National Defence Committee on March 11th, 2008

[The Chair, Conservative, Rick Casson]

I'll call the meeting order.

Today we continue our study of the quality of life in the Canadian Forces, with an emphasis on post-traumatic stress disorder.

We have witnesses today from Veterans Affairs Canada: Kathy Darte and Colonel Don Ethell. Welcome. From the Department of National Defence, we have Major Le Beau, Shawn Hearn, and Cyndi Greene. Welcome to all of you.

I understand, Colonel, that you're going to start with some opening comments. What we usually do is give you the time you need to do that and then we'll open it up for a round.

You're the only witnesses we have today. We have almost two hours. There will be bells ringing at a quarter after five for us, calling us back for a vote, so that will give us lots of time to hear your presentation and get into questions from the committee members.

Sir, the floor is yours.

[Colonel, Retired) Donald S. Ethell (Chair, Joint Department of National Defence and Department of Veterans Affairs Operational Stress Injury Social Support Advisory Committee]

Thank you, sir, and thank you for the introduction.

Before I give you my introductory remarks, you indicated who the team is. I in fact am not from Veterans Affairs, and I don't work for either department. I'm the volunteer chair. I wish I were from Veterans Affairs, with their wage scale.

The two co-managers on either side of me are from DND and VAC. We have two peer support coordinators. I'll come back to them in a minute. They're the “coal face” people, as we call them, who deal with the peers.

There are some members of this team who have been involved with the operational stress injury social support program from the beginning, and one of us, I believe, will be able to answer any questions you may have once I'm finished this presentation.

I understand you've been given a printed version of the slides. I will not read all of the slides. Rather, I will hit a few of the high points and focus on what's new with the operational stress injury social support program, the key determinants to its success, and the major challenges that face the organization.

I am sure that most of you are familiar with the term “operational stress injury”, or OSI. As you know, OSI is not a diagnostic term but rather a term developed by the OSI social support organization here in Canada to put the focus on the injury and to work toward de-stigmatization of the condition. The term is now in use by most clinicians as a way to encompass all operationally related mental health issues. This includes some elements of the U.S. military.

The presentation package contains some background on the joint DND and Veterans Affairs Canada OSI advisory committee, which I chair. This group, formed in 2002, brings together a group of interested people from Natinal Defence, Veterans Affairs, veterans organizations, the RCMP, and various mental health professions three times a year to provide advice to the two co-managers, Kathy Darte and Major Mariane Le Beau, and feedback from me to the senior management in both sponsoring departments--namely, the chief of military personnel, Major-General Walt Semianiw, and the assistant deputy minister of veterans services, Brian Ferguson.

OSISS itself came into being within DND in the spring of 2001 in response to input from SCONDVA, the Croatia board of inquiry, and the DND Canadian Forces ombudsman's office. Shortly thereafter, recognizing the shared responsibility for the welfare of CF members and veterans and their families, a partnership was formed with Veterans Affairs Canada.

OSISS was clearly the result of the vision and drive of one officer--similar to Major Le Beau--by the name of Lieutenant-Colonel Stéphane Grenier, the founder. He has recently returned from a tour in Afghanistan, and is now the OSI special adviser to the chief of military personnel. He and General Couture, then ADM of human resources in DND, and ADM Brian Ferguson are the ones who kicked this off. But as I say, Stéphane Grenier is the founder, and he is dedicated toward this OSISS program.

His VAC partner in that early work, Ms. Kathy Darte, is here today. She continues her great work alongside Mariane Le Beau from DND.

The mission of OSISS is twofold: to develop social support programs for members, veterans, and their families who have been affected by operational stress; and to provide the education and training that will eventually change the culture toward psychological injuries in the CF.

The key to effective peer support--the heart of the OSISS program--is the initial selection of the right kinds of people. For example, I direct your attention to slide three, and to the peer support coordinators who are here today. Shawn Hearn is the peer support coordinator in Newfoundland and Labrador. Cyndi Greene, although she's a Newfoundlander, is the peer support coordinator in Calgary and southern Alberta.

Both of the aforementioned, like all of the peer support coordinators serving military members and veterans, have suffered from an OSI. They are now at a point in their recovery where they can help others like them, which is the basic ingredient of peer support.

Aside from the basic two-week training program they all receive, the OSISS program runs a far-reaching continuous education phase, including self-care for peer support coordinators and the family of peer support coordinators. In the end, it all comes down to developing trust with the members and the veterans and the families who come forward, allowing them to proceed at their own pace and providing a support shoulder to lean on. As Shawn has indicated to many of his peers throughout the years, it is a beacon of hope.

