PSYCHOLOGICAL STRESSES OF PEACEKEEPING OPERATIONS -
	PREVENTION/TREATMENT/RESEARCH:
	THE CANADIAN EXPERIENCE

	W.R. (Bill) Wild
	Directorate of Human Behavioural Sciences
	Canadian Forces

     Although the Canadian Forces have participated in over 30 peacekeeping operations since the United Nations Temporary Commission on Korea (UNTCOK) in 1947, it is only recently that we have recognized that peacekeeping duty can impose significant psychological stressors. Canadian peacekeeping over the past 25 years has been typified by the Cyprus (UNFICYP) and Sinai (UNEF) experiences; relatively peaceful foreign tours whose primary characteristic was the opportunity to travel and pick up some interesting experiences and trinkets. Duty in Somalia, Rwanda, The former Yugoslavia and elsewhere has significantly altered how Canadians view peacekeeping duty. Peacekeeping today exposes soldiers not only to new cultures and scenery but to sights and events outside the normal Canadian peacekeeping experience. Not only is the peacekeeping experience today more intense, the increase in demand for peacekeeping troops has resulted in a decrease in time between peacekeeping tours. At this very moment we have personnel preparing to embark on their fourth six-month tour of the former Yugoslavia. These people have not necessarily volunteered for a fourth tour, rather they just happen to belong to a unit that is returning to Yugoslavia or to an occupation that is in demand. 

     As a result of the changing nature of peacekeeping operations and the increased frequency of deployment, there is an increased emphasis on psychological support to the soldier. Over the next few minutes I will discuss a number of initiatives currently underway in the Canadian Forces. 

     The focus of psychological support to peacekeepers in the Canadian Forces is the management of possible adverse reactions to the peacekeeping experience. We manage reactions by preparing personnel and their families for the peacekeeping tour, preparing them for reunion after the tour, and providing treatment for those personnel for whom the preventative measures were not sufficient. 

	PRE‑DEPLOYMENT BRIEFING PACKAGE

     The Canadian Forces deploys formed units (former Yugoslavia), ad hoc units (Haiti), individuals (UNMOs), and reservists on peacekeeping operations. In each case, pre‑deployment training occurs. One purpose of this training is to prepare personnel to perform peacekeeping functions. Another purpose is to assist the individual cope with the new environment. This new environment has one salient characteristic not specifically trained for in the normal training cycle ‑ stress; the stress of working in an unfamiliar culture, and the stress of working in a dangerous and unpredictable environment. In order to assist personnel cope with this stress, a pre‑deployment briefing on stress is presented to personnel and where possible, families. The briefing covers such topics as signs and symptoms of stress, and means of coping. It portrays stress as a normal reaction and one from which the individual can recover, normally without professional intervention. Briefing material is reinforced by two 25 minute videos, one directed at supervisors and one at the troops. 

	INFORMATION BOOKLETS

Our military social work services has produced a three booklet series on stress covering: 

A. Preparing for deployment stress 
B. Preparing for critical incident stress 
C. Preparing for reunion stress.

All three are short and easy to read in the hope that they will reach a wide audience. Again they are designed for use by military personnel and their families. 

	MISSION INFORMATION LINE (MIL)

     The mission information line is a 1‑800 number (toll free) that families can call to get up to date unclassified information on the peacekeeping mission in which their loved one is involved. Information is updated daily by the national defence operations centre and is available 24 hours a day seven days of the week. During normal working hours, staff are available and ready to answer specific questions. This facility has proven to be a major stress reliever for both personnel, who know their families can get up to date, factual information to balance media reports and for the families. Ten thousand calls a month is normal, with a high of over 15000 in November 1994 when 55 Canadian hostages where taken in the former Yugoslavia. 

	POST DEPLOYMENT BRIEFING PACKAGE

     We have known for a long time that the reunion of families after the long absence of a parent can be stressful for all concerned. Home routines change when a spouse and parent is absent, and must change again when the parent returns. The stay behind parent may have come to enjoy the autonomy of running the household without interference; children may have become comfortable with having only one parent as disciplinarian. These stresses are common in even a peacetime military. The more intense characteristic of peacekeeping today has added a new dimension to the reunion. Today, more so than in the past, the returning peacekeeper may be carrying some emotional baggage from his peacekeeping experience; baggage that may interfere with resettlement. To address this concern, post‑deployment briefing packages for both the military member and the families have been prepared. These packages consist of a script and a series of ohp s that guide a facilitator through a series of lecturetes and participative discussions on stress, reunion and reintegration/ re‑establishing of family relationships. 

     Although it is recommended that a mental health professional give these briefings, it is recognized that operational commitments will often preclude sending‑ a qualified person from Canada. The packages have therefore been designed to be presented by any senior person in the unit. 

     The ideal time to present this material we have found to be one month before return. This avoids the confusion of the last few weeks of a peacekeeping tour when packing, and hand‑overs occupy the members time and thoughts.

