The origin and development of the Canadian occupational therapy profession is closely tied to the military and the context of the times. Although the modalities and tools of the profession can be traced throughout history, the use of activities and occupations for learning were paramount at the turn of the century. It was also acknowledged that if soldiers returning from World War I were to be reintegrated into society and eventually be economically self-sufficient, some temporary supports were needed. Increasingly it also was apparent that some of the injuries were different from those of civilian patients in the general hospital care. With the break out of war, the Military Hospitals Commission was created in 1915 to deal with the increasing numbers of wounded and the more complex needs of returning injured soldiers. The Department of Soldiers’ Civil Re-Establishment (1918) created by an Order in Council was charged with the monumental responsibilities of administering “hospital and medical for the sick and wounded, set pensions, select appropriate training programs and finance settlement loans”(Loyal Edmonton Regiment Museum, 2001).

The focus of Vocational Branch of the Invalid Soldiers’ Commission, Department of Soldiers’ Civil Re-establishment (DSCR) was to facilitate community re-entry and to provide vocational training to returning soldiers who had lost their former pre-war positions. The program had three parts: employment, retraining and medical services. Retraining include 1) Ward Occupations, 2) Curative workshops and Industrial Retraining. Also there were grave concerns about those patients confined to bed and who seemed to need longer “invalid” period (Hunt, 1920).

Educated young women, teachers of crafts and occupations were recruited for bed-side occupations offered during hospitalization. Ultimately a short course to train “Ward Occupational Aids” to be known as “Ward Aides” was designed at the University of Toronto. This occurred through the promotion of high-ranking faculty members who also held DSCR positions. Support came from the DSCR Vocational Rehabilitation program and the leadership of a noted vocational educator, Thomas B. Kidner. He was the Vocational Secretary of Canadian Military Hospitals’ Commission (personal communication I Robinson, Psychiatric Quarterly, 1939). The DSCR assigned the Ward Aides to hospitals (military and DSCR) across the country. References to these facilities can be found from Nova Scotia to British Columbia but most were in the East. It is in these institutions later to be administered by the Department of Veterans Affairs that many of the first “occupational therapists” spent their short careers (Hunt, 1920).

During the intervening years between World War I and II, the Ward Aides would continue to work in the Military hospitals but some would turn their attention to civilian facilities. The Honorable, Colonel H.A. Bruce, Lieutenant Governor of Ontario (1933) notes that after four years of depression, the “wounded and tortured million” became the “new crop of anguished and despondent” beings. Instead of being “shell-shocked they were un-employment shocked” and thus they needed the work of occupational therapists. Unfortunately occupational therapists also found themselves in the ranks of the unemployed as military posts decreased and the expected positions in civilian hospitals failed to materialize (Driver, 1968). Some of the military hospitals were concerted municipal/ provincial sites and eventually returned to their former status (University of Alberta Hospital website) New occupational therapy positions eventual were established.

 In December 1940, at the request of the British War Office and the Department of Health of Scotland, volunteer Canadian therapists were dispatched overseas to organize departments of occupational therapy and an educational program. Five occupational therapists arrived in the United Kingdom the following February for posting.

While over 350 young women completed the program in “bedside occupation” between 1918 and 1919, prior to the onset of World War II, the exact number of “therapists” in military associated facilities is not reported. At the war’s conclusion, 47 Canadian occupational therapists had served overseas from a total of 82 commissioned officers, lieutenants, in military service. Included in these numbers are some of the life members of the association: Thelma Cardwell, Margaret Hood, awarded the Royal Red Cross Medal for her active duty service overseas, and Mary Wilson (Driver 1968, Robinson, 1981). Other life members were part of the therapists recruited by the Emergency Medical Services of the United Kingdom: Ms Amy deBrisay who also in the latter part of her illustrious career was an Adviser in Occupational Therapy to the Department of Veteran’s Affairs and Jean Hampson both of whom served in Scotland. One overseas casualty is noted, that of Lieutenant Sue McLaren (Howland, 1944).

