National Defence Committee on Dec. 6th, 2012

[Jack Harris, NDP, St. John's East, NL]

The medical officers are saying they don't believe that PTSD can be treated, for example.

That's an error, isn't it?

[Col Rakesh Jetly]

Absolutely.

[Jack Harris, NDP, St. John's East, NL]

I was interested in the discussion. You were speaking as a medical professional and you are trying to evaluate this canine program, as opposed to drugs or anything else. Particular drugs don't work for everybody, either; some are successful with patient A, but not patient B.

I liked your notion that it may take a period of time to do a study, but that perhaps this is something that some other branch—the chief of personnel—could investigate, as opposed to a “medical therapy”.

That seems to make sense to me. Is that what you were suggesting?

[Col Rakesh Jetly]

Yes. I think for a health service to be put into place, we have to have evidence on the spectrum of care.

[Jack Harris, NDP, St. John's East, NL]

I understand.

Thank you.

[The Chair, Conservative, James Bezan]

Time has expired.

As I said earlier—Mr. McKay had left the room—the Liberals are allowed one intervention. We are running short on time, though, and I know that Mr. Alexander hasn't had a chance. We do have one bit of committee business, so if the committee is willing, we're going to extend a little bit longer.

With that, Mr. McKay, you have the floor, and then I'll go to Mr. Alexander. We're doing four minutes.

[John McKay, Liberal, Scarborough—Guildwood, ON]

Thank you, Chair, for the consideration.

I apologize for being away while you were speaking, sir.

I once went to a fascinating lecture by an emergency room physician from New York who was lecturing a bunch of U.S. state governors and Canadian premiers about evidence-based medicine. He talked about how evidence-based medicine killed George Washington, because at the time bloodletting was considered to be an appropriate therapy.

He then went through a whole bunch of routine therapies that are given by the medical profession and he disaggregated the evidence on whether or not they worked. That went from mammograms to prostate...the whole routine, and basically it was a bit of an eye-opener for me as a politician, with no medical background, that some of this evidence base is something less than full empirical evidence.

When our previous witness reacted rather strongly to evidence, he reacted as a lay person would react, saying, “Well, I don't know about evidence, but I know that this works for me.”

I apologize if this has already been covered, but if a number of your soldiers are saying that this is really working for them, what are the forces doing to develop an empirical metric that may actually result in this becoming an appropriate therapy, or not, as the case may be? I don't understand.

[Col Rakesh Jetly]

Your point is well taken. Is all the evidence out there that we quote perfect? It's probably not, and that's why things change. The thing that changes what we do is the evidence.

For years and years people thought that esophageal and duodenal ulcers were a weakening in the lining, but then they found out there is a bacterium that causes them, and now they're treated with antibiotics. It took evidence to change the previous evidence.

[John McKay, Liberal, Scarborough—Guildwood, ON]

So what are we doing to gather evidence about what these soldiers are saying?

[Col Rakesh Jetly]

We're not doing anything for this. We're monitoring what our U.S. counterparts are doing and what other studies are doing.

[John McKay, Liberal, Scarborough—Guildwood, ON]

Isn't that the issue, though? The CF has quite a number—certainly in the thousands—of people coming in with PTSD and various other OSI ailments, and a significant percentage of those folks are saying, “This works for me”, so why aren't the forces following up on that?

[Col Rakesh Jetly]

We cannot study every proposed treatment for every illness that comes forward. We're simply not big enough to do that.

We are part of an organization called CIMVHR, which is an research institute to which 25 or more universities have signed on. I'm not sure if you were out when I spoke about my U.S. colleague, who is saying that he has funding and he has tried for years to find a principal investigator to study canine therapy specifically, and things haven't gotten off the ground. I have said that in partnership, if people are interested, research is possible, but the list of proposed treatments that come across my desk on a regular basis is endless.

[John McKay, Liberal, Scarborough—Guildwood, ON]

Out in Vancouver there was a self-help group involving some Vancouver-based soldiers and the University of British Columbia. They got funding from everybody except the forces. Finally, to the credit of the Minister of National Defence minister and the Veterans Affairs minister, they actually did fund it. I don't know what it is that pushes that over the edge.

Anyway, my time is up.

Thank you, sir.

[The Chair, Conservative, James Bezan]

Thank you, Mr. McKay.

Mr. Alexander, the last four minutes are yours.

[Chris Alexander, Conservative, Ajax—Pickering, ON]

Thanks very much, Colonel Jetly, and thanks for your emphasis on the science and the clinical proof that needs to be behind treatment.

