National Defence Committee on Dec. 6th, 2012

[Col Rakesh Jetly]

We have regular meetings, national meetings, and national meetings to which the senior medical officers come. I often speak at those. We continue to explain, understand, and educate on the perspectives from all the folks.

[The Chair, Conservative, James Bezan]

Five minutes is up, and we have to keep moving on.

Mr. Norlock, it's your turn.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

Thank you very much, Mr. Chair.

Through you to the witness, thank you for attending today.

I asked my confrere here what your qualifications are. You're a psychologist?

[Col Rakesh Jetly]

I'm a psychiatrist.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

You're a psychiatrist. Okay. Thank you very much for that, because that's helpful to me.

A psychiatrist must, to provide proper care for his or her patients, follow the dictums of psychiatry—in other words, the scientific training that you would have undergone to get your Ph.D. and then other qualifications. I understand that for some time in the world of psychiatry, PTSD was not thought of as really a legitimate mental illness. Am I correct?

[Col Rakesh Jetly]

That's not entirely true. For thousands of years people have recognized the suffering of people post-conflict. There have been times—during World War I, for example—when people speculated that it might be a physical result of the shaken brain. I think people, especially in the health professions, have always recognized that people have suffered after wars. It's been called different things, but since 1980, which is the timeframe of most of our careers, the American Psychiatric Association coined “post-traumatic stress disorder” largely to explain the phenomenon of the group after.... Certainly my generation wouldn't be part of that.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

Yes, but it's fairly new in the medical world.

[Col Rakesh Jetly]

Yes.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

Thank you.

It is regarded to be a fairly new diagnosis.

[Col Rakesh Jetly]

Yes.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

Thank you.

We live in a society, of course. We know that academia and science move very slowly. In order to accept certain regimes as beneficial to the patient, I think the rule is that we want to do no harm. I'm basing my question on that premise—do the patient no harm. We see and we just heard—in the medical world you would call it anecdotal—that canine therapy is helpful. We just heard from two people, and through them we heard about other cases. We've just been provided some documentation by one of the witnesses from his psychiatrist, who said, “For you, it's working”.

I also understand that in the United States there is a program called Paws for Purple Hearts, in which trained dogs are placed with military personnel suffering from PTSD, but once the patient is seen to be getting better, the dog's removed. I wonder if you are aware of this therapy and if there is a contemplation on the part of the CF, and in particular the medical side of the CF, to incorporate that or to think about incorporating that into therapy.

[Col Rakesh Jetly]

I'm aware of some of the programs that exist. There isn't a plan right now. I'm in communication with my U.S. and U.K. counterparts. The U.S. actually has been trying to fund studies for about five or six years. There's lots of money available; they haven't yet been able to find a group that can conduct the study itself with a primary investigator. My colleague there was saying, “Hey, if there's a primary investigator who you think can run a study, we're willing to fund it.”

I think we need to do the research before I can endorse this as a treatment. That said, if the organization, somewhere else within the office of chief of military personnel.... If people see this as a beneficial thing, nothing stops people from funding it.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

You are aware of the program. Are you aware of the outcomes from the program?

[Col Rakesh Jetly]

The outcomes are sort of anecdotal and testimonial. I haven't seen any randomized control study for demonstrating its efficacy in targeting symptoms or reducing symptoms.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

Thank you very much.

Do you think it worthy of the Canadian Forces to contemplate an actual regime or an actual application of canine therapy utilizing the people who are claiming that it is of benefit? Do you believe it appropriate for you to align yourselves with...? We had a witness in here, whose name I forget—Aiken, I think—and she works with 25 universities, studying....

What do you think forming a partnership such as that, with the assistance of other people in the regime of assisting people in the Canadian Forces, working with clinicians from various universities? Do you think it would be worthwhile to work with them to commence bringing in a program like Paws for Purple Hearts, or whatever we want to call it in Canada—we could give it a Canadian name, Canadianize it—and see how that program would work?

It seems to me that we live in an age where, yes, we look to people like you—a scientist, an expert in his field—but then we see an immediate need. We see a reluctance on the part of science and academia to treat people who are saying, “I'm getting some help here. I don't take medications that we know have side effects. I don't need to see the doctor. I don't need to bother the hospitals as much”, and this program is very cost-effective.

Do you see where we could encourage or entice CF, through this committee, to embark on such a thing?

[Col Rakesh Jetly]

I think it's worthy of study. I do think it's worthy of study. I mean—

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

Do you have a suggestion as to how we might do that?

[The Chair, Conservative, James Bezan]

Mr. Norlock, your time has expired,

Colonel, you can give your response, if you have one.

[Col Rakesh Jetly]

Yes, I can give a brief response.

It's worthy of study. When you sit at my desk, you see many, many ideas come across it. There's equine therapy, agrotherapy, soapstone carving: the list is unbelievable. You could fill your entire agenda for the next 10 years reviewing every one of these. There are anecdotes that they have merit, but I think you have to put the research in place or else it's a slippery slope. I have no doubt these gentlemen have benefited from having these dogs, but we need to have the research.

[The Chair, Conservative, James Bezan]

Thank you.

It's Mr. McKay's turn, but since he's out, we'll have to fit him in later. Technically we're in the first round, which is normally seven minutes. It is the Liberals' turn, but with Mr. McKay out, we'll put him in again in the five-minute round, just to keep them all five minutes.

Next on the list is Mr. Opitz, and then we'll come back to Madame Moore.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

Colonel, thank you for being here today.

I did want to address something quickly. We were disturbed to hear the master corporal say that he was advised that if he had a relapse, then he was on the train out to release.

What's your view of that, sir?

[Col Rakesh Jetly]

Well, I don't think it's appropriate to say that to something. I don't think, on the whole issue of medical release and the idea of when somebody is fit to serve, that it's a simple issue of relapse or not.

In fact I've been championing—quoted, or misquoted, in The Globe and Mail—sending people back with post-traumatic stress, because to my mind, if people are better, it's a good-news story. If people recover fully from their illness and want to continue to serve, we champion that; that's a success story.

When it comes to medical and medical limitations and release items, what happens is there are a few reasons for it. One is the safety of the individual and one is the safety of the organization around them. If you have a bad back, a bad knee, visual problems, dizziness to such a point where there's risk, and it looks like recovery isn't going to occur, then permanent categories are assigned and those types of things. However, I've had soldiers who I felt were fit; we send them back, and as they go into Wainwright they start getting re-exposed to the scenarios and they realize, themselves, that it's difficult.

I don't think it's appropriate to say that if you have a relapse, you're out. I think if you've made a good recovery and you have a relapse, we have to re-evaluate your clinical history and your stability in terms of being able to remain in the forces.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

Are you saying, then, that the underlying goal is to retain them—

[Col Rakesh Jetly]

Absolutely.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

—and make sure that people carry on with their careers?