Canadian soldiers are fighting in Afghanistan as part of the NATO force there, and for decades before that, Canadian units served on peacekeeping missions in places such as Cyprus, Haiti, Rwanda, and the former Yugoslavia. Regardless of their mission, the Canadians have faced the same stresses that affect their U.S. counterparts.

And some Canadian soldiers returned with minds disturbed by the experience. One was Lt. Col. Stéphane Grenier. Grenier is not a doctor. A self-described tough armored corps officer, Grenier found himself one morning years after his return from Rwanda sitting in his car for 45 minutes outside the base clinic wondering how he was going to describe his internal turmoil to the corporal on duty.

"I was oblivious," he recalled for listeners at a symposium at Canada's embassy in Washington, D.C., in February. "I had been injured in Rwanda and didn't know it."

Grenier has helped turn his struggle with the horrors of the Rwandan genocide into a source of refuge for fellow members of the Canadian forces similarly affected by the outcomes of their missions. He is now director of casualty support management at National Defence Headquarters in Ottawa, home of the Operational Stress Injury Social Support Program (OSISS). The program was proposed in 2000, and the first peer coordinator came on board in 2002.

Most existing support programs depended on social workers or other providers for coordination, Grenier found in the course of researching the idea of a support program, but he ultimately decided that only a veteran of military service would have the needed credibility with soldiers.

To that end, OSISS recruits and trains people who have not only served in Canada's armed forces but have also been through the same trials by fire as those they assist: all have been diagnosed with mental health problems at some point in their careers. They can tell the soldiers they're helping:" We've experienced it too, but we're in a healthier place now."

All have to be screened by doctors before they can work in the program." No one wants to see them fail," said Grenier.

Once accepted, the peer-support coordinators take a two-week training course, not to become therapists, but rather to "listen, assess, and refer." They learn to recognize the boundaries between peer support and counseling. This part of the training is extremely complex and emotionally charged because it brings up issues the new coordinators have faced themselves, said Grenier. Additional training covers the nuts and bolts of services and programs available from the Canadian Forces or Veterans Affairs Canada.

The program has about 20 ex-military coordinators, an equal number of family coordinators, and about a dozen bereavement-support members (all of whom have lost a family member in the line of duty). They have served about 4,000 service or family members, mostly on or near half a dozen main military bases. Most cases so far have been soldiers who served in Bosnia or Croatia.

"We want employees to quickly grasp the issue the soldier has and know where to get help," Grenier said. "They know how to build trust to overcome barriers."

One barrier, he believes, is the language of therapy.

"The doctors use words to heal us, and I didn't know what the words meant," he said of his own experience. His situation was difficult enough, but he realized it had to be even harder for a combat arms corporal.

So when he began planning what has become OSISS, the place of language was critical.

Start with "operational stress injury." What happens in soldiers' minds after warfare is an injury caused by the stress of military operations—being under fire, seeing friends killed or wounded, facing the added horrors of civilian casualties. The U.S. Marine Corps and the Navy medical service that serves the corps have adopted similar language, and Grenier has consulted with Marine Corps psychiatrists in developing OSISS. Along with others, he would like to demedicalize operational stress injury.

"We're not trying to challenge the DSM-IV but to bridge the gap between the mental health providers and the people they care for," he said.

The entire organization meets every six months for training. The next session will concentrate on self-care and time-management skills for the coordinators. All coordinators must maintain contact with a mental health provider and run through an annual checklist to minimize burnout.

OSISS also offers services to the families of military personnel. Peer coordinators who help families must live with a person who has had a stress injury, said Melissa Bryden, an OSISS family-support peer coordinator from Winnipeg.

Bryden is not a war veteran, but she has worked for 13 years, half of them full time, as a reservist medical technician in Saskatchewan and Alberta. Her husband, also a medical technician, has served a stint in Afghanistan. Bryden is part of the second half of OSISS, the family-support side. All the family peer-support coordinators must have a family member who served in the Canadian forces.

There is other existing support for the families of deploying soldiers. They are briefed in advance about what they and their service member can expect while in the war zone. Staff at Military Family Resource Centers located on 32 bases across the country brief them again before the soldier returns home and once more six months later. The centers also offer help with child development, parenting support, crisis intervention, and other services. Family coordinators like Bryden attend those meetings. Their contact information is available from the Canadian Forces or Veterans Affairs Canada, but they do not seek out potential families in need. The families that decide they need some kind of help must take the first steps in contacting OSISS, either through using contacts on the base such as the chaplains or via an 800 phone number.

An initial interview with the family often brings a moment of recognition as the family members realize for the first time that they are not the only ones experiencing the problems they have just shared, said Bryden. The peer-support coordinator's job is to try to figure out what the service member or family members need, show them where to get it, and often help them through the inevitable paperwork and bureaucratic maze that veterans and military families in every country seem to face. They function partly as coaches, partly as case managers.

"People with mental health problems just can't navigate the system," said Bryden, so she will go to the family home and help with the paperwork or make sure someone sees a counselor.

The program also launched a speaker's bureau in January 2008 to increase awareness of operational stress injury, address the stigma surrounding mental illness, and urge early intervention.

More information on the Canadian Forces' Operational Stress Injury and Social Support Program is posted at<www.osiss.ca>.▪