National Defence Committee on Feb. 14th, 2008

[Some hon. members]

Oh, oh!

[Capt(N) M.E.C. Courchesne]

Thank you, Commander Briggs.

I feel totally out of my comfort zone in answering that. I would have to defer to our mental health specialists who advise the Surgeon General. I would just like to point out to the committee that any treatment introduced into the Canadian Forces is based on evidence and is well-researched. If there were any indications, then I'm sure our mental health subject matter experts would be advising the Canadian Forces to consider it.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Well, you know, the challenge here.... I'm getting to know military acronyms now, but I understand there's another one called RTC, which I understand means resistance to change. I know that wouldn't apply to the medical services here, but it seems that medicine in some realms is very resistant to change. But when you're talking about the stigma of being on drugs and the treatment for PTSD, period—and we know there are complications if you're on medication when you apply alcohol or any other drug to that mix—there's certainly resistance from some of the soldiers coming forward for help in this realm.

Maybe it would be worth looking into whether a simple vitamin supplement might fortify what's available to them in that realm. I just put that on your radar. Maybe somebody could take a look into it, because I'm aware of some very good studies out there and some very qualified neurological specialists who are actually working in that realm.

[The Chair, Conservative, Rick Casson]

Thank you, Mr. Lunney. We'll take that statement as an offer of help.

Over to the Bloc. Go ahead, sir.

[Richard Nadeau, Bloc, Gatineau, QC]

Thank you, Mr. Chairman.

Good afternoon, ladies and gentlemen. As part of your mandate, you deal with members of the military who are in the Air Force, the Land Force or the Navy. I would like to know whether soldiers, male or female, are able to receive medical services in their language, wherever they happen to work in the Canadian Forces? If they are Francophone, are they able to receive medical services in their language when they request them?

[Capt(N) M.E.C. Courchesne]

I will try to answer your question, Mr. Nadeau. Every effort is made to provide services to military personnel in the language of their choice.

[Richard Nadeau, Bloc, Gatineau, QC]

When you say that every effort is made, does that mean that there are cracks in the ceiling and that some soldiers are not able to receive care in their own language?

[Capt(N) M.E.C. Courchesne]

All Canadian Force clinics are not bilingual, but we certainly have staff…

[Richard Nadeau, Bloc, Gatineau, QC]

I'm not talking about bilingual staff; I'm talking about services in French.

[Capt(N) M.E.C. Courchesne]

If a Francophone soldier from an Anglophone unit requests services in French, we will make every possible effort to accommodate him.

[Richard Nadeau, Bloc, Gatineau, QC]

Mr. Darch, is it the same for the Army? Is there a guarantee that one can receive care in French?

[Col A.G. Darch]

Yes, sir. It's a priority to do that.

What you find is that in our clinics there is usually quite a mixture of anglophones and francophones all across Canada. If, for example, a clinic has one doctor and that doctor is an anglophone and doesn't speak French, there will be a med tech or a nurse who does and who is able to translate for him. That's not ideal; perfectly, we'd like everybody to be fluently bilingual, but we've not reached that yet.

[Richard Nadeau, Bloc, Gatineau, QC]

Do members of the Air Force automatically receive service in French, if they request it?

[Capt(N) M.E.C. Courchesne]

The Air Force is my area of responsibility.

[Richard Nadeau, Bloc, Gatineau, QC]

Yes, sorry; I meant to say the Navy.

[Cdr R.P. Briggs]

Sir, I wish I could respond in French. Hopefully, one day....

The navy has the benefit of having two very large clinics, one on each coast. I've been in both clinics, and they're well populated with bilingual personnel. That's not to say everybody is bilingual, but certainly we have that capability, and I think within the CFHS what we strive to have is not for everybody necessarily to be bilingual, but to have that capability.

However--

[Richard Nadeau, Bloc, Gatineau, QC]

I see; thank you. I'm cutting you off only because we have limited time and I have other questions—not because I want to be rude.

