National Defence Committee on May 8th, 2008

[Dr. Robin Geneau]

Not on the establishment, but once the psychologists got there they made contact with us, and we're doing joint training with them, which is wonderful. This is the way we used to work with the CF. We're participating in joint training. We have a lot of cooperation, and we expect to have a very good working relationship with the OSI clinic once they get off the ground.

[The Chair, Conservative, Rick Casson]

Go ahead. You still have four minutes.

[Joe Comartin, NDP, Windsor—Tecumseh, ON]

So I have some time to get back to Dr. Shay.

[The Chair, Conservative, Rick Casson]

Yes.

[Joe Comartin, NDP, Windsor—Tecumseh, ON]

I haven't read your books, but I've read reviews of your books and other material on you. Could you give the committee any indication as to whether there's a model for treatment of OSI elsewhere in the world that you could point us to that the Canadian military should look at in terms of developing the model for Canada?

[The Chair, Conservative, Rick Casson]

Go ahead, sir.

[Dr. Jonathan Shay]

I hope it's clear that I have been down in the bottom of the ocean, in the trenches with the veterans, for 20 years, but my heart has really been with the active forces in preventing psychological and moral injury in active duty forces. I am not a big literature hound, and I don't pretend to be an expert on the treatment of psychological injury once it's happened. I'm very proud of what I've been doing with the veterans I've been working with, but this is not evidence-based, other than my testimony, my satisfaction.

There is a very rigorously developed evidence-based algorithm for treatment, which was mentioned earlier by one of the witnesses. I apologize for not remembering who. The joint Department of Veterans Affairs and Department of Defense clinical treatment guidelines for PTSD and acute stress disorder and operational stress reaction--I forget the jargon, sorry--but even earlier than acute stress disorder.... This algorithm and the echelons of studies behind it are all on the web under clinical practice guidelines for PTSD of the Department of Defense and Department of Veterans Affairs. I was part of the clinic that was involved with drafting that because of my involvement in prevention, but I wish I could claim more expertise in responding to your question.

[Joe Comartin, NDP, Windsor—Tecumseh, ON]

Let me ask Dr. Belliveau basically the same question. Are there any other models we should be looking at for treatment?

I'm going to come back to Dr. Shay, because I want you to answer the question about prevention as well.

[Dr. Joyce Belliveau]

The centre of excellence, I believe, in terms of treatment issues, is Ste. Anne's Hospital. This is the basis of the OTSSC model, which is a multi-phase, multi-modal, cognitive behavioural model, with all sorts of research evidence with efficacy. It involves a number of different strategies and techniques, including EMDR in the trauma processing phase, but it is evidence-based and there is a very clear algorithm or procedure in place following this model.

[Joe Comartin, NDP, Windsor—Tecumseh, ON]

Ste. Anne's? I don't know where it is.

[Dr. Joyce Belliveau]

It's in Quebec, in Ste-Anne-de-Bellevue.

[The Chair, Conservative, Rick Casson]

I'm sorry, Mr. Comartin, you've run out of time.

Mr. Hawn.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Thank you, Mr. Chair.

We're going to try to spread the time amongst the three of us, so I'll make fairly quick points, if I could.

Clearly there's a problem at Gagetown, but we should be careful not to generalize that across the military, because we've heard evidence otherwise. I think we also need to be careful about numbers. We talk about going from 3,500 to 11,000. That 11,000 includes peacekeeping vets, and it goes as far back as Korean War vets. It's not necessarily Afghanistan-related.

With respect to the situation in Gagetown—you may be uncomfortable answering this question, so feel free not to—are we talking about the same people who are involved in this? Is there a continuity of people who are causing the problem, or is there a continuity of attitude that goes from commander to commander or supervisor to supervisor?

[Dr. Robin Geneau]

There is some continuity of people involved, but primarily it's a structural issue. They lack clinical expertise and they lack an efficient administrative process. It's completely lacking. Structural changes, systemic changes, need to be made.

In the context of the lack of structure, individuals can engage in empire building or control or whatever they want to do, and that can be rampant. This is the reason why we say there needs to be an audit. We believe, as a result of that lack of structure and the lack of administrative effectiveness, there are clients out there in our community who are not receiving services, and we want them found.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

To Dr. Ferrie, just quickly, the suicide rate for soldiers in fact has dropped. The suicide rate that was quoted included other non-soldiers, so I would challenge that source a little bit.

EMDR appears to be pretty valid treatment, and I think the nutraceuticals area bears some more investigation and work, in a positive sense. EMDR and nutraceuticals--have you seen evidence of their use in other countries, such as the U.S., the U.K., Australia?

[Dr. Robert Ferrie]

If you go through the bibliography I've submitted here, you'll find that they have done studies in Israel using nutraceuticals for anxiety and depression. They found that they're more effective than a placebo, which is more than you can say for the SSRIs.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Okay.

I'm going to pass it on to Mr. Goodyear.

[The Chair, Conservative, Rick Casson]

Mr. Goodyear.

[Gary Goodyear, Conservative, Cambridge, ON]

Thank you, Mr. Chair.

Through you, I would like to congratulate the witnesses. In my past life I was a health care provider as well, and I can tell you, it's not such a bad thing to be accused of being an advocate for your patient.

I can also tell you, and perhaps my colleagues, about my experience with the insurance industry. I worked for them and would give them opinions. If they liked the opinion, they would refer more patients to me. If they didn't like the opinion, they would stop referring. Of course, I had other sources of referrals so I didn't really suffer.

At the end of the day, though, what happens when you allow that to continue is that the insurance company—I'm assuming Gagetown has the same philosophy—eventually ends up with only the practitioners who provide only the opinions they like. That tends not to be based on the best interests of the patients. In the insurance industry's case, it would be based on profits. That's never a good thing. You end up with poor-quality providers and profitable insurers. So I have to congratulate you on keeping that advocacy going.

I want to ask some hopefully very quickly answered questions.

I would like to ask our psychologists, if I may, Joyce and Robin, is this type of therapy regulated in Canada? Is it under any supervising authority? Is there a regulatory body outside of the psychotherapy profession?

[Dr. Joyce Belliveau]

Certainly psychologists and social workers have regulated bodies. I'm sure in the OTSSC model there is ongoing evaluation—

[Gary Goodyear, Conservative, Cambridge, ON]

So the psychotherapy association and profession recognize the therapy, and they regulate it, through you.

[Dr. Joyce Belliveau]

We are bound, as psychologists, by evidence-based practice, so the techniques and strategies we use are monitored.

[Gary Goodyear, Conservative, Cambridge, ON]

Can you tell me approximately how many practitioners of this type of therapy there might be in Canada?

[Dr. Joyce Belliveau]

I have no idea.

[Gary Goodyear, Conservative, Cambridge, ON]

Is there a guess? Would it be over 100, under 100, over 1,000...?