Don Richardson’s foray into military and veteran mental health coincided with the end of the Yugoslav Wars of the 1990s.
“One thing about the military is, in general, everyone is healthy. You have to be healthy – healthier than the general Canadian population – to be screened into the military. In the military, you see adult trauma that is a different type of post-traumatic stress disorder (PTSD) than you would see on the civilian side,” said the Western Psychiatry professor and Physician Clinical Lead at Parkwood Institute’s Operational Stress Injury Clinic.
At the outset of his career, Richardson worked as a consultant psychiatrist with Veterans Affairs Canada, at the forefront of the emerging field.
Today, he is a leader in the field, in both medical and research capacities, having been named a research fellow with the Canadian Institute for Military and Veteran Health Research (CIMVHR). Fellows are recognized for their guidance and contributions towards CIMVHR’s mission of enhancing the lives of Canadian military personnel, veterans and their families by harnessing the national capacity for research.
As combat ceased in Bosnia and Herzegovina, Canadian peacekeepers, deployed in the region as part of The United Nations Protection Force, made their way home, suffering from PTSD, having witnessed countless atrocities they could not prevent.
“Shortly after the 2000s, a lot of people from the former Yugoslavia were coming back and we were finding the civilian medical-health system was not prepared to adequately assist a lot of the veterans with PTSD.”
Richardson has more than 20 years of experience in the assessment and treatment of veterans and Canadian Forces members with PTSD and other operational stress injuries and has spearheaded numerous collaborations to develop and publish research on this front.
He has published widely in the area of military and veteran mental health on topics such as risk factors for PTSD and suicidal ideation, sleep disturbances, health-care utilization, treatment outcomes and the impact of psychiatric illness on quality of life. His expertise in interpreting research and analysis has been instrumental in the development and evaluation of programs for Canadian Forces members and veterans suffering from these types of injuries.
“Working with the veteran population, if you’re a civilian, there’s a challenge of developing a trusting relationship. For those in the military, it’s a distinct group and they might be naturally distrustful of large organizations – and we represent ‘an organization,’” Richardson said.
“In the military context, if you’re a soldier, you’re trained that you’re here to protect civilians. The challenge becomes twhen they are ill, they have to come see a civilian for help. It’s a challenge developing a trusting relationship and getting the patient to come back to their next appointment.”
Working within the niche of military and veteran psychiatry, as a clinician and researcher, offers Richardson an entryway into improving patient outcomes while ousting what he sees as negative assumptions in the field.
“There tends to be a myth among not only veterans, but among the civilian population, that people with PTSD – especially veterans – cannot fully recover. It’s the image that if you have something, you have it for life. Part of my research interest is to dispel that,” Richardson explained.
Many veterans who have suffered horrific trauma are able to recover. That recovery doesn’t mean they forget their experiences, but with treatment, they are able to live with good quality of life. A lot of Richardson’s work has focused on finding and better understanding effective avenues of treatment to show this is possible.
“Currently, when someone comes in, we can’t predict if they would benefit more from psychotherapy or medication, or if they need both, so we offer everything – psychotherapy, medication, group therapy, family therapy,” he noted.
The goal is to generate a comprehensive assessment of the patient, to develop standardized measures and symptom profiles to help clinicians prescribe and treat each case on an individual level. When an individual with diabetes goes to a doctor, there are tests and measures that indicate whether a change in diet, exercise regimen, medication or a combination thereof is the best course of action. With something like PTSD, treatment is more nuanced, particularly when dealing with the military and veteran subset of the population.
“It’s a lot of trial and error and seeing how they respond. There are effects of medication; talk therapy isn’t easy. All of the symptoms you have with PTSD when deployed are based on survival, being hyper-vigilant, being able to tell when somebody is good or bad – having black and white thinking,” Richardson said.
“We do a lot of moral injury work, too. When we look at PTSD, we often view it as fear-based; you feel you were threatened and developed symptoms because of fear. But we know there are a lot of people who develop PTSD after witnessing things they could not intervene in. Military members, when they are deployed, the bonds they develop are extremely strong because these are individuals they rely on for life or death. When they lose somebody, it’s a big loss and a lot of grief,” he continued.
“It’s a challenge to ask for help. The self-stigma is so strong but we want to give people a sense of hope that treatment is available. The challenge is, how do we meet the person where they are at? We might have lots to offer but they might not be ready.”