It is essential that the peer support workers understand the role they play: encourage to seek treatment, acknowledge the problem or problems, facilitate referral to a professional resource, and assist with access. The danger for the peer support coordinator is burnout, compassionate stress, trauma, depression, and physical illness. What is absolutely amazing and an attestation to the quality of the people involved, selected by the co-managers left and right, is that the level of care provided by both departments in this program is such that there have been very few problems with the peer support coordinators in the years this program has been running.

There are several new initiatives to talk about in OSISS, which you are welcome to pursue in a question period. They include the bereavement peer support initiative, which delivers support to the immediate families of those who have lost a loved one in military service, again to be delivered by those who have been through a similar event. Though not technically part of the OSISS mandate, it's being done anyhow under the leadership of the managers left and right.

There has been considerable international interest in the success of this program. Ms. Kathy Darte and Major Le Beau can talk to some of these approaches at more length during the Q and A.

The third-location decompression operations in Cyprus provide members rotating out of Afghanistan an opportunity to spend a few days transitioning from the theatre of war to their living rooms and bedrooms, all part of a significantly enhanced redeployment program. Shawn Hearn and Cyndi Greene, the two PSCs we have with us, have both spent time with the troops in Cyprus and can speak on that during the question period.

We have learned that there are several key determinants to success in a program like this. The first and most important is the need to involve peers such as Greene and Hearn right from the beginning in the program development and policy. An excellent interdepartmental partnership is essential, as is the use of a multidisciplinary management team. This OSISS program is a sterling example of excellent cooperation between DND and Veterans Affairs Canada.

The emphasis on self-care and realistic boundaries has been another key area. As I mentioned at the beginning, it is essential to recruit and screen the right people, and this is perhaps the area in which this program has excelled, at least in my opinion. To provide relief for that key group of peer support personnel, it is vital to recruit, train, and retain a network of volunteers. I am sure Cyndi and Shawn will want to talk about volunteers; while they're here, their volunteers are covering the bases with the peers they have on file.

In terms of challenges, there are certainly some out there. For example, there are a number of systemic barriers in place. Some clinicians are still suspicious of those who are not mental health professionals meddling in their business. On the other hand, others who have experienced the value of working with peer support coordinators literally sing their praises.

Just the physical size of the territory covered by this very small group of peer and family peer support coordinators is amazing. We recognize that many soldiers are off in the rural areas where they just literally cannot be reached. Especially for reservists who may live far away from a major base, getting to where we have a peer support coordinator or getting the PSC to the soldier can be a very real challenge. Our two PSCs today can address that challenge in a few moments.

Growing that volunteer network I referred to earlier is another challenge the PSCs face each day. Once the investment has been made to find and train these folks, retaining them becomes another challenge. The peer support groups that are such an important part of this program also take a lot of effort, time, and coordination. Because many peers are reluctant to use on-base facilities, even finding a place to meet can be problematic.

The last challenge on this list is certainly not the least. Let there be no doubt that the culture of the Canadian Forces in dealing with mental health issues has been changing, albeit slowly. However, there's still a long haul ahead. Education and training are key to culture change, and as is often the case, the longer-term investments are frequently overtaken by the shorter-term demands. To even sustain the gains made in the last few years, great effort is required. This is and will remain a significant challenge.

Before I finish I would like Shawn Hearn and Cyndi Greene to give you a two-minute briefing on their activities.

Shawn.

[Shawn Hearn, Peer Support Coordinator, Newfoundland and Labrador, Department of National Defence]

Good day, ladies and gentlemen. My name is Shawn Hearn and I'm the peer support coordinator for the province of Newfoundland and Labrador. I was born in 1972 in St. John's, Newfoundland, and was raised in a very small community, a place called Colinet on the east coast. I now live in Mount Pearl. I'm the youngest of 12 kids. I have five brothers and six sisters. My mom and dad are saints, because they raised all of us. I have a grade 12 education.

I joined the Canadian armed forces in 1990 as a member of the regular force, the Princess Patricia's Canadian Light Infantry. I also served with the Canadian Airborne Regiment. I was medically released from the Forces as a member of the 3rd battalion, Princess Patricia's Canadian Light Infantry para company.

In 1994 I was deployed to Bosnia and worked as a battle group sniper. I was diagnosed with post-traumatic stress in 2000 and medically released from the Canadian armed forces under a 3(b) in June 2000.