We all understand it is very difficult to decide where to invest, especially when therapies are emerging. We do support you in your drive to be as scientifically grounded as any mental health professionals in the world, certainly among militaries. That was among the forms of praise we saw for Canada at the tri-national meeting we were at together in Washington.

I have two questions for you, and they are related. The first is relevant to the two witnesses we had before you with their very personal stories from Afghanistan and their very strong conviction that working with dogs has helped them when other, perhaps more clinically validated therapies, haven't helped as quickly as they would like.

Tell us what you are doing and what research and practice are prompting you to do for those cases in which victims of PTSD don't respond to therapy. We all know already from our study that six to 12 sessions with the right therapist, in the right conditions, can have a positive impact for many, maybe even the majority of cases, but in some cases they don't. Where do you take people after that?

[Col Rakesh Jetly]

I think there are two issues. There are people who respond perfectly by the book as per the evidence, and after 12 or 13 sessions they get well. However, when I was in the U.S. last week, they were talking about a large centre where their completion rate for the therapy was only 18%. Everybody else was dropping out from the rigorously evidence-based treatments, so we've already adapted our therapies to slow things down a little and give people more time for stabilization and those kinds of things.

There are people who respond very well initially; luckily, people are coming forward more than ever. There are people who have a partial response, and these are people we hope stay in the military, although maybe not in their profession. Then there's a group that doesn't respond well, so we try multiple different treatments.

Other than that, I think the important thing that we do in conjunction with Veterans Affairs is the transition toward civilian life. There are the JPSUs and case management. As we're looking at spending some of the additional funds, we're thinking about occupational therapy coming back into the fold for us beyond the two that we have to help people with vocational rehab transition. These are young veterans; these are people in their twenties and thirties with young families, so we want to give them the best transition to life.

[Chris Alexander, Conservative, Ajax—Pickering, ON]

Thank you.

The second question is about the other end of the spectrum, the soldiers who haven't deployed. Maybe they have recently been recruited, haven't been on a mission, aren't yet suffering from PTSD. What are we doing to build the resilience that we know can help prevent this condition?

Some militaries, notably the Israeli, but others as well, seem to have invested heavily in researching and in building.

[Col Rakesh Jetly]

A lot of our allies and we in particular have developed different types of resiliency training. The idea from resilience isn't to have a shield against stress; it's more that stress is inevitable in life and in deployment, and you can bounce back, so we have a cradle-to-grave, if you will, road to mental readiness program in place that starts in basic training.

We're conducting a research study in basic training in biology as well, looking at people's stress and their epigenetic changes in basic training to see if it benefits throughout their career cycle. Leaders, junior leaders, and members themselves get it. We enhance it during deployment, in the pre-deployment phase, in post-deployment, and in the part in TLD that people receive. There is a family component of it as well that families are receiving at the same time.

It's a program that has drawn a lot of international attention. A NATO group is looking at similar training across NATO nations, and they have adapted the Canadian model, with our American colleagues in the same room. Police forces are interested, and we have just started with the Royal Canadian Mounted Police in New Brunswick to help train some of their people to give it themselves. It's a huge area.

I think when we talked about 1980 to 1990 we were looking at trying to identify people who were sick. We've made that shift in the scientific community to say the vast majority of people exposed to trauma don't get ill, so let's try to see what helps people cope and let's try to instill that in people.

[The Chair, Conservative, James Bezan]

Thank you. Our time has expired.

Colonel, I want to give you a little bit of homework. I had a few questions, but I'm just going to give them to you and you can respond to them in writing, because we are out of time. The analysts will provide them to you in writing as well so that you'll have them.

Essentially, our earlier witnesses talked about suicide, so I am interested in the issue of suicide prevention from the standpoint of what we are doing to train our officers, particularly in our academic programs at the Royal Military College, Saint-Jean, and others, to deal with suicide prevention within their units.

Also, what are some of the results from the Canadian Forces Expert Panel on Suicide Prevention? You reviewed that study, and we want to get some information on it.

Also, we never touched on some of the brain injuries that happen. We've been concentrating on the mental health issues, but there are also the brain injury issues. There have been some reports provided on brain injury, what type of trauma it is, and how you deal with that within the Canadian Forces.

With that, I thank you for your testimony today. I will provide those questions to you in writing so that you have them and can respond in a very timely manner.

We are going to suspend. As a committee, we have one piece of business that we have to deal with. We need to clear the room, so I'll ask anyone who is not directly tied to any committee members here to leave.

With that, we are suspended for a brief couple of minutes so we can go in camera.

[Proceedings continue in camera]