National Defence Committee on March 4th, 2008

[LCol Theresa Girvin]

When I arrived, there was an American psychiatrist, and she left after a month and a half or two months. She was with the American military. They rotated their team, which included the psychiatrists, and they brought in a new team that was made up differently.

[Claude Bachand, Bloc, Saint-Jean, QC]

I understand that when Canadian psychiatrists go to Kandahar, they may have to treat Americans, Dutch or Estonian members of the military. What happens in the field?

[LCol Theresa Girvin]

Yes.

[Claude Bachand, Bloc, Saint-Jean, QC]

When the American psychiatrist left, you were the only one there. So there was only one psychiatrist for approximately 15,000 people at the camp in Kandahar. Is that correct?

[LCol Theresa Girvin]

I believe so. I think the population in the CAF is more like 10,000, but I might be wrong.

[Claude Bachand, Bloc, Saint-Jean, QC]

Right. I imagine that you were working full time. Was one psychiatrist enough? I'm surprised by what you're saying. I thought that the physicians and psychiatrists we sent there were supposed to work with Canadians only.

Is one psychiatrist enough for 10,000 or 12,000 people?

[LCol Theresa Girvin]

The medical facility there is multinationally staffed, so we work alongside our American colleagues, the Dutch, the Finns, and in some cases the Australians and the Brits. For the most part the Brits have their own medical people, and people would come in from the British military and see their own British clinic facility, so we didn't see a whole lot of the Brits.

We had regular clinic hours, Monday through Sunday, and we could be on call at any time. But there was also a doctor on call 24/7, so if someone needed to be seen at three in the morning there was a physician who could see them. It might not be a psychiatrist, but if they had concerns and needed to consult, they could always call me.

[Claude Bachand, Bloc, Saint-Jean, QC]

Based on your experience, would you say that people at the front who are involved in combat operations suffer greater psychological trauma than those who stay in the camp?

[LCol Theresa Girvin]

I'm not sure. Could you repeat the question?

[Claude Bachand, Bloc, Saint-Jean, QC]

People going into combat zones, are they more inclined to have PTSD than the ones left behind, the ordinary people who work in the camp?

[LCol Theresa Girvin]

I can give you some general answers. They come from past experience—work done during other conflicts in other militaries, and work done in civilian psychiatry.

You are more likely to develop post-traumatic stress disorder when you have traumatic stress that is more severe psychologically. Yes, being in combat on the front lines is generally more stressful. But balanced against that is the fact that these guys are well trained. This is their job, their career. I think this is protective for them, to a certain degree.

Someone on CAF who is not expecting to have a rocket fall in the camp might find the experience very psychologically traumatic in some ways. So although they might have fewer traumatic experiences, they can be just as at risk for PTSD.

[Claude Bachand, Bloc, Saint-Jean, QC]

We talked about confidentiality earlier. We heard that members of the military were afraid to go to a psychiatrist like yourself or go to a post-trauma centre such as the one in Valcartier because the information in their file may be passed on to their commanding officers.

Could that happen? To what extent is the treatment received by these soldiers kept confidential?

[LCol Theresa Girvin]

A person's medical information, their medical file, is confidential.

There are two pieces of information that go to commanders so they can command effectively. One is whether the person's employment should be limited. Two is the prognosis, or roughly how long their employment should be limited.

As for diagnosis or personal medical information, that does not get released. The information on a person's medical chart, the paper it is on, belongs to the CF, but the information contained on that chart actually belongs to the patient. If the person wants a copy of it and wants to give it to the commanding officer or wants to discuss it with the supervisor, that is up to him or her. That's not inhibited in any way. But as for whether anybody in the health profession hands information on a medical diagnosis or personal medical information to commanders, no.

[Claude Bachand, Bloc, Saint-Jean, QC]

What is the perception of PTSD in the Canadian Armed Forces? I remember the sad events that happened in Edmonton recently, where an allegorical tank was used to poke fun at PTSD. Is it really taken seriously in the Canadian Armed Forces? Do you think that soldiers who receive treatment for PTSD receive good treatment? Is every possible effort being made to rehabilitate them?

[LCol Theresa Girvin]

Sir, your question is about the general perception of post-traumatic stress disorder by the military. It's taken very seriously by health care providers, by mental health care providers, obviously.

[Claude Bachand, Bloc, Saint-Jean, QC]

Is it by the high brass?

[LCol Theresa Girvin]

Absolutely. There are ongoing seminars, there is ongoing teaching integrated into basic medical officer teaching at all levels. People are being educated about various mental health issues and the effects of stress. Information is being provided, but as you are probably aware, providing them with the right information doesn't always totally eliminate people's biases.

[The Chair, Conservative, Rick Casson]

Thank you.

We'll go to Ms. Black.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

Thank you very much.

Thank you very much for coming. I enjoyed your presentation. You've had a very interesting career for 19 years.

Some of the members of this committee visited Edmonton, and we met with some of the families there. I'm just wondering about your experience with PTSD and how it impacts on the family. Does the entire family need to be included in the treatment? If that is the case, what challenges does that pose for people without close family? Is treatment in any way different for people who don't have family members or close family?

I also wonder how that impacts on the issue of health care for the person in the Canadian Forces coming under the military responsibility, and yet health care for family members comes under the jurisdiction of the provincial government of the province in which they're residing.

[LCol Theresa Girvin]

I'm sure I've forgotten some of those questions. First is how the family is affected.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

Are they included in the treatment process?

[LCol Theresa Girvin]

Post-traumatic stress disorder oftentimes, in fact I'd say much more often than not, will include symptoms like irritability and anger. You can imagine how much that might affect an intimate relationship between a spouse and a member or between the children and the parent.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

That's my point.

[LCol Theresa Girvin]

So yes, it does affect them a great deal. Right from the start, they're invited to participate, for example, in the assessment process. If a person has a family, social work services are consulted.

What I also find is that a lot of times it's the spouse who actually urges the member to get help. It's sort of related to Dr. Brunet's studies. A lot of people don't recognize when they're having problems, but their spouses will recognize the change.

So how are they included? They're included in the assessment process. They are allowed a certain amount of support and treatment services from the social workers in the military. But they aren't allowed medical care. We don't have a mandate to provide medical treatment for non-CF members.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

So there was the issue in Petawawa with the children there who weren't able to access counselling services. Did that continue to be a problem in the Edmonton area as well, where you are?