My road to recovery has been quite interesting. I've had several hospital admissions along the way, and I started therapy in 2000, which I'm still in today. With the help of a local psychologist and psychiatrist, I began some peer support on the ground at a local level. I was contacted in 2002 by the OSISS founder, Lieutenant-Colonel Stéphane Grenier. I began to work half-time at the OSISS program in 2002 and 2003 on the advice of my therapist to not jump back into the workforce.

In 2003 I became a full-time employee with the OSISS program. I'm still with OSISS today as the coordinator for Newfoundland. I'm married and I have a baby girl who turned three on February 21.

Thank you.

[Cyndi Greene, Peer Support Coordinator, Calgary and Alberta South, Department of National Defence]

Hi, ladies and gentlemen. My name is Cyndi Greene. I too am from Newfoundland and Labrador. I was born and raised in a small town of 150 people called Pinware on the southern shore.

I joined the regular force in 1989, immediately after high school. I was a cook for 15 years. In my first six years I served with 1 Combat Engineer Regiment out of Chilliwack as one of the very first females integrated into the field units. With them I did two tours of duty. In 1992-93 I deployed with 1 Combat Engineer Regiment to Croatia, and then I went back to Bosnia with them in 1994. In 1995 I was posted to the mighty warships out in Esquimalt, and we did many things with them as well.

Like Shawn, I was diagnosed with post-traumatic stress disorder as a result of my service in 2000. I was medically released in 2004. I started working with the OSISS program as a volunteer in Victoria, British Columbia, and eventually moved to Calgary to take the job of peer support coordinator for southern Alberta. I am based out of Calgary, but I work the whole area of southern Alberta.

I have been with OSISS since February 2006, and like Shawn my road to recovery was quite lengthy. There were administrative issues with work before I finally figured out what was going on. I spent three months in a treatment centre for prescription medication addiction, and from there I saw a psychiatrist and a psychologist. It's still ongoing, although it's not as frequent as it used to be.

I am married to Brad. We have a daughter named Rebecca, who is ten, almost thirty.

I am in contact with roughly 197 ex-military and a few still serving in southern Alberta.

Thank you.

[Col Donald S. Ethell]

Ladies and gentlemen, thank you for your attention.

With that, I would like to invite your questions, Mr. Chairman.

[The Chair, Conservative, Rick Casson]

Thank you all very much. And, Colonel, thank you for your years of dedication to Canada and to Canadians. We appreciate your efforts, all of you.

We will have a seven-minute round, starting with Mr. Coderre.

[Denis Coderre, Liberal, Bourassa, QC]

Merci, monsieur le président.

I'm pretty sure, Colonel, it's not over and you still have a lot of years to give for Canada. Kudos for your job.

Major, ladies and gentlemen, I think we probably have the most important witnesses today, because if we want to know what's going on, through the troops' minds, and the way we treat our soldiers and those who are released, it is important to know what's going on in the field.

My concern right now is that we witnessed issues like Agent Orange, Operation Plumbbob, and now we've heard about the Chicoutimi. What's your comment on those soldiers who feel left alone?

First of all, as you noticed, there is a matter of culture in the Canadian Forces regarding mental illness. At the same time, it sometimes falls through the cracks. There is so much red tape inside the department itself. What would you say about that?

If we have some recommendations to make—and I know that you're not dedicated to a clinical approach—if we are thinking about how we should treat our soldiers, who truly suffer and feel alone sometimes and have to wait years and years sometimes even before having an answer, what's your comment on that?

[Col Donald S. Ethell]

I'll answer that and then I'll ask the two co-managers to provide some input.

Thank you for the remark about service. I've spent a lot of time out of this country and in some contentious areas. To be quite frank, I'm an OSI sufferer myself.

Out in the field, a commander in the field—and I'm not speaking for DND, but I'm speaking as an individual now—has a reasonable amount of autonomy in regard to decision-making, including an example like the Chicoutimi or incidents where a terrible event happens. The commanders on the ground are the ones who have to make the initial decisions. Sometimes--I don't like to use the term “resources” because that may mean money to you--the people and the facilities aren't available to take the appropriate action right then. Then these things will come back to haunt them, such as the Gulf War syndrome, the depleted uranium, the smoke and whatever in the submarine that probably nobody could have controlled, and so forth, and now they're suffering.

Having said that, if you look at what's happened with the new government with regard to settlement of various things that have been pending for years, be they in Suffield or Gagetown, these things do take time. Even the medical community.... Once again, I'm not speaking for DND, but having talked to a number of doctors, there are some who call it the rabbit nest. They know there's something wrong, but they just can't identify it. They'll do what they can for the individual.

