Oh, oh!
Evidence of meeting #16 for National Defence in the 39th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was doctors.
A recording is available from Parliament.
Evidence of meeting #16 for National Defence in the 39th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was doctors.
A recording is available from Parliament.
4:50 p.m.
Voices
Oh, oh!
4:50 p.m.
NDP
Dawn Black NDP New Westminster—Coquitlam, BC
Thank you very much for presenting at our committee today.
We were in Kandahar as a committee last year, and we saw the medical services there and talked to some of the social workers and doctors. I was certainly quite impressed with their commitment and the level of care they were able to provide in a very small and intense kind of environment.
One of the issues that I'm quite interested in is what happens at the forward operating bases. Our study is specifically around post-traumatic stress disorder, brain injuries, and mental health services. We did go up in a helicopter, but we didn't get all the way to the forward operating base; we had to come back because of the weather.
Can you tell us a little bit about that? What kinds of health services are available there under those kinds of conditions, and what would happen if someone exhibited signs of mental distress in one of the forward operating bases?
4:50 p.m.
BGen Hilary Jaeger
Thanks.
Each of the forward operating bases has a team of medical personnel. Usually the head of that team is a mid-level provider, what we call a physician assistant. It's not well known in Canada, but it's well accepted in the United States. I think you're going to hear more and more about them in the Canadian health care system.
Up to now, we've trained them ourselves, and we're very proud of their capabilities. They are senior NCOs, usually warrant officers, and they will have a team of medical technicians with them that varies in size. They actually have pretty good diagnostic skills, and they have very good radar for what's going on with soldiers because they've been soldiers for a long time.
If they see somebody that they or the chain of command suspects is having difficulty, they will usually observe them. They'll take them into a small tented area, or sometimes it's surrounded by concrete barriers and Hesco Bastion. They will usually observe the guy for one or two days and then make a call on whether he is improving and just needed some rest to get himself back on track or whether he needs to be seen further back.
You don't necessarily make the decision to transport back lightly, because sometimes moving from place to place can be one of the more risky things to do. They'll try to use a helicopter, which is less risky.
On top of the core team at the forward operating bases, headed by the physician assistant, the members of the mental health team, who spend most of their time back at Kandahar airfield--the psychiatrist, the social worker, the mental health nurse--will also make periodic trips from time to time just to get the lay of the land out at the forward operating bases, introduce themselves and sort of walk around, along with, of course, the chaplains, who are a pretty good early warning system as well.
4:50 p.m.
NDP
Dawn Black NDP New Westminster—Coquitlam, BC
We've met with them too.
Can the medical practitioners prescribe medication?
4:50 p.m.
BGen Hilary Jaeger
They have a limited range of medications they can prescribe independently. Psychoactive medications are not really part of that list. If they need to use psychoactive medication, they'd have to refer them back.
4:50 p.m.
NDP
Dawn Black NDP New Westminster—Coquitlam, BC
Thank you very much.
At these meetings I've asked before what changes have been made within the Canadian Forces over the last ten years in terms of mental health services and mental health diagnoses. You've obviously had great experience. I wonder if you could give us some concrete examples or some stories that would give us some examples of how much change has occurred and in what way.
4:50 p.m.
BGen Hilary Jaeger
It's hard to say what hasn't changed. That would be perhaps a shorter answer.
When I started treating military patients in the mid-1980s, I hardly ever saw anybody come in admitting they had a mental health problem. They came in complaining of back pain. They came in because they were drinking too much; they got into fights in the bars. Yes, they had mental health problems, but they would never come in admitting it. That has changed quite radically. There is still reluctance, but it's much less. It has to do with increased awareness. It has to do with the work of a lot of people, like Senator Dallaire.
I know you had questions about confidentiality. The committee may be interested to know that in 2000 there was a complete change. Before 2000, commanding officers had the right to know diagnoses and to sort of pry into people's medical details. A CANFORGEN, a Canadian Forces-wide message, issued in 2000 changed that. I don't think it's a coincidence entirely that a lot of our increased mental health workload has occurred since then. People are more able to come forward.
We undertook the Statistics Canada survey, which has been the subject of a lot of discussion here, precisely to find out what we needed to build. We needed to have some baseline idea of what's going on out there before we designed a program to improve our capabilities.
4:50 p.m.
NDP
Dawn Black NDP New Westminster—Coquitlam, BC
Is that the same study Dr. Brunet talked about, where they identified that 57% of people who exhibited some level of mental distress were not asking for treatment or not accessing it?
4:55 p.m.