	CRITICAL INCIDENT STRESS IN OPERATIONS

     The Canadian Forces have, for some years, employed the critical incident stress debriefing (CISD) model popularized by Dr. Jeffrey Mitchell.  When peacekeeping operations resulted in critical incidents, we attempted to apply the CISD model to the operational units by parachuting in Canadian CISD teams. This had varying degrees of success. Teams were met with subtle and sometimes not so subtle resistance from both commanders and troops. The general consensus was that what was a critical incident in Canada was not seen in the same light in theatre. We had a tendency to read our north American newspaper and dispatch a cisd team, much to the annoyance of the peacekeeper. Now, most of the critical incidents are handled by the unit in theatre. Prior to deployment, unit personnel are trained to conduct debriefing and defusings. A team is dispatched from Canada only if no team in theatre is available or unaffected by the critical incident. A CISD is only conducted if: 
A. A clear, identifiable critical incident has occurred; and 
B. The local commander requests assistance. After the recent spat of hostage takings in the former Yugoslavia, no team of helpers was dispatched from Canada; in theatre resources were employed. 

	RESIDENTIAL AND OUTPATIENT PROGRAMME FOR THE TREATMENT OF PTSD

    The chief psychiatrist of the Canadian Forces have initiated a project to develop and implement a combined residential and outpatient PTSD treatment/management programme for members of the Canadian Forces and RCMP. Cognitive‑ behavioural psychotherapy, physical exercise, group psychotherapy focused on self‑exposition, relaxation training, journal exercises and a psychoeducational component are all included in this cognitive behavioural multifaceted approach. A two week trial residential programme has recently been completed with reassuring results. A four week programme is currently under development. 

	SURGEON GENERAL SPECIAL COMMITTEE ON STRESS

    Our medical branch is responsible for the treatment of stress related disorders. The surgeon general special committee on stress, headed by the cheif social, worker of the Canadian Forces, was established to coordinate efforts related to deployment stress, post traumatic stress and combat/critical incident stress. It consists of the director of medical operations of the Canadian Forces, the chief psychiatrist in the Canadian Forces, a member of the psychology branch of the Canadian Forces (personnel selection branch), a member of peacekeeping operation staff, and representatives from other government agencies such as the RCMP, external affairs, and veterans affairs. The committee provides professional and technical advice to those involved in this area in the field and reviews all medical research initiatives related to stress. 

	CURRENT RESEARCH INITIATIVES

     At present we have five research projects underway investigating various aspects of stress in operations. 

Stress in military operations ‑ Canadian forces personnel applied research unit. This study was commissionned by land force command (lfc ‑ our army). It has two phases: 

1. Design a questionnaire to determine the prevalence, nature and intensity of stressors experienced by soldiers during un peacekeeping operations; and
2. Determine the efficacy of the cisd protocol.

To date the, questionnaire has been developed and a trial has been conducted on a sample‑ of 408 all ranks in theatre in the former Yugoslavia. The most salient stressors were leadership/management issues, safety, external relations (with belligerent forces, those they were trying to help, and the media) privacy and adjustment, and family concerns. The questionnaire will now be readministered in another peacekeeping location to test for generalizability, after which phase 2 will commence. 

     Psychological consequences of Canadian un peacekeeping duties in croatia and bosnia 1992‑93 ‑ this study was conducted by a Canadian military psychiatrist in residency at a Canadian university. A battery of instruments was administered to 800 all ranks ( regular force and militia) from three different units, on up to three different occasions (one pre, two post). Incidence of depression and PTSD were determined and the efficacy of preventative measures such as critical incidence stress briefings and debriefings was assessed. As this report has not yet been finalized, findings can not be reported. 

     Traumatic stress in peacekeepers ‑ this study is being conducted by a member of our psychology branch pursuing her Ph.D. under one of our subsidized university plans. The aim of this study is to corroborate the survey data of the previous study using objective data. This study uses archival data such as referrals to alcohol rehabilitation centres, release rates, disciplinary infractions, medical/ social worker/padre visits to assess organizational attitudes and behaviours. If PTSD and depression are as prevalent, following un duty, as the previous study suggests, organizational attitudes and behaviours would be expected to change from pre tour to post tour. This study should be completed by the end of the summer. 

     Residential and outpatient programme for the treatment of PTSD ‑ I mentioned earlier the PTSD treatment programme being developed by our chief psychiatrist. Part of the development process is the collection of clinical and survey data to validate the programme. Approval has recently been given to commence this stage of the project. 

     Clinical evaluation and validation of the Canadian deployment impact scale for Canadian un peacekeepers ‑ a civilian Ph.D. candidate (psychology) earlier this year presented an unsolicited proposal to develop and validate a uniquely Canadian PTSD diagnostic scale. The proposal has received technical approval from the surgeon general special committee on stress I mentioned earlier. The researcher is now responsible for finding a commanding officer willing to permit the administration of the instrument for validation purposes. 

    I'll mention but one more initiative before inviting questions. As we now know, PTSD can develop years after the traumatic event, well after the individual has left military service. In Canada, these individuals would be cared for through provincial medical programmes; the military has no responsibility for personnel once they are released. With socialized medicine, there is no need to. Recognizing that this is not entirely acceptable a senate sub‑committee on veterans affairs in an October 1994 report recommended that: 

 A. The Department of Veterans Affairs immediately establish clinics and outreach programmes for the diagnosis and treatment of PTSD among veterans;
 b. DND set up similar clinics and upon termination of the contract for reserve force members the follow‑up be assumed as per the above recommendation; and
 c. A degree of leniency be shown when adjudicating claims of PTSD arising as a result of the second world war and Korea.  Unfortunately senate committee recommendations are not binding on the government; none of the above recommendations
Are likely to be actioned. The report does show, however, a growing concern for the‑ psychological ramifications of committing troops to battle or near battle. The lessons learned in the second world war are gradually being relearned.