National Defence Committee on Dec. 11th, 2012

[Matthew Kellway, NDP, Beaches—East York, ON]

Thank you, Mr. Chair, and thank you, Commodore, for coming today and providing your testimony.

Given your length of service and your role, have you been following along with the testimony at committee?

[Cmdre Hans Jung]

Well, no.

[Some hon. members]

Oh, oh!

[Matthew Kellway, NDP, Beaches—East York, ON]

It wouldn't really be retirement, I suppose, if you did.

In any case, let me say that one of our early witnesses talked about the rate of mental illness and injury for those serving in Afghanistan and compared it with the rates for other countries also involved in that war, the U.K. and the U.S. If I recall the testimony properly, we sat in between them in terms of the rate, with about 40% of our soldiers returning with some kind of mental injury or illness. I think for about 20% it was PTSD, and for another 20%, depression was the diagnosis.

The other thing we've heard, and I think you've provided this testimony again today, is how unpredictable treatment and cure is, if I can put it in those terms, that these things can reoccur years later and that they're also very difficult to get over in the first place.

One other piece of testimony to which I want to get your reaction was from Rear-Admiral Andrew Smith. He talked and you've talked today about the universality of service, but he talked about the health and well-being of the Canadian Forces members. He talked in these terms:

That includes a whole-of-government approach to ensure that those who serve their country and are called upon to serve with unlimited liability are provided with the care and support they and their families need in the unfortunate event that they become ill or injured. This is the social contract.

I have a really difficult time squaring that testimony and the Canadian Forces universality of service standard with this notion of care and treatment of our soldiers. Frankly, I'm angered and outraged by the application of that standard to the soldiers, who we ask to go into horrifying circumstances—terrifying circumstances—and who come home with injuries. We saw this last week with the two witnesses.

I'm wondering whether you have any response to that position. I think I've heard you try to square it today in financial terms, but this is not a social contract, from my perspective. If it is, it's an extremely one-sided social contract, when we talk about unlimited liability and the horrific experiences that these folks have had and the injuries that have been placed upon them.

[Cmdre Hans Jung]

That is a very complex question. I honestly don't believe that this is actually a.... To me, this is a question that goes to the root of what the purpose of the Canadian Forces is. Do Canadians want a Canadian Forces that is combat capable, or beyond that, is it also a social net for ex-members? In my mind, that's something for the military to answer.

If you want to keep these people, if that's the way the government and Canadians want it, then you have to change the whole construct of the Canadian Forces. There's a whole lot of legal issues, because we have the Charter of Rights and Freedoms, whereas often the other militaries are somewhat, and I don't want to say exempt, but they don't have the same constraints that the Charter of Rights and Freedoms imposes on the Canadian Forces.

To me, in the way I know the Canadian Forces, the mandate of the Canadian Forces is to be combat capable; therefore, universality applies, and Veterans Affairs Canada exists to look after the veterans who can no longer serve in the Canadian Forces.

That is the way I think it's supposed to work. That's the way they work it in the United States.

[Matthew Kellway, NDP, Beaches—East York, ON]

I come at this from the private sector. One of my jobs for many years was dealing with accommodation issues for ill, disabled folks in workplaces. Of course, all employers have their own sense of what they're there to do; it's to provide efficient, productive service, etc., but that doesn't preclude their responsibility—and it's understood in this country outside of the military to be a human right—to accommodate people in their work when they have a disability or an injury of that nature.

I don't see it as an enormous stretch, in the context of the Canadian Forces. It doesn't make it a social net to say that when they return from combat and have suffered an injury or an illness, we will look after them and will have a place for them and their family for as long as they need it.

What is the problem with making a statement of that nature?

[The Chair, Conservative, James Bezan]

Again, the time has expired, so—

[Cmdre Hans Jung]

Again, it comes down to whether or not there is enough room in the Canadian Forces to accommodate all of that, because every person who is not deployable and is accommodated then holds not only a position but a rank, which other people below them cannot ascend to. Even within the same rank, if that person is non-deployable, then the remaining people have to pick up that piece, so you put an additional burden on them.

Because the Canadian Forces is limited in absolute numbers, the greater the percentage you have—

[The Chair, Conservative, James Bezan]

The time has expired.

Mr. Norlock, you have the floor.

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

Thank you very much, Mr. Chair.

Through you to the witness, thank you for being here.

Dr. Aiken spoke about research being done into the relationship between mild traumatic brain injuries or concussive injuries and post-traumatic stress symptoms. Has your experience or work found similar conditions, and what do you think are some of the main contributors to developing PTSD?

[Cmdre Hans Jung]

This is one of the big areas of research that is going to have to put some meat on the bone. Mild traumatic brain injury is another one of those cases in which the military has brought brain injury to the Canadian psyche. Until the military's MTBI. mild traumatic brain injury, issue, concussion in hockey players and football players was almost unheard of; nobody talked about it. We have actually brought this out, and they're learning from our experience also.