BGen Hilary Jaeger
That's the same study that was done in 2002. Statistics Canada did a great job for us in doing an incredible survey. Joel and his team couldn't have...the challenge they have now is to find those almost 200 extra mental health providers...if we hadn't extrapolated from that survey what the real needs were out there.
4:55 p.m.
NDP
Dawn Black NDP New Westminster—Coquitlam, BC
Was that a survey of the Canadian Forces here in Canada, not people on deployment?
4:55 p.m.
BGen Hilary Jaeger
It was a sample of the Canadian Forces. I don't know that it systematically excluded people on deployment.
4:55 p.m.
BGen Hilary Jaeger
Most of the people who responded were back in Canada, a mix of regular forces and reserves.
4:55 p.m.
NDP
Dawn Black NDP New Westminster—Coquitlam, BC
When you were here at the first meeting at which you presented, General Semianiw spoke of the family as the bedrock of operational effectiveness.
When Lieutenant-Colonel Girvin was at our last meeting, she said that post-traumatic stress disorder most often manifests itself with anger and irritability, and most often it would be a family member who might recognize this.
What does the treatment entail? Does it entail the entire family, or the spouse, or the children, when you're dealing with a member who has post-traumatic stress disorder?
4:55 p.m.
Conservative
4:55 p.m.
BGen Hilary Jaeger
We're just warming up.
4:55 p.m.
Conservative
4:55 p.m.
Conservative
James Lunney Conservative Nanaimo—Alberni, BC
Mr. Chair, thank you very much. I know time is short, so we'll just fire away here. I'm glad to have you here.
I pick up on your comment about the trauma and mortality rates in Afghanistan. We're justifiably proud of the good work that's being done on the front lines. So we certainly appreciate the great front-line work patching people up that our services are providing over there.
Going back to the Auditor General's remarks here about who's really in charge of health care services, if I understood your response, you mentioned that oversight has been turned to a spectrum of care committee. Could you explain to us who that is?
4:55 p.m.
BGen Hilary Jaeger
I'll do my best. Governance is one of my favourite subjects, so the chance of my running off at the mouth and going off on tangents is fairly high.
The spectrum of care committee is one that has authority over certain aspects of governance. It decides what things will be provided to members of the Canadian Forces at public expense and how much of those things will be provided.
In the past, basically I was given a pot of money and told, “Sort yourself out, and if you have to make trade-offs to make things affordable, just don't make any headlines while you're doing anything.” That was sort of the governance.
We wrote the spectrum of care to get it codified, so that it wasn't arbitrary and people knew what they could expect. Then we actually put in place the committee that would make the decisions about this.
We struggled for a while to get the right level of representation on that committee. You have to understand that the Canadian Forces is not a board of governance culture; it's a chain of command culture. I have a boss, and for most members of the Canadian Forces, as long as they do what their boss tells them to, then what's the problem? The problem is that this is the health care system for the members of the Canadian Forces; it is not just the operation of the Canadian Forces health services group.
So now we have managed to achieve—with the spectrum of care committee, at least—representation at the L1 minus level. So the seconds-in-command, essentially, of the army, navy, and air force sit at the spectrum of care committee, as does my deputy surgeon general as the professional advisor.
The things that get considered by the committee should be brought up from the environments or from the force employers. They get debated. My staff researches what it is likely to cost, how many people are going to need to avail themselves of this service, and is there an evidentiary basis for including this service. The committee comes up with a recommendation, and that is taken forward to the Armed Forces Council.
I know there's a hot debate now about laser eye surgery. I don't know how that one is going to come out. It's not a medically necessary thing to do, but it's something the operators believe vehemently improves operational effectiveness. So they seem to be willing to invest at least some money in laser eye surgery.
5 p.m.
Conservative
James Lunney Conservative Nanaimo—Alberni, BC
Thank you for that clarification.
I just want to jump back to the last meeting we had, with Dr. Theresa Girvin and Dr. Alain Brunet here, and pick up on the question from Mr. Coderre concerning the reluctance of some officers or soldiers to go on medication, regarding their deployability, and so on.
There was some discussion about EMDR, or eye movement desensitization and reprocessing, as a non-invasive and non-drug approach that seems to get some good results. Could you comment on how widely that's used? With the new personnel coming on, are you seeing promise with this, and is it being used?
5 p.m.
BGen Hilary Jaeger
I know that providers at both our clinics and clinics with Veterans Affairs were comfortable with the treatment. I couldn't tell you how widely spread that expertise is--Joel may know--but I do know that it's considered an effective treatment and is being used at many, if not all, of our OTSSCs.
5 p.m.
Conservative
5 p.m.
Conservative
