would look back and say, when's the Canadian point that was this critical, you'd have to go back to World War Two to find a military event that shifted Canadian history.

Joanne  1:26:10

So Candice, do you have anything to add about that given your time in America and Americans' different views of the role of the military and perhaps being more appreciative of that, how do the American veterans deal with mental health challenges? Is it easier for them?

Candice  1:26:30

I don't know if I would get into which country might be easier or not. I think Brian's points are really good ones, like this categorization of combatant versus peacekeeper. It's so much fuzzier than that. And I think one thing that troubles me with what gets imbued with that, is that then peacekeeping is less stressful than being a combatant. And I think that is not proven out in the rates of mental health problems across the two countries, they're nearly equivalent. I think there could be very stressful experiences in all kinds of ways that people serve their country.

I think the difference might be in the US, it's just the military is a lot bigger. Most everyone knows someone who serves in the military. And I think that's a little bit less so here in my own observation, that it's the prominence of it is probably a bit less. I think that all kinds of military experiences can be stressful, including one thing we haven't really talked about is also just sexual trauma, for example. And our recognition of both men and women being traumatized, not even by their exposure to peacekeeping or combat experiences, but within the military.

So I think there's lots of different ways that people can experience stress within the military. And us trying to think about it in a more complicated way, can probably help our culture understand the ways in which people can be affected by those experience, and therefore decrease stigma and be more supportive of the people who are putting their life and limb on the line for us in their service.

Joanne  1:28:21

Mental health is not just a veteran's issue. How are the impacts felt by families, by friends, and by society as a whole?

Candice  1:28:31

I could say a little bit about, just because I'm very interested in us thinking beyond the individual when we think about mental health, because it really is a ripple effect. You know, people don't exist in isolation. And so really thinking about how there can be a lot of burden on family members, children. We know that the rates of child mental health problems are higher in parents who had mental health conditions.

The rates of mental health problems in partners are higher, as a result of living with someone. It's a strain on peoples' physical health and their mental health. And so for us to, I think, better appreciate the broader range of ways in which people suffer beyond just what's going inside them, I think is really important for us in terms of thinking then how we can help people from a more interpersonal perspective.

Joanne  1:29:27

Brian, how did your PTSD and your healing process affect your own family?

Brian  1:29:34

There was a lot of struggle in there. First time I went to Afghanistan was when my oldest son was four, my youngest was two. And I came back to one kid that didn't know who I was, and the other that was really upset with me for leaving. And up until that point in their lifetime, they'd only known me to go away for, you know, at the most a month or a couple of days here and there on courses or whatnot, and then you go away.

Within a year of coming back, I was gone again on another task overseas. And I do remember a moment where my then five year old says to me, don't let the Taliban kill you Dad. And that's a very different way to be sent off than most people get from a five year old, is the concept that the word Taliban would be on the tip of the tongue of a young boy, shows that this is a different family in a different circumstance than most people around me.

So what I would say in that regard, is how we get the trauma is kind of what's related to being a veteran. And then I would say that the diagnosis isn't really veteran specific. I mean, the doctor can tell you better than I can what symptomology is this issue, and which one is that. And I mean, I'm sure you would find that a problem I have might be something that a paramedic would get, or this could happen to an abuse victim. It's not my job that brings about the diagnosis. It's what symptoms are coming out of me.

But I'll go to the end of that and I would say that in our treatment, what one of the things is amongst the veteran community is we do ask to not be treated different or better, but be treated on our own. I do know of cases where some of our soldiers have gone and have been sent to addiction centers, for example. And in that circumstance, they're in a group therapy session, if you will, with criminals that have been sent there, with drug dealers that have been sent there. And the idea that, you know, two combat veterans are going to sit in a circle with eight drug dealers and criminals, and express their deep darkest thoughts and converse in an open fashion, this is not going to happen.