The fundamental difference between concussion in the civilian sector versus concussion in the military sector is that when a hockey player is hit, it is in the context of a game; the other person hopefully wasn't trying to kill the player. By contrast, in the military sector, the very incident that caused the concussion—a bomb or an IED—is in its very nature threatening the soldier's personal psyche and viability as a human being. The exact incident that could cause MTBI is also the exact precipitating cause that would trigger a PTSD. The question is which comes first, or do they both come at the same time?

Here, I would caution you a little bit. Even within the medical community I think stigma plays a part here. People are desperately trying to find a biological reason to explain why you might have PTSD. To me, there is an inherent potential stigma that the medical community itself applies, because the idea that somehow this huge, traumatic event, which is not normal for most people—somebody tries to kill you in a very horrific way—could not possibly be caused by psychological factors, but rather that you must have received some kind of unforeseen concussion, through some kind of traumatic, compressed air.... It may be, but I think we have to be very careful that if we go too vociferously in that one direction, we are not inadvertently further stigmatizing people.

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

What you're basically saying is that there are probably many causes for PTSD and that this may be just one of them.

[Cmdre Hans Jung]

It could be one, or the other, or a combination of both. I think a lot more research is required.

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

I come from a paramilitary background. Compared with when I did my 30-plus years, we now have a very stringent psychological component to the hiring process. The reason for that psychological component is of course to filter out people with the Wyatt Earp syndrome and to make sure that you're getting the average person out there.

Does the Canadian military have a psychological component? Does the military attempt, in the hiring process, through psychological questions, to see whether the person is prepared to take on the stressors of military life?

[Cmdre Hans Jung]

Are you talking about the recruiting stage?

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

Yes, I'm talking about the recruiting process. In other words, do you try to have a filter or a process whereby you tell people the things that could happen to them? When we watch television we often see the glamorous part, but we don't see the terrible part, seeing your buddies hurt or—

[Cmdre Hans Jung]

In the recruitment process, from a medical perspective we take a mental health history. If there is anything in the history that suggests there may be something, then we request additional information before the file is finalized. If the file is clean or the person never sought out anything and therefore doesn't know what he or she doesn't know, or is actually hiding it, that person will squeak through.

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

Thank you.

You spent 31 years in the Canadian military. Thank you for that service.

Think about when you first came into service and think about when you left service. In particular, think of the time when you were in charge. You were the surgeon general. Are you of the opinion that we have advanced as a country in the care of our ill and injured? Do you have a measure there? Can you compare it to our allies, similar in size, scope, and experience, as far as service around the world goes?

[Cmdre Hans Jung]

I think life in general, compared to what it was when I joined 31 years ago, and the whole health care system have become much more complex. Knowledge, technology, advancement, and research have become more complex. One of the things about medical knowledge is that they say that every five years 50% of the knowledge is obsolete and there are new advances. There have been advances, absolutely, particularly when it comes to mental health. There have been huge advances made in the last several years in particular.

There are a number of measurements out there, including a satisfaction survey. There's Accreditation Canada, which accredits the standard of care in a health organization. A lot of NATO countries are emulating what we're trying to do. Many of them can't emulate; they simply tell me they're envious.

[The Chair, Conservative, James Bezan]

Thank you.

Mr. Brahmi, you have the floor.

[Tarik Brahmi, NDP, Saint-Jean, QC]

Thank you, Mr. Chair.

I found what you said at the beginning interesting, that you did not have a problem with financial resources but with human resources. So we can deduce that there are not enough doctors and that it is difficult to hold onto them.

First of all, can you confirm to us that the Canadian Forces does not train its own doctors?

[Cmdre Hans Jung]

The military trains its own doctors. We train not just doctors. All the health care professionals in the military who we train and who are wearing a uniform are there because they have an operational role. If they're not there, then we don't have them in the military.

[Tarik Brahmi, NDP, Saint-Jean, QC]

Let me rephrase the question more specifically. I was talking about the initial training. Do we recruit students after high school to give them the training they need to become doctors in the Canadian Forces or are they trained at civilian universities?

[Cmdre Hans Jung]

We recruit at various stages. We take medical students. We don't take high school students, obviously. We take anybody who is accepted into medical school, whether they're in first year or throughout their training, in various stages. If they're in medical school at whatever stage and they want to join, and they've passed the physical and so on, then we recruit them. Then we pay for the rest of their training. Some come to us already trained, and others come to us as students.

[Tarik Brahmi, NDP, Saint-Jean, QC]

What do you think of the countries—because we have to compare ourselves to other countries as well—that have chosen to take care of the training of their doctors from the beginning and to make them sign a contract before they even register in school? Right when they pass the school's entrance exam, they sign a contract that requires them to stay in the armed forces for a certain number of years. In France, for example—and this is laziness on my part because it is easier for me to read in my language—military doctors in general practice have to stay in the armed forces for 12 years, and doctors with hospital specialties have to stay for 14 to 18 years, depending on the specialty.

What do you think about that kind of contract, one that would require not only doctors, but also students who want to become military doctors, to commit, before beginning their studies, to stay a certain number of years in the armed forces once they graduate? Could that be an approach to the problem you raised at the start?