Mariane.

[Major Mariane Le Beau, Manager, Operational Stress Injury Social Support, Department of National Defence]

There are many aspects to your question, Mr. Coderre.

I want to speak to the issue of falling through the cracks. It will always be a challenge, inasmuch as you do not control one's life completely, and neither should we as a military institution. I would like to hear some of the comments that Cyndi and Shawn may have with regard to that. But it is an issue we have struggled with and will continue to struggle with in terms of how we can do better outreach. How can we be known? How can we make sure that those people who need help know that we are here and that we can outreach to them, so that they will trust and come forward and ask for help? That's at the OSISS level.

At the most systemic level of the Canadian Forces, and I will say under DCSA, the director of casualty support and administration, in the last year there has been a lot of discussion and steps have been taken to try to counter that--people falling through the cracks--with the creation of the detachments, which I believe you've heard of here, and with some of the plans also to expand these kinds of services across the country. The Canadian Forces are very conscious of trying to outreach to all of their regular and reserve members. They're working really hard to do that.

Sir, will there ever be a perfect net? I don't think that will ever happen, but outreach is something we are constantly working on.

[Denis Coderre, Liberal, Bourassa, QC]

But one of my concerns is that sometimes it sounds like divide and conquer. I'll explain.

There is some lack of transparency or there is a perception of a problem with all the red tape. It's not just based on the clinical approach; it's just to take care of their own situation.

You spoke about Bosnia. There were some problems. There were some of our fellow troops who experienced PTSD, and there was also the issue of uranium. You had Operation Plumbbob in Nevada in 1957; they're still waiting for an answer, and they don't have it.

It's the same thing now regarding the Chicoutimi. After three and a half years, now they're going to check the content of the smoke.

All I'm trying to understand—for the benefit of our future recommendations—is that we spoke about a systemic approach. What should be the best approach to make sure that those people.... At one point, they feel so lonely, and kudos to your organization, because it's all about the follow-up.

But at the same time, if we want to settle those issues, we need to find checks and balances in the process under due diligence that will permit those individuals to see the light at the end of the tunnel. It's more than just a clinical issue. It's clear that they even have problems getting information on their own files.

And they speak to you all the time. What are they telling you about that, Major, Colonel, Cyndi, Kathy?

[Kathy Darte, Manager, Operational Stress Injury Social Support, Veterans Affairs Canada]

Our program is about that. It's about peer support.

And yes, I think if you directed the question to both Cyndi and Shawn, they would both say “Yes, we fell through the cracks. We were very lonely. We were isolated. We did not know what to do and there was no one to help us.”

Peer support is helping break that isolation, helping break that loneliness. It is helping veterans and CF members to get through the red tape, the bureaucratic process.

Oftentimes the peer support will go to visit veterans in various locations. They'll go to their homes, and they'll even see a stack of mail, like this, that the veteran or the member has not been able to open or maybe opened it and was not even able to read, based on the condition or the injury they were struggling with.

What the peer support coordinators are all about is helping to bring those individuals out of their basements—we often say—and back into the world they once were in. They work with them and they work with the health care providers. They work with my department, Veterans Affairs, and they work with DND to help deal with the various issues you have raised.

[The Chair, Conservative, Rick Casson]

Thank you. We'll hopefully have time to get back to some of that.

Mr. Bouchard, for seven minutes. Go ahead.

[Robert Bouchard, Bloc, Chicoutimi—Le Fjord, QC]

Thank you, Mr. Chair.

Thank you for appearing before the committee.

In my region, a 26-year-old soldier died in Afghanistan. I attended this young man's funeral. His spouse is expecting a baby. I saw the parents, the grandparents and the whole family, and everyone was deeply affected by this sad event. Could you explain in detail what kind of support you provide? What support is given by the Department National Defence or the military to the soldier's spouse, parents and loved ones?

[Maj Mariane Le Beau]

I will describe the support provided by the Operational Stress Injury Social Support Program. In September 2006, we formed the first group of volunteers who would offer social support to people—such as spouses, parents and siblings—who had lost a loved one in Afghanistan. The key component of our program is social support, which I can explain. I cannot, however, give you the details about what a designated officer can do or the benefits provided by Veterans Affairs Canada.