And so in that regard, that's one of the things, I think, amongst the veteran community we try to push is, you know what, I don't necessarily want a different treatment for me and my friends. I don't think we deserve better than the rest of the society. But you may have to treat us in a group on our own, the same way you would, for example, and this is where I go back to culture. If we were a group of eight Syrian immigrants that have come from that war, you would probably recognize the culture and say we have to address that. And we have to build that into the therapy.

And I say that for us as well. Because I've seen many cases where the Canadian taxpayer's dollar has gone into something like that, and it had no chance of working to begin with. Whereas things that I've participated in kind of along the lines of what Candice was mentioning, with exposure therapy, but who would I ever be in a room and allow her to expose me to, right? Who would I be comfortable, considering the fact that I've been willing to squeeze the trigger on my government's behalf if I need to. Considering the fact that I've been targeted by people that want to get rid of me. Considering those very unique things, there's a very finite group of people I'm going to enter a therapy session with. And that is something I demand to be respected as I go forward as a patient. And that's something I think we're missing.

Joanne  1:33:39

During the intro, we talked about veterans who represented diverse ages, cultures, abilities, and genders. Brian are these specific groups of veterans assessed, trained, and maybe monitored differently before, during, and after deployment? And recognizing their unique traits, how could they be best served?

Brian  1:34:04

Well, there are some differences. I think they're expected ones. I mean, when I was in the military I had to do a physical exam every five years or when you're going to get promoted, and then that changes when you reach a certain age. So there's standard checkups that will happen to that degree. But in terms of gender, I would tell you that the Canadian military is actually more advanced than the Canadian society in this regard. And a lot of people might find that shocking. But we've been treating people like you're just a soldier for a lot longer than people have been treating each other, like you're just a citizen.

And we had integration in the forces years before it was actually law throughout the country. So I think we actually do a lot better of that than most people think. That said, I'm not in any one of those groups. So it's very difficult for me to say what it's like for someone else. Being someone that ran deployment training for my soldiers, and conducted post deployment training for them when they come back, I didn't ever see a difference there.

Joanne  1:35:08

Candice, can you predict what type of challenges each group might face? Or is a person's history and personality a better predictor of mental health outcomes?

Candice  1:35:21

Yeah, so as I mentioned before, I think that's there's not one factor that really predicts all of that. It's a number of them, but it really is a lot about what happens in the aftermath. And how do we help people after they're exposed to stressful events or challenges, and to support them in that recovery process, really minimize the negativity that can come their way. Brian, I thought, did a really elegant job in talking about the adjustments, when you come out of a peacekeeping mission and then your plopped back in, like how you would facilitate that adjustment.

I think really much more important than us getting stuck on the factors that we can't really change, I can't change an individual's history and what their childhood was like. But I can change what going forward that leadership's interaction with them, the kind of care that they might receive, and the support they might receive to try to facilitate a recovery process.

Here's the thing, most all of us if it's stressful enough, all of us, are going to have mental health symptoms. You know, I'm going to have nightmares about what happened. I'm going to feel more vigilant and more on guard. I may have a startle response that's heightened. But it's really about helping people to recover so that they don't have those kinds of symptoms, long range, that I think is really important for us to think about in terms of helping people longer term.

Brian  1:37:00

I think that's an interesting point. Candice, you just mentioned vigilance. That was something that was a big adjustment for me. But I will tell people that hyper-vigilance in Canada is just called vigilance in a war zone. That's the appropriate amount of vigilance you should have when you come out of a threat situation, is I look at every backpack like it was going to explode, every hand might have a gun, and every dog was going to bite me, because that's the environment you're in. That's actually the truth, there. You have to operate that way. That doesn't fit here. But how do we flip that switch?

Specifically, if I was in the process of training my soldiers to go over to a conflict zone, the specific training on the nature of that mission would probably be from three to six months. So if it takes me three to six months to get you ready to go to the next Afghanistan, but what's the training cycle to bring you back home. And as much as we do try and implement things, there is reintegration training.

When we came out of Afghanistan, one of the best things the Canadian Army did was they stuck us in Cyprus for four days just to breathe a little bit. But that is not six months, though, of unflipping the switch that we switched. And I think that's a key point as of what she was just talking about is, what is vigilance and what's the appropriate level of it?