Do you only deal with soldiers currently on duty? If a soldier has left the Canadian Forces for some reason, can he avail himself of your services for the rest of his life? How does it work once someone is no longer in the Canadian Forces? Can he call on the Canadian Forces for special services or at least a diagnosis, to have an understanding of what he is dealing with, if the consequences of PTSD start to affect him in his daily life?

[Cdr R.P. Briggs]

There is a great deal of cooperation, sir, with VAC and DND currently. VAC has some OSI clinics--operational stress injury clinics--and DND has the operational trauma stress support centres. My understanding is that veterans, as well as members of the RCMP, can come to the OTSSCs for assessment, so there is cooperation even with the RCMP in that respect.

To be absolutely certain of the--

[Richard Nadeau, Bloc, Gatineau, QC]

If I understand you correctly, Commander Briggs, whether it's two weeks, a year, ten years or fifteen years later, he can go to National Defence to receive health care services.

[Capt(N) M.E.C. Courchesne]

Generally speaking, no. When members leave the Canadian Forces, or when they are released, they must rely on medical services provided by the province where they decided to retire to. Our mandate ends the day a member leaves the Canadian Forces. Our mandate is to provide health care services to members of the Canadian Forces.

[Richard Nadeau, Bloc, Gatineau, QC]

And, is it the same situation if, based on the diagnosis, the problem began when the individual was still a member of the military?

[The Chair, Conservative, Rick Casson]

I'm sorry, but your time is up, Mr. Nadeau. We have to move on. You may have an opportunity to answer that later.

Next is Mr. Rota. Then we'll go back to the government, and then back to Mr. McGuire.

[Anthony Rota, Liberal, Nipissing—Timiskaming, ON]

Thank you.

That was something that I'm leading to. Maybe I'll get to that question anyway, so it works out.

This is about the diagnostic process leading to the treatment. You mentioned in an answer in an earlier discussion that a checkup takes place every two years. I take it that's for every person in the forces. Is that correct?

The post-deployment process has an examination or diagnostic process as well. Both are geared to identify mental illness. When given the information, what recourse does that individual have? You mentioned denial, and that's something that concerns me. Can they walk away and just say they don't want any treatment, that there's nothing wrong with them? Can they return to service? Can they challenge their tests? I'm sure they can just ask to get retested or to have a second opinion.

My concern is with someone who is identified as having a mental illness. What is their recourse? What if they are in denial? What is the recourse for the forces, and what is the recourse for the individual?

[Capt(N) M.E.C. Courchesne]

I'll wade into this one.

I think the issue of denial is not at the time we diagnose a person. In most of our experience—and I'm talking as a medical officer right now—once we have diagnosed them, we try to get them access to care. What's reported as denial is people's not coming forth or not being truthful about the symptoms they're experiencing. We can only give the best diagnosis based on the information the individual is willing to share with us. If they are not willing, there are no tests out there...not yet anyway. We don't have those Star Trek things with scanners. I think the denial is in those people who are unwilling to identify those symptoms. But once someone is diagnosed, usually we will get them to care.

Can they refuse? Absolutely. Nobody can be forced into treatment--not in the military, not in Canada anywhere. They can walk away, and that is their right, as an individual, to refuse treatment. It doesn't mean we will recommend them for full employment, depending on the diagnosis.

[Anthony Rota, Liberal, Nipissing—Timiskaming, ON]

The impression I got was that with the checkup every two years, there's a part of the questioning, part of the interrogation, I guess, or the process, that would identify it. Often what happens is people don't really realize what's going on. They know there's a buzz in their head, they know there's something going on, they're not thinking straight, but they don't really know why. Even with simple depression or something like post-traumatic stress disorder, you don't really know what's going on. You know something's not working, but you're not really sure what it is. And you don't always go forward and say, “Well, you'd better check me for this area.”

I would have thought the checkup would identify or would ask the questions that would lead the person or the professional to identify the illness that is present.