The OSISS program began in 2006 with nine volunteers. Last October, we offered a second training session and we now have a total of 17 volunteers. They will provide support across Canada, especially by phone. After all, the family of someone serving in Edmonton may very well live in New Brunswick. And part of the family may live in western Canada.

Approximately 10 days ago, we created a discussion group with volunteers to take stock of the program and discuss what direction it should take. On the basis of the comments and the vision expressed by the participants, we have decided to request a budget to create permanent positions so that we can continue to provide and develop this support service. It is aimed at people who have lost a loved one, who may be a member of the Canadian Forces or a veteran. We feel that there is a real need for this in the long term.

[Robert Bouchard, Bloc, Chicoutimi—Le Fjord, QC]

If I understand correctly, you are talking about phone calls to the spouse or parents. Could you tell us how long that support is offered? Is it for one, two or three months?

[Maj Mariane Le Beau]

It can vary a great deal. Since this is a new program, it is hard to talk about trends. Up to this point, we have provided support to 77 people. In some cases, it may be a spouse, but it may also be parents and siblings. This support can be provided immediately. It is arranged through the designated officer. Some people call 48 hours after the death has occurred and ask for support, whereas other people wait for six months before doing so. Some people want to be called once a week, whereas other people may end the process but come back a month or two later. I cannot really tell you what is typical, since the program has really not been around very long. And we are learning as we go along.

[Col Donald S. Ethell]

If I may, sir, it also is by osmosis. One of my other lives in Calgary is organizing an annual ceremony for all the fallen, except Korea, since the Second World War: 188 names are engraved on the Wall of Honour, including the 79 plus the diplomat from Afghanistan, plus the 31 from Egypt, etc. All the surviving relatives, as we call them, are on the invitation list. It has grown in the last four or five years. The informal and formal receptions are very emotional ceremonies. They are there or they hear of one and then come out.

A separate park in Garrison Green is mission-specific to the Buffalo 9. The Syrians shot down that aircraft. We had 38 relatives who finally came out of the woodwork, if I could use that term, and finally got together for some closure. They had never been honoured. In this case they were all there. It was very emotional, and that's part of it. Professionals will support me that it is part of the healing process.

When I say “osmosis”, the word passes around from the Goddards to the Kellers to the Dallaires to the Walshes to the Isfelds: he's passed on. When they get together there is a great dialogue and the odd coffee and beer drunk at the receptions. That's part of the process, when I say it's osmosis. It is a healing process. They know all about her bereavement program, and they're jumping on board. Unfortunately, there is sometimes not enough money to go around.

[Robert Bouchard, Bloc, Chicoutimi—Le Fjord, QC]

Is it common practice to reintegrate soldiers who have suffered from post-traumatic stress syndrome? When that happens, are they in reasonably good health? I am talking about what I call rehabilitation. How do their peers react? Are they open to the idea of working with soldiers who have been affected in some way and who need rehabilitation?

[Col Donald S. Ethell]

I'm going to ask Shawn and Cyndi to answer that, but in fact rehabilitation is a very important thing. Reintegration--that's a DND concern. Stéphane Grenier, the founder of this program, although he's a sufferer, was found capable of going back to Afghanistan, and he did. Whether he's going to go again remains to be seen. Whether others go is a judgment call by those in DND.

Shawn, do you want to comment on that?

[Shawn Hearn]

Sure.

Sir, in working with a number of peers, of course, as the colonel said--I'm not going to get into the aspects of reintegration--I am working with some peers in the province who have successfully reintegrated back into the military. Right now I have an individual who is actually currently back in Afghanistan. At the end of the day, for some of these individuals, it's a long road to recovery. I guess there's a make-or-break point for some of these individuals. They realize that they can either go back in uniform or they can carry on.

I guess a big role we play, as peer support coordinators on the ground, is helping with their rehabilitation. A lot of these individuals, when they come to us, often feel very isolated and alone. Part of our job is to just break it down. One comment that was made to me this past summer in Cyprus, when I was there for the reintegration back to Canada, was that OSISS works because it's coming from a soldier's perspective, from a veteran's perspective, and there aren't people there in white coats talking to them--and no disrespect to the folks in white coats. I think that's why OSISS works: we've been there, we've walked in their shoes, and we understand what's going on.

A lot of times, with peer support, we can speak to these individuals, as I said, as soldiers. We can break things down. Sometimes we can take off the OSISS coordinator's hat and put back on the infantry soldier's hat and say to the guy, “Listen, your doctors have a treatment plan in place for you, so suck it up and listen to these guys. That's why they're paid the big bucks. They have the knowledge and education to get you going in the right direction.”