Candice  1:38:26

And also, Brian, if I might just tag on to that is, it's unrealistic. Four days is lovely. I'm so glad they gave it to you. But that's just not enough time. If you look at the data, in most people's recovery, it's a minimum three months. And that's without any other things coming into the mix.

So, maybe we need to right size our expectations of people too, in terms of getting themselves back here, and readjusting to what is the norm around safety. The need for safety as it relates to vigilance. And that has a lot of operational implications in terms of having a ready force. But maybe we need to be more realistic about just the human body and mind and its adjustment process. And that it does take time for people to get themselves back here and that's not pathology if you're still misfiring because you're still getting yourself back into the here and now and not back there.

Joanne  1:39:27

So what about veterans mental health as a human rights issue, or a social justice issue?

Brian  1:39:34

Well, I think when it comes to that, veterans don't expect to be treated differently than the rest of society. But what people have to realize is that if I fill out a form for life insurance, and I read the fine print and see who's not included. Look at a provincial Compensation Board, for example, and look at the very few groups of people that don't qualify and you'll find out. And so in that regard, we don't necessarily need special treatment. But we do need a department out there that is there to fill in those gaps that the rest of society does get.

This is one thing that I think was key to why I decided to get involved in advocacy, was I found a lot of people thought that, hey, you've got Veterans Affairs, that means you get more, better, and faster. And one of the truths of it was without Veterans Affairs, I wouldn't get anything at all, because as a member of the military, I don't qualify for some of those other things. So I need this government agency to do it for me. That's one of the things I really like to focus on. Because as a human right, to be fair, I just want Canadian rights. I just want the health care that's out there.

With that in mind, it's a challenge if you're gonna bring someone out of Iraq and you'll potentially send them to you know, Poland, Ukraine, Latvia next year, and he's working in a COVID Hospital in Montreal right now or wherever you might be. There's lots of folks right now that aren't at home because they're getting ready for forest fire season. You know, where do you deliver health care where the average citizen might have to wait for 18 months? Well, we don't have that 18 months, we don't have the four months to wait for an assessment. So that's where our care may need to be different, because if you want the resiliency to redeploy that soldier, you're going to need to give him care on the military schedule.

Joanne  1:41:38

So what about the Hollywoodization of military culture, and how bullying and spirit breaking are portrayed in movies? So we've all seen the screaming sergeant at boot camp, or their recruit who's ordered to scrub the bathroom floor with a toothbrush. How does all that impact on real life soldiers, and those of us who rely on them?

Brian  1:42:06

So it's a good point. I think the profession of arms, the military, is probably one of the most over portrayed jobs out there. I mean, you probably couldn't find a section in a movie store or even on Netflix, of movies about carpenters, or movies about nurses. But there's piles of movies that depict a military event or military life. And that actually, I would suggest it does a disservice because they're not documentaries. They don't show the events.

One of my favorite movies, I'm not going to plug it, but it was a movie about disappointments in the military. It was a movie that came out a number of years ago, where the whole mission they were training for, it didn't happen, and then the movie ends. And everyone, I remember watching it in the theater with a couple of other friends of mine from the forces, and the movie theater was filled with everyone other than that, and everyone was disappointed. It still makes me laugh today.

I remember who I watched the movie with, and remember the three of us burst out laughing because it was the only film that actually depicted what it's like. You can train for something in the military and have it never happen. That's the nature of being ready. You know, the military did a very good job of training for the nuclear attack that never happened in the Cold War. But part of why it never happened was we were ready for it to happen. And that's one of the things I think people miss.

So in basic training, yeah, it's a little rough. You got to get up earlier. But for any parents out there that's ever told their kid to do something and heard the answer, I can't do that. But you start to realize that, well yes, you can do that. But you need to be put in a position where you realize you have to do that. So yes, the military is gonna make you cold, wet, tired, and hungry. And it's going to talk to you probably a little harsher than you might have in the past, because it's building your resiliency to stress.

