National Defence Committee on Dec. 11th, 2012

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

Everybody in the unit knew that this guy was off for the next three hours to see the shrink. I can't see how that helps them reintegrate into the unit, and it doesn't help with the culture.

I was interested in Mr. Kellway's line of questioning because it is, if you will, almost a philosophical issue on what you want the Canadian military to be. You can get into what is accommodation.

It seems to me, at one level, that the level of accommodation for ill and injured soldiers needs to be higher than that for civilians. I say that because the expectation is that they are putting their lives on the line. They are unlimited liability. The corollary of that social contract of unlimited liability is that you have this guy for life, almost. I'm exaggerating but not terribly so. You've got this guy for life because you know darn well that if he goes into theatre, there's a high-percentage chance he is going to come out either ill or injured.

On the other hand, I understand you want a high-functioning military, and for every ill and injured soldier you're carrying, somehow or another, somebody else needs to pick up the burden.

I understand the argument, but I'm not sure I understand where you're coming down on the argument though. From listening to you over the last hour and a half, it seems to me that, in some respects, you anticipate there will be pressure on the physicians to move the ill and injured out and either into civilian life or into veterans care.

[Cmdre Hans Jung]

I don't know. I don't think there's any pressure on the health care system to do anything of that nature. I've been very clear: you make medical decisions based upon the medical natural history. They're very clear on that. We don't push people out; in fact, you will find people on both sides. Some people say, “You guys are taking too long. I want to get out”, and other people say, “You guys are making decisions too early. I want you to drag it out.” Because we get criticism from both sides, we're probably on the right path.

Again, I come down to the issue of social contract. This is a question you should be asking the JAG. It's part of the mandate of the Canadian Forces. Accommodation has been determined by the Supreme Court, I believe, on to what extent the CF should accommodate, and to what extent it's a burden that's unreasonable for the Canadian Forces, given its unique mandate. To me, that is more of a legal issue, and then it becomes a much higher political issue, as I say, almost a social issue, as what you want the Canadian Forces to be.

As a health care provider, if the patient is there, I am there.

[The Chair, Conservative, James Bezan]

But you're not coming into that conversation.

Mr. Alexander, go ahead.

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

Thanks very much.

You mentioned the decade of deep darkness and the state of disrepair into which the military health system had fallen. Could you give us the two or three most important steps taken from 1999 to 2010 to bring the health care system back under Rx2000?

[Cmdre Hans Jung]

I think the biggest thing was Rx2000. That was the realization of the leadership, and remember that this project took almost 11 years. It was a long project.

During that time, we have had various chiefs of defence staff and governments. During that time, there has been steady support, all the way, to go ahead and finish this project, and we did. We did it on time, based upon the time set by Rx2000, and I think we came in under budget for that one. It was the continuous support through those many years by various governments, various chiefs of defence staff, various leadership, to say we need to bring it back up to the standard that we need it to be. Thank goodness we did so because otherwise, we would have been woefully behind when Afghanistan hit.

We, collectively, were prescient enough to go down this path early enough that we were ready and prepared to meet the needs of Afghanistan.

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

Given universality of service and what we ask of members of the Canadian Forces in missions like Afghanistan, there is a natural tension between a health care practitioner's duty to protect a diagnosis, to protect the information about a patient's condition, and the commanding officer's duty of care to the unit and to the person to not deploy the person if they have an operational stress injury or another invisible impediment to being deployed. Do you think that tension is being resolved successfully for the vast majority of CF personnel, or do we still have work to do?

[Cmdre Hans Jung]

I think for the vast majority, that what I call creative tension between the two opposing forces is handled well. This is one of the things we train our new doctors in the military in, including our civilians. We teach them a lot about those diametrically opposed forces and how to walk that fine path. The best way to do that is to look at the patient, look at the person's capabilities and limitations. If you follow that, everything will fall into place.

On the whole, I think we do. The vast majority I think are handled well. But again, as I keep saying, it does not mean the bar is set at 100% satisfaction in everything. Then we'll never meet it.

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

Give us your assessment of the road to mental readiness program for redeployment training. That's obviously something that's been highlighted by other witnesses. It's an important lesson learned and lesson implemented. How do you assess it?

[Cmdre Hans Jung]

I think that is only a part of it, you have to look at the bigger picture. Part of the mental health strategy, and it's already being implemented, is training the recruits about the aspects of mental health. At various levels of leadership training, both for the NCMs and officers, that's being incorporated into their training requirements. It's the general education and then the road to mental readiness, that five-phase thing, that's really around the deployment. If that's all you've focused on, it's too late, because you're not going to teach people, thoroughly change their thinking, based on that thing. They have to come to it from the recruitment stage to be inculcated into the new, enlightened way of looking at mental health right from the recruitment process, whether you're a private or an officer cadet.

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

Have you taken that mental health education far enough upstream in the training process?

[Cmdre Hans Jung]

Yes, we have. We're doing that now, immediately on recruitment. All the recruits get it, and they get it at the junior leadership course, the intermediate leadership course, and so on.

[The Chair, Conservative, James Bezan]

Thank you.

Commodore, in the Canadian Forces we definitely have a great group of mental health professionals working on providing really good services to the members, often in very stressful and traumatic situations. Who's providing them their mental health care?

[Cmdre Hans Jung]

That's a very interesting question.

You've heard “physician heal thyself”. The mental health medical community is not that large, particularly in a base sense, unlike the civilian health care sector where there is no such thing as a supervisor. If you're a private doctor, you're on your own. Even if you practise in a group, it's up to you to seek care and the medical organizations have physician programs for their mental well-being also. But it's really up to the individual. No system gives them that supervision, except in the military.

In the military, if you go to a base, there's a base surgeon and then there's a senior nursing officer. We have a hierarchical system whereby each one of them is supposed to look at the other person. Of course, as you know, there's an annual process, the PER, personnel evaluation report, and a quarterly process, the PDR, personnel development review. We're supposed to interview people. Medical people are no different from any other people, except we have more knowledge in the medical area. We provide leadership. If we see that, the requirement is to take necessary action to provide them with the necessary help.

[The Chair, Conservative, James Bezan]

Thank you.

Commodore, I want to thank you for coming in as a retired member of the CF, as a veteran now. Thank you for your 31 years of service and the great care that you've supervised and given personally to members of the Canadian Forces. Congratulations on your retirement. I hope you have a really enjoyable one. I know that you'll be very busy and your expertise will be called upon, just as we called upon it today. I want to wish you a very Merry Christmas and all the best in 2013.

Mr. Harris, I understand you have a point of order.

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

Thank you, Mr. Chair.

I'd like to put on the record a correction, to paragraph 8 of the dissenting report of the official opposition on our committee's report, “The State of Readiness of the Canadian Forces”.

It's been pointed out by the Office of the Auditor General that the wrong report was referenced in quoting assistant auditor general Jerome Berthelette. In line 3 of paragraph 8 of our dissenting report, there was an inadvertent reference to the Auditor General's report on the F-35s. In fact, the reference should have been to the Auditor General's fall 2011 report. The quotation itself is actually correct, but the wrong report was referenced.

They've asked that we correct it, so I'm putting it on the record as a correction to that report.

Thank you.

[The Chair, Conservative, James Bezan]

Thank you.

With that, we're going to suspend briefly. We have one item of committee business that we have to deal with.

I'm going to ask everyone to leave the room while we suspend.

The meeting is suspended.

[Proceedings continue in camera]