That's a big role we play. I'm not sure if Cyndi would like to add something.

[The Chair, Conservative, Rick Casson]

We'll have to give you a chance later, Cyndi, to do that. We have to move on.

This is a very poor format to get a full-blown debate going, but maybe Ms. Black will help get that organized.

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

Thanks, Mr. Chair.

Thank you all for coming.

We're all aware of the good work OSISS has been doing. We travelled as a committee to Edmonton and spoke to some of the people there and have followed it. So congratulations to all of you for the courage that Cyndi and Shawn show in doing the work they're doing. I know that it's invaluable.

I agree with the whole premise of the peer-to-peer notion, because in the area of the country I'm from there's a first nation saying: “You never understand a person until you walk a mile in their moccasins”. This is one very graphic example of that, I think.

I'm wondering if the number of people accessing OSISS has increased with the Afghanistan deployment. I assume that it has, but I don't know that we've heard any specific numbers. And has the mission presented any particular challenges in this area?

The next question is one I'd like either of you to answer. My colleague Denis Coderre mentioned the Chicoutimi. I'm wondering about the other services. We're hearing now about the army, but I'm wondering about the services for naval personnel, in that instance, or the air services, and how they access the programs as well.

[Col Donald S. Ethell]

Before I get the numbers lady here to talk, you mentioned the numbers coming out of Afghanistan. One of the phenomena, and that's my word, coming out of Afghanistan, even from the clinical staff, is that individuals are coming home from Afghanistan and may present a problem, and it has been a trigger for people from other instances--Kosovo, the Balkans, even going back further, maybe to Somalia, and so forth--who say, “Gee, I have a problem”. In fact, it's wider-ranging.

One of the strengths of having the closing of the ranks in DND and VAC is that some of these veterans from the Korean War and a couple from the Second World War are saying that they think they have those problems too. I don't know what the numbers are that are banging on the doors of the district offices. It's risen dramatically in regard to.... They're not worried about the payoff or the money. The money's nice, but fixing it.... They want it to be fixed, okay? That's where the strength is.

As for numbers, I emphasize to you.... In Afghanistan, we've lost a lot of troops, and there are a tremendous number of wounded. Remember, we're not just dealing with the families of the fallen. Put yourself in the scenario where there's a vehicle blown up, such as with the young trooper from the Strathconas. What about the other people who were “not hurt” in that vehicle? Horse feathers! They were hurt! It may not come to pass for the four to six months that Brigadier-General Jaeger has indicated--and that's a good guideline, in our opinion--but it may be four or five years. Who do they talk to first? It's Cyndi or Shawn or McArdle. Sometimes at Tim Hortons they've heard about them and they want to know how to seek them out.

[Maj Mariane Le Beau]

I think there are definitely two sets of numbers, and I will refer to Kathy afterwards.

As Mr. Ethell is indicating, from the very beginning of the Afghanistan campaign we saw a phenomenon, anecdotal but nevertheless it seemed to come out, that a lot of the peers from the 1990s who had access or services and had ceased to use them were coming back, because they were getting re-triggered. So there's that re-triggering that occurred.

As Mr. Ethell was saying, also from past conflicts, people are feeling re-triggered because it is on the news, because it is out there. So there's that.

There's the fact also is that some of the people coming back from Afghanistan now may come up with some OSI issues but may have been carrying an injury from previous deployments, and there's no way we can tell that either.

There are definitely some soldiers who will develop an OSI who have only been deployed in Afghanistan, especially the younger soldiers. Some of them may have up to two or three deployments already.

I do have some numbers of how many people have had deployments in Afghanistan who are accessing our services, but I guess I want to put that in with all these caveats, because there's no way for us to really tell.

Right now we have approximately 235 peers who have been deployed in Afghanistan, out of more than 3,000 peers. On the family side, we have almost 100 families who are accessing our services, whose partners have been deployed in Afghanistan.

I'm going to pass it on to Kathy.

[Kathy Darte]

I guess what I would add to that is that I think it's a good thing. I look at it in a positive light that we're seeing 235 soldiers coming out of Afghanistan.

Going back to the first question of people falling through cracks and having a considerable delay from the time of the injury to the time they sought out treatment or at least got themselves into treatment, when we started OSISS we were seeing periods of injury to getting into treatment of five to seven to nine years.

Afghanistan is a recent deployment. So if people are coming to us now from Afghanistan deployment, it says that they are getting into treatment and seeking out treatment much earlier. That's the positive side of that.