Now, nowhere in there is there a justification for discrimination or justification for abuse. I don't need to scream my head off in some soldiers face to get my point across. But there does need to be some application of stress. And you need to demonstrate the ability to still be able to do your job under that. And so yes, basic training is a little hard in that regard. But the average military day doesn't involve us screaming yes sir, no sir, and saluting all the time. It's regularly just a job in uniform. But the uniform just says that if we don't come to an agreement as to how this ought to go, it's pre-decided which plan we're going with, and it's the one that that guy said because he's in charge.

But I would say to you, every job has that. You know, in a hospital you've got units of the hospital that are run by the boss, and carpenters work that way, and mechanics have someone running the shop. So I would suggest to you that there's a big mischaracterization out there of what military life is like and it doesn't help us.

Joanne  1:45:17

Candice, any observations?

Candice  1:45:19

Yeah, I just would add on I think that the problem with stereotypes is that they're based in some reality, but then they're overblown and over generalized. And so I think examples of people being abused in these training settings, of course, there are examples of that, but the frequency with which they occur and the severity in which they occur, as they're portrayed in movies, I think leaves people feeling dubious about the military and its culture, which then creates a divide. I just think ultimately it's not helpful for anyone. I think it's a disservice for everyone.

Brian  1:45:59

You know, I can remember a moment in Chilliwack, many years ago, over a decade ago, where I was teaching a particular group of soldiers how to dig trenches properly. And I remember this one trench where they just weren't doing it. They weren't doing it deep enough. They weren't doing it wide enough. And they weren't putting the amount of time and effort into doing it right. And I let them know that. And two years after that, one of those soldiers came back from Afghanistan. He said, "You know what, I never thought I'd need to dig a trench." And he'd been there for a week and they were getting mortared and they had to dig.

And so you know, when things were approached in the military of you need to do this, well, the reason you need to do this is because you're highly likely to go to a place where you actually need to do this, where your life will depend on the lesson I'm teaching you. And that might be one of the things that makes things come across a little harsh. But to be honest, the lessons you're learning in the military aren't lessons that you're allowed to not get. At the end of a course on a machine gun, you have to know it, and people will die if you don't. That's just the nature of it. And I don't think there's as much of an understanding of that as there needs to be.

Joanne  1:47:14

So we can't have this conversation without touching on COVID-19 and its mental health impacts on veterans. So Brian, what are you hearing from veterans about COVID and how it's impacting their existing mental health challenges?

Brian  1:47:32

I guess if I had to talk about the positives first. The Canadian Forces trains every soldier in basic training on what we used to call NBC, which is now called CBRN, which is essentially at the time I was doing it, nuclear, biological, and chemical warfare training. So dealing with a biological agent, a virus, is actually something Canadian soldiers are trained to do. Specific to that there's a specialized Canadian unit within the Canadian Forces that does just that on a domestic terrorism side.

So our knowledge of bacteria and viruses and them being weaponized, is there. Well, that's not what COVID-19 is or at least it's not our understanding of it. But I guess I'd approach it by saying, we do know a thing or two about this. I'll tell you this, though, the Canadian military has very good training, very good capability, but limited amounts of it. And so, you get a tougher answer out of the military if you ask them and notice that there's only so long we can do this. And like I've said to you before, we're doing it with the people that just got back from somewhere, and the ones that are getting ready to go. How long can we do it for?

When you go on from there, I would say COVID-19 is for the veteran community, as I mentioned before, we've got people with a tendency to hermit and we try through therapies and peer support to kind of break that barrier a bit. And then here we are with this reality that has said, go back to your basement, stay in your house, and don't visit people. And that's a bit of a challenge.

Joanne  1:49:14

So what does it do to a soldier's psyche? He's abroad as a peacekeeper, and he comes back and he is maybe feeding an elderly gentleman or changing a diaper or whatever. What does that do to a soldier's psyche?

