National Defence Committee on Feb. 14th, 2008

[John Cannis, Liberal, Scarborough Centre, ON]

Thank you, Mr. Chairman.

Panel, welcome, and thank you for being here.

My question probably follows the same line as the questions of my colleagues, Mr. Coderre and Mr. Hawn. You indicated you assess our men and women in uniform pre- and post-deployment, but you also made a comment, if I may quote, that “some do not seek help”. I can't possibly accept that, because before they are sent off for duty, they are obviously assessed and cleared as being in stable condition physically and mentally, etc. I'm sure that's the case. Then we ask them to do their duty.

The concern I have is that once they return after a six-month duty or whatever, it's mandatory that they be assessed. Am I correct? Once they are assessed, there's an evaluation report that this individual, for example, has this ailment. They do not seek help, so what is the next step after that? You obviously provide them with information that you've identified this problem and this is your recommendation. Is that the process?

[Col A.G. Darch]

Sir, on my saying they do not seek help, actually I think what I did say was that they delay seeking help.

[John Cannis, Liberal, Scarborough Centre, ON]

It's that they delay it. Maybe I misheard.

[Col A.G. Darch]

It's very common in Canada in general on mental health issues for people to delay seeking help. I'm not sure if it's denial or if they're hoping they can solve the problem themselves. I'm not sure.

With respect to the post-employment process, when they have the screening done there are two parts to the screening. The first is the mental health questionnaire that they complete, and there are a number of validated instruments within that looking for different specific things. Then they have a one-on-one confidential interview with a mental health care professional.

Based on those two things, the screening questionnaire and the interview, if there is any concern that there is any symptom of an operational stress injury, or any other mental health concern, then they are referred for further assessment by mental health care professionals that goes into much more depth and detail.

[John Cannis, Liberal, Scarborough Centre, ON]

That they delay seeking help concerns me.

My concern here, as it relates to the Douglas study, which we all understand and accept, is that in order for us to reach a conclusion today...a study is not something we do in two or six months, but a period of time. We've obviously learned, as was pointed out earlier, from other engagements that we were involved in--Yugoslavia, Somalia, etc.

There is a concern among us, you, and all Canadians for these people. How do we then possibly contemplate sending them back after a said period to go back and engage in a specific theatre?

[Col A.G. Darch]

To put the delay in seeking care into more perspective, of the people who are screened during their pre-deployment screening as possibly having an OSI, over 50% of those people are already receiving care for it. If you go back to 2000 or thereabouts, the average time between the person starting to have symptoms of PTSD or operational stress to getting treatment was five to six years. Now we have that time down to months and in some cases even weeks from the time a person experiences symptoms to when they actually start getting treatment.

[John Cannis, Liberal, Scarborough Centre, ON]

In your view, have we learned from our experience in previous conflicts? Has the plateau or the bar risen, would you say? Given our experiences in Yugoslavia, Somalia, etc., and what we're currently engaged in, are there new approaches, new methods, new techniques that we have learned?

We didn't have to wait for the study because, as was mentioned earlier, it's an ongoing process. Do you feel we're where we should be, or could we be better off? Are we restricted from being better off? And do you know what percentage of the overall budget that is?

I don't know what is allocated in the military budget or what portion would go there. I don't think any of us know that, but if you know, what percentage of the budget is allocated towards this type of service? I don't mean necessarily just yours, but for the overall medical service industry, is it strained? Does it need improvement? Do you have any comments on that?

[Col A.G. Darch]

I do know that from 2004 to 2009 we're investing $98 million into health care. We are increasing the number of health care professionals in the military to 447 by 2009. Other than that, I couldn't tell you what percentage of funds are devoted to that.

[John Cannis, Liberal, Scarborough Centre, ON]

But we're strained in terms of having the professionals, as was mentioned earlier in other presentations. They are there servicing the private sector, and we've got to entice or somehow contract out. Is there any suggestion you might have as to how we can retain or manage that cost? Do we have to look for more money to attract and offer other inducements? Do you have any suggestions?

[Cdr R.P. Briggs]

I know, sir, that the number of uniformed specialists has been one issue. We've been trying to get that number increased, because we realize that we don't have enough specialists to meet the mission. I know that CMP as well as our Surgeon General are engaged in trying to get that to happen. Obviously you can deploy uniformed health care givers, whereas you can't deploy non-uniformed folks.

As well, unfortunately the public service wages can't compete with the civilian public sector. I think that's an issue that hopefully is being engaged as well. We rely on our third-party contractor, Calian, to try to entice these folks, but if you look at downtown Toronto, they're short of psychiatrists as well.

