Health Committee on March 4th, 2014

[Col Hugh MacKay]

I'm not aware of our actually using that facility for our PTSD patients. Normally, for post-traumatic stress disorder, because of the nature of the illness, we would try to have people in care as close to home as possible and as close to their family support system as possible.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

They're working with the provincial health care system for the most part.

[Col Hugh MacKay]

If there's a requirement for in-patient care, then we would be organizing that through the local civilian hospitals in the province where the individual resides.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

But if we're talking about consultations with a psychiatrist, for example, would we have a military psychiatrist, or would you send that person to the provincial health care system as well?

[Col Hugh MacKay]

At the present time we have both uniformed and civilian psychiatrists who work in our mental health clinics or who work in our operational trauma support centres. We have seven centres that are specifically set up to help with operational stress injuries like post-traumatic stress disorder, and in those facilities we have military and civilian psychiatrists.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

But it's all within the purview of National Defence. So you're not going to the provincial health care system unless they're an in-patient, in which case they would be in the provincial system.

[Col Hugh MacKay]

That's the situation. We look after them in our clinics; however, occasionally there may be somebody who requires some in-patient care, in which case we would arrange for them to be seen in a civilian hospital.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Thank you so much.

Ms. Brenning, I used to sit on the public security committee, and of course we looked at mental health issues in penitentiaries, and the answer we always got—and of course you laid out the same information today—was yes, in the system we have psychologists and we have social workers. But how do we really know that what's being done is enough? For example, it's one thing to say we have all these professionals, but do we have enough professionals? Is demand being met? Is someone who should be getting treatment from a psychiatrist being treated by a social worker? They would show up in the statistics as someone whose problem is being dealt with, but maybe not in the optimal fashion and the stat wouldn't show that it's not optimal. How do we know?

I guess the same would apply to any of you representing your particular department. We know there are staff available, but how do we know if there is a shortfall, if we need to do more, if we need to invest more? How do we know if we need to spend more so that the level of care is optimal? Are there reports or measurements? I can't imagine the government wanting to publish a report saying that we have mental health professionals in the prison system, but it's really insufficient. Where are we going to get this information?

Maybe we'll start with you, Ms. Brenning.

[Michele Brenning]

Yes.

Maybe I can sketch out a little about what we do for our clientele. Upon intake we do a 24-hour nursing assessment that looks at both physical health needs as well as the mental health needs. That's followed up by a 14-day nursing assessment during which you look at the same measures, and we do a more comprehensive screening. That's followed up by referrals to the appropriate team members, whether it's a psychologist or whether it's a member of an interdisciplinary team.

For men, about 47% of our population gets a mental health service, and for women about 75% of our population gets a mental health service. So the numbers are quite high for those who are accessing the services.

Just to scope out—and you might have covered this in your previous work—we have five regional treatment centres that are in-patient hospital beds, and those are designated under the provincial mental health acts, except for Quebec where the provincial system is slightly different, but they are designated hospitals. They're also accredited by Accreditation Canada. We have five regional physical health hospitals as well that are accredited by Accreditation Canada. So we have a number of processes in place that assess, that provide the treatment to the patients, and that also have the infrastructure in order to take care of the needs of patients.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

We keep hearing that there aren't enough psychologists in the system, but thank you for your answer to that question.

[The Chair, Conservative, Ben Lobb]

You're over time.

Mr. Young, go ahead, sir.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Thank you.

[Terence Young, Conservative, Oakville, ON]

Thank you, Chair.

Thank you all for being here today.

Colonel MacKay, I wanted to ask you about the medical services you provide. I'm sure you know that antidepressants are recognized as one of the largest group of drugs given to armed services personnel; certainly they are in the U.S. One out of four soldiers in Iraq in the U.S. Army is on antidepressants, and they can cause a whole range of adverse effects, including suicide and bizarre acts of violence.

I look at your list of medical practitioners, and it doesn't include naturopaths. I personally have had a positive experience. I've seen a naturopath for three years with measurable, really good, positive results, but non-drug therapy so there's no risk of adverse effects. Do you ever support services in the military for naturopaths to be part of the solution for armed services personnel?

[Col Hugh MacKay]

At the present time we do not use naturopaths in the care of Canadian Forces personnel.

The Canadian Forces follows a program of evidence-based care. We are certainly in a position where we will review any evidence that is available and make determinations as to whether or not the evidence would support certain types of care being provided.

[Terence Young, Conservative, Oakville, ON]

Would you consider a pilot project?

[Col Hugh MacKay]

I wouldn't be prepared to make a commitment at this point in time to a pilot project.

The Canadian Institute for Military and Veteran Health Research is investigating the evidence-based treatments for mental health at this point in time—

[Terence Young, Conservative, Oakville, ON]

Well, I'm thinking of physical health as well.

[Col Hugh MacKay]

Pardon me?

[Terence Young, Conservative, Oakville, ON]

Not just mental health but physical health as well.

I understand you're not prepared to consider something just on the suggestion by a member of this committee. But if there was evidence, would there be a time that you might consider it?

[Col Hugh MacKay]

As evidence develops for any particular treatment methodology, we are prepared to investigate whether or not those treatment methodologies may be applicable to Canadian Forces members if it's for their well-being.

[Terence Young, Conservative, Oakville, ON]

I was particularly intrigued by a comment you made that the Canadian Forces Health Services Group has implemented a pan-Canadian electronic health records system. This is really exciting news for me because I live in Ontario and in Ontario the McGuinty-Wynne government wasted $1 billion trying to develop a system like this. That's $1 billion down the tube with very little to show for it.

Have provincial authorities ever come to you and asked you to look at your electronic records system? Has anybody ever said, “Look, you've got something that works, can we look at that? Maybe that'll work in the province of Ontario”?

[Col Hugh MacKay]

We haven't specifically been approached by a province. But certainly, we participate with the Treasury Board CIO on a committee that is looking at, from a federal government perspective, where we should be going with electronic health records. They do look at our health records and try to capture the lessons that we have learned as we've implemented these health records.

[Terence Young, Conservative, Oakville, ON]

Will these health records follow the personnel as they move from town to town if they change assignments?

[Col Hugh MacKay]

We can access any soldier's record from anywhere that we have a base, including overseas.

[Terence Young, Conservative, Oakville, ON]

Any medical personnel who are authorized can access those records.