Brian  1:49:32

Well, I think people have to remember that you're still sending a soldier. If you send them to war or you send them to a hospital, you're sending the same tool. You know, it's like using a sledgehammer for everything, including things that don't need a sledgehammer. But you're getting that, you're getting what you asked for.

And I think people are starting to see, for example, the honesty and reporting of what the soldiers have seen in the last couple of weeks that they've been there. Not sure the Canadian society was expecting that. And not sure they were expecting that the main information they would get on what's going on inside these centers was just going to be in a blunt, honest truth that comes out of a military report. But that's a good thing. That's actually something we should be lending to the rest of society is how to assess, how to honestly report, and how to forward the information to the people that should have it. That's the strength of the force. And I wish we could emulate that more throughout the rest of society.

Joanne  1:50:32

Candice, what are you hearing about COVID-19 and veterans? And what are you learning that you can maybe apply as you move forward in your work?

Candice  1:50:41

I think the only thing I would add is that I think probably just the uncertainty certainly probably increases everyone's mental health symptoms that they were already experiencing them. So you know, the social isolation is not good for any of us, and trying to find ways around that. I also think people are being cooped up in potentially stressful environments with families that may be in crisis or struggling. And I think it's just a time for people to find themselves particularly stressed out. That's what I am hearing.

On the other side what I'm hearing is that veterans are really appreciating the providers providing more online therapy. A lot of providers in my circle have been reluctant to do that, and are forced now to get more comfortable with that. And I think that's been a welcome change that I'm hoping will lead to more options for veterans and how they access their care.

Brian  1:51:52

Right on that. This is going to produce a silver lining and that silver lining will be it's going to force us to progress on exactly what she's talking about, on delivering care over the internet. I also think, though, it will highlight a couple of problems. One is that we're going to have potentially different tiers of care based on your connectivity. And the care that we can deliver to someone in Vancouver, may be different than what we can do in a extreme rural environment.

But I think she's right, is this has pushed people and patience as well, to realize that you know what, I'm going to have to try do this over the web. And that's there. I'd also add this, is that we have just like every other situation, we have the stresses of everyone else. My biggest problem in COVID as a veteran is what's going on with my kids, and how they're suffering through not seeing their friends, not going to school. I have the same situation as every dad across this country.

Joanne  1:52:54

Such amazing information. I can't thank you both enough for sharing your incredible insights and ideas and passion. I'm just overwhelmed with what you are both doing. So let's now bring this all to a finer point Candice, knowing that Brian is a veteran, and an advocate, what would you like him to know about your vision for the future of veterans mental health?

Candice  1:53:24

Honestly, what I'd like Brian to know is I'd love to partner with him in the future, and to figure out how, honestly, as mental health providers and myself as a treatment developer, and researcher, sometimes we were building stuff and doing things in silos. And I think what I would want to say is that I want to co-create a vision of creating things that actually people want. So bring me that side of the veteran's voice to then kind of what I might know about psychology theory, and what works to build something that more people will want to come to and profit from.

Joanne  1:54:07

That is so exciting for me. Much of my work is helping to build communication and collaboration among people from all sectors, and a partnership between the two of you would be just such a cool outcome from this podcast. So Brian, what would you like Candice to know about veterans' needs and recognizing their diverse experiences, and how you'd like to move forward with your work and maybe with Candice's help?

Brian  1:54:40

Well, one of the things that really interests me as a patient, as an advocate, and I guess you could call a stakeholder as well in the whole world is, I think veterans want to find a way of how can we put our hand on the steering wheel of research a little bit? How can we help get involved in that? Often what's happened in the past is we get consulted at the end, or we get used in the data study, which is fine. I think we want to be brought in even closer to the beginning of research and what the next way forward is.

I'll throw something to you as well. If you ever get to speak to someone from her background again, what I would like people to ask is about the different senses. And this is something I've found amongst myself and my friends is that some people found a lot of therapy through what they would paint, that didn't work at all for me, or some others did from listening to music, not really my thing. But I found the sense of smell could, if it was a wrong smell for me, trigger an event, and if it was the right smell for me, pull me out of an event. And I would really like someone to drill down on first of all, what that is, and how do I learn more about it. Because whatever is good, if we can make it replicable, we make it better for other people.