So it's hard to develop this capability. It's tough. It's just tough. But I would say that we are getting a whole lot better. Certainly our screening I think has improved. The enhanced post-deployment process is much better.

I would say that Dr. Mark Zamorski, in the directorate of medical policy, is somebody who you should talk to. He is ramrodding the post-deployment process, and he has done a lot of research and a lot of work with the U.S. DOD in that respect.

Certainly our PHA going to two years and having more mental health questions are the things that have come around since 2002. In 2002 we did our first Statistics Canada-Canadian Forces study on the prevalence of mental health within the CF. That gave us a lot of good information that we've moved forward with.

Our Canadian Forces health lifestyle information survey, CFHLIS, is now moving up from every four years to every two years. The Chief of Military Personnel has okayed that significant expenditure of funds. These survey answers give us a baseline idea of the prevalence of mental health illness for the CF population.

So we have learned, I think. We probably have a ways to go. We'll always be chasing our tail, probably, but I think we've come a long way.

[The Chair, Conservative, Rick Casson]

Thank you.

Over to the government and then back to the Bloc.

Mr. Lunney.

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

Thank you.

Thank you for coming. It's great to have you here today.

I want to pick up on a comment by Colonel Darch about decompression in terms of post-deployment, and I want to take the conversation back another way for just a moment, over to Commander Briggs.

Regarding decompression, part of your advice to the navy was in this area of hyperbaric oxygen. Or I thought I heard you mention that at the beginning of your statement.

[Cdr R.P. Briggs]

I did my postgraduate work in hyperbaric medicine, which involves not only clinical hyperbarics but submarine and undersea diving medicine.

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

Could you explain to the committee for just a moment what effect hyperbaric has and how the military uses it with your divers and so on?

[Cdr R.P. Briggs]

Currently we're not using clinical hyperbarics within the military for anything other than decompression illness, which is decompression sickness as well as arterial gas embolism.

From time to time we will be involved in therapeutic dives in hyperbaric chambers for civilian folks. For example, on Vancouver Island we've done that several times over the last 10 or 15 years where folks have not been able to get to the Vancouver General Hospital. I believe DRDC Toronto has been involved from time to time in doing that as well.

So we do it from more of a civilian point of view. But ever since we really devolved our in-patient care in the mid-90s, as I recall, except in selected areas like Halifax and Valcartier, I believe, we really haven't had the capability to deal with in-patients on a regular basis.

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

Could you comment on the types of conditions that people would have sought help with on those few occasions?

[Cdr R.P. Briggs]

Certainly. There was necrotizing fasciitis, as I recall, decompression sickness, and carbon monoxide poisoning possibly.

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

It drives more oxygen into the system.

[Cdr R.P. Briggs]

Exactly. And that decreases inflammation and a host of other effects as well.

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

So it would be anything that would benefit from more oxygen.

You'd be aware of studies involving chronic neurological problems related to hyperbaric. For example, even kids with cerebral palsy have used hyperbaric in some instances. Does it improve neurological function?

[Cdr R.P. Briggs]

There have been some investigational studies, I believe. I don't think it's an approved indication yet in the United States, though.

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

No. I know there certainly are centres that are using it in the United States.

I guess the interesting point is there's evidence that when you compress the body and drive more oxygen into it, even brain injuries can be reduced. It's outside-the-box thinking, but there is some research going on in that realm.

It's a question I've raised before, but I'll raise it again since we have three medical experts and advisors here—and I know how well briefed all of you military people are, so you'd be aware of the questions I've raised before.

In about the last 20 years there's been a tremendous increase in research into the effect of nutrition—vitamins, minerals, and nutrients in physiology and certainly on neurological functions, research into vitamin B1 and thiamine in supporting the nervous system. A lot of people take anti-stress vitamins that always contain vitamin B, and so on.

I know they're waiting for me to mention folic acid in terms of heart disease.

[Some hon. members]

Oh, oh!

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

I know you have all our soldiers taking it!

We know that many of the members here probably should be taking some niacin to keep their blood pressure down—it might improve performance in the House.

There are indications that vitamin fortification might help people coming under stress. Has anybody even looked at it that way?

I'm glad to see you use terms like “we're a learning organization” and are looking at “lessons learned”. Here we have an outside-the-box situation where our Canadian soldiers are in a compressive zone, in terms of the combat zone and the assignment they're currently pressed in right now. Is anybody looking at outside-the-box solutions to maybe help with this? Are you aware of any studies that way?

[Cdr R.P. Briggs]

I'll defer to Captain Courchesne.