 By 1943, occupational therapists were serving in the Royal Canadian Medical Corps, the Royal Canadian Navy and the Department of Veterans’ Affairs. Captain Helen Irvine (UT 32) in her 1945 report to CAOT on overseas services stated that between January 1 and October 31, 1945 the monthly average number of patients receiving occupation therapy was 3,856, peaking in March with over 5140.

Of the 182 recorded employed therapists in Canada in 1945, 67 were in military associated medical services, including three still within the United Kingdom (Smith, 1945). Of note is that the “Ward Aide” therapists who were graduates of the emergency courses, worked under Soldier Civil Re-establishment, not medical services. It wasn’t until the mid-1940’s when there was a dramatic restructuring and transformation of Department of Pensions and National Health to become two separate departments would the therapist come under medical services in the newly created Department of Veterans’ Affairs (Driver, 1968).

With this restructuring, as well as the fact that families are treated by civilians, there was an ongoing reduction in the need for rehabilitation services, thus occupational therapy in the Canadian military. Dr. Tanya Packer, current Chair of the Dalhousie Occupational Therapy Program was the last Canadian trained in the Regular Officer Training program in Canada. She was released at the rank of Captain in 1983/84. At that time there was a lack of career progression beyond the rank of Captain because enlisted women could not go into the battlefield. However during her service she was the most senior occupational therapist in the service and was considered an Advisor to the Surgeon General in Canada. (personal communication, February 3, 2011).

However, as Canada has moved from peace keeping to war, the need for occupational therapy services has once again emerged. Currently there is one occupational therapist in uniform Captain Chantel Berube. She created a return to work program in Val Cartier which resulted in a significant increase in the retention of military members, thus demonstrating that soldiers could be retained rather than discharged. This was important to the military as it has been recognized that retention is critically important not only because of their knowledge, but because of cost of training. However, military occupational therapy classification remains an issue under discussion. For those members requiring extensive occupational therapy, currently most receive services in designated hospitals either in Edmonton or Ottawa. As well, those members unable to return to active service are transferred to Veterans Affairs Canada (VAC) where there are occupational therapists currently working as case managers, or often are employed on a private contract basis to work with discharged members and their families.

Both DND and VAC currently recognize the need for increased occupational therapy services – which has been supported by the lobbying effort of CAOT, as well as individuals such as Muriel Westmorland who is currently Chair of the New Veteran’s Charter, and is first Chair of a new augmented Veterans Affairs Advisory Council which has four major sub-committees looking at care of the elderly veteran; mental health of the forces members and veterans; young veterans with special needs; and rehabilitation. Actions such as this continue to create opportunities for occupational therapists to experience increasing opportunities with our Canadian soldiers and veterans for the future. Thus DND and VAC remain two important areas of growth for the profession, both as non uniformed contracted services as well as providing increased opportunities for reservists and those occupational therapists who proudly wear our countries uniform.

 

References

Driver, M. F. (1968) A philosophic view of the history of occupational therapy in Canada. Canadian Journal of Occupational Therapy, 35, 2 53-60.

Dunlop, W. J, (1933) A brief history of occupational therapy. Canadian Journal of Occupational Therapy, Sept, 1, (2) 6-10.

Hebert A B (1933) An Address, Annual Convention: Canadian and Ontario Occupational Therapy. Canadian Journal of Occupational Therapy, Dec 1 (3) 6-9.

Howland, G, (1944). Presidential address. Canadian Journal of Occupational Therapy 11. (2) 31-33.

Irvine, H, (1945). Report on Occupational Therapy in the Royal Canadian Medical Corps Hospitals Overseas. Canadian Journal of Occupational Therapy 12. (2) 35- 41.

Loyal Edmonton Regiment Museum (2001) Military History: Interwar Years: Veterans’ Rights. Accessed February 3, 2011

http;//www.lemuseum.org/ler/mh/interwar/index.html

Psychiatric Quarterly, (1932). Psychiatric Quarterly 6 (3) Death of Thomas B. Kidner.

Robinson, I. M. (1981). Muriel Driver memorial lecture 1981: the mists of time. Canadian Journal of Occupational Therapy

Smith, E (1945). News Notes: Canadian Journal of Occupational Therapy 12 (2) 62-63