And I guess I would say this as I wrap up my side of this is, I like to remind people that out of the things you invest in, whether it's defense, or veterans care, or security as a whole, these are some of the things that are untangible in government spending. And they're often easy to overlook. Like, if I tell you that this one government will build more MRI machines, or I think lately with the COVID situation, if you say, well, we're going to spend on masks, gloves, and face shields, people see what that is, they get it. But people don't get what security is. And in fact, security is the absence of a thing.

That's something that the average citizen might need to wrap their head around a little bit more. And when it comes to why you need to invest in security forces and military, and then what we have to provide care for them afterwards. When we provide a secure nation, a perfectly secure nation, there's nothing on the list of things that happened. Whereas if we fill in potholes, well, we can count the potholes.

And so often it becomes very hard to quantify to people, especially if they feel the country hasn't been attacked in a number of years, or they don't see a threat over the horizon. It's easy for them to say, well, let's spend a little less on this bubble we call security. While that's how Veterans Services get cut. That's how hospitals get shut. And I challenge people if you like security, you need to pay for it.

Joanne  1:57:39

We're fast approaching the finish line. So I'd like to bring us back to the title, which is Veteran's Mental Health: Personal and Scientific Perspectives on Healing. And although I don't have a personal or scientific perspective, I do have one as founder and CEO of the Fresh Outlook Foundation. Our passion is inspiring community conversations for sustainable change. And we do that in a variety of ways. But the real crux behind everything we do is triggering better conversations and collaborations among people from all walks of life, to address important community challenges.

So I believe that when policies and programs are created that reflect the collective insights of decision makers, veterans, advocates, and mental health professionals we'll take a huge step toward healing. And this inclusive approach is not only the right thing to do, but it also generates the most robust and innovative solutions because each group brings unique gifts to the table. So Brian, can you comment on this need to meld stakeholders' unique characteristics?

Brian  1:59:02

I actually think what Candice was mentioning earlier, if we could call that the olive branch she's offered, first of all, I'm going to say yes, and it's part of the way forward. Patients and clinicians are also stakeholders in forward progress, especially in mental health. You know, if you look at the mental health of veterans, it's pretty easy to see that the military would benefit from that. But so will the local mental health systems that exist will have less problems on the correctional system if we tackle this properly.

You know, the kids going to school, our kids, my kids will be better off if I'm healthier. And there's such a ripple down effect, a positive one of good care and a negative one when it's not done right. And so that's the way stakeholders need to move forward. I think patients and clinicians need to be moving hand-in-hand forward, and being able to influence each other in what that looks like.

Joanne  2:00:04

Candice, anything you can add about how the academic community can contribute to this discussion and in the actions that are needed?

Candice  2:00:14

I think the biggest way the academic community can benefit is to just listen. Obviously, we have science and theories, but how did they actually apply? And so really listening to the stakeholders that Brian just mentioned, and to be part of community building, and not in our towers, so that we can actually be exchanging ideas, and not just letting them flow one direction. I think that represents a change in how universities are trying to think about their role in our society, and that's very important as it relates to veterans and service members, and being more actively involved in listening to them and their needs, and how we can better serve and better research to provide more information.

Joanne  2:01:03

So to wrap things up, can each of you share in one word or one sentence what you think about the following: the greatest challenge veterans face in their move toward better mental health, Brian.

Brian  2:01:17

I think it's the reintegration piece, coming back into the country and the country wrapping their arms around them as they come home.

Joanne  2:01:25

Candice?

Candice  2:01:26

I would say access.

Joanne  2:01:28

The greatest structural barrier to optimizing veterans mental health.

Candice  2:01:33

I can go first. I think the structural barrier that we need to change is the expertise of the provider network.

Joanne  2:01:41

Brian.

