National Defence Committee on Dec. 6th, 2012

[Col Rakesh Jetly]

Absolutely.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

They might even be in a different trade.

[Col Rakesh Jetly]

Yes, absolutely.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

Okay.

[Col Rakesh Jetly]

It would be their own trade first. The goal is full recovery in their own trade, and if not that, in another trade. For every mental health professional, that's the first goal when they first sit with a patient.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

So remustering is an option.

The CF has launched a pilot program of virtual reality therapy. It is an audiovisual technology developed in the U.S., of course, that allows patients to relive the situation and the traumatic event. Can you talk a little bit about that?

[Col Rakesh Jetly]

We're working on it.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

So there's not a lot of data.

[Col Rakesh Jetly]

No. We're embracing it and we're exploring it. There are some American platforms. We are working right now on trying to Canadianize the software. I don't want Canadian soldiers to be exposed to American uniforms and Humvees. I want it to be our LAVs and where our folks are.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

Understood.

[Col Rakesh Jetly]

We're on the way.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

You spent time in a Role 3 hospital in Kandahar and you've dealt with various operational stress injuries throughout. You've witnessed them. You've treated them. Can you tell us about some of your experiences there and the differences you found in treatment? One size does not fit all for an operational stress injury.

[Col Rakesh Jetly]

Absolutely.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

You have variances.

[Col Rakesh Jetly]

Operational stress injury is a paradigm. It's a non-clinical term. Treating PTSD is different from treating depression and is different from treating panic disorder.

What I have found, as somebody who's served 20 years, is that nothing is perfect, but what I've found really impressive is how much people are talking about it and how many people are coming forward in the Role 3s, right in theatre. They are describing their differences and the difficulties they're having. Chain of command will walk in with a soldier and say, “I'm a little bit worried about how this corporal or master corporal is doing, doc. Can you check him out?” That's the main thing I've noticed.

You know, when we deployed to Rwanda, there was absolutely zero mental health support. By the time we reached Kandahar, we had psychiatrists, social workers, and mental health nurses. We have a full psychiatric team. To a psychiatrist, that's a dramatic difference.

Even in theatre, our first aim is to help the soldier complete his or her task and to complete his or her tour. That's very important for most soldiers, so we do our best and work in a confidential way with the chain of command to try to keep people in. Sometimes it's a respite inside the airfield for a couple of weeks and learning some grounding techniques, much like you heard about what the dogs do, to stay grounded and not get caught up in the hypervigilance and arousal and those things. Our first aim, even in theatre, is to help people complete their tours.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

You talked about education being a factor in being able to treat soldiers affected by the various forms of OSIs. In my own experience, dealing with my own soldiers, it was a constant round of ensuring that they would self-identify and come out and feel secure about doing that. I think security is paramount in giving a soldier the confidence to actually self-identify and seek that treatment.

Now, in cases where you may find that the educational process has not exactly sunk in and they're not actually reacting to somebody effectively, as Mr. Harris described in Petawawa, what are some of the things you can do, in your field, and that the chain of command can do, to rectify that situation in terms of education and how you sort out—

[The Chair, Conservative, James Bezan]

Mr. Opitz, your time has expired.

Colonel, you can respond.

[Col Rakesh Jetly]

Sure. What we're requiring is an attitudinal shift. Quite often, I find that people talk forever about the middle ranks—the junior officers and NCMs, the master corporals and sergeants—saying that they're the ones who don't get it. However, I think they also have the most difficult jobs.

I think it's very easy for a general or a colonel to say that all of the guys need this, but if you're running a small section that has three people responsible for driving people back and forth from Petawawa, and two of them are sick, it gets very difficult. I think the junior leaders have the hardest job. I think they have to decide when someone needs a pat on the back, when somebody needs time off to go deal with difficulties, and when someone need a nudge, so I empathize with the junior leaders. I think that's probably the hardest job.

[The Chair, Conservative, James Bezan]

Thank you.

We're going to keep on.

Ms. Moore, you have the floor.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Thank you, Mr. Chair.

I would like to discuss the labour shortage in the mental health field. Since 2010, the number of workers has not risen past 380, and yet the goal is 447 practitioners. What's more, the ombudsman's report describes the burnout plaguing caregivers.

Clearly, providing mental health support to military members is not necessarily easy. Indeed, we're hearing accounts of difficult experiences. This can weigh quite heavily on health professionals as well. What steps do you take to make sure your health professionals—your nurses and doctors— don't end up burning out? Do you assess them? What do you do to make sure you aren't making them sick, as well, as they try to care for everyone, despite the lack of staff?

[Col Rakesh Jetly]

That's a good question. Thank you.

Care of our own is certainly a very important issue within health services and certainly within mental health, and the risk of burnout is something that we certainly do recognize. Mental health professionals are passionate and dedicated.

It has been a while since I've run a clinic—it has been a few years—but there were some things I did in Halifax, such as, for example, no lunchtime meetings. At lunchtime, take your break. Everybody calls a last-minute rush meeting and calls it lunch.... Also, go home at four o'clock; I may still be here, but you go home. There were those kinds of practical things.

Also, training is a big issue—training, understanding your boundaries, understanding your limitations, and being good at what you do. We run regular training in the leading-edge psychotherapies of cognitive processing therapy, EMDR, and those kinds of things. We offer people clinical supervision when they're stuck with difficult cases so they can consult an expert. We have four mandates, for example, within the operational trauma and stress support centres—assessment, treatment, outreach, and research—so we rotate your job so that you're not always sitting three feet from people who are suffering. Sometimes you're doing some assessments, sometimes you're getting out of the office to teach.

There are a lot of things in place to protect people from themselves, almost, from burning themselves out and continuing to go through things.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

The Directorate of Mental Health where you currently work has a staff shortage rate of 41%. That means nearly half of your positions are vacant. I'd like to know how the directorate fulfills its mandate if all the positions are not staffed. What projects and programs are on hold because of this staff shortage? What can't you do right now because you are short on human resources?

[Col Rakesh Jetly]

I missed your numbers. How many below are you saying we are?

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

According to the statistics I have, 41% of the positions within the Directorate of Mental Health are vacant.

[Col Rakesh Jetly]

That's not true.