Operational Stress Injury (OSI) Clinics Offer Mental Health Treatment Programs for Canada's Wounded Warriors

It's a quiet, comforting, welcoming place, tucked inside the

1 December 2018


It's a quiet, comforting, welcoming place, tucked inside the south-side entrance of Edmonton's Northgate Centre shopping mall.

Although a staff of 22 psychiatrists, psychologists, social workers, psychiatric nurses and others work at Edmonton's Operational Stress Injury (OSI) Clinic - one of 10 such sites across Canada - the hallways are quiet this late November morning.

Kelsey Clelland, the affable and informative OSI Clinic Manager, gives me a brief tour of the facility's comfy, family-friendly meeting rooms and well-equipped boardroom, where team meetings, case conferences and even therapeutic yoga sessions are regularly held.

After we adjourn to her office for an hour-long chat, Clelland tells me she spent seven years in Winnipeg and Edmonton working for Veterans Affairs Canada before she was hired by Alberta Health Services (AHS) to manage the OSI Clinic, which is fully funded by Veterans Affairs.

It's clear she loves what she does, and is deeply committed to the hundreds of clients who walk through the clinic's doors each year, seeking help with their struggles over Post-Traumatic Stress Disorder (PTSD), depression, anxiety, and substance use.

Clients include Veterans, Canadian Armed Forces members, and active or retired members of the Royal Canadian Mounted Police (RCMP), along with their families.

"The average age of our clients is in the mid-40s, but we see people as young as 19 and all the way up to their 80s. So it's a wide age range with a mix of males and females, although there are more males just based on the populations we serve. It's not unusual to see people who have been dealing with their symptoms for a long time," she explains.

"Most of our clients are married or in common-law relationships, so we work with their families too. They can attend intake, treatment sessions, treatment overviews, and caregiver support groups. We also offer couples' therapy as long as the couples' issues are related specifically to the operational stress injury."

Since Edmonton's OSI Clinic services a huge catchment area, extending from Red Deer to the Northwest Territories, many clients travel long distances to appointments. In such cases, the referral organizations - whether it's Veterans Affairs, the RCMP or the Canadian Armed Forces - will often cover travel costs.

"All of our referrals come from these three sources. There are no walk-ins, no GP (General Practitioner) referrals, nothing like that. We work closely with our partners so they're only sending clients to us who they believe are a good fit with our services."

Besides Canada's network of 10 OSI Clinics, a string of OSI satellite sites in smaller centres offer similar services. Meanwhile, the Department of National Defence (DND) offers its own Operational Trauma and Stress Support Centre (OTSSC) programs at seven DND bases across Canada.

The OTSSC programs provide assessment, individual and group treatment for individuals dealing with PTSD or other mental health issues related to their operational duties. Like the OSI Clinics, OTSSC programs employ multi-disciplinary teams that include psychiatrists, psychologists, social workers, mental health nurses and addictions counselors.

"In Edmonton we have both an OTSSC and an OSI Clinic, so they (OTSSC) would primarily see the still-serving members of the military, and we would see the folks who are releasing (from service) and the Veterans," says Clelland.

The OSI Clinic offers Prolonged Exposure Therapy (PE), Eye Movement Desensitization Reprocessing (EMDR) Therapy, Cognitive Processing Therapy (CPT) for individuals or groups, as well as Cognitive Behavioural Therapy (CBT) for anxiety and depression, and targeted programs to address issues around anger management and emotional regulation.

"We also offer therapeutic yoga. It's not so much focused on the pretzel twisting exercises but it's more about breathing and relaxation. We also recently started a caregiver support series. It's information-based and runs for three sessions. Family members, typically spouses, can attend to learn more about operational stress injuries, how to support their spouse and also how to support themselves," she explains.

Dr. Atif Ijaz, a Clinical Lecturer in the Department of Psychiatry at the University of Alberta, is one of three psychiatrists who work part-time at the Northgate OSI Clinic. The others are Dr. Theresa Girvin and Dr. Udeme Akpan.

Dr. Ijaz completed his Psychiatry Residency program in Ireland, and practiced there for over a decade before moving to Alberta in 2013. Two years later, he joined the team at the Northgate OSI Clinic, where he spends half of every week.

His remaining workdays are allocated to the Alberta Heartland Primary Care Network in Fort Saskatchewan and the Edmonton North Primary Care Network, which also operates out of Northgate Centre.

"I was a little bit worried initially when I joined the team of the OSI Clinic, because I never had any experience working full-time with Veterans or with the police," he says. "But it has been a real pleasure, not only working with such a great team of clinicians, but getting to know and really understand what our clients have gone through as well."

While many of the clinic's clients had similar traumatic experiences in Afghanistan or other war zones, or in the sometimes-violent and stressful world of policing, individual impacts can vary widely, he explains.

"Like other conditions in Psychiatry, PTSD comes in many colours. So you can have people with trauma who have personality attributes that have allowed them to deal with it, and it doesn't affect them as much. They may only need short-term therapy, intervention or medication," he says.

"But there are others whose lives have come to a complete standstill because of the condition they have. It becomes chronic and they feel helpless. At that point, you're not only treating their mental health conditions, but dealing with the impact on their family and other social issues. So those are the challenges we try to help people cope with."

The OSI Clinics aren't designed or funded to treat members of municipal or provincial police forces, local fire departments, or federal agencies such as Corrections Canada or the Canadian Border Services Agency (CBSA). But if individuals currently employed by such organizations also have prior military or RCMP service they may qualify for treatment.

"Each of the municipal police services, fire departments and EMS (Emergency Medical Services) tend to set up their own in-house treatment programs. Some contract these programs out as well, so there is a real mixed approach. Each group is looking at what best meets the needs of their members," says Clelland.

"One of the other programs that has been successfully rolled out across the country is the Road to Mental Readiness (R2MR). It was originally developed by DND and it's more of a pro-active, awareness-building approach to give people the language and tools to discuss mental health issues. It has since been modified and delivered to a number of fire and police services including the RCMP. So it's really about getting the conversation going and making the topic of mental health more front of mind for people."

As for the impact of the OSI Clinic's various treatment programs on clients, Clelland says they are overwhelmingly positive.

"We have a lot of clients who finish services here under what we call 'goals met,' which means based on their treatment plan and the goals they identified, they feel like they've met them and they're happy with where things are at. That could mean a reduction in symptoms for some, or the elimination of symptoms for others. It could be about the quality of sleep or mood, or around feeling comfortable in the community or around different triggers. So I'd say there's a large number of folks who are happy with what happens while they're here."

Not surprisingly, Dr. Ijaz says clients who have strong family and social support networks tend to do better than individuals who don't. "The more supports they have, the better the prognosis, although personality attributes also play a role," he says.

Although societal awareness of mental health issues has grown exponentially over the past decade or two, and there is now a greater willingness to discuss such issues openly, prejudice and negative stereotypes around mental illness still remain, he adds.

"I would say it is still a big problem. I have Veterans who experienced some trauma 30 years ago, or going back to the 1960s even, and they are only now talking about it. They felt that vocalizing their symptoms was a sign of weakness, and it could cost them their service. They struggled privately with symptoms all their life. So yes, we have come a long way from where we were 10 or 15 years ago, but we still have a ways to go."