Retired Sergeant Tobias Miller joined the Canadian Armed Forces in 2002 and deployed to Afghanistan three times over the next decade.
A survivor of childhood sexual abuse, Miller says he was already traumatized when he enlisted. But he did not disclose his history during the Forces’ initial screening process, because he did not want to ruin his chances of being admitted.
It was not until 2006, when Miller applied to join a special operations regiment and had to undergo comprehensive psychological screening, that it dawned on him just how inadequate the initial assessment had been.
The test, called a psychological screening inventory, consisted of a few hundred questions about things like his relationship with his mother and how often he gets angry. The initial screen, by contrast, had included just a single mental health question.
By enhancing their screening process, the military could save itself from admitting people who are unfit to serve for mental health reasons, Miller says. And it could avoid exacerbating the health conditions of individuals with pre-existing mental health problems.
Miller knows. In 2011, on his 41st birthday, a teammate stepped on an improvised explosive device, killing the teammate instantly and severely wounding Miller. This experience — coupled with Miller’s experiences of abuse as a child — affected him profoundly. At one point, Miller was taking 26 pills a day to manage his PTSD and other associated symptoms.
Michelle Kole, a clinical psychologist who specializes in military trauma, says it is not uncommon for pre-existing mental health conditions to affect soldiers’ mental health once they begin their service.
“When an individual has pre-existing trauma, the introduction of new traumatic events can provoke an already sensitized limbic system,” she said, referring to the part of the brain involved in behavioural and emotional responses. This can “cause responses that can seem more intense than expected.”
A 2016 paper on undeclared mental health disorders in the Forces estimates that eight per cent of all Forces personnel who are released for disciplinary reasons have pre-existing mental health conditions before joining the military.
But in an environment where resources are scarce and applicants are expected to self-report, there is only so much the Forces can do, Kole and other experts say.
“I’m not sure what the answer is, because to do a full battery of psychological testing would be in the thousands of dollars,” Kole said.
One question
The Forces abide by a “universality of service” principle, meaning all soldiers are required to maintain a standard of physical and mental fitness that ensures they can be sent into combat.
Members of elite special forces units and mechanics alike must be able to handle weapons, perform basic combat functions and deploy anywhere around the world at a moment’s notice.
Having a mental health disorder does not necessarily preclude someone from joining the military, said Derek Abma, a spokesperson for the Department of National Defence in an emailed statement. Instead, applications are evaluated on a case-by-case basis.
“If pre-existing mental health conditions are identified, follow-up actions are initiated to ensure that the applicant is able to meet the common enrolment medical standards,” the statement said.
All applicants are required to complete what the Department of National Defence described as a “detailed” medical health questionnaire, followed by an interview with a medical technician, to determine their eligibility.
But the questionnaire only includes one mental health-related question, Abma confirmed. By contrast, the equivalent US questionnaire includes 19 questions.
Whether it is one or 19, the applicant can — and often does — lie their way through, Kole says.
“If you’re trying to get out of a bad situation, and you think your best option is to join the military, you are not going to be honest about what’s really going on for you,” she said.
Retired Lieutenant Colonel Chris Kilford served in the Forces for 36 years in various command, instructional and diplomatic roles. He says he does not remember undergoing any psychological testing when he joined the military decades ago.
But he also does not view questionnaires, or even more rigorous psychological testing, as the most effective way to screen for mental health issues. In his view, the Forces’ basic training program is the best form of screening.
“That is probably when you’ll identify someone that has slipped through the system,” said Kilford, who is now director of the Canadian International Council, a defence policy think tank.
“The lack of sleep, the intensity of tasks, the need to work in a group: these things act as a screen. And people break,” he said.
The Department of National Defence seconded this view.
“As recruits transition from civilian life to the structured environment of the military [in basic training], they are faced with physical and mental challenges that will test their resilience, adaptability, and teamwork,” Abma said.
But according to Miller, the Forces’ emphasis on teamwork in basic training can result in strong recruits picking up the slack for individuals who are struggling.
“No man gets left behind: that narrative is pushed the entire time. I went through basic with 40 guys and all of them made it,” he said.
Lip service?
Joshua Curran joined the military at age 17, and went on to serve in several highly coveted combat positions, including as a lead scout navigator. In 2012, he deployed to Afghanistan for nine months.
While he was overseas, Curran received a breakup email from his then-partner and began drinking heavily shortly thereafter. Before returning to Canada, where he no longer had a place to live, he cycled through the Forces’ “decompression” facility in Cyprus. The facility is a rest-and-recovery centre where military personnel unwind and transition back to civilian life after a deployment overseas.
“They give you, like, a 10-minute screening and ask you things like if you’re suicidal, how many times a week you drink.”
Curran says he knew of colleagues who were struggling with alcoholism or PTSD at that time.
“[Y]ou just lie your way through it because there’s no follow up. As long as you answer the questions right, no one ever checks in on you again.”
After returning from Afghanistan, Curran started to struggle with drug and alcohol abuse. Three years later, he was demoted from corporal to private after the military discovered his substance abuse problems.
Because the consequences of being truthful can be disastrous, lying about substance abuse and other mental health problems is rampant and routine amongst service members, Miller says.
“When you go to do a deployment assessment with the doctor, one of the questions they ask you is how much you’ve been drinking. And about 80 per cent of people are lying about that,” he estimates.
In its emailed statement, the Department of National Defence said soldiers’ mental health is a priority and recruits are provided with resources if they are struggling.
“In cases where recruits identify as having a mental health concern, [the military] provides immediate access to mental health services, either through military or civilian practitioners,” Abma said.
Kole says the military may pay lip service to the mental health of its recruits. But in her view, it is not their primary concern.
“I think when people are on the frontlines of combat, surely it would make sense to do some type of neuropsychological evaluation after each deployment. But [the military] can’t afford to do that,” she said.
“And if I’m spending hundreds of thousands of dollars training these warfighters, I can’t afford to lose them [for mental health reasons] after one deployment, even if they’re a shell of their former selves.”