Brian  2:01:42

Part of the mechanism going forward and helping people has gotta incorporate the peer support systems more as a veteran. If I read in a book that a particular therapy is the right one, I'll think about it. But if four of my buddies have gone and said, that's the thing to do, I'll go for sure.

Joanne  2:02:02

The greatest opportunity for strong veterans mental health.

Brian  2:02:06

Good leaders, and brave leaders, and leaders that themselves are willing to come forward if they have a problem. That was a huge part of me getting better was I'd seen someone else that was suffering and was brave enough to come forward. It's leadership.

Joanne  2:02:21

Candice.

Candice  2:02:22

I'm gonna say connection, which goes along with the peer support idea, but also people banding together.

Joanne  2:02:30

The one thing we could do right now to improve veterans mental health.

Brian  2:02:35

I don't want to sound like a broken record. I think the biggest thing is the country being educated about what we're doing, and that will prepare the country to receive us better when we come back from doing it.

Candice  2:02:46

And you know what, mine is very aligned with that. I think it's like seeing you, that we actually see you, meaning that we recognize you but we actually see you if you need help.

Joanne  2:02:59

And finally, your personal commitment to being the change we want to see in this field.

Brian  2:03:06

Well, for me, paths may change down the road. But in terms of advocating for veterans that are suffering, I'm not going anywhere. I think it's natural to go that way once other people have helped you.

Joanne  2:03:19

It's all about patience and persistence, isn't it? And I promise to continue the conversation about veteran's mental health. So if any of you listening have an idea that you'd like us to investigate for a future podcast, please send me an email to jo@freshoutlookfoundation.org.

Thank you again, Brian and Candice for joining me. I've so enjoyed getting to know you both, and now have a much greater understanding and appreciation of the people who serve to keep our country glorious and free.

Brian  2:04:00

Well, I appreciate the opportunity to first of all get to meet Candice. Joanne you've helped me, give me a moment to just explain my story a little bit. And I think going forward, what I really want is people to realize that, it's not the Canadian Forces, it's your Canadian Forces. You've not only paid for it, you have a very direct stake in it doing its job well. And that also comes with it the implication, the responsibility to look after your Canadian Forces' veterans. And every opportunity that we have to speak up about that issue, and clarify, and put our finger on exactly what that means, it's a good opportunity. So thank you very much.

Joanne  2:04:45

Candice.

Candice  2:04:46

I just want to say what a delight it was to have the dialogue with Brian, such a pleasure to meet you. And Joanne, thank you so much for your commitment to actually facilitate these dialogues, to really push these issues forward, and heighten people's awareness to the importance of them. And perhaps my favorite thing to come out of that episode was the possibility of getting to partner with Brian to further the cause of military and veteran's mental health.

Brian  2:05:18

I wanted to just tell my story a little bit. I wanted to have people hear me and I want them to hear me as a patient. And as someone that's trying to do something about the mental health situation for veterans. I don't want them to hear me as a victim. I don't see myself that way. I'm very proud of what I've done, and I would do it again. But I wanted to make sure that I could explain to people that it's not just guns and bombs that present the problem. There's a lot of stressors outside of that. Lots of things that get acted on, or witnessed, or you have to participate in, or don't get to do anything about, that creates a stress for veterans as well. And I thought that was an important point to drive home.

Joanne  2:06:02

You can connect with Brian by email at brianrmckenna@hotmail.com, and you can follow him on Twitter at @brianmckennacd. For more about Candice's work, email her at candice.monson@ryerson.ca. You can check the show notes at freshoutlookfoundation.org for more contact information, and all episode resources.

A huge thank you to the Social Planning and Research Council of BC for its ongoing support of the podcast and for our virtual summit. And thank you for listening. If you enjoyed the podcast and would like to support future episodes, check out the options at freshoutlookfoundation.org/donations.

In closing, as Winnie the Pooh says, I'm so lucky to have something that makes saying goodbye so hard. So instead, I'll say be healthy, and let's connect again next week.

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